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Medical examiner, forensic services approved by commission

Following a review of other options, Washington County commissioners approved a new agreement with East Tennessee State University to provide medical examiner and death investigator services.
While Mayor Dan Eldridge’s appointment of Dr. Karen Cline-Parhamovich as the new medical examiner preceded the resolution for the agreement on the agenda, Commissioner Matthew Morris made a motion to lay the issue on the table until a discussion of the contract with ETSU was held. The motion was seconded by Commissioner Robbie Tester and passed with unanimous approval.
“Basically, what we’re doing is entering a new agreement with ETSU for forensic services, and we’re amending tonight how we pay for it,” Eldridge said during the Sept. 22 commission meeting.
A rolling average was previously used to determine the cost, he said, with 63 autopsies completed during the prior year. “The cost is now based on the population of Washington County to meet the requirements of the National Association of Medical Examiners accreditation.”
The difference during 2014-15 at a per capita rate rather than per case will be approximately $222,000 compared to the $135,000 paid last year, largely in part because of the expected increase in the number of autopsies. “I’m going to throw out the number of 110-130 for this year due to the change in rules,” Eldridge said.
According to Eldridge, the final agreement reached with the William L. Jenkins Forensic Center at ETSU will bring the county into full compliance with the new rules of the Tennessee Department of Health Office of the Chief Medical Examiner that went into effect at the end of November 2013.
Chapter 1200-36-01: Investigation of deaths resulting from opiate, illegal or illicit drug overdose requires 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.
The new requirements ended the previous arrangement of the Washington County Sheriff’s Office serving as deputy coroner.
In January, commissioners approved transitioning the responsibilities to Washington County/Johnson City Emergency Medical Services Inc. and allocated $78,000 in new spending for start-up expenses, including two new staff positions, training, equipment and a coroner vehicle.
Washington County will still incur approximately $80,000 annually for EMS to conduct the on-site death investigations.
Commissioner Lee Chase questioned the rationale in the dollar figure that changes annually in the four-year contract, reaching a high of $272,000 in the second year, and Eldridge said it is due to the WLJFC’s incrementally increasing its staffing level.
“Is that due to the increase in autopsies?” Commissioner Joe Grandy asked.
“No, it’s due to the pushback from eight county mayors,” Eldridge answered, referring to the need to add the necessary increase in costs over a period of time rather than all at once. “Every county in East Tennessee is considering the same contract.”
Morris asked why the word autopsies is not explicitly included in the agreement as opposed to death investigations, which EMS will conduct on site.
Eldridge explained the scene investigation by the EMS is the preliminary work of the autopsies, with the pathology work being done in the lab. “We’re not changing the scope of services with ETSU,” he said. “We’re only changing the way we pay for them.”
Morris said he would like to see it spelled out in the contract, and Eldridge requested an opinion from the county attorney.
“I think the autopsy is included in the death investigation, and it’s also laid out in the compensation,” interim County Attorney Tom Seeley said. “I would recommend we not amend.”
In response to Commissioner Tom Foster’s question about the portion of the payment that is directed toward building debt, Eldridge said the forensic facility underwent extensive renovations during 2006 and all eight counties agreed to shoulder the debt. “We’ve been paying this since 2006,” he said.
Commissioner Todd Hensley said the Budget Committee determined the county would be spending a comparable amount under the new agreement.
“We’re probably going to spend less this year if we no longer pay the $30,000 that was going to medical examiner fees,” Eldridge added.
During a budget workshop with the full commission on Sept. 15, Eldridge said in order for the WLJFC to receive accreditation with NAME, the medical examiner must be a resident of the county he or she serves. “The only opportunity to become accredited is if Karen Cline can be the medical examiner,” Eldridge told commissioners, pointing out Cline already serves as the chief medical examiner for the State of Tennessee.
Cline is a board-certified forensic pathologist who also serves as director of the WLJFC and continues to perform autopsies for the eight counties of the First Tennessee Development District. The WLJFC agreed to absorb the $30,000 in fees if Cline is appointed medical examiner.
Commissioner Robbie Tester expressed concern about a conflict of interest in appointing the person who wrote the changes in the rule regarding the investigation of deaths resulting from opiate, illegal or illicit drug overdose.
Eldridge said the rule applies to the State of Tennessee, not just Washington County, and is the result of previous action by the legislature. The number of autopsies in the county has doubled since the rule went into effect, he added.
“If we don’t pass this, what is another choice?” Commissioner Tom Krieger asked.
Eldridge said the next closest forensic center is in Knoxville, which could lead to a significant increase in transportation costs.
“While I understand there is potential conflict, I’m with the mayor in that I don’t see how (Cline) is lining her pockets,” Hensley said.
Chase made a motion to approve the agreement with ETSU, which was seconded by Hensley. The motion passed with Tester opposed and Commissioner Katie Baker abstaining.
Commissioner Joe Wise then made a motion to approve the mayor’s appointment of Cline as medical examiner. Commissioner Forrest Boreing seconded the motion, which passed with a majority voice vote.