Travis County Commssioners Court
September 2, 2003
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 22
Number 22, consider and take appropriate action on the state requirement for accreditation of the medical examiner's office. We have known for some time now that we had to accredit the lab. But the agency interpretation of the law is that we have to get the office accredited, also. That's the new wrinkle in this deal. Okay?
>> I'm danny hobby, I'm the emergency services coordinator and so today I would like to just simply review with you a new development that -- that as you mentioned, judge, is upon us and that is that they are now in rule making bringing in the office, the medical examiner's office, as well as the lab. As you are aware, we have already submitted through our regular budget process the -- the necessary steps that will move us forward in the accreditation of the lab. I have tried to put together the staff has tried to put together several memos that will describe for you what's involved and it's very similar to the one that's involved with the lab except now you are dealing with a pathologist and that's what critical in the accreditation of the the office. What is -- what is a burden for us, at this particular time, is that -- that's why I wanted to bring it before you today, is that the same time lines apply for the office as they do for the lab. Which is -- which is bringing to us the action that's needed for us to consider, not necessarily take today, but to allow you to give us direction on where you would like to go with this. And that is we can look at it budgetarily, we can try to in the time that we've had, lay out for you what we consider to be the costs and for the accreditation staff has recommended that it would take one pathologist in '04 and one pathologist -- additional pathologist in '05, along with the accreditation, along with the supplies, operational expenses that go along with that. Darrel lien dunn -- darlene dunn is here today with the medical examiner's office, we do not have the doctor's with us at this particular type. One is out of town and the other is -- is out today as well. And may be here as we are speaking, but I'm going to play the role of more than a coordinator today if that's okay. And give you -- give you as much information and darlene will as well as you need. But -- but we also have the budget office, p.b.o. Is also working on scenarios, too, where they are going to bring forward to you, I think, how we would pay for this and it's a mixture of -- of -- allen if you are listening, this is your appropriate time to come down here.
>> allen miller.
>> looking at you.
>> come on up, allen, why don't you join us. We want you to have a few scenarios to think about, in regards to how we would pay for it. As you know with the labs we were able to come in and basically lay out a formula that -- that would have a pay back by raising the fees and we did that and darlene sent out letters and that's already been done. So the lab we feel like we are pretty well moving along as we should. However now that we are thrown in the medical examiner's office there are several things that I would like for you to think about and consider. The staff -- the recommendation, whether we too it now or later, I think now the time frame of the mandate is that we do it now. It's effective September 2005. September '05 which gives Austin two year process. Our recommendation is to phase it like we did the labs, one is pathologist expenses this year, another in '05. And along with that, though, is not going to be as -- as simple as the lab in that hiring a pathologist is not going to be perhaps the easiest thing to do. So as we describe in the memo, or the several letters that I have sent you, there's a problem nationwide in hiring these folks. And of course what you are also seeing in these figures are the baselines. Those salaries that come in at base. Around that's something that -- and that's something that we were recommended to do by h.r., We understand why that is. But I just must tell you that as we get into the process, if we move forward with this accredit addition process, there may be some negotiation with regard to salaries because not only is it affecting the Travis County medical examiner's office, this is of coursing other medical examiner's -- affecting other medical examiner's offices around the state. The first reaction that we had, of course, from staff was do we just roll over and do this? Let's go fight it. And let's walk across the street and let's go see if we can't maybe get some extensions. And see what's really going on here as far as our time line and whether or not we are -- we are stuck with it. We decided on two -- two avenues. The first is to go forward with the accreditation, bring forward to you the plan for doing it and moving forward with that. The other, though, that I would like to lay out for you is that because of the fact that we are in -- in still our legislative process across the street, and the governor is going to be calling a third session, would it be possible to send me over with some remarks from y'all or from whatever that you would like to give me and just simply go and check out with our representative bob cam and really check out and see if there are any extensions take could be given with regard to the office. Not the lab, but in regards to the office because of this late date. Our understanding is, and in listening to other folks that are like us, they are in the same boat that we are. Here's the last minute deal, we have already submitted our budgets, and what do we do? And so -- so I'm assuming they are going forward like we are. However, I do know that there is at least one that is sending a delegation this week to talk to the authors of the bill, the staff. And to see what options are available there. So I would like to throw that out if I could and that is that -- that we might want to -- to go over and just have a discussion in regards to this whole matter.
>> I think that I would do --
>> I would like to also --
>> [multiple voices]
>> there's another element that we must look at as well. That is with the accreditation, what we are doing is one of the requirements is that each pathologist would be limited to 250 to 350 autopsies. Of course as you know, counter pathologists do more than that. And this is going to I think also make us look at and consider our current pathologist and their situations, the current range that they now have with you in regards to autopsies. So -- so I don't want to -- to come and just give you one picture acratation, hiring new -- accreditation, hiring new staff, there are other issues as well.
>> well, danny, since we have set the standard before on other things, seems like we could set the standard for the number of cases that each pathologist could handle. And I guess it would be part of the conversation that you would have with our delegation. As well.
>> well, I think in regards to the number of -- correct me if I'm wrong darlene. As far as accreditation --
>> you don't think there's any way to work with that figure with our delegation? We could try.
>> I don't think there's any [multiple voices] it was pretty set.
>> I'm darlene dunn with the medical examiner's office. The accrediting agencies that provide this service, they are all basically the same, no more than 250. But like the national association of medical examiners' office, they are on the list. And their -- their guidelines, their standards seem to be written more towards offices with academic surroundings. And part of their duties are for academic purposes and they get paid separately for that. So obviously they don't have the time. So they are limited to 250. So we are thinking that maybe the national association of medical examiners, that they need to revisit this. But this takes time.
>> right.
>> I see one or option that is -- that has not been listed here and I would like to get more information on that. A, we have got to wait to see if the governor expands the call because they are not taking up anything unless the governor adds it, but that doesn't mean we can't have conversations and hope he does get it add. That is how many autopsies are done of Travis County folk?
>> there's about 590.
>> 590?
>> yes.
>> which means the rest of those are all folks that are outside of Travis County? Now, I realize that there is a revenue cost there. But if we took the approach of we are going to have to bring, you know, lessen those numbers so we don't have to hire extra people, we have got -- 250 times three, that's 750, we have more than enough to handle the Travis County burden that our taxpayers invested in that facility and are investing in the general fund. And that is that we limit our out of county contracts. I'm wondering what is the mandate that Travis County handle autopsies for how many counties is it now, darrel lien?
>> 44.
>> where is it said that -- that the lack of these facilities in 44 other counties, is the mandated responsibility of Travis County to figure out how to add more people on to take care of things that are going on outside of our borders?
>>
>> [one moment please for change in captioners]
>>
>> I talked with the capco region to start, that is tied into our hospital service area with brackenridge.
>> what drives this is a little problem in houston involving evidence of a criminal case.
>> that's huge.
>> that resulted in major problems and caused the powers that be treat evidence, who is accredited, who is not, and the solution really was a higher standard imposed by the state of Texas so we get sort of caught in the middle. Some counties met this threshold. One is close as bexar county. So we think the accreditation is a good thing. It's just -- and we saw it coming, I guess, but we were hoping to have more time do it. Taking the lab at one time and then the office maybe later seemed to make a lot of sense, having both imposed at one time seems to be a bit burdensome now. Seems to me we ought to spend more time putting the plan together, in the meantime I think our legislators and whoever else will listen at the capitol, may as well know, so it makes sense to me for us to basically authorize that the medical examiners and the staff put together like a written document that we share, because I think you would want to go over and present an accurate picture, you want to be as dramatic as the facts allow you to be but I don't think you want to overstretch that. The other thing is I hear us saying we're not trying to avoid responsibility, we think in view of the circumstances more time may be required? Right.
>> yes.
>> when you pose for a medical examiner it's not like you get droves of people applying. Nationwide a small pool of medical examiners. Because in addition to getting the academic requirements behind you, there's what, an internship?
>> no, not necessarily. If you're board certified you can be hired right away.
>> you finish the schooling and then take the certification test?
>> right, and then you're eligible.
>> I'm not arguing at all on terms of accreditation, absolutely. But one piece of it has to do with the number of autopsies. We can get in total compliance with with all the accreditation if we reduce the number of autopsies that our three forensic pathologists perform. We can do that without adding on new people. It's just that the state in trying to shift an unfunded mandate though this county, there are other ways that we can absolutely meet the accreditation and handle everything that this county needs in terms of that facility. There are multiple pieces to that.
>> take a look at I so allen, on '03, though, from a budget perspective. What information do you have to share with us?
>> the only issues outstanding right now is that if you have an additional pathologist in f.y. '04 it's not currently reading recoveredry the revenue that is charged by the fee and the revenue part of the revenue certification. If the court wanted to look at an adjustment to the current fear to f.y. '04 you would have to increase it by another $200 to cover the cost of the pathologist. I think there are a great deal of unknowns in here in trying to provide you with a reasonable level of analysis, I think we will require a little bit more time. If y'all are wanting to phase in a fee structure overtime but I eve been costing out a fee schedule and proposals. I think danny raises issues I think we need to take into consideration when we're costing out any figures or estimates but I think the problem that the court has right now is if they decide to add an additional pathologist for f.y. '04 the fee would need to be adjusted or you can take it from another area in the general fund.
>> I see baseline 136, 136,000.
>> yeah.
>> that's the one, right?
>> I believe that is including the benefits associated with that salary.
>> yes.
>> and that is just for one.
>> okay. Why don't we do this, then? Why don't we authorize that we put together a one or two-pager that basically highlights issues raised by this mandate from our perspective and do we need to see that before we direct staff to share that with our deligation and other legislators?
>> it's always helpful to see some word smithing purposes if nothing else so we're aware.
>> if we have this back on we can take a look at that, is that okay? And in addition to that we look at the various options, maybe provide cost detail, cross them out, including the one added today and take a look at that next week also. Now, do we think we will have sufficient space to get this done or if we add these people do we need to expand the space?
>> well, the building expansion is supposed to take place in '04, they would have to move it up on their calendar so that the expansion is done, so the old file room can be used for pathologists.
>> and that expansion is in the preliminary budget?
>> yes, sir.
>> all right?
>> another reason for us having to add more fte's on for other counties what we need to be in compliance.
>> seems to me we would want the other counties to pay for whatever we have to add because of them. So one way to breakdown the cost analysis may well be for Travis County here is what we must have, here is what it will cost, and for the other counties for which we perform services, here are the additional needs, here is what they cost and basically set the fee to recover that.
>> uh-huh.
>> and I guess at some point we have to ask ourselves from a human capacity perspective, what's our maximum, and we're looking at the number of autopsies, and I guess if you're looking at a minute number or a maximum number per pathologist then you've got to factor that in too.
>> uh-huh.
>> so...
>> and there was one thing I would like to add to this, and that is that because the doctors aren't here, they're going to have a response I think in regards to Commissioner Sonleitner in regards to why we would want to do the out of county autopsy. Dr. Peacock was there and gave a very passionate response as to why it's important that we continue those, so I think in fairness I will try to have either one or both of them here next week so that they can give you that side of pit, which I think is important for you to hear.
>> but I think an increase is still a lot more inexpensive to the other counties rather than setting up their own lab.
>> exactly right.
>> and being certify and that kind of stuff.
>> because they usually only send 10, 15 maybe 20 body as year. It's not cost effective for them to set up a medical examiner's office. And we agreed to provide these services, so a real big decision.
>> not like we're passing on any additional cost to them.
>> on capital murder cases the state of Texas steps in on helping out small counties that get decimated by capital murder cases. This seems like it might be something else, but it might not come back to tarrant, and bexar and travis, those counties that have heavenly is invested, that somehow this burden needs to be shifted to our taxpayers and that's where we need to make sure that we're not going deaf sit to do these things on behalf of other counties. It's not that we're not good neighbor, it needs to be something where we recover our costs.
>> yeah, I think it can be done.
>> not a motion but directions put together for us to odai look at next week. And maybe it would help to try to get one of our pathologists here next week, if it will help to set this at a time certain in the morning or afternoon, i'll try to do that.
>> okay.
>> linda Moore smith is here. We may need to get some discussions going with a [inaudible] related to salaries because the out of county autopsies in large part help supplement the salaries of our three pathologists and if that business goes away, there may need to be some internal issues because as darlene correctly mentioned, it's very difficult to find these folks, they are expensive, but it's because of an expertise that is very, very needed and precise and so anyway, we may need -- not now, but if you guys can work with hr...
>> [inaudible - no mic]
>> okay.
>> brought in by the outside.
>> excellent. Thanks, linda.
>> who is sponsor 2703.
>> it's a slew of folks, let me see if I can find it here.
>> probably out of houston.
>> actually I know representative keel is one of them. Let me see if I can find it here. Trying to find the bill. That's where it has the...
>> you can let me know.
>> here it is.
>> because the bill was an appropriate one. Absolutely appropriate. And of course we need to get our accreditation. It's just there are ways to get there.
>> i'll have to get back with you -- oh, here it is. It's bailey, paxton, dutton.
>> they're all out of houston.
>> no retaliation, people. We'll see you next week.
>> okay.
>> yeah, next week. Sorry about that, if I knew you were coming we would have held it up, but we'll have it back on for next week.
Last Modified: Wednesday, September 3, 2003 7:52 AM