SOUTH WHITEHALL TWP, Pa. – A death investigation can establish what killed someone without answering the question that often matters most to the people left behind: How did it happen?
A gunshot wound may explain the physical cause of death. An autopsy may reveal that an infant died unexpectedly. Toxicology testing may identify drugs in someone's system. But determining whether a death was a suicide, an accident or the result of something else can require evidence that investigators don't yet have.
In Lehigh County, 11 deaths – as of Monday, Oct. 19 – have been classified as undetermined so far this year, as many as the county recorded over the previous four years combined.
For Lehigh County Coroner Dan Buglio, the designation is not a convenient way to close a case. It's an acknowledgment that investigators have not established the circumstances surrounding a death with enough certainty to make a definitive ruling.
"If we're not 100% sure on how to rule a manner of death, we're not going to just guess, and we're not going to do something just to have a statistical number," Buglio said.
The number of undetermined deaths has increased as investigations have become more complicated, Buglio said. The cases this year include deaths involving infants, a young adult who died from a gunshot wound and other circumstances that have left investigators without enough evidence to determine a manner of death.
The cases are not necessarily connected, and an undetermined ruling does not mean investigators suspect a crime occurred.
Instead, it means the available evidence has not provided a definitive answer.
Cause of death isn't the same as manner of death
The distinction between cause and manner of death is central to understanding why a coroner might leave a case undetermined.
The cause of death identifies the injury, disease or other physical condition that resulted in someone's death. The manner of death describes the circumstances surrounding it, generally classified as natural, accident, suicide, homicide or undetermined.
An autopsy can establish a cause of death without resolving the manner, Buglio said. That determination requires a broader investigation, including an examination of the scene, interviews with family members and witnesses, toxicology results and information gathered by law enforcement.
In one case this year, a young man died from a gunshot wound, though investigators have not yet established whether the shooting was a suicide or an accident.
Buglio said in addition to physical evidence, he looks for additional indicators that would support a suicide ruling, such as a note, information from a person's phone or interviews with people who knew the deceased. Without enough evidence to make that determination, he said, he will leave the manner of death undetermined rather than make an assumption.
He also considers the consequences of a ruling for surviving family members.
"I don't like to jump on a suicide and put that stigma on a family if I'm not 100% sure it's a suicide," Buglio said.
Information that emerges after a death can change the picture. A family member cleaning out an apartment might find a note. Someone might come forward with information about a conversation they had with the deceased shortly before the death. Investigators could uncover new evidence while reviewing electronic devices or pursuing other leads, prompting a coroner to revisit an earlier determination.
Infant deaths can be especially difficult to classify
Several of this year's undetermined cases involved infants, including babies who were 2, 3 and 6 months old, Buglio said.
Investigations into sudden, unexpected infant deaths can be extensive. Investigators review medical and prenatal records, examine the scene and consider the circumstances in which the infant was found, Buglio said. They may use a doll representing the infant's size to reconstruct the position in which the child was found.
Law enforcement and the district attorney's office may also participate in the investigation.
The goal is to determine whether the death resulted from a natural cause, an accident, neglect or another circumstance.
When investigators cannot establish the manner of death, Buglio said, they will not assign one simply to avoid leaving the case unresolved.
He said the term sudden infant death syndrome, or SIDS, is no longer used in the same way by medical professionals, who have moved away from the term as a catchall classification.
In infant cases, as in other investigations, the absence of evidence supporting one explanation does not automatically establish another.
"We don't have enough evidence to say it's an accident. We don't have enough to say it's natural," Buglio said. "We just don't know."
"We don't have enough evidence to say it's an accident. We don't have enough to say it's natural. We just don't know." - Lehigh County Coroner Dan Buglio
New technology can reveal more questions
The coroner's office has expanded its investigative capabilities, including through toxicology testing that can identify drugs that might otherwise go undetected.
Buglio said the office uses its Randox testing system on bodies that come in for investigation, regardless of the person's age or known drug history. The results can uncover substances that were not suspected initially, leading investigators to examine where the drugs came from and whether someone else might have supplied them.
Those cases can require additional testing beyond the office's standard panels.
In one investigation, Buglio said, additional toxicology testing cost about $4,500. In another, the office waited months, possibly close to a year, to find a laboratory with the equipment needed to test for a particular substance.
The technology can provide answers, but it can also reveal new avenues that investigators must pursue.
"We're seeing more complicated investigations with drugs," Buglio said. "As the cases become more complex, sometimes the investigation becomes more complex. The law enforcement side becomes more complex."
Some cases remain unresolved for years
An undetermined ruling does not necessarily mean an investigation has reached its final point.
Buglio said his office generally follows up on these cases every 60 days, contacting law enforcement to ask whether investigators have uncovered new information. A case can be resolved within months, take years or remain undetermined indefinitely.
Lehigh County had two undetermined cases remaining at the end of 2025, Buglio said. The office had initially classified more cases that year but resolved several as additional information became available.
He hopes the same will happen with some of this year's cases.
Buglio said he may never be able to resolve one or more of the current investigations. But he intends to keep checking for new information for as long as he remains coroner.
"On my end, to me, an undetermined is not — technically, the case is closed, but in my eyes, I want to be able to put …a manner on that death," he said.
The unresolved cases weigh on him, he said, because families may know the physical cause of a loved one's death but still have no explanation for the circumstances that led to it.
"Because we're not giving them closure," Buglio said. "I've seen the vast majority want answers, too."
For Buglio, continuing the investigation means doing what he can to find those answers, even when the evidence is slow to emerge or may never come.
“We’ll continue to do that because that’s what our job is. That’s what we owe the family,” he said.