Travis County Commissioners Court
May 16, 2006
Item 9
Number 9. 9-a is consider and take appropriate action on medical examiner's office issues, including, a, a is recommended organization chart, request for a new forensic autopsy supervisor position and staff recommendation to adjust or amend the medical examiner's office budget to fund changes approved by the Commissioners court furg fy '06. And 9-b is authorization for recruiting expenses for chief medical examiner and deputy medical examiners positions for Travis County medical examiner's office.
>> good morning, judge Biscoe and Commissioners court. We're here today to discuss several items. The chief administrative office for the medical examiner is here and I also have (indiscernible) to my right from pbo that we've worked very closely with on these items, and we want to provide a full report and accounting to the court of all the actions of the medical examiner's office to date. We'll --
>> do you have anyone else?
>> yes, I do.
>> [ laughter ] I am so sorry. We have the chief investigator, medical investigator for the medical examiner's office, brenda tisly with us also. She likes to be incog neat tow, but we've asked her to step up today and she's agreed. We'll start with the creation of the new forensic autopsy supervisor position. We brought this position to the court before. I think it was in February. And since then we've had -- we've done more work in terms of the research of medical examiner's office throughout the state of Texas and we also had beth join us, the chief administrative officer, in March. We have had an opportunity to look at the organization and look at other medical examiners' offices and she has a report for you.
>> thank you. Currently the medical examiner's office has four forensic autopsy technicians. These positions provide coverage for the office seven days a week for eight hour shift during the day. The technicians are currently being supervised by the medical examiner, investigator, chief, brenda tisly, and she also supervises the eight investigators and the nurse forensic investigator that we currently have on staff. During administrative review that was conducted last year it was recommended that supervisor levels be between seven and 10 employees. Because there isn't a forensic autopsy supervisor at this time, our chief investigator has been providing the supervisory responsibilities for those employees, which brings her to a total of 13. And because she has the responsibilities of supervising those employees, there are other job functions and responsibilities which we have been looking at that she's unable to perform. Many of them administrative. Primarily development of policies and procedures specifically related to the investigative functions of the office as well as some of the autopsy functions that our office provides. So freeing her up from some of that responsibility will allow her to focus more on the responsibility and development, which was the number one recommendation in the review. And also provide some oversight of the investigative reports that come out of our office and provide training and quality control measures within the organization. We view the forensic autopsy supervisor position as a working supervisor. We currently with the four supervisors -- the four technicians that we have on staff do not have adequate coverage for when we become fully staffed with our four pathologists. And I’ve included under exhibit 2 an example of what the staffing structure looks like currently. With each technician assigned to a physician and one assigned to intake and release, the processing aspect of the organization, then that leaves us short, at least five days a week and short two people five days a week and short one person two days a week. So we would look at this position as providing coverage that isn't otherwise available for when employees become sick or go on vacation or otherwise not in the office. In addition to that, the forensic autopsy supervisor will be supervising functions that are very critical and specifically identified in the administrative review. And that includes the intake and release functions, making sure that bodies are properly processed, that we document all the possessions, where we are stored and recorded and who they're released to. Things that in the past have come up during -- some issues that were looked at during the administrative review. We also looked at other medical examiners' offices in Texas, and each of the offices that are comparable to our own, such as bexar county, dallas county, harris county, have a comparable position. There is an individual who does provide that oversight and also working coverage for the forensic autopsy position. So for that -- for those reasons we're looking to fill that additional person, to have that additional oversight, the quality measures being addressed and then also to deal with the coverage issues that we're currently facing.
>> the cost of that position, just for the rest of the fiscal year, is $15,000. Approximately.
>> we have the medical examiner's office is in the midst of fundamental changes, including personnel changes. Including the fact that we're looking for a new chief medical examiner. We believe that this change needs to be made immediately and that no matter who we bring in as chief medical examiner, that person will see the need for this position the same as we do today. Because it makes sense to to me last time I heard it, but I am sort of wondering whether this is a position we would wait for the chief medical examiner -- for him to fill or whether we believe that in view of all of the facts that we need to go ahead and try to post this position and get this person on board.
>> we would like to get this person on board as soon as possible. The policies and procedures and the process changes that we're looking at are things that need to be implemented now. I believe that a new chief is going to be very supportive and come from an environment where this position exists within the scope of that environment. And I don't see an issue there in terms of waiting.
>> so we need this person and we need this person now.
>> yes, sir.
>> okay.
>> let me ask, beth, would the m.e. Most likely be the person to hire this position if they were in place or is that -- or is this an obligation of yours?
>> typically not. The position would report to me and would be similar to that of the chief investigator, the office manager, the toxicologist. So it would fall within the structure of the hierarchy that we've set up. The medical examiners would be involved obviously to the extent that it involves someone who is supervising the technicians that assist them during autopsies. And so it would be a collaboration between the medical examiners, not just the chief, but all of them, and then also administration. But there would be a lot of administrative oversight that would really be more appropriately delegated to the cao.
>> the judge was kind of headed in the direction that I would like to consider, and that is since we -- I don't know how many people we have to hire because of so many things going over there, but I would sure like to have in place the key people that we know that we're going to have so that if they did want to have a say in not the position -- because it sounds like that y'all have got that pretty wired. This is something that whatever person comes in or whoever that person is that they're probably going to be saying forensic autopsy supervisor is a needed spot, but I know how people are when they come in. It's like, that skills set is not exactly what I think that you really need there. And even though it's going to be in your purview to a great deal, I can't see why we can't wait a little while until we get at least our key personnel in the next hopefully 90 to 120 to maybe 180 days anyway, if that's what it takes. But that would be my only question. I think you've done your background work to justify this position, and if we weren't needing to hire two, three people where we're going to be at, I wouldn't have as much ang its about it -- angst about it. But that is unless we can't make this thing work without it, I’d sure like to have a full board of pathologists in place to let them really weigh in that they make the person.
>> and I agree with that. My concern is if we wait three to six months to get this position filled, that is three to six months where I don't have the full resources available to start really focusing on those policies, procedures and those other criteria that we know need to be addressed now in terms of improving quality and processes.
>> I don't understand your explanation on that, because I think it's also possible for you to begin laying the groundwork that is really necessary so that when the m.e.'s come in, they just land and I don't know that they're going to be paying attention to this part of the structure. And they can just land and start working with whatever -- as changes need to be made, I think they will come in, blend in and they'll fall in place, but I really -- I really hear them.
>> I agree, Margaret. I’m not questioning that. And I think that I would feel more comfortable if I hadn't watched there be so many personality issues. This office is probably no different than a lot of departments. Before you know it, you've got things set in place and you bring somebody in and for some reason, somebody that's as important as a pathologist is going to be in the whole scheme of things. If this thing were a year, I’d say beth, you need to get on with your getting on, but I’m going to look at you pretty hard if we do this in six months, we get everybody in place and all of a sudden, do you know what, somebody just doesn't have the right personality to work in the spot because of the chief medical examiner that we have. And to me I don't mind waiting a little time, but if this is what you think that you've got to do, obviously this is something that is very important to us and the community, and we wouldn't have brought you on and wouldn't have done the changes that we've made if the direction that I think you all see that the court is going in is we want to make sure that we have a good functional operational and highly thought of m.e.'s office. So if you don't think that that's going to be an issue -- but I’m not going to be very happy. It's really difficult to let people go when they go to work for the county. We go into executive session. And how do you let somebody go? Those things make me nervous.
>> the skill sets for this job are very specific within the industry. In the turnover that we've had, we have worked very, very hard to obtain a good working crew to the extent that all the employees that I have on the first floor, we have an incredible crew right now and we work very hard through that application process to ensure the most qualified and the best fit. And typically in the industry this is a position, like beth said, that does fall under the operations end of it. And with the knowledge and the people that we have there now, I think that we would be able to get through that application process and get somebody in there that will fit. That's our goal.
>> and I’m landing where Margaret is landing in terms of, you know, the new chief is going to have enough to deal with when they land, and I am very sensitive in terms of that the deputy medical examiner or a second or third pathologist is somebody that that chief needs to have some input in. Because that truly is the core team. But this is on beth's side of the ledger and we need to get this filled and it would be lovely if all of this stuff could happen simultaneously, but Gerald, you were right on target. It could take three months to six months to fill the chief's slot and we just can't go through.
>> okay. Next issue.
>> well, the next issue is to approve the organizal chart for the medical examiner's office. And have you in your backup two chart, one that shows the addition of the forensic autopsy supervisor proposed and one that does not. And the difference between the charges you can tell is that the chief investigator has in one chart, second chart, has a responsibility for not only the forensic medical examiner's investigator, but also for the forensic autopsy technicians, which are four positions. On the other chart, if you approve the forensic autopsy supervisor, then they report directly to the chief administrative officer and supervise the four autopsy techs.
>> which one do you recommend and why?
>> we are recommending of course the one with the forensic autopsy supervisor proposed because this is what we have rrched as best -- researched as best practices.
>> okay. Questions about that?
>> no.
>> so would the forensic nurse not be more in line with -- from a supervisor standpoint. I can see from the direct boss in the exhibit 4, would forensic autopsy technician be more aligned with the forensic nurse investigator than --
>> no.
>> no. The forensic nurse investigator has specific responsibilities that are investigative, but also have some medical aspects to them. And some outside responsibilities such as serving on committees and doing outreach in the communities, those types of things. That's why that position is pulled apart and reports directly to brenda. But the autopsy technicians and the medical examiner/investigators have specific job responsibilities that require reporting directly to the chief investigator.
>> and if you can look at this as the forensic autopsy supervisors, they're really in the industry. The nomenclature is they're morgue supervisors. These are the people that assist with the autopsies and their primary duty is really the morgue and taking care of that aspect.
>> so at the accredited forensic centers, we think that the recommended organizational chart is what we see?
>> yes, sir. With the exception that some of the accredited centers that we have visited, for example, do not have the chief administrative officer. The court made that con in a sent decision that would be reflected not only of Texas best practices, but also of national best practices. In a hospital model that says you have a chief executive officer that takes care of the business model and that allows the medical doctors to handle the medical aspect and be focused and devoted to that aspect of the business.
>> judge, I really feel firmly about threes two items as far as moving expeditiously. I mean, with the situation being in a crisis state of affairs, the medical examiner's office, for example, what we're talking about, I just really feel strangely we've got to move forward as quickly ass possible and do the things being recommended here today. I again would like to applaud staff, but I can see the urgency. And it's a hot button issue, there ain't no doubt about it. And acrilttation is part of the -- accreditation is part of the remedy for this. I’m willing to move forward on this.
>> there are one or two other recommendations, right? What's the third one?
>> the third one is an issue really of accountability. I was appointed as sprim chief -- interim chief administrative officer for the medical examiner back in October. Since then we've been making a lot of changes. The court has approved a lot of hiring and work that we've done on the medical examiner's office. This is an accountability report for the state of the budget at this point in time as of may 15th. I wanted to do this to lay the ground -- (indiscernible). That way beth can kind of start with a clean slate as far as the budget is concerned. We have been working with pbo. We told them sometime ago that we would be over budget and that's what this report is. I’ll be very quick about going over it. If you'll look at the last page, it's kind of really the line item detail for you if you want to take a quick look at that or at your leisure. There are some assumptions, which is the page right before that, that we've made. The overall shortfall is estimated to be about 172,000. Now, that is our best estimate right now t could go down. I don't really anticipate it going up. It depend oz when we hire the doctors, which is really the big budget item. The assumptions are dr. Bayardo's salary, dr. Peacock's salary. One new (indiscernible) at 158 and then two new -- one new deputy medical examiner. Two approved at midpoint. A vacant position in the office filled by July 1, autopsy expense, and that's the -- what we're paying doctors to come back in on weekends to help support with the autopsy services, to 300,000. This does not include the new forensic autopsy supervisor. The majority of -- well, a big chunk of that, if you go to this other page right before that, is that the positions that we have hired are really under minimum of pay grade in the '06 budget. And we have hired mostly at midpoint or close to midpoint or over midpoint. And we've done this because we've got now two master's, two individuals with master's in forensic pathology in the office. We have one with a bachelor's in forensic science, the first graduate out of st. Edward's university with that degree. We have an individual with 14, 15 years in law enforcement, and we have an individual with 23 years of medical as a paramedic in the military and civilian life now hired. So we have a real good staff now that is skilled and we have to pay them more. So that in and of itself was approximately $58,000 of that shortfall. This is where we are at, this last page provides line item detail of where the shortfall is. This is an estimate at this point in time, and we are again towards the end of the year, and we will provide you a better estimate, but we I wanted to have the opportunity to come to you and show you where we were at and talk about the things that we have done with the money which have been approved by you and just provide you accountability. Accountability for the work that's been done.
>> alicia, when we voted to add another medical examiner, did we fund that position for the full year?
>> no, sir. I believe you funded for -- I believe it was a hire date of June 1st, but you didn't fund it. This is part of what the shortfall is. In other words, you didn't transfer money for it.
>> we didn't transfer any money?
>> no, not for that position, no, sir.
>> okay. So do you need it today or are you putting us on notice that you will need 172,000 at some point, based on the way the budget is unfolding?
>> we have looked at this and we agree with alicia and her staff and the medical examiner's staff that there is approximately 172,000-dollar projected cost overrun. And as alicia indicated, we routinely budget positions, mid positions at minimum. And as you've seen in order to get the qualifications in the m.e.'s office, they had to substantially go above that. We have suggested, as we do to other departments, that they come back later when we get into the August time frame. When these numbers get firmed up to come forward with a budget adjustment, we would recommend coming out of allocated reserve. That allocated reserve identified ear marks right now, so there were adequate funds to cover these projected expenditures?
>> > we do have that first expenditure in our first revenue expenditure estimate, which I believe is scheduled the auditor's office will brief you on next Tuesday.
>> is that the same as employee health insurance?
>> yes.
>> by the way, I’m here because allen miller's wife delivered a 10-pound little baby boy on Sunday. So I’m pinch hitting here.
>> so we need to be put on notice that a shortfall in this amount is expected and will probably need to be covered before the end of the fiscal year.
>> yes, sir.
>> but no action required today except to be informed.
>> we would like the court to take action on the allocated -- not the allocated reserve, but the salary levels that they have indicated on those that have been hired because we're developing the '07 budget and we'd like to incorporate those in. So if you could indicate by a vote that you agree with the salary levels that alicia --
>> and five new positions is what you're talking about?
>> yes, sir. And they've been to the court before under personnel amendments and you've approved them that way, but I think pbo wants a confirmation.
>> when we approved them, we didn't make sure the funding was covered?
>> we normally do not increase budget targets --
>> we didn't? That's why I move approval of exhibit 5, which would be taking $58,758 from allocated reserve. That's what we need to do, right? Discussion of that motion? All in favor? That passes by unanimous vote. Now, the other parts of a there, the organization chart and the new forensic autopsy supervisor position, which would require an expenditure of budget of $15,000 by the end of the fiscal year.
>> yes, sir.
>> move approval of both of those actions. Discussion? All in favor? That passes by unanimous vote.
>> would that cover all of a?
>> and let's move to b. B is simply request for recruiting expenses, and your page shows that and a total of $20,770.
>> yes, sir.
>> that's air travel here, lodging, meals, plus other. Other legal activities?
>> yes, sir.
>> [ laughter ] absolutelyother legal activitie. That's just kind of our factor for when we book the flights and those sorts of things.
>> discussion? All in favor? That carries unanimously. Anything else on item number 9?
>> thank y'all.
>> you did approve the organizational chart, judge, with the proposed?
>> that was the intention.
>> thank you.
>> the recommended one is --
>> exhibit 3.
>> and do you have a copy of that? Okay. Exhibit 3 was covered in the motion already unless there is confusion or an objection to that. That was the one covered in the motion.
>> all right.
>> thank y'all much.
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Last Modified:
Wednesday, May 17, 2006 10:30 AM