MEDICAL EXAMINER - Washoe County, Nevada - Official Website

MEDICAL EXAMINER

Medical Examiner POS/FTE 14/13.35

Total Funded Positions/Full Time Equivalents 14/13.35

Mission The mission of the Medical Examiner is to investigate unexpected and unexplained deaths in order

to identify and report on the cause and manner of death. We apply scientific investigative techniques and medical procedures, using integrity and compassion to serve families and public agencies impacted by sudden unexpected death.

Description The Medical Examiner investigates cases of sudden, unexpected, natural, and suspicious death.

State and County laws mandate that certain categories of sudden death be reported to and investigated by this office. All suspicious and many apparent natural death scenes in Washoe County are attended and evaluated by trained Medical Death Investigators employed by the Medical Examiner’s Office. Most of these deaths are ultimately determined to be due to natural causes, but as many as 40% of reported cases are found to be due to accidents, homicidal trauma and suicides. Of the deaths reported to and falling within the office’s jurisdiction, approximately 30% will require autopsy or medical examinations. Medical doctors specializing in forensic pathology, conduct these autopsy and medical examinations. Responsibilities of the office include:

• Determining the cause and manner of death for reported cases • Preparing and signing death certificates in all cases of unnatural and in many cases of natural

death • Conducting investigations of death scenes • Identifying, collecting and processing evidence in order to ensure scientific integrity and

usefulness • Recognizing unsuspected homicidal violence • Recognizing and reporting communicable and dangerous diseases, poisonings, and consumer

product safety concerns • Positively identifying the dead • Notifying the decedent’s next of kin and providing proper assistance to grieving families • Ensuring integrity of the personal property of decedents • Providing expert legal testimony in criminal and civil matters • Preparing for and responding to mass disasters • Assisting in providing for burial of indigent citizens in accordance with local and state laws

Statutory Authority: NRS 259 – Coroners

Programs and Fiscal Year 2010-2011 Base Budgeted Costs Department Total $ 1,883,488

1

Expenditures Summary

Salaries & Wages

Employee Benefits

Services &

SuppliesCapital Outlay Total

% of change from

previous year

Authorized FTE's

Funded FTE's

FY04/05 Actual 723,885 210,439 365,478 - 1,299,802 11.50 n/aFY05/06 Actual 791,721 233,952 402,777 7,890 1,436,340 10.50% 12.75 n/aFY06/07 Actual 808,168 243,159 421,403 - 1,472,730 2.53% 12.12 n/aFY07/08 Actual 1,168,213 353,100 280,808 104,677 1,906,798 29.47% 12.12 n/aFY08/09 Actual 1,073,799 320,364 497,633 39,249 1,931,045 1.27% 16.50 n/aFY09/10 ETC 1,081,119 355,331 568,215 39,733 2,044,398 5.87% 14.60 13.35 FY10/11 Base 1,144,487 388,663 350,338 - 1,883,488 -7.87% 14.60 13.35 Note: Authorized full-time equivalent positions (FTE’s) have been approved by the Board of County

Commissioners. Due to budget reductions an authorized FTE may not be funded. Includes office restructure with addition of two Medical Examiners and one Supervisor.

Fiscal Year 2010-2011 Budget Reduction Target • $56,000 (The target reduction is not included in the expenditure data shown in the previous table).

Long Term Goals • Obtain office accreditation by the National Association of Medical Examiners. • Publish annual reports for the Medical Examiner’s Office. • Explore developing a new Regional Forensic Sciences Center in Washoe County to house the Medical

Examiner functions and Crime Laboratory Facilities.

Goals for Fiscal Year 2010-2011 • Provide information and resource packet for families dealing with sudden deaths that are investigated by the

Medical Examiner’s Office. • Pursue inspection and accreditation by the National Association of Medical Examiners. • Prepare and publish an annual report.

Accomplishments for Fiscal Year 2009-2010 • Assisted in the development and implementation of a customized Medical Examiner computer case

management system. • Obtained or utilized non-matching federal grant funds through Nevada Homeland Security partnerships

approximating $250,000. These funds are being used to purchase necessary supplies and equipment for mass disaster response and management, and equipping of rural Nevada jurisdictions for fatality case management.

• Participated in the development, recruitment, and training for the Northern Nevada Chapter of Trauma Intervention Programs (TIP), a volunteer program providing on-scene counsel and personal support to families and victims of sudden death and trauma throughout Washoe County.

• Modified office staffing schedules and shifts to more efficiently cover the Office’s 24/7/365 service mandates. • Provided two-day intensive training in death investigation and fatality management to more than 15 rural

county Coroner offices within Nevada and Northeastern California.

2

• Regularly participated as member(s) of Nevada’s Mass Fatality Planning Task Force, the Washoe County Child Death Review Team, and the Domestic Violence Fatality Review Team for Washoe County.

• Prepared and adopted written procedures and protocol for office operations and scene investigations.

Department Objective

Measure

FY 07-08

Actual

FY 08-09

Actual

FY 09-10 Estimate

FY 10-11 Projected

Investigate and report on unattended, unnatural, or

unexpected deaths

# of cases investigated Avg. cost per case (all cases) Investigations per FTE # of court testimonies # of reports distributed/# of pages Jurisdiction Terminated with Scene Response Jurisdiction Terminated (Abandoned/Unclaimed)

2,063

$702

152

50

1,382

N/A

N/A

2,478

$544

275

50

10,145

N/A

N/A

2,600

$500

280

40

10,000

150

55

2,700

$525

290

45

10,000

145

65

Conduct autopsies upon those

victims wherein scene investigation compels the need for

proof or analysis meeting court acceptable diagnostic standards

# of autopsies conducted for WC # of autopsies conducted for external agencies Total autopsies per year Total Medical Examinations per year Total Autopsy-Med Exams per ME/MD

354

258

612

307

400

299

237

536

314

386

300

230

530

300

415

300

225

525

310

418

Provide post mortem and lab support to regional, state, and

federal agencies lacking facilities or technical staff to perform this

function

# of outside agency assistance cases Revenue from external services

331

$379,726

348

$462,538

325

$465,000

325

$490,000

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Report to the Board of County Commissioners Fiscal Year 2010/11

Department Budget Plan SECTION 1: REDUCTION PLAN Please complete a reduction plan form for each cost center with proposed reductions Department: Medical Examiner and Coroner Division: Program: 153010 Provide a Description of the Reduction Plan Description: (Reduction plans must be sustainable and yield ongoing costs savings or revenue.) Total Budget Reduction Target: $56,000 (3% of FY 10/11 Initial Funding Level) The WCMECO proposes the following processes and strategies in support of the County’s strategy and objective of producing a balanced and sustainable budget for the Washoe County Medical Examiner and Coroner: INCREASE OPERATING REVENUE:

Anticipated revenues shall exceed existing budget plan by, at minimum, $30,000.00 from Medical Examiner Fees/Coroner Fees/Toxicology Fees and Other Reimbursements.

For historical purposes, revenue tracking shows: FY 07/08 WCMECO exceeded targeted budget revenues by $59,939.00 FY 08/09 WCMECO exceeded targeted budget revenues by $48,539.00 FY 09/10 WCMECO shall exceed targeted budget revenues by approximately $30,000.00 For the past three years the WCMECO averaged $46,000.00 per fiscal year in excess revenues.

We propose receiving reimbursement through Social Services Health Care Assistance

Program (HCAP) for “Unclaimed/Indigent” and “Abandoned” bodies in the amount of $545.00 per case. The WCMECO averages approximately 75 cases per year (X $545.00 = $40,875.00 in additional revenue). A Memorandum of Understanding has been written, proposed, and is awaiting approval. The current MOU caps remuneration at 100 cases per year.

We propose instituting invoicing for autopsy reports distributed in excess of three copies per

case (one to primary law enforcement agency, one to District Attorney, and one to decedent’s family). Other copies are typically requested by insurance agencies, attorneys/law firms, and other investigation/intervention agencies (estimated 750 annual at $25.00 ea. = $18,750.00).

Washoe County Budget Fiscal Year 2010/11 Page 1 of 3 printed on 4/8/2010 at 10:54 AM


Department Budget Plan PERSONNEL Proposals provide structural changes that streamline services, maximize employment, enhance efficiency of office processes and achieve sustainable labor costs.

#1: Reclassify one Deputy Coroner Tech/Investigator position to Supervising Coroner Investigator. Recruitment for this supervisor shall emphasize Quality Assurance and Efficiency in Death Investigation and Business Management Skills. The fiscal impact to reclassify this full-time position is $13,810.00 per fiscal year. Funding for this position shall be realized through additional revenue streams. (Background) The current working supervisor’s span of control is nine full-time investigators plus six “intermittent hourly” investigators. This office is also now tasked with additional job duties essential for modernization/upgrading of operations and practice standards not previously managed by the Coroner. New duties include Statewide Mass Fatality Planning, Homeland Security Working Group participation, Nevada Disaster Mortuary Unit staffing, equipping and maintenance, Grant Preparation and Administration, and NAME Inspection and Accreditation.

#2: Provide additional funding for “intermittent hourly” (IH) Deputy Coroner Tech/Investigators. (Background) IH employees are primarily utilized for after hours relief when case dispatch is heavy and for holiday coverage. They are also utilized for office coverage during employee vacations and sick leave, and are CRITICAL to staffing this office, which is mandated to provide 24/7/365 coverage with only nine (9) full-time investigators and/or autopsy technicians. IH employees tend to be less experienced, and more frequently need to call a supervisor for phone instruction and back-up further emphasizing the need for increased supervisory staffing identified in Priority #1. The fiscal impact would be $14,000.00. $10,000.00 shall be transferred from the “Holiday Work - 701140” category and $4,000.00 shall be realized through additional revenue streams.

#3:

Allow MECO to recruit and hire a pool of “intermittent hourly” transcribers for use during vacations or extended leave of the single transcriptionist. The fiscal impact would be $4,500.00 per fiscal year. Funding for this position shall be realized through additional revenue streams.



Department Budget Plan SECTION 2: REDUCTION PLAN FINANCIAL DETAILS (double click to enter data)

Item Description of Reduction ItemCost Center Account(s)

Dollar Impact

FY 2010/11

1 Increase Revenue for Toxicology Fees 153010 460318 15,000$ 2 Increase Revenue for Medical Examiner Fees 153010 460341 8,000$ 3 Increase Revenue for Prof. Service Reimbursements (Testimony) 153010 485127 22,000$ 4 Decrease Revenue for Coroners Fees 153010 460315 (14,000)$ 5 Increase Revenue by Reimbursement from HCAP 153010 TBD 40,875$ 6 Increase Revenue by Reimbursement for Autopsy/M.E. Reports 153010 485300 18,750$ 7 Reclassify current Tech/Investigator position to Supervisor 153010 701110 (13,810)$ 8 Increase funding for Pooled Positions 153010 701130 (14,000)$ 9 Decrease funding in "Holiday Work" category 153010 701140 10,000$ 10 Hire "Intermittent Hourly" Forensic Medical Transcriber 153010 701130 (4,500)$ 11

Totals 68,315$

SECTION 3: REDUCTION PLAN IMPACT STATEMENTS (Describe the impacts of the reduction plan) Impact to Public: More consistent, dignified, and professional management for unclaimed and

abandoned remains cases shall be provided. “Business Operations” Investigations Supervisor shall help streamline case

completion and report preparations and distribution.

Impact to other Customers:

Intermittent hourly employees provide increased 24 hour staffing, potentially reducing scene response times (better scene response).

Impact to Employees:

Ongoing requirement for employees to flex schedules. Availability of intermittent hourly employees provides relief to full-time

employees and reduces need for overtime. Intermittent hourly employees offer reduced potential for full-time

employee “burn out” (healthy employees).

Impact to Stakeholders:

Additional supervisory support shall allow current supervisors to “work” and finalize cases more quickly (decreased turn around time).

Grant purchases improve quality of examination techniques (better work product).

“Business Operations” Investigations Supervisor shall enhance office’s ability to identify, obtain, and manage other funding sources (grants and new review).


Washoe County Washoe County Medical Examiner Medical Examiner

& Coroner& Coroner

20102010--11 Budget Presentation11 Budget Presentation

Ellen G.I. Clark, M.D.Ellen G.I. Clark, M.D.Chief Medical ExaminerChief Medical Examiner

April 12, 2010April 12, 2010

MissionMissionThe mission The mission

of the Medical Examiner of the Medical Examiner is to investigate unattended, is to investigate unattended, unexpected and unexplained unexpected and unexplained

deaths in order to identify and deaths in order to identify and report on the cause and report on the cause and

manner of death. manner of death.

MissionMission

We apply scientific We apply scientific investigative techniques and investigative techniques and

medical procedures, using medical procedures, using integrity and compassion integrity and compassion

to serve families and public to serve families and public agencies impacted by sudden agencies impacted by sudden

unexpected death.unexpected death.

About the Medical Examiner About the Medical Examiner & Coroner Office& Coroner Office……..

““The Biggest Little DepartmentThe Biggest Little Department””We operate 24We operate 24--77--365365Scene Response Scene Response -- Gerlach to InclineGerlach to InclineBusiness office hours Business office hours (M(M--F, 8 amF, 8 am--5 pm)5 pm)

We have 13 fullWe have 13 full--time employees time employees (1 vacant, 1 frozen/eliminated) (1 vacant, 1 frozen/eliminated)

and 6 and 6 ““intermittent hourlyintermittent hourly”” employees.employees.

We serve 18 other Nevada (and) We serve 18 other Nevada (and) California CountiesCalifornia Counties

Medical Examiner/CoronerMedical Examiner/Coroner MandatesMandates

NRS NRS -- Chapter 259 : WCCChapter 259 : WCC-- Chapter 35Chapter 35

Certain categories of sudden Certain categories of sudden death must be reported to and death must be reported to and investigated by the Medical investigated by the Medical Examiner/Coroner.Examiner/Coroner.Investigation (Scene) response is Investigation (Scene) response is mandated 24 hours/365 days.mandated 24 hours/365 days.

Medical Examiner/CoronerMedical Examiner/Coroner DutiesDuties

Prepare and sign death certificates in Prepare and sign death certificates in all cases of unnatural and in many all cases of unnatural and in many cases of natural deathcases of natural deathIdentify, collect and process evidence Identify, collect and process evidence in order to ensure scientific integrity in order to ensure scientific integrity and usefulnessand usefulnessRecognize unsuspected homicidal Recognize unsuspected homicidal violenceviolenceRecognize and report communicable Recognize and report communicable and dangerous diseases, poisonings, and dangerous diseases, poisonings, and product safety concernsand product safety concerns

Medical Examiner/CoronerMedical Examiner/Coroner DutiesDuties

Positively identify the deadPositively identify the deadNotify decedentNotify decedent’’s next of kins next of kinProvide assistance to grieving familiesProvide assistance to grieving familiesEnsure integrity of personal property Ensure integrity of personal property Provide expert legal testimonyProvide expert legal testimonyPrepare for/respond to mass disastersPrepare for/respond to mass disastersAssist in providing for burial of Assist in providing for burial of indigent citizensindigent citizens

WCMECO WCMECO Organizational Chart 2010Organizational Chart 2010

ChiefMedical

Examiner

AdministrativeAssistant II

SupervisingDeputy Coroner

MedicalTranscriber

Proposed 2010Intermittent

HourlyMedical

Transcriber

Deputy CoronerInv. (1)

IntermittentHourly

Tech/Inv.(6)

Deputy CoronerTech/Inv.

(7 – 1 frozen- eliminated)

AssistantMedical

Examiner

*Proposed 2010Supervising

Deputy Coroner

*Proposed 2010reclass

Deputy CoronerInv. (1)

A Brief Budget HistoryA Brief Budget History

20082008--2009 Budget Reduction2009 Budget Reduction5% 5% -- $ 97,163.00$ 97,163.00


($239,000 Target, $100,500 credit for ($239,000 Target, $100,500 credit for revenues/income) revenues/income)


Cumulative Budget ReductionCumulative Budget Reduction20% 20% -- $ 392,163.00$ 392,163.00

2011 Projected Case Load2011 Projected Case Load

2,700 Cases Reported2,700 Cases Reported525 Autopsies Performed (225 OAA)525 Autopsies Performed (225 OAA)310 Medical Examinations (75 OAA)310 Medical Examinations (75 OAA)418 Postmortem Exams per M.E. 418 Postmortem Exams per M.E. **290 Cases Per FTE290 Cases Per FTEAt Minimum At Minimum -- 3 Scene Responses/Day3 Scene Responses/Day

* Emerging Issues* Emerging Issues--SustainabilitySustainability

Budget StrategiesBudget Strategies

Supplement Funding Through GrantsIncrease Revenue

Medical Examiner Professional ServicesContract Services

Funding Through GrantsReduce Staffing for Graveyard ShiftMaximize Efficiency

Scene ResponseOffice Operations

Cross Train Employees

20092009--10 Accomplishments10 Accomplishments

Implemented a computerized Medical Implemented a computerized Medical Examiner case management system.Examiner case management system.

IT and WCSO PartnershipIT and WCSO Partnership

Obtained and utilized nonObtained and utilized non--matching matching federal grant funds through Nevada federal grant funds through Nevada Homeland Security partnerships Homeland Security partnerships approximating $250,000.approximating $250,000.

EOC , Law Enforcement, Fire Dept. PartnershipEOC , Law Enforcement, Fire Dept. PartnershipPlans, supplies and equipment for mass disaster Plans, supplies and equipment for mass disaster response and management.response and management.

20092009--10 Accomplishments 10 Accomplishments

Northern Nevada Chapter of Trauma Northern Nevada Chapter of Trauma Intervention Programs (TIP) Board of Intervention Programs (TIP) Board of Directors Participant.Directors Participant.

A volunteer program providing onA volunteer program providing on--scene counsel scene counsel and personal support to families and victims of and personal support to families and victims of sudden death and trauma throughout Washoe sudden death and trauma throughout Washoe CountyCounty

Modified office staffing schedules and Modified office staffing schedules and shifts to more efficiently cover the shifts to more efficiently cover the OfficeOffice’’s 24/7/365 service mandates.s 24/7/365 service mandates.

Increasing Intermittent Hourly EmployeesIncreasing Intermittent Hourly Employees


Obtained nonObtained non--matching federal grant matching federal grant funds through American Secretary for funds through American Secretary for Homeland Preparedness Homeland Preparedness -- $30,000.$30,000.

Mass Disaster Response Partnership Health Dept.Mass Disaster Response Partnership Health Dept.

Obtained nonObtained non--matching federal grant matching federal grant funds through Recovery Act DOJ funds through Recovery Act DOJ --$25,000.$25,000.

Unidentified Persons Data Base Upgrade Unidentified Persons Data Base Upgrade –– NV LEANV LEA


Provided courses and training in Provided courses and training in death investigation and fatality death investigation and fatality management to more than 15 rural management to more than 15 rural county Coroner offices within county Coroner offices within Nevada and Northeastern California.Nevada and Northeastern California.Participated in NevadaParticipated in Nevada’’s Mass s Mass Fatality Planning Task Force, and Fatality Planning Task Force, and Washoe County Child Death Review Washoe County Child Death Review Team.Team.

Medical Examiner/CoronerMedical Examiner/Coroner 20102010--11 Budget Reduction11 Budget Reduction

Base BudgetBase Budget$ 1,857,488.00$ 1,857,488.00

Reduction TargetReduction Target3%3%

$ 56,000$ 56,000

Budgetary PlanBudgetary Plan WCMECO 2010WCMECO 2010--20112011

Increase Revenue for Medical Increase Revenue for Medical Examiner Fees Examiner Fees (Testimony)(Testimony)

$22,000$22,000

Increase Revenue for Medical Increase Revenue for Medical Examiner Fees Examiner Fees (Examinations)(Examinations)

$8,000$8,000

Increase Revenue for Increase Revenue for Toxicology FeesToxicology Fees

$15,000$15,000

Decrease Revenue for Decrease Revenue for Coroners FeesCoroners Fees $$(14,000)(14,000)


Increase Revenue Increase Revenue Reimbursement from HCAPReimbursement from HCAPSocial Services Health Care Asst. ProgramSocial Services Health Care Asst. Program

$$40,87540,875

Increase Revenue Increase Revenue Reimbursement for reportsReimbursement for reports Autopsy and Medical Examination ReportsAutopsy and Medical Examination Reports

$18,750$18,750

Reclassify current vacant Reclassify current vacant Tech/Investigator position to Tech/Investigator position to SupervisorSupervisor

$$(13,810)(13,810)


Increase funding for Pooled Increase funding for Pooled PositionsPositions

$(14,000)$(14,000)

Decrease funding in Decrease funding in ““HolidayHolidayWorkWork”” categorycategory

$ 10,000$ 10,000

Hire Hire ““Intermittent HourlyIntermittent Hourly”” Medical TranscriberMedical Transcriber

$ (4,500)$ (4,500)

NET SAVINGS/REVENUE NET SAVINGS/REVENUE INCREASEINCREASE

$ 68,315$ 68,315exceeds targetexceeds target

Budgetary Plan (Impact)Budgetary Plan (Impact)

Impact to Public:Impact to Public:–– More consistent, dignified, and More consistent, dignified, and

professional management for professional management for unclaimed and abandoned remains unclaimed and abandoned remains cases shall be provided.cases shall be provided.


Impact to other Customers:Impact to other Customers:–– Intermittent hourly employees Intermittent hourly employees

provide increased 24 hour staffing, provide increased 24 hour staffing, potentially reducing scene response potentially reducing scene response times (better scene response).times (better scene response).


Impact to Employees:Impact to Employees:–– Ongoing requirement for employees to flex Ongoing requirement for employees to flex

schedules.schedules.–– Availability of intermittent hourly Availability of intermittent hourly

employees provides relief to fullemployees provides relief to full--time time employees and reduces need for overtime.employees and reduces need for overtime.

–– Intermittent hourly employees offer Intermittent hourly employees offer reduced potential for fullreduced potential for full--time employee time employee ““burn outburn out”” (healthy employees).(healthy employees).

Budgetary Plan Budgetary Plan (Impact)(Impact)

To Stakeholders:To Stakeholders:–– Additional supervisory support shall allow Additional supervisory support shall allow

current supervisors to current supervisors to ““workwork”” and finalize and finalize cases more quickly (decreased turnaround cases more quickly (decreased turnaround time).time).

–– Grant purchases improve quality of Grant purchases improve quality of examination techniques (better work examination techniques (better work product).product).

–– ““Business OperationsBusiness Operations”” Investigations Investigations Supervisor shall enhance officeSupervisor shall enhance office’’s ability to s ability to identify, obtain, and manage other funding identify, obtain, and manage other funding sources (grants and new revenue).sources (grants and new revenue).

Sustainability Sustainability

Redirect Staffing to Heavy Shifts Redirect Staffing to Heavy Shifts Expand IH employee poolExpand IH employee poolExpand Independent ME ServicesExpand Independent ME ServicesIncrease Fees for ServiceIncrease Fees for Service

Assumes Caseload Remains Assumes Caseload Remains ““StaticStatic””

Emerging Issues and Emerging Issues and ConcernsConcerns

Inadequate FacilityInadequate Facility50 year old building50 year old buildingLast remodel 20 years agoLast remodel 20 years agoOverburdened infrastructureOverburdened infrastructureNo plan for new facilityNo plan for new facility

Emerging Issues and Emerging Issues and ConcernsConcerns

Case Load Case Load –– Work DutiesWork DutiesCases per ME are too highCases per ME are too highA 3A 3rdrd Medical ExaminerMedical ExaminerNew procedures, technology New procedures, technology and funding and resources and funding and resources mandate more work per mandate more work per employeeemployee

A Forward LookA Forward LookRevenue OpportunitiesRevenue OpportunitiesTrainingTrainingSubspecialty OutsourcingSubspecialty Outsourcing–– QA and InventoryQA and Inventory–– Specialized SciencesSpecialized Sciences–– Inspection and AccreditationInspection and Accreditation–– ME hours flexibility/reliefME hours flexibility/relief

QuestionsQuestions

MEDICAL EXAMINER - Washoe County, Nevada - Official Website

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