Her office investigates all unnatural deaths in Clark County.

Clark County Coroner Melanie Rouse is our guest this week on Nevada Week In Person.

♪♪ Support for Nevada Week In Person is provided by Senator William H. Hernstadt.

-Welcome to Nevada Week In Person.

I'm Amber Renee Dixon.

She grew up in Denver, Colorado, and once worked in an emergency room there.

But when a patient would pass away, she knew there was more work to do.

Her curiosity about what happens next to that person and their family led her to pursuing a career in what she calls the other side of medicine.

Melanie Rouse, Clark County Coroner, thank you for joining .

-Thank you for having me.

-When I just said that, "the other side of medicine," that must be inside jargon, right?

(Melanie Rouse) So we really do consider decedents to be our patients, so we are caring for them in providing that last diagnosis due to their death.

-Oh, boy.

Good to have people like you who want to be part of this profession.

-We have an incredible team at the Clark County Coroner's Office that works very hard to really find those last pieces of closure and to determine what happened to people.

-I imagine, and correct me if I'm wrong, that this would be a position that may not be appreciated until it's needed.

A family member may not know how important you are going to be to them at some point in their life.

-I don't know about that.

We unfortunately encounter people on the worst days of their lives, often under very unexpected circumstances.

And I think just knowing that we do care about what we're doing and that we're compassionate about it and that we have empathy towards them, I think, is incredibly important.

-And I guess I'm more referring to the answers that you can provide, which would be, I mean, give me an example of some times people have no idea what happened.

-So I think it's determining cause and manner of death and the underlying questions that people may have related to that, as to how did somebody end up, at this point in their life, being deceased.

-What drew you into medicine in the first place?

-So I think, you know, growing up in a household that was ran by a nurse was a big part of that.

So I had an interest in medicine from very early on.

And then starting my career, looking at both the legal side of things as well as the medical side, this kind of seemed to be the best balance of both worlds.

-Will you elaborate on the legal side.

What stood out to you?

-I do have a background in Criminal Justice Studies, so this allows us to not only answer questions, but, as an independent agency conducting investigations, we are a neutral party that makes our determinations to provide information to those that need it, including community stakeholders, such as like our district attorneys and law enforcement agencies as well as the community as a whole.

-What is the typical education path for someone who ends up becoming a coroner?

-So I think that the education varies greatly across the country.

There are various different positions in coroner offices that are elected.

I am an appointed individual.

I started my career in medicine and also working as a medicolegal death investigator and then eventually becoming certified as a fellow of the American Board of Medicolegal Death Investigations.

-Will you tell me about those communications with family members.

This is something that you've been doing for a long time.

Do you remember those first calls you had to make and what they were like?

-So I think it's important to always remember to approach somebody and let them know what's going on.

I think transparency is incredibly important, being honest and straightforward, being direct with that individual, but also giving them the opportunity to ask questions that they may have.

-Any lessons learned over the years and best ways to handle those communications?

-So I think the lessons learned is that we don't use jargon or generic terms, you're very direct about how you communicate with somebody.

I also think it's important to be open and honest with them about where you are in the investigation, giving them realistic and reasonable expectations for time frames and turnaround times.

-Your journey on this path took you from Denver to Arizona, where you worked with the medical examiner there for 15 years.

But also while you were there, you were a member of the Disaster Mortuary Operational Response Team.

What does that team do?

-So I am actually still an active member of the Disaster Mortuary Operations Team.

It is under the Assistant Secretary of Preparedness and Response at the federal level.

That team responds to disasters and mass fatalities that occur due to multiple reasons, including natural disasters such as earthquakes and hurricanes.

And our mission is to go out to identify individuals, to return them back to their families members, and to reunify them and make sure that they have a final disposition.

-What drew you to become involved in that?

-So I think it's an important component to what we do as medicolegal death investigators.

I think being able to share that with other communities that are in need of it is important.

-Yeah.

What is happening at mortuaries when there is, when there are mass casualties?

-A lot of times a system may become overwhelmed because they don't have enough resources to respond to that incident, and they still have to keep up their community commitment, the deaths that they would be receiving normally.

So that overflow is where they would call in for a Disaster Mortuary Operations Team for assistance.

-Tell me about Yarnell Hill, that fire.

2013, what was your involvement and what was the impact on you from it?

-So in that situation, we had actually just-- it was not actually in Maricopa County where it occurred, but our former medical examiner had actually just taken over that office.

So serving as the mass fatality coordinator at the time, we got together a group of very strong individuals that have a huge background in death investigations.

We collaborated and agreed to assist and support that response.

So we handled the 19 firemen that died unfortunately in that incident, made identifications, made sure that their families were involved in the process and had a say in what was going to happen for their final disposition.

-How are you taking care of yourself mentally with this much death that you are surrounded by?

-So it's a lot of work-life balance.

You have to have the balance of both worlds.

I would say being heavily involved with my children's lives gives me that opportunity.

My daughter serving as a competitive cheerleader keeps me very busy in travel and working with her and supporting her in her efforts, also with my son and following his career path now that he's graduated high school.

I think those things are incredibly important to keep you balanced and maintained.

-What has their transition been like from Arizona to Las Vegas?

-They both really like it here.

They've gotten very netted in their communities.

They've had a really good core social group, which I think helps greatly with that adjustment.

-And what do they think about what Mom does for a living?

-They think it's fascinating.

In fact, I've had my daughter want to follow me around for the day and learn a little bit more about what I do.

My son thinks it's very interesting as well.

We've brought them in to Take Your Child to Work Day events that have been hosted by Clark County.

So I think they find it interesting.

I think they also think it's important, and they see the things that we give back to the community.

-The tremendous value in it.

Speaking of that, we had talked off camera about a shortage of people in this profession, not just in the US, but across the world.

Why do you think that is?

-So there is currently a shortage of forensic pathologists.

So those are the doctors that actually complete the examinations.

So we think that the shortage is likely due to a multitude of factors.

It could be related to funding, it could be related to the advanced education that's required to go into that side of medicine, but also, I think it's a lack of exposure.

So people don't necessarily get exposed to pathology in their, early on in their medical careers.

-And you have taken some steps to change that, at least here in Las Vegas.

How so?

-So our teams have worked collaboratively with the UNLV School of Medicine to ensure that people are exposed to forensic pathology early on.

In fact, we've started a one-day rotation where all of the first-year medical students do rotate through our office to get some level of exposure.

We are also in the process of having fellows for the first time in Clark County, so we got our Advanced Credit Graduate Medical Education accreditation.

So we now have a fellowship program that we will be starting to have those fifth- or sixth-year medical professionals come through to learn how to do forensic pathology.

-That's huge for Nevada, considering the lack of residencies that are available here at the moment.

You talked about the exposure, and I wonder the exposure that you provide to the public, information regarding how people are dying, what's going into that so that they can perhaps change their own lives, so that legislators can perhaps change policy, so that people who are using certain products may not be able to access those products anymore.

When you think about that, what have been some of the biggest accomplishments that have come out of the recording of this data?

-So if you think about public safety as a whole piece, a lot of safety measures have come out of medical examiner and coroner offices.

Specifically, you think about safety equipment used on-- in works-- in the work field.

You think about equipment that needs to be maintained and upkept.

A lot of that comes out of our information.

We also think about product recalls, so taking things off the market that are not safe, such as bumpers in cribs, such as Back to Sleep campaigns, things of that all comes out of the information that's collected by us during our investigations.

-And it's important work.

And that is one of the pieces of advice that you gave to people interested in this profession.

I got that from the International Association of Coroner's and Medical Examiners.

They profiled you; they featured you.

It was that.

It was also never forget the importance of self-care.

And then, "have knowledge of our own biases and be willing to overcome them."

What would an example of a bias be that would impact a coroner's ability to do their job?

-Well, I think it's again stressing the importance of us conducting an independent investigation.

We should never enter a scene or enter an investigation with a preconceived idea of what may have occurred.

I think we need to go in with an open mind.

We need to go in and be aware of the sights, sounds, and surroundings and collect that information and make sure we're giving every scene the time and the effort that it deserves.

-Okay.

Because you are given some preliminary information, perhaps from the cops, right?

And then you want to make sure that you're not just focused on that.

-Correct.

-Okay.

I also would like to know how your time in this career has affected how you handle death in your own life, in your personal life.

Has it impacted that?

-I would say a lot of people would reach out to me for advice.

They would reach out to me for information, for explaining the processes to them.

I would say that's probably the biggest impact.

I think death still hits home when it hits home.

So again, you have to be able to have that separation and that balance.

-I mean, so now you are almost a therapist of sorts for some people.

-Well, I wouldn't say I'm qualified for that, but I certainly can be a nice shoulder to be around when somebody's in need.

-When you arrived here in 2021, you talked about perhaps making minor changes.

Have you made any changes to the operations of the Clark County Coroner's Office?

-So we have made some changes.

We've also made some changes to follow what's industry standards across the-- across the country.

We've also made some efforts to fine-tune some things that were already in place, to make sure that we have good data abstraction tools, to make sure that we are an agency that is driven by those things.

And I think that that's really been kind of the approach that we've taken, is to really get us to be a leader in this industry.

-One example that you did give me was heat-related deaths.

How did you change that?

What was happening prior, and I'm sure you had experienced this in Arizona, right?

-Yes.

In fact, we modeled a lot of what we do here now after the Maricopa County Office of the Medical Examiner.

They had a very standard protocol that was really well written.

And obviously they see a lot of heat fatalities, so it's really standardizing the language that we use for death certification so that we can get that information back.

And it's also evaluating it to look at things like acclimation, to look at things that could impact individuals that make them more susceptible to succumbing to the heat.

-Which you told me would be drug use.

-It is absolutely drug use.

It can also be not being acclimated to their environment.

-I see, for perhaps a tourist that is here and not used to the heat.

Melanie Rouse, we could go on and on.

I really appreciate your time.

Thank you for joining Nevada Week.

-Thank you for having me.

-And to see more interviews like this, go to vegaspbs.org/nevadaweek.

I'll see you next week on Nevada Week In Person.

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