Travis County Commssioners Court
September 9, 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 38
Item 38, consider and take appropriate action on the state requirement for accreditation of the medical examiner's office, and we should have put here and lab. How are you all doing.
>> thank you investigate. I'm with the emergency services coordinator and I'm here today with the medical examiner's office. As you can see, the cream of the crop is here. We've got the doctors with us today as well as darleen dunn with that office. Today we would like to go over with you some of the things that we discussed with you at the last court meeting, and that was looking at the situation at hand, which is in rule change, we -- regarding house bill 2703, we received word several weeks ago that we now need to look at including the entire office. Not just the lab. And as you are aware, we did move forward based upon the initial passage of this house bill to go ahead and lay in place the appropriate dollars as well as the appropriate change in the fee that we charge for autopsies for out-of-county autopsies. And that has all been done and submitted and the letters have all been sent out. And so for the lab, I don't think any of us are going to be here today to question or have concern in regards to the lab portion of this. We feel like that is appropriate and we've moved forward accordingly. However, we do feel that we have some concerns in regards to what has been done in rule change. And to the point of where I made the recommendation, you gave it back to me, which was danny, go and work with staff and develop a letter that can be sent to the appropriate parties. I.e. Our legislative dell --delegation and outline our concerns. I got together with staff and that letter has been written. The draft letter has been sent to you, which hopefully you have in front of you. One of the things we would like to accomplish today if possible is for you to approve the letter so it can be sent out to the appropriate parties. There was a deadline in regards to the ruling making, which was this past Sunday. But I went ahead and took the liberty to go ahead and send a note on Saturday which said that we are anticipating a formal response from Travis County shortly. And they did respond back this morning saying thank you for your comments. I wrote back and said you haven't received all my kph-pbts. You are about to receive -- comments. You are about to receive them. So I believe that we can use that particular e-mail to get our comments in to the rule-making folks. Of course, the other group that we want to address is our legislative delegation as well as the authors of this particular bill. And we now -- some of you have been sent, and judge, I believe you sent it to me yesterday where the Texas conference of urban counties is now getting involved in this, and i'll let the doctor mention that in just a few moments. In more detail. But we feel like now we're beginning to hear other voices. And so we think it is our right to go forward and challenge this and lay out our concerns. And so if it's appropriate, I would like to kind of do this in a staged process this morning. One is to have dr. Peacock go with the memo and that way you can ask questions if you so desire, but there she will lay out the concerns for the entire office. And then you also asked us to go back and look at, well, if we need to move forward with the accreditation of the office, then what are those budgetary options. And so we've done that and we've got a document that we'll pass out to you when we get to that point. Which will lay those out for you. If that's okay with you, why don't we go ahead and begin, and I would ask dr. Peacock go ahead and review with you that memo.
>> hello. I'm dr. Allysa peacock, the deputy medical examiner. I've been mostly involved with the meetings of people regarding this issue. In response to some improperly submitted evidence and that incorrectly convicted people from the houston lab, the legislators took it upon themselves to mandate that all crime labs be accredited. Which is a good thing. In the rule-making or in the rule interpretation phase of this, the people at d.c.s. Determined that the medical examiner or any entities in which autopsies are performed in this state must be accredited. I don't think they understood what they meant when they passed this rule. Because they did understand that d.p.s. Does not have the expertise to oversee or acredit medical kp-fors, they turn to the only accredit be board which is a small and voluntary group of medical examiners in the nation. The name -- I will refer to the national association of medical examiners as the name. The name accreditation standards are very tight and they are very much directed towards entities or medical examiner's offices that are affiliated with large teaching institutions and are in the academic end of things. They've certainly by reading through the checklist, you become aware that these are not in the pragmatic arena of things. Another thing that I don't think the legislators were aware of is the scarcity of board certified medical examiners in the nation. There are existing and living 605 board certified medical examiners in the nation. Of which 348 are practicing. If this rule stays in effect, Texas would have to have roughly 100 of those board certified medical examiners in the state, which is roughly a third of those in the nation. And that's unlikely to happen. So is what we could see from this is the closing of some of the smaller office, some of the less financially secure offices, those in the valley, several in east Texas, maybe in el paso, and those cases then would end up having to be transported to the larger accredited offices with all the associated costs of that. Which would then increase their need for more pathologists. It's a bad circle to be in. Texas is -- this decision is unprecedented. This would be the only state that requires accreditation of all entities in which autopsies are done. Now, in their rule-making, saying this took effect September 1 of this year, they did include a grace period whereby for a two-year period we could save duplicate and several spep mens that are to be tested, whatever that means, and then we would comply with the law. At the end of that two careers, there's no option other than accreditation. We see some real horrific problems with the logistics of implementing this law. And we would like your permission to approach that. I don't disagree with the fact that we need standardization and good, reputable and reliable scientific information to be presented in court, because we want this all to be scientifically neutral. But we would like your permission to go forward with approaching the legislators and the rule makers to see if we can have this changed into a way to implement this that does not financially impact the taxpayers of Texas and/or disallow prosecution of cases that need to be prosecuted. I don't want to empty the jails.
>> one other thing that will happen between now and the two-year grace period is we will have another regular session of the legislature.
>> yes.
>> goodness knows how many more special sessions in between there. That's another matter. But again, I think it's absolutely appropriate to get this before them. And I would hope that you could share this with kate who is sitting behind you with the statesman because they've written a lot on this and your letter would be helpful to get to more appropriate entities to get the word out of there and see what else can be generated in terms of attention to this problem.
>> that's a very good letter.
>> thank you.
>> very good letter pointing out all of the problems.
>> and in the meantime, I think that we don't know what their actions are going to be. We need to at least be ear marking some of the moneys to go forward toward this accreditation process because we don't want to at the end of the two years be caught short.
>> and this isn't about the lab's accreditation. I just want to make sure people understand she it's totally separate. We're moving forward on the lab accreditation. It's the medical examiner's office that unexpected -- unintended consequences I think is a better way to say it from the rule making that came out of that [inaudible]. [one moment, please, for change in captioners] .
>> so we would actually be sending had letter to the delegation -- this letter to the delegation.
>> yes.
>> then a cc to the authors --
>> [multiple voices]
>> yeah, Ron is over at d.p.s.
>> then the other thing that I have in that opening paragraph is that we would like to have, which I think you have already given me that authority, but we would like to go ahead and work with bob cam and i've already had discussions with him so that we can go ahead and pursue that legislative end if we need to through him.
>> then also keep working with the conference of urban counties, issue with other offices in the state of Texas.
>> as dr. Peacock mentioned, we have received information a meeting is coming soon and so we will move forward with that, too.
>> we were able to talk about this issue in the conference call, conference of urban counties call and we brought it to everyone's attention.
>> we appreciate that.
>> are you sharing the budget information now or later?
>> we are prepared if you would like to go to the next part here and share with you some of the budget information that we have.
>> okay.
>> are we going on wait on a motion to approve the letter being written? Until afterwards or --
>> I would move approval of the letter. The delegation getting the letter to the persons that you mentioned, what was the other part? Two basic areas, one to d.p.s., The third the legislative delegation, the third was the authors.
>> I would say cuc as well. Jim alison at tac as well. As their legislative --
>> Texas is --
>> yeah.
>> so is this the letter or do you put it on something else?
>> this would be the letter. Unless you would like to have a cover letter to go with it.
>> or I can have it addressed --
>> seems to me that there awghtd to be maybe -- ought to be maybe a cover sheet from the Commissioners court. I would think that would get a little more attention or double the attention. Motion by Commissioner Gomez, seconded by Commissioner Sonleitner, any more discussion? All in favor? That passes by unanimous vote.
>> okay. Hopefully now you have the budgetary balances in front of you, we would just like to go through that briefly with you. I would like for darrel lien to -- to -- darlene to --
>> I'm darlene dunn, office manager for the medical examiner's office. You had asked for different scenarios, whether to continue funding services to other counties or not. We came up with three. The first one is to discontinue the services, expand the forensic center, accredit the entire department. We are estimate 1,472,400 in revenue if we had continued providing these services in fy '04. The expansion of the forensic center, the accredit addition of the -- accreditation of the laboratory and department, they have been mandated, the explanation alone costs 261,050. If we could discontinue performing the county autopsies, the laboratory would not need the forensic toxicologist that they had previously requested, and their associated costs and one of the gas spectrometers that they had requested or the two forensic pathologists we requested last week with their associated costs, the two microscopes, totaling 472,021. However, while we would still need one mass spectrometer, the fees totaling [indiscernible], funding for the accreditation of the department and certification of the investigators and continued education for the investigators. In our allocated target fy '04 budget, we have operating expenses set aside for performing these autopsies, out of county autopsies at 547,320. Of these funds, 281,000 is -- is set aside to compensate our staff taxologists for performing these -- staff pathologists for performing these autopsies. The remaining is general operating expenses. If we discontinue out of county autopsies, we could decrease those from 1400 to 600. For accreditation purposes, requires 250 to 350 autopsies per pathologist per year. As a result we would be able to decrease the staff by one pathologist, reducing our budget by $136,359, that includes benefits. However, that would eliminate the -- the relief factor for the staff pathologist.
>> let me, if I can darlene, go ahead, we just received new information this morning that may impact that one pathologist that it may not be a true reduction because it may be within six months that you would have to put that person back.
>> right. There are two -- dr. Peacock can explain this a little better.
>> in the accreditation, the no deficits would be 250 autopsies or less per pathologist per year. With a minor deficiency you can have up to 350 autopsies per pathologist per year. But if they praw you between 250 and 350, approve you between 250 and 350 then you are provisional accreditation for six months, then you have to go through it again every six months to show them that you are going to hire somebody else. So really we --
>> it makes sense to leave the third one there.
>> yeah. We need to shoot for 250ed unless we can get the law, the rule making undone.
>> okay.
>> well, now, is that rule making based on what's happening in other states or are they just kind of --
>> in the entire united states, there are 43 medical exercise's offices that are accredited. Of the several hundred entities that do autopsies. These are associated like I said with teaching institutions. Why they picked 250 I don't know. Because we are comfortably doing twice that amount. But we don't have to teach medical students and residents and interns and fellows both at the autopsy table and across the microscope and in lecture halls and in labs. So a lot of their time is chewed up with teaching duties and responsibilities that we don't have. I -- you know, one thing that we batted around was talking to name and saying can you make standards for service organizations and standards for teaching organizations.
>> where does name get its authority.
>> d.p.s. Gave it to them.
>>
>> [indiscernible]
>> right, it's a voluntary organization of medical examiners from around the nation.
>> so that's eve avenue that we might -- that's another avenue that we might explore. We haven't met yet with the other medical examiner's offices and we want to take any idea that anyone has to try to make this workable.
>> uh-huh.
>> for this state.
>> okay. Our staff pathologists are paid below market because they receive compensation for performing these out of county autopsies. Funding would be needed to increase their salaries to current compensation levels. We are estimating 193,200 would be needed on -- to compensate two of our pathologists. If we -- if you decide that the third pathologist would stay in our department, we would need additional funding. Below is a synopsis of what we just went over. A loss and expense to Travis County would be $2,036,730. Less the -- the supplies and personnel that we wouldn't need, that would be a total loss and expense to Travis County at $1,576,828 that we would need. Option number 2, continue doing services for the 41 surrounding counties, expand the center and accredit the listen and the department. The expansion of laboratory and accreditation of the laboratory and department have been mandated whether we do the out of county autopsies or not. Continuing to perform autopsy services will require the addition of one forensic taxologist in fy '04 and one in fy '05 with related cost. One mass specotroheater in '04 one in '05 and the accredit addition of expense of 13,900, that would be annual costs. For departmental accreditation, we would need a forensic pathologist in f y '04 and one in fy '05. The name accredit addition at $2,000, one microscope in fy '04 and one in '05, certification for investigative staff and continued education for the investigators and the two new pathologists. Below is the -- is the synopsis of what I just had gone over. This would be a total revenue of 901,300. Option number 3, to continue providing services to the 41st surrounding counties, expand the forensic center and a accreditdate the laboratory only, this is provided we can do something. That would bring a total revenue to Travis County of 105 a 788. -- 5,055,788.
>> something we haven't brought up is how would we pay for this if we decided to bring in the additional pathologist in '04 and '05 and we just laid out the dollars, but one option, of course, would be as we did with the last, and that is that we would consider increasing the fee. We increased the fee from $1,500 to $1,800, that's been done. According to my budget expert, allan miller, for every $100, you would generate $81,000, for every $100 increase, you would generate $81,000. So you would pay for the -- the number one pathologist pretty easily over a short period of time. As well as the second pathologist. So that is for your consideration, too, is -- is if we are required to go forward, then you have these three options but if the option is to go forward and I think our recommendation would be to go forward for accreditation of the office, that we could look at increasing the fee.
>> does increasing the fee, what factor do you put in there, the more you go up, the less business you get or is it just that these things are so expensive to -- to put in, which is obviously the reason that we deal with 44 counties because so many of those counties are small they just don't have the resources to do it. But there's some factor in that, isn't there, allen?
>> yeah. The work loafd the department we are getting for this budget year for fy '03, they were estimating for '04 that they would have 890 out of county autopsies. We looked at the rates of increases and decreases for setting the fee increase before. And we took the -- what I think was the worst case scenario, which was the last time that there was a significant increase in the fee and dropped the autopsies accordingly to get it from 890 down to the 818. It's entirely possible that -- that the other counties may not have any other place to send their clients and the -- and they might need to send them to Travis County anyway and the workload would be around 890 as well. But we factored in that it would be reduced from 890 to 818. I think regardless of what we increased the fee, I'm not sewer that it would reduce it much below there unless we started seeing massive fee hikes. But these are just projections and --
>> but you just said 10, on roughly a 10% drop I mean from the 890 to the --
>> yes.
>> so you do have some imperical numbers to work with on it.
>> we did just get word yet from [indiscernible] counties that lubbock just got a brand new medical examiner's office approved I think they are tying into Texas tech, which will help west Texas, but there has been no movement in the central Texas area of anybody adding on a medical examiner's office that would --
>> well, the lubbock medical examiner's office was existing prior.
>> they have a teaching relationship now, is that what it was?
>> actually, their building is located in the medical school.
>> oh, okay.
>> and actually has been. It's expanding and they reconfigured their relationship a little bit.
>> so what -- what's the nearest pathologist school to Travis County?
>> baylor.
>> san antonio.
>> bexar county.
>> bexar county?
>> uh-huh.
>> of course they have a medical school there. I mean, so that's -- that's a big help there.
>> it's bexar county, tarpt county and one other one that --
>> dallas [indiscernible]
>> and bexar. Uh-huh.
>> also, while I think there are other medical examiner facilities, I think -- please correct me if I'm wrong, but there aren't many that do anywhere's as close to the out of county workload that Travis County is currently doing.
>> right.
>> so even if the workload would shift, I'm not sure if those areas are even capable of managing that workload increase.
>> they don't want it.
>> yeah.
>> you would think that our fee is pretty much at market? Now?
>> a little bit above, but we do good, accurate and fast turn around type of work and so they are willing to pay a little bit more.
>> I have received several calls from different offices about their on fees. They wanted to know what we were charging because they are anticipating increasing theirs.
>> we may be a little head of the mark but I think they are rapidly right behind us.
>> if you are not accredited already, you are looking at a substantial infusion of dollars to comply and so you have got to generate that money somehow, either you fund it with public dollars or you increase the fees for the service basically.
>> correct.
>> whether you are in Travis County or one of the other counties.
>> and below -- south of corpus christi there's not a medical examiner's office in Texas. The way that the valley handles it that that they have two pathologists in private practice and doing forensic practice too, like in funeral homes and a general morgue. Those people would have to ship them all north if this accreditation goes through.
>> I think one county was looking at creating a medical examiner's office, I don't know how far along they are.
>> they are not very far at all. I spoke to them --
>> that's why I think there may be some political will out there because of the difficulties that the counties are going to get into that they have perhaps some pressure points related to rule making because it's like we love to do it, but you have made it impossible for us to do what you have said.
>> yeah. We are sitting on on a big population base that we can conceivably, even though it's going to be tight, do it. But the people in the valley, those are very poor counties and to -- to have them have to fork over millions of dollars to start a medical examiner's office and get it accredited is going to be prohibitive for them.
>> I think just the labor pool of -- of a very small set of folks is --
>> yeah.
>> [indiscernible] [multiple voices]
>> doctors, what would -- I mean, obviously given that this was really caused by the houston incident, I mean, I think everybody knows that that's where it came from, what would be your recommendation to legislators to say, if we understand the problem that we have here, would it be that you would say, you need to have five of these accredited medical examiners that if you -- if you have capital -- capital -- situation that that's where you have to -- where you have to take it, I mean, versus, you know, creating a situation where everybody's medical examiner's office has to be accredited? What would be you all's recommendation? Because obviously that's what these legislators are goings to want to hear from you all, how do we fix this problem. Problem.
>> I think accrediting the crime labs and the forensic toxicology labs would certainly get rid of that kind of a problem. I don't think the legislators fully understand that medical examiners are licensed physicians. We have to have real licensure every year, we have to show that we've had continuing medical education and also by the nature of what we do, our autopsy reports are reviewed by defense experts, the slides we use are looked at by defense experts, our testimony is looked at by defense experts, but the very nature what was we do we are continually peer reviewed and I don't think that the legislators really understand that aspect of it. If they insist on accrediting us in some way, to be inclusive of the medical examiner's office rather than to exclude the smaller and poorer counties. This is really going to disallow a lot of prosecution of cases that need to be prosecuted. What if a hospital pathologist is called upon to do an autopsy in a hospital and during the autopsy they discover it's a homicide. Is that case never going to be prosecuted because it wasn't an accredited facility? Something like that. You know, that you could always imagine that -- that something comes up, some piece of knowledge comes up in a way that you did not know, did you not know to send that one to an accredited place, now you have a homicide on your hands.
>> all of the -- all of this is so different from what was going on in the houston crime lab, not the medical examiner's office, but the crime lab where people flat out did not have the credentials related to the d.n.a. Testing. They didn't have the degrees, experience, supervisory, just flat out -- or the knowledge.
>> or the knowledge.
>> this wasn't there. That is so different than what you just described dr. Peacock.
>> allen, what is the recapture that we have with regards to expenses versus -- I mean, what we charge, what do we cover percentage-wise for our medical exercise's office.
>> well, it's a twofold question. What I would like to say I think that it's clear from what darlene is doing, our office my quibble about a couple of the numbers that she's done. It's clear this they are being largely supported by the out of county fee. When I say that the workload of what they are doing on an hourly basis on a day to day activity still justifies the fee that they are charging because they are working a significant amount of time on the county cases. But to manage an office require as core amount of staffing to be present at all times, it's just what that core level of staffing would be. The budget for the medical examiner's office alone, without dealing with capital cost of things is 1.9 million. A simple, simple comparison is we generate 1.4 million in fees and we have a $1.9 million general operating need. Now, that is very puff, I would not recommend -- very rough, I would not recommend using that, there are indirect rates, [indiscernible], utility rates, capital construction, capital replacement things, too, but we -- the out of county business is helpful to Travis County as well as helpful to these other counties.
>> anything else today?
>> no, sir.
>> so we have -- on the budget issues we need to keep those in mind as we go through the budget, basically.
>> uh-huh.
>> we think that a rule will be adopted by the department of public safety when? Have they said that?
>> well, actually, it's -- right now just finished with the comment section so I don't have the actual schedules that they are going to do except an e-mail that I got this morning it looked like people could still send in comments. I think there's still some more time there. I don't know of a specific date that they set --
>> well, as far as I know the rules, unless we can -- unless we can invent someone to revisit they are already in place.
>> [multiple voices]
>> in that grace period.
>> in that grace period.
>> okay.
>> my point is that once the rule is adopted, I don't know that you can depend on the legislature doing the right thing when it returns. You almost have to plan to comply.
>> right.
>> but there is room to work with.
>> thank you all very much.
>> thank you.
>> so are you or are you not going to bring back the out of county autopsy fee issue? We have already made one decision but does it need to be revisited in light of this new situation? I'm sorry. Because we are going into the markup tomorrow, that's still out there.
>> yeah.
>> we can certainly do that and that of course our recommendation to do that -- that was our recommendation to do that, we wanted to look at paying it through the -- [multiple voices]
>> see if the fee would be in place.
>> I'm sorry.
>> don't we need to see what the state does?
>> I would like to see what the state -- I would recommend that we --
>> there is -- there is no October 1 deadline for increasing the fee, right? It's just that we have to go through various procedural steps to do it. But it seems to me that we ought to put our energy into persuading the states to do the right thing. I would think that if other counties are basically taking the same statements, complaints, observation that's we are -- observations that we are, you would think that they would at least consider doing that. The other thing I'm sure the legislators had in mind doing the right thing and may have been unmindful of the full effect of their actions. So if they don't think we are just crying wolf, my guess is that they will reasonably respond is what I'm hoping.
>> uh-huh.
>> but I think the minute they adopt it, then we ought to put our fees back on the court's agenda and let us act.
>> > and I will be back to give you a status of how it's going in regards to the meeting that's we are going to be attend being in working with the legislature --
>> my point in dealing with the legislators is that I'm a firm believer in bullets. You all gave six or seven real good ones, I think that I would come up with a one pager that really made it clear, here are the bullets right here.
>> yeah.
>> because I'm having a little trouble finding the points.
>> the only reason why it was written that way, judge, is I was trying to figure out a way that we can really address the d.p.s. And the rule making folks, they need that extra detail I believe.
>> I agree.
>> I mean for a meeting with the delegation members.
>> yes.
>> be sure the draft with klbj and the statesman that would be helpful, too.
>> thank you all.
>> thank you.
>> thank you.
>> moving quickly.
Last Modified: Wednesday, September 9, 2003 7:52 AM