Travis County Commissioners Court
February 7, 2006
Item 14
Number 14 is to consider and take appropriate action on the following items regarding the Travis County medical examiner's office. A report from human resources department on market study findings and recommendations for medical examiner and deputy medical examiners job classifications and titles. 14 b is request for an additional deputy medical examiner's f.t.e. Position and begin recruitment immediately. 14 c is a briefing from the county attorney on out of county contracts with the medical examiner and deputy medical examiners. This item may be discussed in executive session under government code annotated 551.071, consultation with attorney. A first?
>> item 14 a you have the backup memorandum dated January the 31st, very simple I will start at the recommendations and as you want to peel it back, in terms of data sources, the markets that we looked at, we can certainly do that. But the methodology was -- was identical to what we did before. One of the things here we had an opportunity to work with the medical examiner's office and your interim c.e.o. To really look at the organization and structure of that operation. We tack into account the -- we took into account the consultant study that was completed in 2005, the recommendations that were embraced there, as well as the anticipated direction that the court would want to consider perhaps going in. What we are recommending on this particular item is a pay range of the chief medical examiner that would begin at minimum of 183352 to a max of 293364. Of course the midpoint is shown there as 238358. We are also recommending two levels for the deputy medical examiner title. We did find in the marketplace that whereas we have one title within Travis County, that the market does support two levels of the deputy me title and the minimum, mid and max of course numbers are represented there. But the deputy medical examiner 2, the minimum that we are proposing the range is 160,147. The max of 256,235. Deputy medical examiner 1, minimum 122,175,000 to a maximum of 195481, 122,175. We will look very expensively in the -- extensively in the marketplace to find out what is required of these titles so we could appropriately assign titles involved as well as meet the needs recommended by the staff. The marketplace does support at the department me level board certification or a person who is lebl to be certified -- eligible to be certified. A distinct difference from the requirement of the deputy medical examiner two title as well as the chief medical examiner, whereas each of those titles indeed require board certification. With that the marketplace supports that as I indicated, and we have all of the information on page 2 of your backup that shows the methodology, data sources, markets that we looked at, but in general these are staff's recommendations. Related to the chief medical examiner and the deputy me, two levels, series that we are proposing.
>> I see the listing of Texas counties, but -- I don't see the amount. I don't see the salaries next to them.
>> the salaries for each the counties?
>> do we have that information.
>> we have that here.
>> that's what we compared Travis County to right?
>> yes, yes, harris, bexar, tarrant of course is a contracted service, but dallas county as well as el paso counties we have individual incumbent salaries available for you.
>> okay. May we see that?
>> yes, sir.
>> and --
>> if you have enough copies.
>> yes, sir, we will get you the -- the copies. Do you have -- [indiscernible]
>> we will get you copies of those. Just to remind the court that today all that we are asking really is to approve the minimum and maximum and not the actual salaries. And this is done in order to allow us to recruit. The actual salaries, I think we can address in executive session, would be negotiated. Judge, I will give you my copy.
>> alicia, would you like to share these with them? This is just -- [indiscernible]
>> zoo we have a similar arrangement with the other counties, also.
>> yes, the recommendations that we are making is based on the actual data coming out of each of the counties. For each of the counties represented here, we are showing you the actual salary for each incumbent within the me offices within those counties. What you would get if adding up all of the salaries within that, would be the salary data that we really collected to establish the salary range that's we are recommending. Along with other data, but we did find that the ranges fall within the realm of the incumbent salaries that are recommended here.
>> this is a weird question. If there's only like -- this is a small little group of folk, there's like 400, where do you find these folks if chances are you are already working in another place, are they actively coming out of medical schools and owe owe.
>> would you like to come up --
>> dr. Dr. Roberto bayardo, medical examiner, the school is very small, only three facilities that train forensic pathologist, san antonio, dallas, fort worth. Only three come you the every year. 7 presently there are vacancies -- 20 or so vacancies in the entire state. So we have to draw from other states to fill those vacancies.
>> so there's only one, dr. Bayardo, that comes out of each?
>> that's correct, yes. Only three forensic patologists out of the state of Texas, yes.
>> hum.
>> that's -- that little pool of -- of folks.
>> also appropriate from a recruiting standpoint to -- to source candidates for vacancies that you might have. And a part of what happens not only within these particular titles and any other titles, if your compensation level and salary structure is such that it becomes -- at least, you know, attractive to others who are in other m.e. Offices, that becomes a very valid pool to -- to draw from. In addition to those who are graduating from -- from the schools that dr. Bayardo mentioned.
>> it almost sounds like it might be a recruitment technique to say hi we are pay for your medical school if you will put in and work that off for x number of years. I know that's what they did for a lot of rural counties when they had a hard time attracting doctors to come work there. We may need to get creative here.
>> uh-huh. [multiple voices]
>> dr. Bayardo, is this just a field that so few medical professionals want to practice in? Is that --
>> that's correct.
>> literally what it is.
>> because remember in order to become a forensic pathologist, first we have to be a general pathologist. You go to work for a hospital or a group of pathologists your salary is going to be almost double what you can make being a forensic pathologist. Only people that really like this type of job is going to go into that field.
>> it's a little bit like my brother-in-law is an animal surgeon and to come out of veterinary school then to go to become board certified for surgery, I mean there are 23 schools in the country and they only have one student a year that gets in.
>> yeah.
>> so it's like -- it's like this field. I mean, just such a limited number of people that do it.
>> that's correct. Incredible.
>> folks go into the medical profession to save lives, unfortunately in this particular line of work that opportunity has passed. And it takes a special kind of person who will -- who will face that day in and day out. Takes a special person.
>> most of the pathologists that have been trained in the united states they don't like to do autopsies. So they prefer to leave that to the physicians assistants or to the forensic pathologists like me, see.
>> but the-- I?m looking on page 1. The salary range structure. Those are based on research involving the counties that are listed on page 2.
>> that's correct.
>> and so the ranges would be comparable from minimum to maximum?
>> yes, sir.
>> okay. Any other questions regarding a?
>> move approval.
>> b.
>> ooh, sorry.
>> b?
>> yes, sir. In item no. B, the request is for an additional medical examiner position. Currently we have one chief medical examiner and two deputy medical examiners. If you look on page 3 of your memorandum, it talks about the number of autopsies that are performed. Currently there are about 1400 autopsies per year. We took that number and divided it by three, it comes out to about approximately 466 autopsies per year. And that does not take into account the external exams or the administrative time taken for example by dr. Bayardo where he is not able to perform autopsies because he's doing administrative work. If we look at the national association medical examiners, their standard, this is the level 2 standard, is 350 autopsies per year. Their level 1 is 250 autopsies per year. When we discussed the -- when you first received the report on the medical examiner's office in August, one of their recommendations is to work towards name accreditation. I believe that paper said that it's one way that the public is assured that the practices of office are done at -- at best practices at standards that -- that assure quality or that go a long way towards assurance of quality. So what we are doing here with the additional medical examiner is again to request the -- the position to meet the current workload. And also work towards the standards of the -- of the national association of medical examiners. I believe dr. Bayardo if you have anything to add?
>> yes. It's a very critical position as you mentioned now that -- that one of my assistants, dr. [indiscernible], she is going to be out of work for a minimum of four weeks, a maximum of six weeks, so I have to take care of her job and my job. You know the last four days I have performed 25 autopsies in only five days. So we need to have somebody else to -- to pick up the slack when somebody gets sick or out of work.
>> dr. Bayardo of the 25 that you have done in the last what three -- four days.
>> four days.
>> how many, what's the -- what's the breakdown of out of county and in county.
>> most of those were out of county cases.
>> it always gets you back to -- to the question that we continue to ask ourselves, what is it that drives this? Is it the -- because we clearly do more out of county occupies than we do in county. Autopsies than we do in county. I think all of us are -- are want our patologist to not go overworked. And at some point in time you have got to find a number where you are comfortable on out of county. If we are predicating what we are going to do, I?m certainly, you know, not against another pathologist, if you have got to do it if you are going to do 1400. If you don't you're just you have to tell dr. Peacock, come on back to work, she can't have her operation or whatever because you can't handle the workload. It really does beg the question of what is our stance really going to be with -- with out of county and -- because that really drives it more than anything. Because we clearly have enough staff, if we just say we are the Travis County medical examiner, that's who we are. Now, if we got time to -- to do something else, then -- then we do it. But I don't -- I don't know how much conversation that -- that that takes, but I think that I understand the criteria by which we need to base what -- what do we -- what do we need insofar as numbers of pathologists, of doctors?
>> several perspectives to that particular question. And we are working on precise model, joe lissard to be here to address that. From the research there are three points to make. Traditional Texas counties have served the surrounding areas. Dallas, tarrant and bexar, yes, all serve surrounding counties. To the extent that you have a population boom as you've had in those areas. Some of those counties have chosen to limit the number of counties they serve or the cases that they take. So -- so you are right, that is an issue, a public policy issue, that the court needs to -- to explore. The second point is that because recruitment is so difficult in this area, that it -- even if you approve the position now, we are talking about three or four months, in order to -- in order to recruit. The third is that even -- even with four pathologists, you are doing several things. You will establish public policy, in terms of defining your service area. That will require a proper notice of the county's because there's only 11 medical examiner's offices in Texas. So they will have to find another office to go to and I?m only aware of two private practices. In -- in autopsies. So the counties will need some additional time in order to determine who their -- who they are going to. We also have name accreditation that we will be working with. And working towards that the workload of administrative duties and the creation of appropriate procedures in order to meet those standards will take additional time from the doctors that you have on staff.
>> alicia if you have 254 counties in the state of Texas and you have 11 m.e. Offices, I mean, not every county does 40 -- not every m.e.'s office does 45 counties.
>> no. There's some counties that we have discovered on our list that really haven't been using us.
>> that we have ever performed an autopsy for.
>> we haven't performed one in -- in the last [indiscernible]
>> obviously I remember looking at those numbers and it was like eight or 10 of the counties were probably what 75 or 80% of them, alicia, joe? So that's probably --
>> bastrop, Williamson and victoria is really kind of on the top five or so. That we perform -- and hays county. And three of those four are in our geographic cog area.
>> this is the discussion I had when Commissioner berkman called from Williamson county when he saw that that was under discussion. I would hope that we would continue to take a regional collaborative approach to all of this because let us please remember that there are many cities located in Travis County that are co-located in the county next door. The unfortunate reality of crime is that oftentimes a crime starts in one county and concludes in another. So you have joint investigations going on, between travis and Williamson county, Williamson county and the city of Austin. So I am extraordinarily interested in keeping our traditional relationships with those who share a border with us, because those roads connect between us, certainly the cities of, quick and dirty, the cities of Round Rock, Pflugerville, Cedar Park, Leander and Austin have either their corporate city limits or their e.t.j.'s going over county lines, it would seem extraordinary that you would say city of Austin, Williamson county we will not do your autopsy but city of Austin Travis County we will. I think we need to keep our regional collaboration. Now, victoria is not on that list. And they send a lot of folk to us and I?m -- I know that it's because they feel like they get good service from us as opposed to going someplace else. But that's the one that just caught my eye and attention. Williamson and hays are also part of capital area metropolitan -- the empo transportation. If you include bastrop and caldwell, those five counties make up what will be the future campo and is certainly our clean air coalition, so to me I don't have any issues with the immediate five county areas, with five counties. Because those are the shared borders and it is quite logical and likely that there will be joint law enforcement investigations between those two counties.
>> I think that's a good idea. I?m certainly not -- we don't do the county, but I do want us to have an eye towards -- we can't do 770. And 594 hours and dr. Peacock having an operation or dr. Bayardo, you know, having an operation. So we do noticed to have an eye towards let's get back into some reality with, I mean, maybe victory I can't you go to bexar or somewhere.
>> harris.
>> if you are going to do another pathologist, let's not put our path yolgologist and all of our staff where the stress level is so high you can't get sick don't have a birthday, don't expect a vacation. So that's the eye that I want to keep towards this thing. Let's just be mindful that there are numbers that we know we are going to do out of county and obviously there are? That we probably ought to say hey you are right next to us, you do business with us --
>> the breakoff point though, close to lunch time, but there is a breakoff point where we have got to look at it. I can understand what Commissioner Daugherty said and also what Commissioner Sonleitner said. There is a breakoff point in all of this meaning that, you know, whatever we do all of this end up going to the general fund. The question is with the person that we are bringing on board all of these other kind of things, how much money does it take for us to offset and generate the cost that's necessary to continue the operation, but by the same tonight contend maybe there need to be better cost sharing outlook on those folks that we are using as far as workload. Because understandable we definitely don't want to create the same situation that we are trying to get out of. I -- that's where Commissioner Daugherty is coming from, as far as the regional folks, Commissioner Sonleitner is suggesting, maybe there need to be do cost sharing, due dill against, maybe a whole bunch of things. At the bottom line we need to make sure that it pays for itself. We do not offset or get around where we can't do our proper accuratation, I think it's very important. Workload is important. How we manage that I think is just as important.
>> looks like we will have to take c in executive session this afternoon. But Commissioner Sonleitner a moment ago moved approval of a.
>> second.
>> which would basically set the salary range for the various pathologists at our medical examiner's office. Any more discussion? All in favor? That passes by unanimous vote. And b basically is to -- to approve the addition of one deputy medical examiner, f.t.e. Position and authorize recruitment immediately of two -- to commence immediately. We think that will take several months to get done.
>> yes, sir. The request is to fund it at midpoint. I would like to add if we could take about 35 to $40,000 of that salary, make sure that we get a computer and a desk and that if you would approve about 35 or $40,000 --
>> that needs to an specific item though.
>> sure does.
>> if we approve the range, basically we approve posting of the range and we -- as long as we fit the person within the range we are legal.
>> yeah.
>> so if we -- if we entwine b and a --
>> I second the motion, judge.
>> whatever the other person needs we need to come back.
>> I second the motion, judge.
>> any discussion of b? If we take action during the next three or four weeks, I?m hoping that we do on all of the issues, then, you know, we -- if we need to stop that, we can. But it's kind of frightening to have two when he ought to have four. You know. Anyway, all in favor? That passes by unanimous vote. Vote, also. And let's this afternoon probably have I would guess 20 to 30 minutes worth of work where we should be able to reach executive session discussion on c at about 2:00. Okay? Is there an open court part of that discussion? On c? 14 c?
>> 24 c?
>> if so, we will have it in open court then convene in executive session for the other part. My question is what restrictions, if any, does state law police on a county's right to contract with -- with smaller counties to perform autopsy services? That was generated by -- by various claims from a -- from a concerned citizen. Barbara if you could -- move to recess to 1:30. All in favor? That passes by unanimous vote.
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Last Modified:
Wednesday, February 8, 2006 10:44 AM