Travis County Commissioners Court
March 21, 2006
Item 8
8. Consider and take appropriate action on follow-up issues from medical examiner work session: a. Approval of goals for national association of medical examiners accreditation;
>> good morning, alicia perez, executive manager for administrative operations. I have here with us the new chief administrative officer for the medical examiner's office, beth devorary, also joel who has been assisting us also with the work at the medical exercise's office. Since last summer the court has been diligently working to improve operations at the medical examiner's office. I have been working with the medical examiner and staff and have invested significant amount of resources for the improvement of that operation. The court has also set direction for the adoption of best practices and performance measures to ensure accountability. And the best practices have been taken from the national association of medical examiners. As we spoke before, 11 medical examiners in Texas only three are accredited. And there is a national movement towards going through a -- to accurate addition as the best practices. Accreditation as the best practices, what we have today is before the court is to follow, take another step in the direction towards the goal of accreditation for the Travis County medical examiner's office, what you have before you are the accreditation goals, they have been presented to the court before. They have also been presented to the medical examiner and the deputy medical examiner and both the goals and the performance measures have been approved by the doctors. So we are here for formal adoption. Not only does this -- these goals state the goal, but it also provides a time line by which the medical examiner would achieve accreditation. At this point in time the initially be July 1st of '06, that has been moved back from April the 1st. We still expect that will be completed by that time, but we are making arrangements for have it either videotaped or see how soon we can get the other two medical examiner's on board. That's why we switched it from April to July to see if we can get the medical examiner's on board by thennd the -- and the two new ones. If not we can go ahead and videotape it and we will allow them to also take a visit to dallas who is providing the training for free and all that we have to do is cover expenses. So the deputy medical examiner from -- from dallas county and the office administrator and that is a facility that has been named accredited now since 19 the 6. I believe. 1997 I believe.
>> I move approval of the goals.
>> good.
>> okay.
>> we think that the entire process may take us through October 1 of 2008?
>> yes, hopefully before we get fully staffed but that is the date by which we have set that is -- we would achieve main accreditation. That's just making the application. Doesn't necessarily mean that you are accepted.
>> that's correct. Credit. By the time that you have the application, you have done self assessment, you have had a team in to check and do a dry run, make sure that everything is in order, by the time you submit your application, you have got your ducks in a row to get accredited.
>> when they visit us in number 5, no later than August 1 of '07, we except them to be able to point out what's good, what needs to be improved,, we noticed to work on that between then and I guess the next 13, 14 months.
>> yes, sir, absolutely. That is a team, on number 5 it is a team of medical examiners have that been inspectors and are -- are usually board members and have -- have participated in the development of a owe over the policies on a national level. They come in, do the preliminary inspection. Then they tell you what your deficiencies are, then you get ready for the final inspection.
>> okay. There's a motion to approve the -- the goals regarding main accreditation. Anybody here on this item? All in favor? That passes by unanimous vote. Two is a performance measures.
>> yes, I’m going to turn it over to beth to go through that. Let me say on the performance measures, these are performance measures that are for the individual doctors as well as a team of doctors. This is again part of ensuring the accountate that the court -- accountability that the court wanted to have. Doctors have reviewed it and have approved.
>> we are -- we are seeking approval of the performance measures which are based on the measures I’ved in the main checklist. That's under tab 3 in the materials that you have. Broken down into the individual and team performance measures. The individual measures are going to focus on the first piece, a time frame for the completion of autopsy reports, 50% being completed within 30 days of autopsy, 95 within 60 days and then the 95% of the remaining cases completed within 90 days. It also includes participation in external check sample and proficiency surveys. At least semi annually. Presenting and attending case reviews at least once per quarter. Meeting the standards that are relating to medical examiners. As outlined in the main checklist. On the case reviews this is a particular important action. When we visited dallas, tarrant and bexar county, the three accredited facilities and also visited harris, the case review provides a -- an arena or a forum by which doctors, staff, investigators, pathology techs get together and review cases. They talk about difficult cases, any questions they may have. It's an opportunity for all staff to get together and learn from each other by using real cases that they deal with on a day-to-day basis.
>> becomes quality assurance. A lot of these are specifically focused on quality measures. Standards related to medical examiners, include things like your path yoltionz are board certified, lower air disturbanced in the state, employed full time, appropriate training and expertise to perform the job that they are doing. Also standards related to post mortum examinations. If you look under number 7 in the checklist, you will specifically see some of the standards that are outlined there. But primarily focuses on the adoption of policies and procedures that outline the operations and the examinations and how they are conducted. It also includes measures that address the documentation that's required and how and when autopsies are performed. Under the team measures, we focus on the -- on the equalizing the caseloads so that the pathologist does not perform more than 27% of the caseload. Based on our figures, from -- that we have compiled, based on 1500 autopsies this would be about 405 autopsies, that the deputy medical examiners would perform. It also includes a staff signout conference on a monthly basis. Again this is an opportunity for a quality control to be in place, for there to be discussion about cases and ensuring that they are being handled appropriately. Autopsy and external exams are reviewed and signed by the chief medical examiner and at least one deputy medical examiner. All homicides are reviewed and signed by all medical examiners. Again another quality control measure. The reports that are generated need to meet the standards that are outlined in the name accreditation checklist, the last team measure is attainment of name accreditation goals adopted by the Commissioners court.
>> so how are these performance measures enforced? Well, they can be enforced through the contractual language that we have with the medical examiners, a lot through policies and procedures and training monitoring that needs to be done to ensure that in fact they are being implemented.
>> if the comowrlt say one year -- if the Commissioners court say one year after the adoption of these standards wants to know about compliance with them. And will there be a report available to review.
>> right now these are tied into the name checklist in the named standard. Part of what we have under our target goals are -- me providing a report to the court on at least a semi annual basis of the status of the implementation efforts. I will be coming back to you, letting you know where we are in the process.
>> there would be evidence available that documents conformance or non-conformance.
>> what is required with the name accreditation is an annual report that goes into number of cases, type of homicides, cases for different age brackets. It's a pretty extensive report. We have seen it produced and like I said three outfit the 11 medical -- out of the 11 medical examiner's office, I anticipate within a year our office, the medical examiner's office in Travis County will also be able to produce a report. I think the report is extremely beneficial in terms of the knowledge that it provides, the accountability and also to the public and health care system of the investigation of deaths in Travis County. So -- so you will have an annual report, I suspect.
>> you don't want to -- to learn that you have not been conforming a year later. You want to learn that a month later, don't you?
>> I guess my -- my concern is that if you put in place new practices, procedures, protocols, then -- then you really ought to know month after month after month, how you are going in terms of -- of compliance.
>> yes, there will be monitoring mechanisms that we will have in place to ensure that in fact-- the goal is to -- the practices, the main standards setters have said are good practices basically.
>> I didn't want to put all of the --
>> move approval.
>> second.
>> you all finish your presentation?
>> yes, sir. C is an executive item.
>> discussion? All in favor? That passes by unanimous vote. And c is for executive session discussion?
>> yes, sir.
>> yeah.
>> now if I may say so in number 10, in my mind I have several specific recommendations that I would like to make on that letter kind of based on comments that I heard from a couple of our partners. Over the last few months, I would like to take another week --
>> okay.
>> I don't see myself reducing those to writing over lunch unfortunately.
>> sure.
>> okay. I have more than enough stuff to do. If that's all right, I will make sure that I get that done by next week, okay? Probably get it to you all by 5:00 on Friday. I think it will be fairly straightforward, but I’m -- there were concerns raised to me I think we ought to address. I’m thinking if the two who raised them had them, maybe the others did, too. Both county judges.
>> sure, yes, sir.
>> just as a question of who this needs to be sent to, I see it's addressed to dear fellow county Commissioners, also needs to include a county judge. But it seems like it ought to be certainly to the -- outing to be sent to the county judge. A lot of these small rural counties the judge is also the chief budgeting officer, would be the point person, that would be very easy, seems like it ought to be specifically sent to a specific county judge and you know ask that it be cced to the others on the Commissioners court. But I think it needs to go to the county judge.
>> okay. So we would call up c -- 8 c in executive session this afternoon under the -- under the consultation with attorney and personnel matters exceptions. Take another week on 10. Anything further regarding the medical examiner's office today.
>> judge, let me ask something. The one thing that kind of jumped out at me on -- on correspondence that we are going to be sernding to the county -- sending to the county judges whatever, I think that we -- we need to let all of these folks know that -- that we are already alerting to the fact that we are -- that we are looking at our contracts and obviously they know that we are going to be probably making some changes. I really want to make sure that -- that we explicitly state that we are going to have the ability or we are going to be looking to have the ability to -- to if we are overburdened that -- that we need to have some mechanism that allows us a legal out. Because at this stage somebody may go oh, I may want some time here to start looking where we might go. If people are used to having these contracts with us, they might expect -- judge that might be something that you are going to put in there. I feel really, really strongly about it. As we mentioned one of the problems that we know that we have is the potential to be way overwhelmed, overburdened with work at our me, especially if we lose a patologist or something happens. So I just really want somebody to know that they need to be looking at that.
>> uh-huh.
>> I think as pa part b to that, we need to make it exceptionally clear that you are not going to get cut off this year or next year. We have already made that. I think if I were getting a letter from us I would want to know that up front. It's almost like paragraph 1, 2, 3, 4, 5, needs to be the first paragraph saying hello, this is why we are writing you this letter. We want to tell you up front, though, that while we are reviewing all of this stuff, we have voted to continue our services on a regional basis to everyone including you, and that for this fiscal year and for next fiscal year you can count on us being here in terms of a regional partner. Then because I think that's -- that's the -- at least the conversation that's I’ve had with our partners in Williamson county, they are like are you going to cut us off? It's like no. So it just takes the tension level down a bit.
>> okay.
>> judge, also -- I will work on the letter.
>> what I will do is circulate my draft, change any way that you see fit, hopefully we will have one to approve next week before sending out.
>> okay. Thank you all.
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Last Modified:
Tuesday, March 22, 2006 7:57 AM