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Increased number of autopsies will impact county

Equipping EMS to conduct death investigations is only the beginning of the cost to Washington County, commissioners learned during last week’s meeting.
“This is the largest unfunded mandate in years,” interim County Attorney Keith Bowers said, referring to the new rule from the state medical examiner regarding unattended deaths in Chapter 1200-36-01: Investigation of deaths resulting from opiate, illegal or illicit drug overdose.
A resolution to allocate $78,000 in new spending to EMS for start-up expenses including two new staff positions, training, equipment and a coroner vehicle was considered during the Jan. 27 meeting.
Mayor Dan Eldridge said EMS is the most logical organization to take over the responsibility in any kind of affordable manner. “This resolution gets us through the fiscal year,” he told commissioners. Annual costs going forward are estimated at $80,000.
The Washington County Sheriff’s Office is no longer able to serve as deputy coroner due to requirements for a new set of data that must be recorded by investigators who are licensed emergency medical technicians, paramedics, registered nurses, physician’s assistants or persons registered by a diplomat of the American Board of Medicolegal Death Investigators and approved by the county medical examiner.
Commissioners were surprised the cost from the changes was falling to the county. “So there was no provision from the state?” Commissioner Pat Wolfe asked. “They just passed it, and we have to absorb it?”
Eldridge said the state medical examiner has the authority to change the guidelines, and the county must comply. “We’re dealing with the suspicion of drug use (as a factor in the death),” he said, estimating the additional autopsies could cost the county $330,000 per year.
WCSO Capt. Shawn Judy concurred. “If we go in and there is a pill bottle with 20 missing, that’s an autopsy,” he told commissioners. The WCSO is working with EMS during the transition of services.
Commissioner Ethan Flynn asked if the county was consulted about the changes.
“We received notification of the implementation of the new rule,” Eldridge answered. “There was no comment period.”
Commissioner David Shanks said he believes the additional cost burden was unintended. “I think we need to send it back and stay out of compliance,” he suggested.
According to Eldridge, the county’s exposure from not complying is too great to chance. “We would be taking on considerable potential liability,” he warned.
Shanks wanted more time. “When is the drop dead date to comply?” he asked.
That date was Nov. 28, 2013, according to Eldridge, and Washington County has been in compliance since the first of December.
Commissioner Mark Ferguson expressed dissatisfaction with the mayor’s response to the new requirements. “I understand it’s a state rule, but this should have gone to Public Safety (Committee) to be ironed out,” he said, adding Eldridge was going around the commission and not following procedure.
Commissioner Lee Chase asked if the purchase of a coroner vehicle, listed at $32,000 in the proposed breakdown of expenses from EMS, could be deferred for two months and an ambulance continue to be used.
EMS Executive Director Dan Wheeley said while possible, it would not be a good idea. With the number of transports expected to increase significantly from the 65 that were made last year, that would be additional time areas of the county are left unprotected. “It’s not a problem with response, it’s the transport that ties up an emergency response vehicle,” he said.
Commissioner Doyle Cloyd asked if the new vehicle would have to be equipped as an ambulance, but Wheeley said they are looking at an enclosed van or truck, and medical response equipment onboard would not be required.
Flynn asked Bowers for a recommendation.
Because there is only a small window of time available to try to get an amendment to the new rule, Bowers recommended a called meeting with representatives from neighboring counties.
Eldridge said the forensic center at the James H. Quillen Veterans Affairs Medical Center, a division of the East Tennessee State University Department of Pathology, also should be included. “They are very much a part of the global issue we are all trying to find a solution to,” he said, adding the center is one of only five in the state. “We all have a stake in this.”
Flynn made a motion to amend the resolution providing funds to EMS that includes directing Eldridge to prepare a statement of concern letter and mail to all stakeholders. Chase seconded the motion for an amendment, which received unanimous approval.
The resolution, as amended, passed on a motion and second from Commissioners Sam Phillips and Steve Light respectively, with Shanks being the only member opposed.