Higher forensic services costs hitting counties' budgets dead on

Nathan Baker • Apr 9, 2014 at 9:00 PM

Rules and regulations revolving around death investigations in the state are making for some lively discussions in eight Northeast Tennessee counties.

East Tennessee State University Dean of Medicine Robert Means officially announced Monday that the college is seeking approval from the counties’ governing boards for an increase in the price of services to help pay for new staff at the William L. Jenkins Forensic Center, where autopsies and forensic consultation for authorities in Washington, Sullivan, Unicoi, Carter, Johnson, Hawkins, Hancock and Greene counties are performed.

Means pointed to new state regulations and the relatively low cost of the services performed at the forensic center on the campus of the Mountain Home Veterans Affairs Medical Center in justifying the change, which would charge the counties $2.79 per capita instead of basing the costs on a five-year average of the autopsies ordered by each county.

“It’s really a question where we don’t have a whole lot of choice,” the new dean said.

Accreditation standards set by the National Association of Medical Examiners, through which forensic centers in Tennessee are statutorily required to maintain accreditation, recommend that centers have a certified death investigator available to consult with authorities at the scenes of deaths whenever the need may arise.

On top of that, a state law enacted last year to ensure uniform reporting and investigation of drug overdose deaths set up a new rule handed down by the Chief Medical Examiner’s Office recommending autopsies for such deaths and requiring investigators to consult with a regional forensic center before ordering an autopsy.

ETSU’s forensic center cannot meet those round-the-clock availability requirements at its current staff level, Means said.

With the additional $845,000 expected of the counties by switching to the new pay model, the center plans to hire more death investigators, a new forensic pathologist and increase pay of its current staff to meet those requirements.

But mayors in the affected counties, already facing lean budgets caused by declining sales tax revenues and increasing expense requirements from the state and federal governments, aren’t taking the fee increase lying down.

“I think this is close to ridiculous,” Greg Lynch, mayor of Unicoi County, which is estimating a cost increase from the $19,000 it currently pays for forensic services to $51,000 under the new structure. “To expect a small county like us to pay $32,000 more — it sounds like they’re overstaffing this thing without considering the effect on the smaller counties.”

Sullivan County Mayor Steve Godsey said ETSU estimated his county’s share would be increased by $400,000 under the new model.

“They’re going to have to lower their request,” he said. “I know they’re wanting to put on additional employees, folks to do various things, but we just don’t have an additional $400,000 a year.”

Both Lynch and Godsey wondered if the cost increases could be implemented gradually to help lessen the immediate burden on their budgets, and Godsey posed the possibility of asking cities to contribute toward the fee hike.

Dan Eldridge, Washington County’s mayor, highlighted the costly medical examiner requirements already placed on counties and questioned the need for multiple investigators on the same case.

The county recently pledged $78,400 in startup costs and $80,870 in recurring funding to Washington County/Johnson City EMS to meet state requirements that a certified death investigator be on the scene of suspicious, unusual or unnatural deaths.

The statute mandates that such investigator be a licensed EMT, paramedic, registered nurse, physician’s assistant or a person registered with the American Board of Medicolegal Death Investigators.

Combining the increased cost of the county’s certified investigators and the new fees requested by the forensic center, Eldridge said death investigations would cost Washington County an additional $300,000 each year.

After receiving a letter Tuesday from Means, Eldridge said he was confused about the role ETSU’s new death investigators would serve.

“The rules from the state medical examiner were very clear in regard to the mandate put on county governments to provide qualified death investigators,” he said. “I don’t see why ETSU’s forensics center is basically meeting the same requirement.”

Karen Cline-Parhamovich, director of the Jenkins Forensic Center and the state’s appointed chief medical examiner, said the staff at the medical college would serve more as consultants and coordinators to the investigators in the field.

“Anything important to the pathology examination that’s going to be collected from the scene, we don’t have the opportunity to go back and do it over,” she said. “According to Tennessee’s rule, the death investigator at the scene calls us at the center, gives a report describing the case, and the investigator or pathologist on call here communicates with the person on the scene.”

By receiving reports from the four other regional forensic centers in the state, the in-house staff can keep an eye out for trends in the state that could indicate a wider health concern, she said. If the consulting investigator recognizes a possible connection to other cases, he or she can help the investigator on scene look for pertinent evidence.

One of Cline-Parhamovic’s assigned tasks when appointed as Tennessee’s chief medical examiner in 2012 was to develop practices ensuring that death investigations in the state are carried out uniformly and accurately.

The state’s laws and her office’s rules are part of that.

All of the county mayors said their governing boards were considering contracting with the Knox County Regional Forensic Center.

Means said the counties are welcome to do so, but said, even with the increases, ETSU’s services are still lower than other centers in the state.

The estimates on costs were also figured on all of the eight counties buying in, he said.

With budget season fast approaching, the counties will face that decision in the coming months.

Lynch said he felt the proposal from ETSU was still up for negotiation, and he planned to work with the center to lower the costs to Unicoi County.

Means didn’t say Wednesday that counties would be dropped from the center’s services if they don’t pay the new rates, but did say the school is looking to collect the new revenue soon.

“We would like to do this going forward moving into our next budget period,” Means said. “But we do understand that they have their budget process and it may take a little while to get this in place.”

Follow Nathan Baker on Twitter @JCPressBaker. Like him on Facebook: www.facebook.com/jcpressbaker.

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