Travis County Commissioners Court
January 30, 2007
Item 12
We ready for number 12. Alicia perez must be headed this way. And facilities. Those are the only two item left on the regular -- there they are. Number 12 is to receive update and take appropriate, on improvements at medical examiner's office.
>> good afternoon, judge and comidder, alicia perez, executive manager for -- manager for executive operations. We wanted to provide the court an update on the improvements that we're making at the medical examiner's office. About six months ago we started on a course of changing the original design to kind of adapt what the court did in terms of adding staff, adding another doctor. And so we went back to the staff at the medical examiner's office and redesigned. And what we have before you is just an update. The court approved a contract last week and approved some funding to be transferred also, and this is the update. I know Commissioner eckhardt, you had some questions also, so we wanted to just provide a good update for you. Leslie?
>> they do also have the backup.
>> you have the outline so you can follow along in your handout. Facilities management has an update on the medical examiner's office. The first part of the report is interim improvements complete understand 2005 and twowk. If your backup have you a document like this. I apologize -- we'll be up shortly. Here we go. The first part is the improvements that we're complete understand the interim period from 2005 and 2006 after the original addition project was tabled. These improvements include upgrade to the exhaust system serving the autopsy areas on the first floor, extending emergency power to one computer in the investigator's area, to remain critical operations during power outage. Prior to that time only the body coolers were served by the emergency generator. Also we enhanced security by adding 10 video cameras and recording equipment in the morgue area. Also on the first floor we installed a dutch door between the receiving room and the investigator's office so during active periods in the receiving area they can keep the lower half of the door closed to keep traffic out of the investigator office and manage work flow better. We also increased workstations in the investigator area for two additional f.t.e.'s. This is another picture of the dup door. On -- dutch door. On the second floor similar to the first floor we extended emergency power from the generator to a critical item, in this case a refrigerator which stores specimens, which we need to be maintained during power outage. And that refraij rater is -- refraij rater shown here. On the third floor there is a new staff position, the chief administrative officer, who was starting work in 2006 for whom when he to make an office space, and we used an existing office for that position and then converted some file and support areas for a replacement office for the office manager who gave up her space for the cao and doing that we had to rearrange some of the support areas. Our current facility improvements per the renovation of 2007 focus on four primary goals. We need to provide functional space to support the work load for four pathologists. We need to provide work space for the new staff, which includes the fourth deputy m.e., who is yet to be hired. Forensic autopsy supervisor, pathology techs, lab techs who have been hired, and then an additional clerical person, records analyst on the third floor. Paragraph also two existing positions needed to move from a team open office area into private office to perform their functions, that was the chief investigator and the senior forensic nurse investigator. And last but not least, to meet the mam accreditation standards for the facility. Our schedule for these improvements are that we've already had construction contract approval January 16th and had some supplemental funding approve last week by Commissioner court to cover our contingency and security improvements. Construction is scheduled to begin in February and will be completed in April.
>> how important are the security improvements?
>> they are important. Do you want to address that on the security improvement?
>> the security I am presumes are critical. The cameras that are down downstairs in the processing area and the coolers provide not only a means for us to monitor what's happenogthat floor, but also to make sure out building is secure.
>> the building is secure and it provides circuit for the belonging that came in with the body, the processing, all that. A little double-check if anything goes back and have you then the video evidence of how the body came in and what returned to the family and also who is in the area.
>> there is a named standard that addresses security in a variety of different areas, and this helps us meet that standard.
>> we actually had the 10 cameras and one recorder installed last year. What we're doing this year is to coordinate with some of the other things happening in the space. We have to move the recording equipment over, move one camera, add a camera and then we have to upgrade and tie together the intercom system between the various rooms and the first floor so that there's better communication during the work flow, and especially after hours when it's short staff. Moving on, improvements to the first floor morgue and investigator area. In the autopsy work area, we need to provide three optimally functional workstations in order to have appropriate space for four pathologists to complete their work load. Right now we have three stations, but there's some problems and issues with them that need to be corrected for them to really be able to be used simultaneously full time. Those include reconfiguring some plumbing at each of the three work stations, repairing doors and then also the floor in front of the drains may seem like a small thing, but you know how it is when you're at a restaurant and the table won't sit stable? Well, that's especially worse when it's someone working in the autopsy room and the cart won't sit stable. So we're going to do some fine tuning with the floor there. And you can see the drain in front of the station here is kind of in a critical place. In this particular suite there are two autopsy table that can be used simultaneously. We usually have not just used one because one of them was not optimally functional, but now with four dock werz we will need those two functional and of course we have the decorp room which is separated and outside the building. So we'll be able to have all four doctors working -- three of them working at the same time.
>> some of those little sugar packets or sweet and lo packets, that's how they usually do those tables at the restaurants.
>> [ laughter ]
>> I don't think that meets the standards. In the next slide that we have on shreen, screen, you can see a view of the second work spaition in the main autopsy room, which is the one that is especially compromised by a cabinet hanging on the wall and the work shelf on the wall next to it that cramps the space that the technician has to work in. So we'll be taking care of those and getting them out of the way. We're getting some new medical storage carts that will be much more efficient and appropriate for having the right materials at hand for the functions they perform. An also we're going to improve the lighting. Sounds as I remember. We're replacing all the light fixture so we get lots of good light in these rooms. Other health, safety and accreditation issues in the autopsy areas are, we have a hand sink which if you see in the pictures to the right, it's just above that yellow wash bucket. We're going to add knee controls so someone who needs to wash their hands can do that without having to touch the faucets and also an eye wash station at the hand sink. Right now the eye wash stations are at the autopsy stink sinks and they're not functional.
>> and something as small as that paper towel dispenser where you have to touch it, that will change so you don't have to touch it. Again, it's for sanitation.
>> hands-free is a good thing.
>> we'll be extending the intercom as I mentioned the autopsy rooms, and we'll also be improving the air flow balance to help with the odor issues. Elsewhere on the first floor we'll be larging the -- enlarging the receiving room because it's kind of grand central station there, building new larger tissue storage room because we've exeed the capacity of the current room and we'll tr v. To build a new cart wash station in the garage because the existing one will be displaced. And adding circuit camera in the garage. In the receiving room, the slide there shows the wall between the receiving room and the garage. That's the wall that we're going to move to the south. Like you do at home, expand into the garage when you've run out of room elsewhere. And this is the cart wash area that will be enclosed and become the new tissue storage room, which is why we have to relocate the cart wash into the garage. Elsewhere on the first floor we'll be building a private office for forensic autopsy supervisor, who is a supervisor, a small office right next to the receiving room, and also making a small private office for the forensic nurse investigator. We'll be remodeling an existing storage room for the chief regularrer, which is adjacent to the receiving room and the investigator's office and we'll also be modifying workstations in both of these areas. On the second floor we will not be moving any walls, but we're taking care of some equipment issues. We have a fume hood in histology lab which is inadequate that's being replaced. We're adding a second bio safety cabinet, which is where they perform various kinds of tests. The histology lab is where they make the slides. Nand the main part of the main lab room we'll be adding some equipment exhaust hoses for five pieces of lab equipment to upgrade safety there. This is a picture of the current fume hood. And the new fume hood will have a complete enclosure on it to encompass the piece of equipment constituent sitting on the -- equipment sitting on the counter pop there called the stainer. We'll have a second one so we will have one like this, existing one that's got its own internal filter. The second one, the new one, will be connected to external exhaust, so we'll be upgrading our safety factor as well as work load capacity in that room. And in order to do that we have to move some of the freezers into the storage room and along with doing that we'll be getting one new freezer and one new refrigerator to expand that storage capacity. And that type of storage is very critical obviously in keeping the south lamars and specimens -- in keeping the samples and specimen. So now we have an alarm if any of the freezers or refrigerators shut down so we have to extend that monitoring system to the relocated units. We're also in the lab converting one person office to a lab area and a storage room into a two-person office that will provide one new f.t.e. Space for lab technician, and we're getting some larger secure storage cabinets for some of the controlled substances, medication evidence that we have on that floor. On the third floor we're going to create office expansion space by reducing the lobby and removing some extra restrooms. There are actually two sets of restrooms on that floor, and we're going to cut back to one set of restrooms that will be shared by visitors and staff. It's a small population sebbed there and that's -- sevenned there and that's sufficient. We're also going to relocate the clerical area and add one new workstation and build a new fourth office for the deputy m.e. In the photograph you see here the window for the resiptionist. -- receptionist. That wall will move towards you towards the elevator so we will have a very modest waiting room and the clerical area, as I said, will be reconfigured and enlarged to better meet county space standards. Outstanding issues include the gate remodel, which is on the original work plan to prevent vehicle damage, we have a very steep and narrow alley condition there that's kind of been compromised by a retaining wall on the neighbor's curb site, so when the long vehicles are trying to back through the gate around a wall on their left and between this retaining wall on their right, it's a pretty tight deal and there have been some damages to funeral home vehicles, which is a problem. Widening this gate will impact the grading in the parking lot and alley and because that have we will have to coordinate with the city. And we'll have a cost update on what that construction cost will be after we finish design. But as of now that construction cost is not funded because we had to use all the current project funz to pay for the interior improvements, and that was --
>> you expect that cost to be insignificant or fairly significant?
>> until we have a firm grasp on the extent of the repaving, it's a little tricky.
>> judge, there's going to be between 10,000 and $15,000. I was about to ask if -- two thing. One is that I did see reference to the year 2010, having I guess selected a site for another facility. And I guess if we're able to achieve that,ing with construct a new one which would take, what, 18 months?
>> the need for the new facility was identified last year as being 2010 is when we need the facility to open. We need the facility to open in 2010. And the time frame for planning, designing and building that is -- would be a several-year process. It's probably going to be close to a year to build something of that scope and probably nine months to a year to design it in detail.
>> pretty ambitious. If we have to make improvement s to this facility, so be it, but whatever we can forego, I will do that and take the same money and spend on the new facility. The other thing is each of us has known and I guess sort of bought into the notion that we'll need another deputy medical examiner, but we have not funded one.
>> you have funded four right now.
>> I see, the fif the one, yes, sir. The fifth one you have not. And you're correct. You have funded four --
>> with the four we will not get to the accreditation standards. We need a fifth in order to meet accreditation standards.
>> these improvements are to accommodate four.
>> that's correct. That's the maximum we can do at this location.
>> not five. So we really need to try to fast track it selection of a site for another facility. So has a decision been made to delay the hiring of a fifth one until we have a new site?
>> well, yes, actually a decision has been made to hold off on hiring a fowrtz until wech office space to put the fourth pathology.
>> what about the fifth one.
>> I have no idea where we would put a fifth path pathologist, nor is there a place for them to work out. We will have to wait to to hire the fifth until we're in a new building.
>> or work with schedule.
>> office sharing. There might be a way to creatively do that.
>> do we think that if all the other requirements are met, we will be able to achieve name accreditation with four?
>> my understanding is that even though we would not meet the accreditmation for autopsy to pathology ratio, if there were plans and designs to build a new building and that would meet the standards.
>> are we on schedule with getting a new facility and ramping that up?
>> what we got this year was a survive thousand dollars to do -- $75,000 to do the design or to do planning. And '--
>> we're not behind, but haven't gone out there and aggressively sought it out. I have two or three things in mind, but it's like site agriculture jail. When your nearest neighbors out what you plan to put there, they sort of come out opposing it. So I think we need to -- if we're serious about that, I think we also need to be serious about selling the current facility. Normally it doesn't take I multiple years to sell one, but if it's a foregone conclusion that we are vacating this one as soon as we can find a site and build another one, we need to let people that we think should be interested in this one know it will become available at some point in the future.
>> we have a bit of a dilemma with that. We can take it up in executive session, but the property is leesd from the leased from the city, so we have to work through some of those issues.
>> so we own the building, the city owns the property.
>> we lease it.
>> the city was the first buyer that I had in mind.
>> [ laughter ] so there goes my plan.
>> it just doesn't meet our particular needs, but the building is a solid building.
>> how much of the appliances and fixtures envisioned in this presentation would be transferable to the new location?
>> certainly the new refrigerators, freezers, safety cabinets, could be relocated. Possibly also the fume hood. That's a piece of equipment that's connected and can be disconnected. Some of the -- we're not buying that much furniture on this project, and the ability to relocate furniture just sort of depends on the arrangements of the new work spaces and whether the old furniture fits.
>> the point is what we can take, we should take.
>> yeah, my point is if there's a way to separate out in this proposal what's transferable with a mind in the purchasing these items to transfer them so that we can see whether the lion's share is transferable or whether it's not. Are we spending more on upgrading the actual walls of the building or are we spending more on fixtures and appliances that could actually be relocated to the new facility.
>> the lab equipment, as I recall, is somewhere around $30,000. The construction cost is around $200,000 for the new project. To we're spending most of the money at this point on things that will not be transferable that are attached to the building.
>> have we maximized the computer space of this as far as maybe having a strong database, having something similar to what works somewhere else in the medical examiner's office that we're not doing here? And of course, that's something that maybe can be looked at. I don't really know where we are on that, but I do know that -- I suspect that there's an opportunity for the computer end of this being maybe a standard or whatever folks may be using and looking at. I really don't know the answer to that, but I'm just expecting there may be some room for technology to interface with some of the activities that goes there with the computer world. So can somebody maybe help me on that a little bit?
>> actually, we're in the process of converting to an upgraded version, which is what we use at our office. We anticipate with the newer version that we will do -- be able to do exactly that. We would like to move to a paperless system, but with the new cma may be able to interface with digital x-rays, with digital photographs, and a lot more capability and a lot more efficiency using this new upgraded system. We've had some glitches in converting the old data to the system and we're fixing those as we speak. Once that's done we will be able to move to a new system.
>> I guess ultimately is there anyone else in that arena as far as medical examiner that has the same capability which -- as far as what you mentioned as far as what we're trying to go to. As far as maybe looking at how they're doing it and who they're using and stuff like that to make sure that we're locked into becoming more efficient compute wise. Do we know of anyone else that may be doing such a thing as far as those things you just mentioned, as far as where we're trying to go?
>> we're working with a company, the technology company, on the conversions and looking at our needs and we'll prepare something for fy '08 if where we need to go.
>> I have one other dwe. Question. There's approximately 200,000 in construction cost. How much of that 200,000 will be passed through to an eventual buyer and how much is sunk costs? Is there any ballparking on that?
>> no. We don't have any information on that at this time.
>> would that be something that the 75,000-dollar contract, would that be the planning and review needed for the scope of the new medical examiner's facility and the consultant to be consulted, could that be part of the scope that have consultant's work to figure out -- I suppose that consultant is going to be on the new facility. What I'm asking is as we go down this patsd of spending this money on both facilities, construction and appliance and fixtures, if there's any way we can do it with a mind towards its eventual sale and mafg to a new facility so we minimize our sunk costs.
>> we've tried to balance carefully between spending money on something that we know is limited term investment and doing what's right for the building so that it will have value when we leave. I think that's the best way I could characterize that we've been prudent.
>> but it's such a specialized building in term of the particular work that is conducted there that it would be difficult to recoup all your costs because autopsies are --
>> what's the likely use for this building when it's sold?
>> some of the possible ideas are all health related. E.m.s. Training was one notion that was mentioned. Then there's groups that work with bio -- tissue bank, bio medical products that would need the clean operating rooms for doing what they do combined with lab and staff space. That's the mix that we have there, one floor of each in proximity to the hospital.
>> what about indoor paint ball facility?
>> [ laughter ] this building is pretty unique. Fortunately for us, most of the thing that we're doing here buildingwise aren't overly expensive, and most of those things, all of the fume hoods and all this we might be able to take with us. Let me ask another question. Are there any medical offices, medical examiner offices that are name accredit that had work more than one shift? I mean, is there anybody that works -- the pathologists, anybody work from 3:00 to 11?
>> not that I'm aware of. Most of them work a traditional 8:00 to 5 day.
>> that would be one of the questions like you ask the courtrooms, why aren't the courtrooms used for those -- I would think that a pathologist needs a couple of people to like help put the bodies or whatever, but other than that and some sort of an office space, so it may be one of those things that you look at and say, okay, here's a room, and by the way, one or two could do that. Maybe they don't -- everybody likes to work conventional hour.
>> and your analogy to courtrooms is probably what is happening. We know that there are courtrooms that are night courts, but traditionally that's not the norm. When we looked at the name accredited facilities in Texas, the norm is you work seven to three or eight to five and mo of the autopsies are done in the morning with the reefn and all the reports done in the afternoon. And that is the norm. Can it be done definitely? Just like reports, probably can.
>> speaking of looking at, there are two more pages.
>> yes, sir. With you had -- I'm not sure which page, we stopped on the page about --
>> planning for new medical examiner facility. Let's start there.
>> we'll start there. Backup, as has been mentioned, we have need to put a new facility into service by 2010 based on last year's study. 75,000 was funded this year for planning to review the needs and scope for that new facility f you remember last February's presentation and work session there were a range of service areas possible from the current 40 plus county service area double to very smaller sets. And corresponding staff size and building size associated with that.
>> can we take our medical examiner a map of Travis County, after identifying large tracts of land already owned by Travis County? And then the question is is this close enough to wherever we need to be? That's the easiest thing in the world, I think. And three of four come to mind when we put it that way. Then the question is what kind of traffic do we encounter, but since we're travelling with cadavers and not trying to get to the emergency room, really as long as the trip is reasonable, it seems to me that it really ought to do. Commissioner Gomez and I sort of discussed that a few days ago, and when you think about it, we own several large tracts of land in different parts of the county, but it's not near downtown, but some of them are really not that far away. The downtown area is fairly accessible. But if everything is out there, then maybe being downtown doesn't matter anyway.
>> being on a major road is upon because the investigators do have more time constraints on when they have to report to a scene than the return trips. So both their input and chief medical examiner's input would be relevant to evaluating the appropriateness of available sites.
>> okay. That's my contribution to today's discussion.
>> [ laughter ]
>> thank you, judge. The last slide is just a summary of how we've been funded for improvements and how we've been spending those funds. The total funding including the supplemental funds approved last week is $440,900. We spent approximately $38,000 for the design and city fees on the addition project, which was tabled in 25 when the medical examiner's office was reorganized and the scope of the project changed. We spent about 41,000 on interim improvements which we've review in the presentation earlier, and we have the total of about 306,000 being spent on the current improvements that includes the 200,000 on construction and the ffe costs and the engineer's fees.
>> so you're 34,000, leslie, is that -- you've still got that.
>> I still have that. That's what I have to finish.
>> so the question mark is the 12 to $15,000 that roger had mentioned.
>> that's correct.
>> okay. Questions, comments?
>> Commissioner eckhardt, have you had your observation of a full autopsy since you've taken office or had you lr seen one of those?
>> I haven't seen one at this m.e.'s office yet.
>> it will do something for your allergies.
>> Commissioner, we would love to have you join us some morning.
>> looking at the pictures, my imagination is running wild.
>> [ laughter ]
>> it's probably even wilder than your imagination. It's certainly an experience and I would encourage you to come over if you haven't.
>> I actually would like to as macabre and twisted as you have i. That is.
>> having worked at the facility for several years, it's very good to see how thing have improved there and the increased professionalism of everyone. And facility sz very much looking forward to giving these people what they need to do their job.
>> we stand behind facilities.
>> thank you.
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Last Modified:
Wednesday, January 31, 2007 6:55 AM