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EMS to take over county death investigations

New rules from the Tennessee Department of Health Office of the Chief Medical Examiner are changing the way deaths in Washington County are investigated.
During the Jan. 15 meeting of the Budget Committee, Mayor Dan Eldridge and Commission Chair Greg Matherly provided an update on what it will take to bring the county into compliance with the rules that went into effect in November 2013.
“If there is a suspicion of drug involvement, we are (now) required to send the body for autopsy, and this is where we run into a problem,” Eldridge said, referring to rules in Chapter 1200-36-01: Investigation of deaths resulting from opiate, illegal or illicit drug overdose.
Until now, the Washington County Sheriff’s Office served as the deputy coroner. Matherly, a WCSO captain, said 16 death investigations were conducted over the 2013 Thanksgiving weekend alone.
“We had criteria that determined if an autopsy was needed,” Maj. Russell Jamerson said. “If not, we called the funeral home.”
Another change involves the scene report that must be completed before the body is moved. In addition to the report growing from one page to eight pages, the investigator must now be a licensed emergency medical technician, paramedic, registered nurse, physician’s assistant or person registered by a diplomat of the American Board of Medicolegal Death Investigators and approved by the county medical examiner.
“As you can see, this immediately puts the WCSO out of death investigations,” Eldridge said. “We contacted Dan Wheeley who graciously agreed to step in and fill the gap.”
It didn’t take long for Wheeley, executive director of the Washington County/Johnson City EMS to determine the challenges involved in taking on the additional responsibility.
“We have been sending an EMT or paramedic on calls with the WCSO because it’s still under their supervision, but that zone truck was out of service all day,” he said. “We can’t take paramedics who provide lifesaving care out of their zones.”
The process also requires too much time from a first responder. “You can wait hours for the funeral home,” Wheeley gave as an example.
Commissioner Joe Grandy said it would seem more efficient for Washington County to establish a separate coroner’s officer.
Wheeley proposed a less expensive option that would train six EMS staff members to serve as medical examiner investigators. Three of the investigators would be shift lieutenants who would move from field staff to administrative positions. The fourth investigator would come from a budgeted EMS position that is unfilled, with the final two being new positions. All of the investigators would be paramedics.
According to Wheeley, Dr. Vince Pinyard, county medical examiner, will continue to make the final determination of whether an autopsy will be ordered. “The death investigators are his eyes and ears,” Wheeley said.
In addition to two new staff positions, the proposed $78,000 start-up expenses include training, equipment and a coroner vehicle. The average 145 transports per year are now done by ambulance. Not only is using an ambulance more expensive, Wheeley said, the transport ties up a zone unit and leaves an area unprotected.
Grandy asked how much more the county could expect to spend on autopsies under the new rules. According to Eldridge, $140,000 was spent for the 135 conducted last year, and an additional $120,000 is estimated for those where drug involvement cannot be ruled out.
“This is a liability issue,” Eldridge said. “If there is any possibility of drug involvement, an autopsy will be ordered because how do you define suspicion?”
Matherly pointed out the new rules apply to all unattended deaths, and not just those that occur as the result of violence or an accident.
“So this is grandma who dies at home?” Grandy asked, seeking clarification.
Wheeley confirmed the rules would apply to a person who is taking medication and dies while sleeping. “The family can’t refuse an autopsy if the coroner orders one,” he said.
Grandy made a motion to recommend $78,000 to enable EMS to adequately fund the start-up and training necessary to provide death investigation services under the new rules from the state’s Office of the Chief Medical Examiner. Annual recurring expenses are estimated at $80,000.
Eldridge said the county has become involved in a very extensive process, but Matherly said the transition has been great and the WCSO will continue to help until it is completed.