Anahi Ortiz Speaks for the Dead

The overdose crisis isn’t abstract to the Franklin County coroner. It’s a flood of bodies she can’t ignore—and human suffering that weighs heavily on the doctor and her fellow “last responders.”

Jack Shuler
Franklin County Coroner Anahi Ortiz at the T.J. Evans Trail in Johnstown

When the work gets to her, Dr. Anahi Ortiz starts walking. She drives to a park or a nature trail and begins to move, one foot in front of the other, at least 10,000 steps. It has to feel like a lot, comparable to all that she deals with in her line of work. 

Since taking on the job of Franklin County coroner in 2014, Ortiz has witnessed an unprecedented rise in overdose deaths. In 2019, nearly 71,000 people in the United States died from unintentional drug overdoses, and 2020 will likely be worse when the final numbers are calculated. In Franklin County, the situation is particularly grim. During the first half of last year, 437 people died of accidental overdoses—a 73 percent increase from the same period in 2019. By August, the death toll was more than 500, nearly matching the entire total from 2019, Ortiz says. 

Ortiz shares this information with anyone who’ll listen, posting regularly on social media and speaking to the press. Her work has earned her the admiration of advocates for harm reduction, an approach that seeks to reduce the harms of drug use and minimize the punitive nature of drug policies. They say Ortiz’s social media alerts are important for warning people who use drugs, as well as their families and friends, about bad batches. “Nobody does it as frequently and consistently as she does,” says Dennis Cauchon of the advocacy group Harm Reduction Ohio. “She seems to have really been shaped by what she sees.” He pauses briefly and then adds, “By all the bodies.” 

To most people, these overdose deaths are just numbers—abstract statistics that seem to accumulate and multiply endlessly. To Ortiz and her colleagues, however, they are horrifyingly real: They are the bodies of sons and daughters. They are the remains of broken lives and policy failures. They are an avoidable tragedy that must be examined up close. This grim but essential work can take a toll, and that’s why Ortiz seeks solace in exercise and nature. It’s her way of relieving the stress, of preventing the human suffering from overwhelming her. 

On a cold December day, I join Ortiz for a hike along the T.J. Evans Trail in Johnstown. We walk toward a stretch enveloped by bare hardwoods, skeletal limbs sheltering us from the gray sky. To our left, a stream meanders through a leaf-covered forest floor. I hear nuthatches, cardinals and downy woodpeckers. 

As we walk, the sound of gunfire cracks across the countryside, possibly from hunters in the distance. It rattles the moment. But Ortiz keeps on. One foot and then the other. 

***

In November 2014, Ortiz, then a pediatrician at Nationwide Children’s Hospital, was appointed coroner after her predecessor, Dr. Jan Gorniak, was named the chief deputy medical examiner for Washington, D.C. Gorniak encouraged her to apply. As in all but two Ohio counties—Cuyahoga and Summit—voters choose the Franklin County coroner, and Ortiz, a Democrat, has since won elections in 2016 and 2020. 

A few months after her initial appointment, one of the doctors on Ortiz’s staff approached her, noting an alarming increase in overdose deaths. Ortiz started investigating, calling around the state. She talked with the appointed medical examiner in Cuyahoga County and learned about an overdose fatality review board created there. He told her it was difficult to convene, to get collaboration from every agency, but such a regular assessment can provide crucial information in addressing the crisis. She wanted to see if she could make it work in Franklin County. 

“Looking back now, I’m thinking I had some balls to think that I could do something like this,” Ortiz says. 

In 2015, Ortiz began gathering people representing a host of agencies—Franklin County and Columbus health departments, the Office of the Franklin County Public Defender, the City Attorney’s Office, the Ohio Board of Pharmacy, representatives from law enforcement and treatment facilities, among others. The work of the fatality review board is to gather information and try to get a picture of the decedent’s life and what led to his or her death. The point is to find gaps in the system, to assess how this person’s death might have been prevented. Ortiz believes that the review board has helped improve communication among different agencies—just bringing them to the table—and helped fuel her own push for better access to the overdose reversal drug naloxone. Most importantly, the board has helped those trying to address the crisis begin to see commonalities among overdose deaths. 

Experts know that many of the people who overdose and die have been through the justice system at some point. They know that many have witnessed a homicide or domestic violence when they were young. They know that there are people who have been trafficked. They know that many of these folks have suffered some trauma early in their lives. 

All of this information is useful, Ortiz says, because it can help shape policies that might address this catastrophe, one that Ortiz points out became an even greater issue when the COVID-19 pandemic hit. It has made treatment harder, fostered isolation and challenged harm reduction efforts like syringe exchanges, distribution of naloxone, or the practice of never using alone. 

A report from Harm Reduction Ohio indicates a 20 percent increase in overdose deaths in Ohio in the first six months of 2020 compared to the same period the previous year. In May, 548 people died, more than in any other month on record. The group also notes that for the first time since the 1980s, Black people are dying of overdoses at a higher rate than white people in the state. 

***

Even before becoming coroner, Ortiz felt the impact of addiction. She was born in Castle Hill, South Bronx, to an Argentine mother and a Puerto Rican father who met while he was on shore leave as a merchant marine. Her father struggled with alcohol use, which led to a divorce. Eventually, he died by suicide. “My sister, brother and I have talked, and we know [substance use disorder is] in our genetic makeup,” Ortiz says. “I’ve seen it. I’ve lived it. Not as a person in recovery, but as family.” 

Ortiz’s mother was a college graduate and worked as an accountant before immigrating. In the U.S. she could only find work as a home aide and later as a nanny. On weekends she would clean houses, bringing a young Anahi along with her to help. Ortiz says her mother was her “guiding light,” whose tenacity and work ethic inspired Ortiz and her two younger siblings. All three are overachievers: Her sister was a buyer in the fashion industry and now works for an NGO helping women in developing countries grow businesses; her brother is a retired NASA engineer. 

Ortiz started at Cardinal Spellman High School in 1972—the same year that future Supreme Court Justice Sonia Sotomayor graduated from the same school. Because her mother was a single parent, her children were eligible for scholarships to attend the Catholic school, but they were required to maintain all A’s. And so they did. Ortiz credits Sotomayor’s tenure at Cardinal Spellman for opening doors to other young Latino students. The future Supreme Court justice’s academic success helped others see the potential in students who, Ortiz says, were often shunted to trades or community colleges rather than universities. 

At Cardinal Spellman, a guidance counselor suggested Ortiz, who was especially interested in math and science, consider medicine, noting she was good with people and might prefer the life of a doctor over that of an engineer or researcher. The counselor proposed that she volunteer at a hospital. 

“So I became a candy-striper, and that’s where I got the bug. I was like, ‘I want to work in a hospital. And I want to make things easier for people like me, for kids like me.’” Growing up, she says, she had poor medical care—the emergency room was her doctor. “When you’re sick, that’s when you go.” 

Her guidance counselor had her apply to Harvard, Yale, Stanford, Northwestern and City College’s new Sophie Davis School of Biomedical Education, a very competitive B.S./M.D. program. She got into all of them but chose Sophie Davis because she didn’t want to have loans—and she wanted to be close to her mom. 

After City College, Ortiz did her residency at what was then called St. Luke’s Roosevelt in Washington Heights and then worked as a physician in New York. Ortiz moved to Ohio in 1996 to take an ambulatory medicine position with what it now called Nationwide Children’s Hospital.

Rate of Overdose Deaths by Year (2007-2019) for Ohio and Franklin County

Ortiz says she went into medicine to help underserved patients, and it has become clear that people with substance use disorder are some of the most neglected. “As I started working on [the overdose crisis], I saw how underserved these people are and how much stigma there is attached to the issue and to the people.” 

To that end, she wants to help support people who are using—via harm reduction methods—as well as those in recovery. “You can’t just treat someone and say, see you later. You don’t do that with a diabetic.” 

Harm Reduction Ohio reports that Ohio’s overdose death rate is No. 2 in the nation with 37.8 deaths per 100,000—the national average is 19.6. But drug use rates are not that high (save for heroin). In fact, they are below average: 36th for cocaine and 42nd for meth. The issue, experts point out, is not the drug user; it’s the drug. Ortiz says that when they started the overdose fatality reviews, they were seeing mostly heroin and pills. Today, the primary cause of death is a synthetic opioid called fentanyl, which has adulterated the drug supply in Ohio to such an extent that most illicit drugs contain it. During the first half of 2020, more than 85 percent of overdose deaths in Franklin County involved fentanyl. 

Right now, Ortiz is working on an education campaign about the dangers of fentanyl called the FIND Awareness project, a collaboration with Columbus City Attorney Zach Klein and U.S. Attorney David DeVillers. The primary goal is to raise awareness about the presence of fentanyl in cocaine, methamphetamine and pressed pills through billboards targeting ZIP codes where overdoses have been the highest. Ortiz hopes for bold messaging so that folks will learn about the risks of fentanyl use, as well as how to seek help. 

Klein says partnering with Ortiz to address this issue made a lot of sense to him—she’s the one seeing the trends firsthand and has been an important “community voice” who has “always been on top of raising awareness about spikes and how to get treatment.” 

Drug prohibition has, again, created a problem. This is, essentially, “the iron law of prohibition,” a concept attributed to cannabis activist Richard Cowan, which asserts that the more we ramp up law enforcement, the more potent illicit substances will become. The war on drugs has pushed people who use opioids toward more dangerous substances. And so, every overdose is a policy failure, as writer Abraham Gutman claims. 

There is significant access to naloxone throughout Ohio—a recent law change has made it legal to distribute. But naloxone distribution could always improve. 

For her part, Ortiz’s alerts warn people, and harm reduction advocates can encourage people to use slowly and not alone. For any of this to work, ongoing communication and relationship-building with people who use drugs is paramount. To do this work, many cities run multiple syringe service programs, drop-in centers, or, as in Canada, safe consumption sites. 

Ortiz remembers when syringe service programs were launched in New York City in the late 1980s to combat the HIV/AIDS epidemic, programs that have become even more robust in the decades since. She wishes there were more access points for people who use drugs in Franklin County, more ways to connect. 

It took a lot, she says, to push out naloxone and to make it less restrictive in Ohio. “It took quite a few years to do that, whereas that wasn’t the story in New York. It just goes to show how difficult it is to get things pushed here.” 

Ortiz says she “was never a real proponent before of safe injection sites,” but that now she can see their purpose. She sees them as another place to connect with people who use drugs and to link them to resources and maybe treatment via social workers. It can be, she says, “a warm hand-off” for people who use drugs to find help. “Evaluate them if they’re ready and get them hooked up to treatment,” she says. “The chance is higher through these places for them to get into treatment than just off the street.” 

In Canada, safe injection (or consumption) sites have been credited with saving thousands of lives. At Vancouver’s Insite, the first such site in North America, which had over 170,00 visits in 2019, there were no deaths. 

For her part, Ortiz would like to focus on getting more naloxone distribution in the communities that need it most. “Let’s go to where the people are,” she says. 

Franklin County coroner Dr. Anahi Ortiz at the new Franklin County Forensic Science Center on Frank Road

Suzanne Plymale is part of a group of women from around Columbus who drive the streets distributing naloxone to those who need it most—homeless people and sex workers. They call themselves Central Ohio Harm Reduction and model their work on the classic grassroots organization Food Not Bombs by handing out harm reduction supplies, no questions asked. The coroner’s office has partnered with COHR at pop-up events where they pass out naloxone, as well as care packages, winter clothing and camping gear. 

Plymale appreciates Ortiz’s support with these projects, but even more, she appreciates her consistent efforts to raise public awareness. “Accurate data released in a timely manner helps people coordinate a response,” Plymale says. 

Both a harm reduction activist and a person in recovery, Plymale says that Ortiz has played an important role simply by reaching out to grassroots organizations like hers. She appreciates someone in power listening to them, showing compassion for a vulnerable population. “You don’t hear people saying, ‘Aw, man, our coroner’s amazing!’ It’s really thankless work. But it’s a really important job.” 

Especially in a moment when so many are dying. 

Forty-seven people work for the Franklin County Coroner’s Office, and everyone—from the secretaries to the forensic pathologists—is exposed to violence in some way. As an agency, they must determine the cause and manner of death for accidental deaths (homicides, suicides, overdoses, vehicle collisions). An investigation begins with a phone call from law enforcement or a hospital, and a trip to the scene. On site, investigators take photos and speak with police and members of the family. Then they bring back anything that’s on the body or around the body except for firearms. At the Franklin County Forensic Science Center, the morgue staff photographs the decedent with and without clothes. They search the body. Then a forensic pathologist performs an autopsy with assistance by a morgue tech. At this time, they take fluids for a toxicology screen and to determine what, if anything, was in the victim’s system when he or she died. 

Ortiz worries about how the death toll is affecting her employees’ mental health. And it’s been a particularly brutal year: In addition to the overdose deaths, there has been a record-setting number of homicides in Columbus, plus two killings of Black men by white police officers at the end of 2020, drawing national attention amid the country’s ongoing racial reckoning. In December, Ortiz spoke with the grieving mother of Casey Goodson prior to releasing a statement to the press about his killing by a Franklin County sheriff’s deputy. “She kept apologizing because she would break down, and I told her, ‘Take your time. I have all the time for you.’” 

After a particularly hard week in 2017, Ortiz asked her human resources team to send in a psychologist, a trauma specialist, to speak with people who need help. Then she started thinking of ways to do it permanently, how to help people who are what she calls “last responders.” Now a counselor comes once a month for a group session and individual counseling for anyone who wants it. Along with half of her employees, Ortiz is now an instructor in mental health first aid. 

“This has been a somber and disturbing December,” Ortiz said in a Christmas Eve tweet. “Two police-involved shootings of Black men. Black and brown people in Columbus living in fear. The highest number of overdose fatalities in the state. Increase in homelessness. It’s time to demand a change in city leadership.” 

When I ask her about the tweet, she says people need to make their voices heard—write letters, make phone calls, protest peacefully. “What’s telling to me is the silence. I see the media out there tweeting and putting out news reports about how much the violence has increased—and the leaders, there’s silence. It’s just silence.” No one seems to have a clear plan, she says. “A lot of people feel this way and don’t say it.” 

But not many people see it—unrelenting, up close, every day—the way she does. 

***

Ortiz has always been a walker. She used to walk on a treadmill, but since COVID-19 hit, she has been going outside more. At the onset of the pandemic, Ortiz’s walking companion was her wire hair fox terrier named Jordi—until the miles wore him down. “The poor dog ended up with a slipped disc,” Ortiz says. “And then he couldn’t walk for six weeks!” That made her feel a little bit guilty. 

It’s no secret that exercise can reduce anxiety levels. And researchers have shown that walking fosters creative thinking—an idea celebrated by poets and scholars for centuries. Thoreau wrote that his mind was energized the moment his “legs begin to move.” 

Ortiz says she likes to do 4 miles in one shot at least three times a week to get all the stress out. And she obsesses over her daily step counts, showing me her smart watch during our December walk together. “And I keep looking at it like, ‘Today’s really bad; I didn’t do much today so far.’” 

When we approach the 2-mile mark, we pass some horses (“they’re gorgeous,” she says) and hear the crow of a rooster. As we stop to turn around, a gray and white cat waltzes onto the path. “Well, hello you!” Ortiz says. It sniffs our shoes and rubs against our legs. 

In the distance, we hear the crack of gunfire again.