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Why is Texas keeping deaths a secret?

Why is Texas keeping deaths a secret?

Picture of Cary Aspinwall
[Photo: City of Minneapolis Archives via Flickr.]

This week we launch a new feature in which we ask distinguished reporters to highlight an issue or story that is either being missed entirely by the media — or significantly undercovered. We start with Cary Aspinwall, investigative reporter for the Dallas Morning News. — Ed.

The missing story: A lack of accurately reported data and public records related to death, especially in Texas.

Where we stand: Until 2010, Texas had a system in place where summary index data, including cause of death, could be acquired from the state through public records requests.

In recent years, however, the state Attorney General has allowed Texas to keep this data secret, under the guise of preventing fraud.

This is especially frustrating because Texas also does not have a central medical examiner or coroner’s office. There are 13 separate county medical examiner’s offices, in a state with 254 counties. In many places, a Justice of the Peace — a court official, not a medical doctor — determines who gets an autopsy and an official cause of death.

Why it matters: We don’t have accurate public information and records about how people are dying in Texas.

Researchers can’t agree on exactly how much the maternal mortality rate has spiked here, but the state put together a task force to study the issue before learning the increase they were so concerned about may have been wrong.

So some causes of death in Texas may be overreported, others underreported.

When computational journalist Stephanie Lamm and I spent several months in 2017 examining all the jail deaths of women in Texas, we found at least 10 drug-related cases that were labeled incorrectly. Many women had died in county or city jails of drug overdose or withdrawal, but we found cases where some deaths were wrongly labeled as accidents, suicides or natural causes instead of drugs.

How can Texas know when it has a problem if its own numbers aren’t right?

[Photo: City of Minneapolis Archives via Flickr.]


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The accuracy of death certificates is highly questionable. For example, medical errors/infections in hospitals constitutes the 3rd leading cause of death according to research but these are rarely documented in a death certificate. Every state should have an office or person whose responsibility is to keep accurate vital statistics like this. And the information should be available to the public without having to do an open records request. Hiding (or worse, never even documenting) causes of death is just plain ignorant if you ever want to prevent these deaths.

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How do you think these inaccuracies are affecting the death counts in Covid 19. Have the number of medical examiner’s been increased in 2020 to address these inaccuracies?

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Texas COVID19 death counting changed in late July and are now being determined by death certificates. That caused a one time 8% jump in the state statistics but seems to be more accurate than the prior method of relying on (overwhelmed) local/regional public health depts. This article describes the change: Having said that, the COVID death count could still be inaccurate based on the death certificate. We encounter this with medical errors and hospital acquired infections - did the harm event cause the death or the underlying condition of the patient? I hope that COVID is included on anyone with a dual diagnosis at the time of death because it is impossible to determine if COVID was the primary cause of death, but important to note. The Patient Safety Action Network advocates for death certificates to include the presence of a medical injury or infection before or at the time of death, even though the event might not be completely determined as the primary cause. We know there is COVID transmission in hospitals, so, as with medical harm, there may be a disincentive for doctors to put COVID on the d.c. if the transmission happened in the hospital.

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