07/14/1997 Audit •
AUDIT REPORT OF
MONROE COUNTY
MEDICAL EXAMINER'S OFFICE
July 14, 1997
•
`DOUNry
0
M'6IWQ OG
y .7;JJ G�•� 11,
U :
ti �O "` F� ,
4, �OUN11. .�
Prepared by:
Internal Audit Department
Clerk of the Circuit Court
Danny L. Kolhage, Clerk
Monroe County, Florida
IIJ
_J K;4�GOU..... �.
•D ic' •:fp
Iry''fjO:• lQO
f CCUtRI•
t--�-
f
;Danny IL. la o tb a ge
I BRANCH OFFICE CLERK OF THE CIRCUIT COURT BRANCH OFFICE
3117 OVERSEAS HIGHWAY MONROE COUNTY 88820 OVERSEAS HIGHWAY
MARATHON,FLORIDA 33050 500 WHITEHEAD STREET PLANTATION KEY,FLORIDA 33070
(- TEL.(305)289-6027 KEY WEST,FLORIDA 33040 TEL.(305)852-7145
FAX(305)289-1745 TEL.(305)292-3550 FAX(305)852-7146
FAX(305)295-3660
July 14, 1997
The Honorable Danny L. Kolhage
Clerk of the Circuit Court
Re: Audit of the Monroe County Medical Examiner's Office
Dear Mr. Kolhage:
The Clerk's Internal Audit Department has completed the audit of the Monroe County Medical
Examiner's Office. The purpose of the audit was to assess compliance with the applicable
chapters of the Florida Statutes, and the Monroe County Board of County Commissioners'
policies, procedures, resolutions, ordinances, and agreements. We also evaluated the adequacy
and effectiveness of the Medical Examiner's Office system of internal accounting and
administrative controls and appraised the economy and efficiency with which the Medical
Examiner's Office employ's its resources. Our audit did not address the medical operations of
the Office since we do not have the expertise and training required of a medical examiner.
We would like to thank the Medical Examiner and his staff for their cooperation while
conducting the audit.
Our audit revealed that the Medical Examiner's Office needs formally established general goals,
objectives, procedures and detailed financial and program information with which to measure
the effectiveness of the program. The Agreement between the Board of County Commissioners
and the Medical Examiner should be specific as to the responsibilities of the Medical Examiner,
revenue collection and remittance procedures, and the salaries of the Medical Examiner and the
Associate Medical Examiner. The Medical Examiner's Office should institute new operating
procedures in order to comply with all applicable Florida Statutes.
As more governments enter into contracts with private business organizations to administer
public programs, the emphasis has changed to include strong financial and internal controls in
the contract and equally important government management oversight. The Medical Examiner's
program is administered on a contractual basis and should have strong administrative and
PI
management oversight by the County. The action plan provided by the Medical Examiner and
the County Administrator was not specific to the individual findings, therefore, the internal
auditor is unable to determine if the new systems will correct the deficiencies reported.
The accompanying audit report is provided for your information. Additional copies of the report
will be provided upon your request.
Sincerely,
c't‘ P7a)LA-ur
Sandra L. Mathena, CPA
Internal Auditor
cc: Board of County Administrators (5)
James Roberts, County Administrator
James Hendrick, County Attorney
Kirk Zuelch, State Attorney
Dr. Robert Nelms, Jr., Medical Examiner
Reggie Paros, Division Director of Public Safety
John Carter, Director of the Office of Management and Budget
Sandee Carlile, Clerk's Finance Director
Maurva Greene, External Auditor
AUDIT REPORT OF
MONROE COUNTY - MEDICAL EXAMINER'S OFFICE
TABLE OF CONTENTS
Page #'s •
I. Scope and Objectives 1
II. Methodology 1-2
III. Background 3-6
IV. Conclusions 7
V. Audit Findings:
A. Revenue Process Lacks Adequate Documentation and Internal Control
1. The Agreement does not address revenue issues 8
2. Revenue collected not reported or identified 9-10
B. Incomplete Monthly Activity Reports 11-12
C. Professional Services
1. Actual funds spent for professional services are higher than funds
budgeted. 13-14
2. Time and salary allocations do not match actual workloads 15
D. Contractual Services of Chief Forensic Investigator, Diener,
and Removal Services
1. Unable to determine the appropriateness of the fees paid for
investigative, diener, removal and miscellaneous services 16-18
2. Removal fees and travel reimbursement 19
E. Phone Usage and Billing Process
1. Phone bills lack adequate documentation for reimbursement 20
2. Cellular phone usage 21-22
3. Late charges reimbursed 22
F. Capital Outlay Funds Requested but None Spent on Assets. 23
G. Purchase of Medical Examiner Facility 24
AUDIT REPORT OF
MONROE COUNTY - MEDICAL EXAMINER'S OFFICE
TABLE OF CONTENTS
Page #'s
V. Audit Findings Continued:
H. Removal Service Not In Compliance With Florida Statutes And
The Florida Administrative Code
i 1. Removal service not in compliance with Florida Statutes 25-26
2. Removal service not in compliance with the Florida
Administrative Code 61G8-24.021 and 61G8-24.022. 27-28
3. Removal service not in compliance with the Florida
Administrative Code 61G824.024 Operating Procedures 29
I. Monroe County Code Chapter 63-1636 30
VI. Exhibits:
A. Statistic & Budget Analysis - Monroe, Collier, Palm Beach and
Charlotte Counties
1. Office of the Medical Examiner County Comparison A-1
2. Florida Medical Examiner Districts A-2
B. Palm Beach County Revenue Documentation/Processing B-1-2
C. Monroe County Comparison of Actual to Budget C
D. The Agreement Between the Medical Examiner and the Board of
County Commissioners•
D
VII. Auditee Responses
AUDIT REPORT OF
MONROE COUNTY - MEDICAL EXAMINER'S OFFICE
I. Scope and Objectives:
A. At the request of the Monroe County Clerk of the Circuit Court, the Internal Audit
Department conducted an audit of the Medical Examiner's Office. The Audit Period is
October 1, 1994 through December 31, 1996.
B. The purpose of this audit was to assess compliance with applicable chapters of the Florida
Statutes, the Monroe County Board of County Commissioners' policies, procedures,
resolutions, ordinances, and agreements. We also evaluated the adequacy and effectiveness
of the Medical Examiner's Office system of internal accounting and administrative control,
and appraised the economy and efficiency with which the Medical Examiner's Office
employs its resources.
C. Our audit did not address the medical operations of the Office. Our audit was limited in
this area because we do not have the expertise and training required of a medical examiner.
H. Methodology:
A. The following personnel were interviewed to obtain information about operations of the
Monroe County Medical Examiner's Office:
1. County Administrator
2. Senior Project Supervisor for the County Administrator
3. Medical Examiner
4. Chief Forensic Investigator
5. Secretary for the Medical Examiner
6. Assistant County Attorney
7. Chief Accountant for the Clerk of the Circuit Court
B. The Internal Audit Department examined the following documents:
1. Florida Statutes related to the Medical Examiner's program.
2. Medical Examiner policies and procedures
3. Agreement between Monroe County and the Medical Examiner for the fiscal year
D. Analyzed the budget, revenue, expenditures and operating statistics for the audit period and
compared budgeted amounts to actual expenditures.
E. Reviewed invoices and analyzed expenses for appropriateness.
F. Compared Monroe County Medical Examiner's budget and operations with other counties
of similar size and geographic area. (See Exhibit A-1)
G. Reviewed other counties Medical Examiner contracts.
2
III. Background:
A. Organization of the Medical Examiner's Function:
The Medical Examiner's of Florida have the statutory responsibility of investigating
violent, sudden, unexpected, environmentally related and suspicious deaths as well as
unexplained and/or unexpected infant deaths. The Medical Examiner's Act, Chapter
406, Florida Statutes, was enacted by the 1970 Legislature in order to establish minimum
and uniform standards of excellence in statewide medical examiner services. The
recommended standards for a medical examiner system are that the chief medical
examiner is a board-certified forensic pathologist with a number of years of experience
and that the assistant medical examiner is at a minimum a board-certified pathologist with
forensic experience. A board-certified pathologist has received advanced training in
recognizing and interpreting diseases and injuries in the human body. This knowledge
enables the medical examiner to make significant contributions to medicolegal
investigations. All District Medical Examiner's are appointed by the Governor of the
State of Florida for a three-year term. For each district, nominees for the District
Medical Examiner are submitted to the Governor by the Medical Examiner's
Commission.
There are twenty-four Medical Examiner Districts within the State of Florida. See
Exhibit A-2. Monroe County (District 16) has the smallest population and smallest total
district deaths of the twenty-four districts. However, Monroe County's population of
tourists and temporary residents introduces difficulties in the evaluation of mortality data.
The responsibilities for the Medical Examiner's Office in Monroe County are
contractually vested in the District 16 Medical Examiner (Monroe County). On August
13, 1996, the Board of County Commissioners authorized execution of an agreement
between Monroe County and the District 16 Medical Examiner with a budget of
$299,891 for the fiscal year October 1, 1996 through September 30, 1997. The budget
was prepared by the Medical Examiner and includes all costs of the Office.
Under this contract, the Medical Examiner is responsible for all medical/technical aspects
of the operations and for providing competent investigative, administrative, secretarial
and technical support staff. The Office utilizes a medical examiner, associate medical
examiner, forensic investigator, medical secretary and autopsy technician. In accordance
with Chapter 406, Florida Statutes, the County, through its Board of County
Commissioners, is required to establish and pay reasonable compensation, fees, and
expenses for the services of the District Medical Examiner and associates.
The Medical Examiner is also in private practice as a Pathologist and the Assistant
Medical Examiner is an employee of the private practice and also performs medical
,examiner duties. The Chief Forensic Investigator is a subcontractor who is incorporated
but estimates that 95% of his total duties are medical examiner related.
3
L
B. Population and Work Load Statistics in Monroe County
In Monroe County during the fiscal year 1995-96 there were 139 autopsies, 55 body
inspections and 436 cremation approvals performed. Autopsies take anywhere from two
to six hours to complete plus travel time to the facility where the autopsy is performed.
Cremation approvals take approximately five minutes to complete. The age, name, sex
and diagnosis are collected for cremation approvals. If the diagnosis and the age seem
unusual further questioning is done.
The rate of violent deaths varied among the different Medical Examiner Districts, with
District 16 (Monroe County) having the highest rate of 10/100,000 and District 22
(Charlotte County) having the lowest rate of 3.6/100,000. Violent death is defined in
the context of the presented statistics as death resulting from accidents, suicides, and
homicides as well as undetermined deaths and deaths still under investigation.
The FDLE Medical Commission's 1995 Annual Report that provides information on all
districts, states that 6.8% (10,481 natural deaths) of all deaths in the state were examined
by a Medical Examiner. The spread of the percentage of the natural deaths examined
ranges from 3.1% to 12.6% with only three districts exceeding 10%. District 16 natural
deaths examined compared to the state average is as follows:
Year District 16 State
1995 11.79% 6.80%
1994 10.04% 6.98%
1993 18.25% 7.83%
The assumption of jurisdiction by the Medical Examiner's in cases of natural deaths is
largely a matter of discretion and individual policy.
C. Medical Examiner Programs in Other Counties
We compared the budget and operations of the Medical Examiner Programs in Collier,
Charlotte and Palm Beach Counties. For an analysis of this comparison see Exhibit A-1.
Collier County (District 20)
Collier County operates the Medical Examiner's Office on a contractual basis as District 20
Medical Examiner's Florida Corporation. The Medical Examiner Commission's 1995
Annual Report shows a population of 186,504 and 1,854 district deaths. Of the 1,854
District 20 deaths there were 210 autopsies performed. Collier County's rate of natural
deaths examined for 1995 is 9.0%.
The Office employs four individuals, a medical examiner, associate medical examiner,
office manager and one part-time technician to assist with autopsies. The total budget for
4
,
I
jul
I
the fiscal year 1996-97 is $441,314. The Medical Examiner's salary is $120,000 and the
Assistant Medical Examiner's salary is $82,000. The Medical Examiner and the Associate
Medical Examiner are not engaged in private practice and are considered full time.
Collier County compensates the Medical Examiner for services in the amount of $16,761
semimonthly through the contract period. The Collier County Medical Examiner must
maintain a full professional staff (associate medical examiner and laboratory technicians
must be maintained in order to perform the medical examiner duties set forth under the
agreement). The County stipulates that compensation provided under the agreement is
intended to cover the anticipated normal activities/work load of the Medical Examiner based
upon past statistics and reasonable projections. In the event of a disaster or occurrence
unusual in nature or magnitude, the Medical Examiner shall petition the Board of County
Commissioners for reimbursement of all extraordinary expenses and compensation due to
the disaster.
Charlotte County (District 22)
Charlotte County operates their Medical Examiner's Office on a contractual basis. The
Medical Examiner Commission's 1995 Annual Report shows a population of 127,646 and
1,955 district deaths. Of the 1,955 district deaths there were 83 autopsies performed. The
philosophy of this office is to focus on trauma deaths. If it is a clear-cut case, they do not
perform an autopsy and feel it is easier on the family.
The office employs a full-time administrative assistant, medical examiner and associate
medical examiner. They also have investigators paid on a per call basis. The diener is paid
per autopsy. Both the Medical Examiner and Associate Medical Examiner work together
in a private practice. The approximate salary of the Medical Examiner and Associate
Medical Examiner is $100,000 and $50,000 respectively for medical examiner activities.
The total budget for fiscal year 1996/97 is $235,304. Charlotte charges $15 for copies of
autopsy reports and $20 for cremation approvals.
Palm Beach County (District 15)
Palm Beach County is a Charter County. The Medical Examiner Commission's 1995 Annual
Report shows a population of 962,802 and 11,909 district deaths. Of the 11,909 district
deaths there were 858 autopsies performed. They have a contract with the Medical
Examiner that covers only the professional services of the Medical Examiner. This contract
requires the Medical Examiner to select the Associate Medical Examiner and then the
County negotiates a contract directly with the Associate Medical Examiner. The salary of
the Medical Examiner is a flat fee of$125,000. Payment is made to the Medical Examiner
on a monthly basis ($10,416.67). Language in the contract states that the Medical Examiner
will devote substantially all of his time to the performance of medical examiner duties.
of Public Safetyis in charge of providingautos and laboratoryfacilities,
The Director g autopsy
supplies and support staff. The Director is the medical examiner liaison and assists in
preparing the annual budget, monitors revenue and expenditures to ensure accountability and
5
administers all budget amendments.
The County employs three full- time forensic investigators, their salary range is $27,400 to
$41,600. The County uses a private livery service that charges $99.95 per removal. All
revenue earned by the Medical Examiner's Office is remitted to the County with the
exception of expert witness fees. The total budget for fiscal year 1996-97 for Palm Beach
County is $1,568,705.
6
IV. Conclusion:
A. The revenue process lacks adequate documentation and internal control.
B. Monthly activity reports are incomplete. County Management should establish general
goals or objectives, monitor the medical examiner program and obtain complete and
detailed financial and program information to measure the effectiveness of the program.
C. The actual amount spent for professional services are higher than the amount originally
listed as a line item in the approved budget.
D. Documentation of time spent on medical examiner activities is not complete and not
informative.
E. The Medical Examiner does not have a contract with the corporation that performs
investigative, diener, removal and miscellaneous services. The Medical Examiner
should have a contract with the corporation that specifically states work to be performed
by the corporation and should require documentation of services performed before
payment is made.
F. The payment of travel expenditures in addition to removal fees may be inappropriate.
G. Phone bills lack adequate documentation for reimbursement. Cellular phones are not
used in accordance with Monroe County Instruction 4403.
H. Capital outlay funds were requested but none were spent on assets.
I. The County should evaluate the future plans of the medical examiner activities that
include the option of purchasing the facility in Big Pine Key.
J. The removal service is not in compliance with the Florida Statutes and the Florida
Administrative Code.
K. The Monroe County Code Chapter 63-1636 titled Medical Examiner contains outdated
information.
7
I
V. Audit Findings:
t.
A. Revenue Process Lacks Adequate Documentation and Internal Control:
1. The Agreement does not address revenue issues:
Finding(s):
A review of the Agreement between the County and the Medical Examiner (Agreement)
reveals that the contract does not address revenue issues.
The Agreement does not provide any direction for revenue procedures. In reviewing other
medical examiner contracts from other counties some contracts are specific as to the fees
to be remitted to the County on a monthly basis. There are also fee schedules and written
procedures to follow for revenue collections. Expert witness fees are retained by the
Medical Examiner in most counties. In one Medical Examiner District the expert witness
fees are used for the travel and education of the medical examiner employees.
The Agreement should address revenue issues such as fees charged for specific services, and
if such fees should be retained by the medical examiner, remitted to the County or used to
reimburse medical examiner expenses thus reducing the overall County funding for medical
examiner activities.
Recommendation(s):
1. County Management should analyze the different types of revenues the Medical Examiner
could charge and make recommendations to the County Administrator for fees that should
be charged and how the fees will be reported and used. The Agreement with the Medical
Examiner should be specific as to which fees can be retained by the Medical Examiner
and how other fees should be reported and remitted to the County.
2. The County Attorney should review the current contract and make changes that address
the reporting and disposition of revenues generated by medical examiner activities.
Medical Examiner's Response:
No comment.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for general response.
Assistant County Attorney's Response:
With regard to the item concerning the reporting and disposition of revenues, the County
Attorney's Office has already prepared the suggested changes and forwarded same to the
County Administrator's Office.
8
2. Revenue collected not reported or identified:
Finding(s):
A review of revenue collected from medical examiner activities reveals that no revenue is
reported to the County since there is no contractual requirement to do so, and such revenue
is commingled with revenue from the Medical Examiner's private practice.
The Agreement Does Not Address Revenue Issues; see Finding A-1.
The Medical Examiner's Office charges for the following services:
Copy of autopsy report $ 10.00
Photographs $ 25.00
Expert Witness Fees -
Criminal $ 0.00
Civil $ 150.00/hr
When an individual requests a copy of an autopsy report or photographs, the individual
sends a letter with a check for the appropriate fee to the Medical Examiner's business. The
funds are then deposited and commingled with private practice revenue. The Medical
Examiner stated the revenue collected is nominal. However, since there is no audit trail,
we were unable to determine the actual amount collected for these services.
In addition, there are no charges for other medical examiner services provided. For
example, no fee is charged for cremation authorizations. Other counties charge $30 for
cremation authorizations. Cremation authorizations are requested by funeral directors, and
approved by the Medical Examiner or Associate Medical Examiner. A unique and
individual number is assigned to each cremation authorization. This number is recorded in
the cremation ledger and provided to the requesting agency. There were 436 cremation
authorizations in fiscal year 1995-1996. At a fee of $30 per approval, this would generate
$13,080 in additional revenue to offset the costs of the Medical Examiner's Office. See
Exhibit B-1"Revenue Documentation/Processing Palm Beach County".
i
Other counties charge for the following services and remit the proceeds to the county:
1. All fees received for making copies of certificates, slides, documents, reports,
photographs, and other reproducible items.
2. All fees or payments received from State agencies for work performed by the Medical
Examiner, and/or any Associate Medical Examiner, excluding expert witness fees.
3. All charges billed to and paid by another Medical Examiner District or individual
and/or any Associate Medical Examiner using county equipment or Medical Examiner
personnel.
9
County Management should consider what additional revenue could be collected and
develop appropriate policies and procedures for their collection. County Management
should establish appropriate fees to be charged for medical examiner activities and whether
--- such fees should be retained by the medical examiner, remitted to the County, or offset
against medical examiner expenditures. When possible, this revenue should be included in
the Medical Examiner's budget.
Recommendation(s):
1. County Management should analyze the different types of revenue the Medical Examiner
could charge and make recommendations to the County Administrator for fees that should
be charged and how the fees will be recorded. The Agreement with the Medical
Examiner should be specific as to which fees can be retained by the Medical Examiner
and how other fees should be reported and remitted to the County.
2. The Medical Examiner should have separate accounting records for medical examiner
activities. Revenue from such activities should not be commingled with revenue from
the private practice of the Medical Examiner contractor.
Medical Examiner's Response:
In my opinion, revenue from any civil litigation, civil depositions, civil consultations, etc.,
should not go to the county.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
10
l �
B. Incomplete Monthly Activity Reports:
Finding(s):
A review of the medical examiner monthly activity reports revealed that they are incomplete
and do not reflect the activities of the Medical Examiner's Office. Also, the reports are not
reviewed by County Management.
The purpose of the monthly activity reports is to provide County Management with monthly
statistics on the hours spent on Medical Examiner activities and workloads, and provide
information to support the budget. The Agreement with the Medical Examiner states the
monthly activity report should contain at a minimum the following:
A. Number of all investigations and narrative reports for non-autopsy medical
- examiner cases.
•B. Number of all autopsies performed.
C. Court cases and medical/legal conferences, number and hours spent.
_ D. Number of authorizations for all cremations-and burials at sea and anatomical
dissections.
E. Number of hours of scene investigations.
F. Measurements of the month's and year-to-date performance record in accordance
with the budgetary performance standard service statements which reflect levels of
community service.
G. Any other activities not described above.
For items C, E and G the report stated "See Time Sheet." The time sheets did not provide
a clear response to these items. In our discussions with the Medical Examiner, the time
sheets are incomplete due to time constraints and therefore, reflect some but not all of the
work of the Office.
For all monthly reports, item F is not addressed by the Medical Examiner. Community
service goals, as requested in item F, should be specific and measurable and contain time
frames for completion. For an example of what another county provides see Exhibit C -
Performance Standards for Collier County (District 20). One community service goal used
by Collier County, measures the percentage of cases where phone calls reporting home
deaths is returned within thirty minutes. Another community service goal used is the
percentage of cases where the initial death certificate is signed within seventy-two hours of
death.
The Medical Examiner submits the monthly activity report to the County who then files the
report. There is no formal review of the report by County Management. The report should
be fully completed so that all work performed for the Medical Examiner's Office is
adequately documented and provides informative statistics to aid in the budgeting process.
County Management and the Medical Examiner should establish appropriate community
service objectives and related performance measures to gauge success in attaining them.
11
Monitoring compliance with the contract and the community service objectives is essential
for sound quality assurance and will provide the County information on the quality of
services they are providing to the citizens of Monroe County.
Recommendation(s):
—, 1. The monthly activity reports should contain at a minimum, all information stated in the
agreement between the Medical Examiner and the County. County Management should
review the activity reports monthly, document their review and inquire if the report is
incomplete or if there are any significant fluctuations in services. Administrative
oversight responsibility should be assigned to an individual designated by the County as
the administrative liaison to the Medical Examiner's Office.
2. The administrative liaison and the Medical Examiner should develop meaningful
community service objectives for Monroe County and related performance measures to
be included in the monthly activity report "Item F." County Management should have
an established procedure for determining whether the program is effectively conducting
its operations. County Management should develop a set of standards, a valid reporting
system and a means of comparing and evaluating the discrepancies.
Medical Examiner's Response:
It is my personal opinion that this is all a waste of time, for me and anyone else involved.
It appears to assume that I am totally unresponsive to everyone around me.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
12
1_
C. Professional Services:
_ -_ 1. Actual funds spent for professional services are higher than funds budgeted.
Finding(s):
A review of the past two years' budget to actual expenditures, reveals that payment for
professional services were more than originally budgeted even though total expenditures for
medical examiner activities were within the total budgeted amount. Professional services
include the salary of the Medical Examiner and the Associate Medical Examiner. See
Exhibit C Comparison of Budget to Actual.
For the fiscal year 1993-94 the actual amount paid for professional services was $207,588.
For the 1994-95 budget, the Medical Examiner agreed to reduce professional services to
$169,194. This represented a reduction of $38,394 over the prior year actual. However,
- - the actual amount paid during that fiscal year was $207,193 which was $37,999 more than
the amount budgeted. Transfers were made from other expenditures and capital outlay to
cover the increase for professional services.
In the 1995-96 Agreement a clause was added stating an expenditure line item could not be
changed by more than 10% without approval by the Board of County Commissioners. This
clause was taken out of the Agreement before the end of the fiscal year because as stated
in the amendment the clause was considered "unnecessary for the County's budget and
finance purpose. " Therefore, transfers among expenditure line items were allowed provided
the total budget remained the same. That year professional services were $9,199 more than,
budgeted.
The Agreement does not state the individual salaries for the Medical Examiner and the
Associate Medical Examiner and does not restrict transfers among expenditure items. The
Clerk's Accounting Office reviews and approves expenditures for payment in accordance
with the executed agreement, therefore, all budget transfers are allowed.
Recommendation(s):
1. The Agreement should specifically state the individual salaries of the Medical Examiner
and the Associate Medical Examiner. Amounts for operating expenditures and capital
outlay should not be transferred to professional services without the prior approval of the
Board of County Commissioners.
Medical Examiner's Response:
I agree with "recommendations". Under "Findings", paragraph 2 is inaccurate. I agreed
to reduce the total budget by $38,394, not my salary. The paragraph also does not reflect
how much the total budget was decreased compared to the previous year.
13
li
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
•
•
•
14
2. Time Allocation and Salary Allocation Do Not Match Actual Workloads:
Finding(s):
Based on our audit we were unable to determine with certainty the total amount of time the
Medical Examiner and the Associate Medical Examiner spent on medical examiner
activities. This information is necessary to determine if compensation to the Medical
Examiner and his Associate is appropriate.
Both the Medical Examiner and his Associate work for the Medical Examiner's private
practice. The Medical Examiner stated that he was unable to determine the percentage of
time he and his Associate spent on medical examiner duties. Therefore, in order to estimate
the time spent on medical examiner duties, we analyzed time sheets submitted with his
monthly reports for fiscal year 1995-96. However, these time sheets may be incomplete.
See Finding B-1 "Incomplete Monthly Activity Reports." This analysis reveals the
following combined hours worked by the Medical Examiner and his Associate on medical
examiner activities:
Maximum hours worked per month 148
Minimum hours worked per month 55
Average hours worked per month 85
Total hours worked per year 1,022
The Medical Examiner's private practice contracts with Fishermen's Hospital. This contract
states: "If the pathologist (M.E.) is unable to provide the service required hereunder due to
temporary absence or illness, he shall provide a suitable substitute at no additional cost to
Hospital. " This contractual condition with Fishermen's Hospital reveals that the Medical
Examiner and his Associate provide services that are not related to the medical examiner
program. Time sheets should be submitted with the monthly activity report to allow County
Management to determine if amounts paid represent appropriate public expenditures.
Recommendation(s):
1. Accurate and complete time sheets should be completed by the Medical Examiner and
the Associate Medical Examiner so that informative data are available to determine if
amounts paid represent appropriate public expenditures.
Medical Examiner's Response:
Time sheets do not reflect all times, or how many nights or weekends called, or the fact that
we are always on call, 24 hours a day, 7 days a week. I believe time sheets are a waste of
time, they cause diversion of mental concentration, and are demoralizing.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for general response.
15
D. Contractual Services of Chief Forensic Investigator, Diener, and Removal Service:
1. Unable to determine the appropriateness of the fees paid for investigative, diener,
removal and miscellaneous services:
Finding(s):
Discussions with the Medical Examiner revealed that there is no formal written contract
between the Medical Examiner and the corporation that performs investigative, diener,
removal and miscellaneous services. In addition, the corporation is not required to provide
documentation to the Medical Examiner for payment of these services. Because of the lack
of a written contract and documentation we were unable to determine if the expenditures
were appropriate.
W.S. Enterprises, Inc. is a corporation wholly owned by the Chief Forensic Investigator that
provides investigative, diener, removal, and miscellaneous services for the Medical
Examiner. As stated by the Chief Forensic Investigator, 95% of the work performed by the
corporation is for medical examiner activities. These services are paid to the Chief Forensic
- Investigator through his corporation at a monthly fee plus submitted expenses. These
expenses are then submitted to the County for reimbursement.
The monthly fee currently paid is based on a formula designed by the Medical Examiner.
This formula was developed prior to 1993 and was originally based on the following
charges: $35 for each cleanup, $35 for each forensic investigation, $65 for each autopsy
assist, $27 for each external exam, $38 for each toxicology exam and miscellaneous work
at $17 per hour.
The Chief Forensic Investigator is paid, through his corporation, a monthly fee of $430 per
month for scene investigations and conducting telephone interviews. There is no support
for services provided.
In addition, for diener services the corporation receives $1,180 per month. Diener services
consist of autopsy assistance and cleanup. Again, there is no support for services provided.
For miscellaneous services, the corporation receives an amount that fluctuates each month.
For the fiscal year 1995-96 the monthly miscellaneous amounts ranged from $343 to $706.
The bill for miscellaneous services only provides the date and charge for the service. The
bill does not provide a full description and hours required to perform the service.
16
W.S. Enterprises Inc. received the following compensation for fiscal year 1995-96:
Title Annual
Compensation
Chief Forensic
Investigator 5,160 @ 430 per month
Removal Service 20,520 @1,710 per month
Diener Service 14,160 @1,180 per month
Miscellaneous 6,990 as submitted $19 -
$41 per hour
Travel & Meal 5,176 ranges from $428
Reimbursements to $570 per month
Cellular Telephone 1,816 ranges from $169
to $401 per month
$53,635
-' We could not determine the appropriateness of these fees due to the absence of records.
All bills submitted to the Medical Examiner's Office should contain documentation of
services provided, such as medical examiner case number, date of service, description of
service, amount and hours worked. The documentation of services performed should be
available for budget planning purposes and to justify that the compensation remitted to the
corporation is appropriate.
To clarify the responsibilities of the corporation that performs investigative, diener, removal
and miscellaneous services, a contract should be executed with the Medical Examiner that
describes the duties to be performed, a payment schedule for each service, cellular telephone
procedures, and recordkeeping requirements.
Recommendation(s):
1. The Medical Examiner's Office should consider executing a formal written contract with
the corporation performing investigative, diener, removal and miscellaneous services.
2. The Medical Examiner should review the monthly billing for appropriateness, before
submitting it for reimbursement.
Medical Examiner's Response:
1. Concerning "recommendation #1." a contract would limit my flexibility in dealing with
the corporation, or corporations, or individuals performing the services, and would be
of no advantage to the county. Concerning "recommendation #2," the flat fees were
based on a two-year study for "appropriateness" from 1988 and 1989, then averaged
monthly, similarly to M.E. salaries. Workload has increased from 110 to 140 autopsies,
but flat rate has only been adjusted for inflation, not the workload. W.S. Enterprises has
provided the work of 3 employees working or on call 24 hours per day, 7 days per week,
52 weeks per year.
17
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
18
2. Removal fees and travel reimbursement:
Finding(s):
A review of travel vouchers and discussions with the Chief Forensic Investigator reveals that
payment for travel expenditures may be inappropriate.
For the fiscal year 1995/96 the Chief Forensic Investigator was reimbursed $5,176 for travel
and meal reimbursement which was received in addition to his monthly service fees. The
Chief Forensic Investigator stated that the monthly fees for removal services include travel
and use of his vehicle. The Chief Forensic Investigator's corporation bills the Medical
Examiner $1,710 per month for removal services and $430 per month for investigative
services. In addition, the Chief Forensic Investigator bills the Medical Examiner $.29 a mile
plus lunch and/or dinner which is paid directly to the Chief Forensic Investigator and not
his corporation. Monthly travel reimbursements range from $428 to $570.
Since there is no contract between the Medical Examiner and the Chief Forensic
Investigator's corporation (see finding D-1), we were unable to determine if the payments
of theses travel expenditures were appropriate. The Medical Examiner should have a
' written agreement with the Chief Forensic Investigator which explains the monthly fee and
what they include, and County Management should determine if current payments of travel
to the Chief Forensic Investigator are appropriate.
Recommendation(s):
1. County Management should analyze the removal service fees and related travel expenses
to determine if they are appropriate.
Medical Examiner's Response:
Travel expenditures are well documented on travel vouchers, and do not adequately cover
the cost of maintaining a vehicle now. Vehicle used cannot be used for anything else due
to odor of decomposed bodies.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
19
E. Phone Usage and Billing Process:
_ _-- 1. Phone bills lack adequate documentation for reimbursement
Finding(s):
A review of original cellular telephone invoices submitted for reimbursement revealed that
there is no backup to determine which calls relate to medical examiner activities and which
are personal. The County is allowed to reimburse expenditures for business purposes only.
The total cellular phone bill for fiscal year 1995-96 was $4,542. Cellular phones are
invoiced based on total airtime usage. Monthly airtime can be purchased for a specific price
(package minutes). Therefore, there is a charge for all calls made with the cellular phone,
not just long distance calls.
Telephone logs are not kept by the Medical Examiner's Office. As part of the audit we
requested, for two monthly bills that the Medical Examiner and the Chief Forensic
Investigator indicate which calls are personal. This analysis revealed that personal phone
calls, both local and long distance, represent from ten percent to thirty-two percent of the
total airtime usage.
Per Monroe County Instruction 4403 dated February 1997, states: "It is the intention of
the Board of County Commissioners to provide cellular telephones for official and emergency
communication only. The cellular telephones may be utilized for personal calls BY
EXCEPTION ONLY and must be documented. " Proper documentation should be kept on
all phone calls made from a cellular phone. This documentation should be provided with
the monthly bill and only business phone calls should be reimbursed.
Recommendation(s):
1. Documentation of medical examiner activity for long distance phone calls and cellular
calls should be submitted with telephone invoices before reimbursement.
2. The County policy on cellular telephone usage should be incorporated into the Agreement
with the Medical Examiner.
Medical Examiner's Response:
No comment.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
20
it
2. Cellular phone usage
Finding:
Auditor's observations revealed that a cellular phone is used even when a standard phone
is available as a matter of convenience. The cost of cell phones is substantially more than
the cost of standard phones. In addition, the Medical Examiner uses three cellular phones.
We question the necessity of three cellular phones.
The total communication bill for fiscal year 1995-96 was $6,158 which is approximately
$500 per month. Communication invoices show that the County pays for three cellular
phones, two standard phones and three beepers for medical examiner staff. Cellular phones
are invoiced based on total airtime usage.
The cost of the standard phones and the cellular phones for August 1996 is as follows:
Standard Phone M.E. Office Marathon 35.25
Standard Phone Big Pine Facility 42.76
Mobile Number 664-7584 (used by the Medical Examiner)
270 package minutes 89.95
228 additional minutes 47.59
long dist./directory 12.65
taxes 21.21 171.40
Mobile Number 872-7908 (used by the Chief Forensic Investigator)
270 package minutes 89.95
387 additional minutes 109.12
long dist./directory 2.25
taxes 28.64 229.96
Mobile Number 872-8157 (used by the Associate Medical Examiner)
15 package minutes 19.95
402 additional minutes 133.80
long dist./directory 38.95
taxes 26.22 218.92
Standard phones should be used whenever possible in order to reduce the cost to the
County. In addition, we question the need for three cellular phones.
21
,
Recommendation(s):
1. A standard telephone should be used if available instead of a cellular phone because
of the costs associated with airtime usage.
2. County Management should question the Medical Examiner concerning the need for
three cellular phones.
Medical Examiner's Response:
I disagree that my cellular is used for convenience when a standard phone is available. This
would be a rare exception, usually involving a long distance medical examiner call out of
the 305 exchange, which the hospital will not pay for. Also, the need for three cellular
phones is easy to explain: one for the medical examiner, one for the associate medical
examiner, and one for the forensic investigator/diener/livery service.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
3. Late charges reimbursed
Finding:
A review of phone bills submitted by the Medical Examiner's Office reveals that the County
reimbursed the Medical Examiner's Office for late fees.
Recommendation(s):
The Clerk's Finance Department should consider if the payment of late fees is appropriate.
Medical Examiner's Response:
I agree that the payment of late fees is not appropriate if the county's reimbursement to me
from the previous month is not late.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
22
F. Capital outlay funds requested but none spent on assets.
Finding(s):
An analysis of the budget for capital outlay reveals that for the fiscal year 1994/95 capital
outlay requested was $3,917 and $1,217 for the fiscal year 1995/96. No capital assets were
purchased for either fiscal year. For both fiscal years these appropriations were transferred
to personal service and/or operating expenses. Also, in the Medical Examiner's budget
request, a list of capital outlay was not provided.
The budget request should require a list of assets to be purchased during the year. During
the year these funds should only be used for the purchase of requested assets, unless a
modification is approved by the Board of County Commissioners.
Recommendation(s):
1. A list of capital equipment to be purchased should be submitted with the budget. Such
appropriations should only be used for the purchase of requested capital assets unless
otherwise modified by the Board of County Commissioners.
Medical Examiner's Response:
No comment.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
23
G. Purchase of medical examiner facility:
Finding:
A review of the lease agreement for the Medical Examiner's Office in Big Pine Key,
discussions with the owner of the property and the Medical Examiner, and review of
correspondence between the County and the Medical Examiner revealed that the County has
not fully considered the option of purchase versus leasing the facility.
The County currently leases a facility in Big Pine Key for medical examiner activities at a
cost of$2,109 per month. The lease expires May 31, 1997. The owner has expressed an
interest in selling the property. The current sale price could range anywhere from $200,000
to $300,000. If the facility is sold, the County will have to find another suitable facility
at an undetermined cost. Collier County is currently in the process of building a facility at
the projected cost of $984,000.
The County Administrator stated that the future plans of the medical examiner activities are
uncertain. Therefore, purchase of the facility has not been considered.
Recommendation(s):
1. County Management should evaluate the future plans of the medical examiner activities
that should include the option of purchasing the facility in Big Pine Key.
Medical Examiner's Respons:
I agree that the county should provide a decent and adequate facility as provided for by law.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
24
H. Removal Service Not In Compliance With Florida Statutes And The Florida
Administrative Code:
1. Removal service not in compliance with Florida Statutes:
Finding(s):
The removal service is not registered with the Department of Business and Professional
Regulation in compliance with Florida Statute 470.0301.
Florida Statute 470.0301 states: "In order to ensure that the removal, refrigeration, and
embalming of all dead human bodies is conducted in a manner that properly protects the
- public's health and safety, the board shall adopt rules to provide for the registration of
removal services, refrigeration facilities, and centralized embalming facilities operated
independently of funeral establishments and direct disposal establishments, and cinerator
facilities. " The practice of funeral directing does not consist of removing or transporting
human remains from the place of death, or transporting human remains from or to a funeral
establishment.
Any removal service used by the Medical Examiner's Office should be in compliance with
the Florida Statutes.
Recommendation(s):
1. The removal service should be registered with the Florida Department of Business and
Professional Regulation Board of Funeral Directors and Embalmers, the necessary fees
remitted and a copy of this license should be kept on file in the Medical Examiner's
Office.
Medical Examiner's Response:
If the county will require any particular documentation, and will be specific, I will be
obligated to require the same documentation from all entities providing any and all services
in same category, or else body cannot be moved or removed at all. I would question
whether the county would really want to become involved, since there is a "hold harmless"
clause in the Medical Examiner contract with the county.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
25
Auditor's Comment(s):
The subject of this comment is noncompliance with the requirements of Florida law
applicable to removal services, not county regulations.
26
2. Removal service not in compliance with the Florida Administrative Code 61G8-24.022
Inspection and 61G8-24.021 Requirements for Inspection:
Finding(s):
The removal service vehicle has not been inspected as required by the Florida
Administrative Code 61G8-24.021 and 61G8-24.022.
The Florida Administrative Code 61G8-24.021 requires that the vehicle must be inspected
annually for the following requirements:
(3) Vehicles, for the removal of dead human remains shall be constructed so that:
(a) bodies contained therein shall be secured to prevent displacement during a motor
vehicle accident,
(b) whenever a vehicle is used to transport more than one dead human body at a time:
1. dead human remains are transported in a manner that separates the remains
from other remains, and
2. dead human remains, if stacked, are supported by racks or other support of
sufficient strength to separate the dead human remains.
(4) Separation for dead human bodies shall be by use of:
(a) a cot,
(b) a body bag within a box, or
(c) a cremation container.
(5) Removal services shall maintain the following minimum equipment in a clean and
sanitary manner and shall have this equipment available whenever dead human bodies
are stored or in transit:
(a) one light weight body bag
(b) one heavy weight body bag
(c) one cot cover for each cot, if cots are used for transport
(d) one first-aid kit
(e) one fire extinguisher
(t) sufficient protective clothing to meet the needs of the staff accompanying the
removal that, at a minimum, contains:
(1) disposable gowns
(2) shoe covers
(3) protective eyewear
(4) gloves
(5) masks
(6) waterproof aprons
Since no inspection has been performed we were unable to determine if the vehicle is in
compliance with the above requirements.
27
Recommendation(s):
1. Annual inspections of the vehicle should be performed by the Florida Department of
Business and Professional Regulation, the necessary fees remitted, and a copy of the
annual inspection should be kept on file by the Medical Examiner's Office
Medical Examiner's Response:
I would have to keep on file copies of the annual inspection of all companies removing or
moving bodies, not just W.S. Enterprises, or I will not be able to allow the body to be
removed at all, and the body will have to remain at the scene. I can forsee all kinds of
difficulties with this, whereas now everything is functioning smoothly with all entities
cooperating with each other voluntarily. Why fix it if it isn't broken?
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
Auditor's Comment(s):
If the recommendation above is not followed, the Medical Examiner's Office will not be in
compliance with Florida law and the Florida Administrative Code.
28
! 3. Removal service not in compliance with the Florida Administrative Code 61G8-24.024
Operating Procedures:
Finding(s):
The removal service is not in compliance with Florida Administrative Code 61G8-24.024
Operating Procedures which requires the removal service to maintain a log of removals and
track their identity from time of receipt until delivery of the remains to the authorized
person.
Florida Administrative Code 61G8-24.024 states, "Removal services shall establish a system
of identification of human remains received for removal.- This system shall be designed to
track the identity of the remains from time of receipt until delivery of the remains to the
authorized persons, or until otherwise disposed of in accordance with instructions from the
authorized person. "
No log of removals is maintained. In order to be in compliance with the Florida
Administrative Code, logs should be maintained.
Recommendation(s): •
. 1. The removal service should establish a system of identification of human remains
received for removal. A log should be designed to track the identity of the remains
from time of receipt until delivery of the remains to the authorized person.
2. The Medical Examiner's Office should request and retain a copy of the removal log.
Medical Examiner's Response_
If a removal log is required by the county, then all services and companies doing removals
in this county, even if from another county, will be required to submit a "removal log" to
this office. Again, this is more work for everyone and will result in problems that do not
exist now.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
Auditor's Comment(s):
The scope of our audit was to ensure that the Medical Examiner's Office is in compliance
with Florida law and the Florida Administrative Code. The state requirements for removal
service operating procedures are located in Rule Chapter 61G8, of the Florida
Administrative Code. Per our audit, we found noncompliance in this area.
29
I. Monroe County Code Chapter 63-1636
Finding(s):
Our examination revealed that Chapter 63-1636 of the Monroe County Code titled Division
5. Medical Examiner contains outdated information.
Section one of the code states "such examiner shall receive as his compensation the sum of
three hundred dollars ($300.00) per month, and as additional compensation the sum of ten
dollars ($10.00)per case handled, except in rape cases he shall receive the sum of twenty-
five dollars ($25.00) and an additional compensation of seventy-five dollars ($75.00)
whenever an autopsy is authorized by the state attorney. " This fee schedule is not followed.
There are other inconsistencies. The code should be reviewed and updated.
Recommendation(s):
1. The County Attorney should review Chapter 63-1636 of the Monroe County Code and
recommend changes to the Board of County Commissioners.
Medical Examiner's Response:
I agree.
County Administrator's Response:
The County Administrator did not respond item by item. See Section VII., Auditee
Responses for the general response.
Assistant County Attorney's Response:
With regard to the second item, concerning the inconsistency between Chapter 63-1636 and
current practice, Chapter 63-1636 is not a County ordinance, but rather a special act of the
Legislature. Sec. 406.17, F.S., part of the Medical Examiner's Act, provides, among other
things, that special acts inconsistent with Chap. 406, F.S., are superseded. Under Sec.
406.08, F.S., the BCC is authorized to establish the medical examiner's fee schedule. In
doing so, the Board is not restricted to any specific amount. In my opinion, this is an
inconsistency with the specific fees in Chapter 63-1636. Therefore, Chapter 63-1636 is
superseded by Chapter 406, F.S. Any other mandates in Chapter 63-1636 that are
inconsistent with current County procedures, etc., authorized by Chapter 406, F.S. (whether
directly or by implication), are likewise inconsistent with the general law and so are also
superseded. As a result, I do not think any action is needed from this Office or the BCC
on this auditor item.
30
VI. Exhibits
I a
EXHIBIT A
Statistic & Budget Analysis
Monroe County
Collier County
Palm Beach County
Charlotte County
1
Exhibit A-1
Office of the Medical Examiner
County Comparison
County Monroe Charlotte Collier Palm Beach State
District 16 22 20 15
J. Po_pu1ation 83,401 127,646 186,504 962,802 14,149,317
Total Deaths 670 1,955 1,854 11,909 154,127
Natural Deaths Examined 79 93 167 498 10,481
% of Natural Examined 11.79% 4.76% 9.01% 4.18% 6.80%
Violent 68 71 152 591 9,303
# Autopsies 117 83 210 858 14,258
Body Inspections 30 77 89 229 4,954
Cremation Approvals 403 1,133 1,227 4,352 59,981
Cases Accepted By_M. E. 550 1,297 1,546 5,441 79,765
Budget Per Capita $3.60 $1.84 $2.37
- 96/97 Budget $299,891 $235,304 $441,314 $1,568,705
95/96 Budget $289,957 $230,937 $448,300 $1,401,631
95/96 Actual $289,957 $225,955 $439,076 $1,385,435
Facility Rent/Own $25,304 $15,277 $23,000 Cy_ Owned
-, M.E. Salaty_ $112,537 $110,000 $120,000 $125,000
Associate M.E. Salary $72,035 $50,000 $82,000 $115,000
-I- Total Personnel 4 4 4 15
Monthly Pyments Invoices Pro-Rata Pro-Rata Couy Dqp_t.
Fee Charged For Services Yes Yes No Yes
Contract With County Total Total Total M.E. & Associate
.'n1111S11 Pt-B
I FLORIDA MEDICAL EXAMINER DISTRICTS
l
¶ATA
______
, 1
tA.A7iiiittleie1/4WaroiRAY1 it.14
A It
li
t
14 °MMLN •
2
•F _4f�
�� ' 23
3 iiiii
DISTRICT ONE DISTRICT TIME r
Escernble Oronge
Okeloosa Osceola �„J�
Smile(lose 7
Wdlat DISTRICT TEN
Iloldee r 4
W
DISTRICT TO Ilipldands 5
Franklin
% ' ft II
Polk
ftlk
Gadsden
Jelierson DISTRICT ELEVEN
Leon Dade N WO ORAMS!
Melly 6 mix OJ6LIKA s+
Taylor DISTRICT TWELVE
Wskulls I.IeSolo 9 ${
Manaloo
DISTRICT THREE
Columbia 1 1 S(uncle li) 11 3 A O
DIole DISTRICT THIRTEEN
Ilamlllon IIIIlSb rough Q hoist[ CJ
Laleyelle •• Sr
I
0 ��.Madison DISTRICT FOURTEEN 4 •j p1uJ�
Suwsmes pay 12 `St nC.faro MWrIAubJ
lhoun R
DISTRICT FOUR Gull \`}(
Clay Ilolmes At ttaLr
i-I Duval Jackson
KJYIf
Nassau ' Washington • NatMx .1
QOfI_}(`1 �r 15
DISTRICT FIVE DISTRICT FIFTEEN •
Cilium Patin Deech V
lotnendo 21
Lake DISTRICT SIXTEEN DISTRICT TWENTY-ONE eJh11Xt►4
Marlon Monroe Gledos
Sunder Lta ticw 17
^20
DISTRICT SEVENTEEN Lee
DISTRICT SIX Urowerd y
Pasco DISTRICT TWENTY•TWO
11 Abe
• Pinellas DISTRICT EIGHTEEN Chadolle 11
Dreverd I rl
DISTRICT SEVEN u
Volusla DISTRICT NINETEEN DISTRICT TWENTY•TIIREE 4
l 'Minisllirnr 1•ul
it
DISTRICT EIGHT Mmtk, SI.Jolns V
•
r. Madras Okeechobee
Dakar SI.Lune DISTRICT TWENTY-FOUR , 1 6 00
Dre,llord Seminole (tlCi ")
Gilchrist DISTRICT TWENTY O�scy
levy Collier
Dillon
1
1
L.
i
f
1-7
EXHIBIT B
Palm Beach County
Revenue Documentation/Processing
I
C..
XIIIBIT B-1
•
TO: Assigned Personnel, Medical Examiner's Office
1, FROM:
Director, Victim Services and Support
SUBJECT: Revenue Documentation/Processing
(Medical Examiner's Office)
PPM VSF-008
Lffcctiv Dat
10/01/93
10/01/93
amosilolicv•
I r
To record and document in accordance with the established policies and procedures of Palm
Beach County.
rocedurc•
This office has set fees for cremation approvals, duplicating of autopsy reports, and
photographic reproductions. These fees arc:
Cremation Approvals $30.00 each
Autopsy•Reports 5.00 each •
Roll of 35mm Film 13.00 each
Micro-Slides 10.00 each
Other Copies .15 per page
All payments other than for cremation authorizations arc made at the time of delivery
f
the documents. The recording and depositing of the checks and money orders for the e
services is the same as for cremation authorizations.
Cremation authorizations arc requested by funeral directors and their representatives, and
approved by the Medical Examiner or Associate Medical Examiner. A file copy of the
death certificate is maintained in the office and a unique and individual number is assigned
• to each cremation authorization. This number is recorded in the cremation ledger and
provided to the requesting agency..
L_.
•
•
1_
{,XIIIBIT B-2
At the beginning of each month, the requesting a
1 6 bC11cics arc billed by the Senior Clerk
Typist for the previous month's issued authorizations. Payment is to be made bycheck
payable to the Board of County Commissioners by the fifteenth of the month. No currency
is acceptable. When received, the check is endorsed with the County deposit stamp, a cash
receipt slip furnished by Finance is prepared, a copy of the slip given or mailed to the
payee. Once a week all receipts and copies of cash receipt slips arc sent to Finance by the
Senior Secretary. The Senior Secretary will validate receipts with the daily log and monitor
posting of receipts by Finance.
As payments arc made, copies of the payment shall be made and a record of the payment
made in a ledger maintained for each type of transaction. If a funeral home becomes
delinquent (no payment by the fifteenth of the month), no further cremation authorization
numbers will be assigned to the delinquent agency until the outstanding balance is paid in
•
full. Other penalties may be imposed based on County Policies. All checks shall be stored
in the safe until transferred to Finance as cited above.
Authority;
County Policy #CWF-002
Resolution #92-1212
Clyd ' . Siii i, 'rector
Victim Services and Support
Department Approval
Paul W. Milcllh
•
SUPERSEDES AND RESCINDS:
PPM MEF-001 / DATED OCTOBER 1, 1993
PPM VSF-008
Page 2 of 2
I, I�
EXHIBIT C
Monroe County
Comparison of Actual to Budget
- _
EXHIBIT C
•
Office of the Medical Examiner
Comparison of Actual to Budget
For The Fiscal Years 1994/95 And 1995/96
For the Fiscal Year 1994-95 For the Fiscal Year 1995-96
EXPENSE Actual Budget Difference % Actual Budget Difference %
Professional services-all other, medical
examiner and associate medical examiner 207,193 169,194 $37,999 22.46% $182,199 $173,000 $9,199 5.32%
Professional services-medical/surgical,
toxicology/radiology_. —._..... _..__.... . _5,816 15,419 ($9 603) 62 28% 6,413 7,763 ($1,350) -17.39%
Contractual services-other,investigator/diener
—/transport/livery services/funeral supplies __ _46,258 ____51,893 ($5,635) -10.86% _ 47,020 46,666 $354 _0.76%
Travel and per diem —_ _ — — _ 6,038_ 8,394 ($2,356) -28.07% 7,593 7,092 $501 7.06%
Phone&postage/freight_._.__...__ 6,572 __.._.__.9,097 ($2,525) _27.76% 6,021 7 491 ($1,470) 19.62%
_Rentals_-.all,Big-Pine Key facility_.._.....__..._._...-----------.--------_---_--34,533 31,800 $2,733 8.59% 26,137 26,114 $230.09%
Risk Mangement.-____- — _—...._.__.....__.-_.__......................................--3,888_..._._.___3,888 $00.00% 1,856 1,857 ($1) -0.05%
Re_pairand maintenance ----_..-...-_-- 254 1,289 ($1,035) -80.29% 357._......_._..............689 ($332) -48.19%
Miscellaneous expenses-all — -- 14,285 27,695__— ($13,410) -48.42% 12,171 16,596 ($4,425) -26.66%
Office Supplies ______________ ____—__-_._.._---___.,____467 6,973 _ ($6,506) _93.30% 190 1,473 ($1,283) __-87.10%
_Cpital outlay.. ..._...._.. — — ..... ........._. — -- ._.._�_.....-_..__.3,917 ($3,917) -100.00% ._........ 0.._..__...._1,217....— ...._._.._($1,217) -100.00%
TOTAL $325,304 $329,559 ($4,255) ($41 $289,957 $289,958 ($1) -0.00%
EXHIBIT D
The Agreement Between the Board of County
Commissioners of Monroe County and the Medical
Examiner, District 16
(The Agreement)
-I .
EXHIBIT D
AGREEMENT
•
THIS AGREEMENT entered this �-Lt;1
---�—day of � 1996,
between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA (hereinafter"County"),
5UU Whitehead street, Key West, 330,10, and
ROBERT J. NELMS,JR., MD, Medical Examiner, District Sixteen.(Monroe
County), (hereinafter "Medical Examiner"), appointed by the Governor of the
State of Florida.
WHEREAS, Chapter 4106, FS establishes Medical Examiner Districts, now,
therefore,
IN CONSIDERATION of the mutual cove
nants below:
1. CONTRACT PERIOD. This agreement is for the period October
1,1996, through September 30, 1997. This agreement shall remain in effect for
the staled period unless one party gives to the other written notification of
termination pursuant to, and in compliance with, paragraph 12 below.
2. SCOPE OF AGREEMENT. Medical Examiner shall provide the
work plan and services as described in detail in Exhibit A, an attachment to this
document, which Exhibit is incorporated herein by reference.
3. AMOUNT OF ACREEMEN'1/1'AYMEN't'. County shall
appropriate funds provided to County by the MEDICAL EXAMINERS
COMMISSION and such other funds under its control, as are required under FS
406.08(1), in accordance with the Medical Examiner's
Budget. County shall make
payments in accordance with the budget for County fiscal year ending
September 30, 1997, which budget is attached hereto as Exhibit 13 and
incorporated herein by reference, upon its approval by County. County ha:: the
authority, under FS 406.06(3), to establish reasonable salary, fees and other costs
as arc necessary for the operation of the Medical Examiner's office. The Medical
Examiner's Budget may be altered as to the individual line items, or components,
within N.% of the amount stated for that item or component, without imcrea;;inl;
the total dollar amount, and without requiring a written amendment to this
agreement.
4.
ACCOUNTING AND KL'COItUS. Records of Medical Examiner
pertaining to this Agreement shall be kept on generally recognized
principles, acceptable to County, and shall be available to the County
to a accounting
authorized representative of County, FDLE and the Auditor Cen
, y orr an
ual for audit.
Both parties shall maintain such records as are necessary to account for '
funds disbursed by the Medical Examiners Commission. Al! records relatedstate
this A lu
1,►eement shall be kept for a minimum of three years subsequent to the
i termination of this Agreement. Medical Examiner Shall be responsible for
! repayment of any and all audit exceptions identified by County or its agents or
representatives. In the event of an auditb exception, the County's obligation
under this Agreement shall be reduced if the exception is ascertained prior to the
termination of this Agreement. In the event there are insufficient moneys due lu
Medical Examiner at the time of identification and notice thereof to Medical
Examiner to cover the amount of audit exception or the Agreement has
terminated, Medical Examiner shall reimburse County for the amount of the
audit exception.
1 County shall provide the Medical Examiners Commission with
County Annual Expenditure Report, identifying total funds expended or
I encumbered and budgeted, for Medical Examiner services du
ring the current
County fiscal year (forms to be provided by Commission); a copy of the budget
I adopted by County for Medical Examiner for•FYEb
September 3�, 1J97, and a
copy of any Medical Examiner Office financial audit report prepared for County.
5. MODIFICATIONS AND AMENDMENTS. Any and all
1 . modifications and amendments of this agreement shall be approved by the
County and Medical Examiner in writing. No modification or amendment shall
I - become effective until approved in writing by both parties.
G. ASSIGNMENT. Medical Examiner shall not assign this
[I agreement, except in writing and with the �iior written approval>r I l l oval of County,
which approval shall be subject to such conditions and provisions as County may
L.
• 2
deem necessary. This agreement shall be incorporated byreference into any
y
assignment and any assignee shall comply with all of the provisions herein,
unless expressly '
p Y provided ld Ullll.►W1Sl. in an amendment authorizing such
assignment. Unless expressly provided for therein, such approval shall in no
manner or event be deemed to impose any obligation Upon either party'in
addition to the covenants and promises contained herein.
7. INDEMNIFICATION. Medical Examiner hereby agrees to
indemnify and hold harmless the County and any of its officers and employees
from and against any and all claims, liabilities, litigation, causes of action,
damages, costs, expenses- including but not limited to fees and expenses arising
from any factual investigation, discovery or preparation for litigation- and the
payment of any and all of the foregoing or any demands, settlements or
judgments (collectively the "Claims") arising directly or indirectly from any
negligence or criminal conduct on the part of Medical Examiner in the
performance of the terms of this Agreement except to the extent that, in the case
of any act of negligence, Medical Examiner reasonably relied on material
r I supplied by, or any employee of, the County. Medical Examiner shall
immediately give notice to County, by certified mail to the Mayor of County, of
any suit, claim or action against Medical Examiner that is related to the activity
under this contract and will cooperate with County in any investigation arising
as a result of any suit, action or claim related to this contract.
8. ANTI-DISCRIMINATION. Medical Examiner will not
discriminate against any person on the basis of race, creed, color, religion, sex,
age, national origin, physical handicap, or any other characteristic which is not
.
jub-related, in its recruiting, luring, promoting, ter►uin;ali►ig or any urea
affecting employment under this Agreement. Medical Examiner agrees to
include this paragraph in all contracts it enters into with other persons or entities
and to abide by all Federal and Stale laws regarding non-discrimination,
including but not limited to,Titles VI and VII of the Civil Rights Act of 1964 (42
3
I USC 2000d), Executive Orcler'11246, Executive ' '
Order 11375 and U.S. Department
of Labor Regulations (42 CFR Part 60).
9. ANTI-ICICICIIACIC. Medical-al Examiner warrants that he has not
employed, retained or otherwise had acted on his behalf any
, officer subject to the prohibition Section. • former i county
1 n in Section 2 of Ordinance No. 10-199Q or any
county officer or employee in violation of Section 3 of Ordinance Nu. - l c
and that no employee or officer of the County has anyfinancially ISO,
al l
otherwise, in Medical Examiner except for such interests permissible
by law and
or
fully disclosed by affidavit attached hereto. For breach or violation of l
this
paragraph, the County may, in its discretion, terminate this Agreement without
liability and may also, in its discretion, deduct from the contract or ,
price, or otherwise recover, the full amount of any fee, commission,1 utchatic
1 percentage,
gift, or consideration paid to the former county officer or employee.
10. PU1fL1C EN'I'1'1'Y CRIME. A person or affiliate who has been
placed on the convicted vendor list following a conviction for public entity crime
may not submit a bid on a contract to provide any1 �
goods or services to a public
�
entity, may not submit a bid on a contract with a public entity fur the
construction or repair of a public building or public work, may not submit bids
on leases of real property to public entity, may not be awarded
or perform work
as a contractor, supplier, subcontractor, or consultant under a contract with an
y
public entity, any may not transact business with any public entity in excess of
the threshold amount provided in Section 287.017, for CATEGORY TWO
period of 36 months from the date of being placed on the convicted vendor list.
11. COMPLIANCE WITH LAW. Medical Examiner shall comply
with all federal, slide, and local laws, ordinances, 1'e lll'
L �Illuns and rules
applicable to the services to be performed by each party under the terms of this
• Agreement. Medical Examiner shall maintain such licensure as is required b
law to carry out the services in this Agreement. y
�_ •
-L
4
11
II12. INDEPENDENT CONTRACTOR At all times and for all
purposes hereunder, Medical Examiner is an independent contractor and not an employee, agent or servant of the County or of the FloridaEnforcement. No statement in this Agreement Ala Department of Law
t, shall be construed so as to find
Medical Examiner or any of its employees, contractors, servants, or agents
to employees of the County or State, and they shall be entitled to none of the rights• ,
privileges, or benefits of employees of County or State.
13. TERMINATION FOR CAUSE Olt LACK O1'FUNDS AND NON-WAIVER.
A. If Medical Examiner fails to fulfill the terms of this
Agreement, or attachments, properly or on time, or otherwise violates the
provisions of the Agreement or of applicable laws or regulations
governing the Use of funds, County may terminate the Agreement by
written notice of sixty days, which notice shall specify cause. All finished
or unfinished supplies or services compensated under this A greemelit
shall, at the option of County or pursuant to stale statute become properly
of County. The County shall pay Medical Examineri fai •and
equitable
compensation for expenses incurred prior to termination of the
Agreement, less any amount of damages caused by Medical Examiner's
breach, If the damages are more than compensation payable, Medical
Examiner will remain liable after termination and County can
affirmatively collect damages.
B. In the event that the Governor appoints a successor to the
Medical Examiner named herein, this Agreement shall terminate on the
day prior to the effective date of such successor's appointment.
C. In the event that funds front County edmutot he continued at
a level sufficient to allow for the purchase of services specified herein, this
Agreement may be terminated upon givingwritten notice of thirty days
to Medical Examiner delivered in person or by nail to Medical Examiner.
5
D. County shall not be obligated to pay for any services or
goods provided by Medical Examiner after the effective dale of
termination.
E. Any waiver of any breach of covenants herein contained to
be kept and performed by Medical Examiner shall not be deemed or
considered as a continuing waiver and shall not operate to bar or prevent
County from declaring a forfeiture for any succeeding breach either of the
same conditions or covenants or otherwise.
14. INSURANCE. County shall provide insurance for Medical
Examiner in compliance with FS 406.16.
15. SEVL'RABILI'1'Y. if any provision of the Agreement shall be held
by a court of competent jurisdiction to be invalid or unenforceable the
,
remainder of this Agreement or the application of such provision other than
those as to which it is invalid or unenforceable, shall not be effected thereby; and
each provision of the Agreement shall be valid and enforceable to the fullest
extent permitted by law.
16. NOTICE. Unless specifically provided otherwise in this
Agreement, any notice required or permitted under this Agreement shall be in
writing and hand-delivered or mailed, postage prepaid by certified mail, return
receipt requested, to the other party as follows:
To County: County Administrator
Public Service Building
College Road, Stock Island
Key West, 33040
(305) 292-4441
'1'o Medical Examiner: Robert J. Nelms, Jr., MU
'P.O. Box 500878
Marathon, Pl. 33050-0378
17. CONSENT TO IUIZISU1CTION. This Agreement, its
performance, and all disputes arising hereunder, shall be governed by the laws
1 . 6
of the Slate of Florida and both parties agree that a proper venue for any action
shall be Monroe County.
18. REPORTS. Medical Examiner shall develop record-keeping
a
system which can be used to provide County with a monthly report, which shall
be submitted on a monthlybasis
asis and begin no later than a report for the month
of October, 1996, and which shall include, as a minimum the following:
A. Number of all investigations and narrative reports for non-
autopsy medical examiner cases.
B. Number of all autopsies performed.
C. Court cases and medical/legal conferences, number and
hours spent.
D. Number of authorizations for all cremations and burials at
• sea and anatomical dissections.
E. Number of hours of scene investigations.
F. Measurements of the months and year-lo-dale performance
record in accordance with the budgetary performance standard service
statements which reflect levels of community service.
C. Any other activities not described above.
H. The activity report shall be submitted by the 10th day of the
following month to the County Administrator.
19. ENTIRE AGREEMENT. This Agreement constitutes the entire
agreement of the parties hereto with respect to the subject matter hereof and
supersedes any and all prior agreements with respect to such subject mailer
between Medical Examiner and the County.
2U. FDLE. The Florida Department of Law Enforcement shall nut be
deemed to assume any liability for the acts, omissions to act, or negligence of the
County or the Medical Examiner, their agents, servants and employees; nor shall
[ County or Medical Examiner exclude its own negligence to FDLE or any third
party.
I .
7
•
IN WITNESS WHEREOF, the parties hereto have executed this
Agreeni ok, ate first above written.
e4" —73 :.,•••
e‘full
BOARD OF COUNTY COMMISSIONERS
Attest: :1 • 1.70 AGE,CLERK 01,MONROE COUNTY, FLORIDA
• • •• •-•
Alt< fasAkeA4A424..t.,
ByZirkitlfette4 I. By
epuly CILrk / • Mayor/CI mum
•
Witness
Robert J. Nelms, Jr.
Witness
APPROVED AS TO FORM
ANI;j0 _EOM:SUFFICIENC .
BY
IRA NE A. N
ATE
•
•
8
EXHIBIT
SERVICES TO BE PROVIDED BY ROBERT J. NELMS,JR., MD
This Exhibit, incorporated into the A ;reement between County
i • Medical Examiner, on the 1/, day and
of Vt: t,%`' 1996, sets forth
the services to be provided by Medical Examiner pursuant to paragraph 2
thereof:
The District Medical Examiner agrees to fulfill his duties as set forth in
Chapter 406, FS and rules promulgated by the Medical Examiners Commission
as follows:
A. OFFICE
1. The Office of the Medical Examiner shall be established and
maintained in such a manner that it provides for the necessary
facilities and personnel to accomplish its duties and responsibilities.
2. The Office shall be an independent agency.
B. APPOINTMENT
1. The Medical Examiner shall be appointed by the of the
,
of Florida. His tenure will be for he length of thaovernor ppointment which
normally is three (3) years.
•
2. The Medical Examiner shall name and appoint qualified professional,
technical, clerical and other staff of the Office. The staff shall be
directly responsible to the Medical Examiner, and shall include
associate medical examiners, secretary, forensic investigator(s), diener,
custodian, histotechnologist, et cetera.
•
C. INVESTIGATION OF DEATH The Medical Examiner or his appointed
associate medical examiners shall have the authority and responsibility:
1. To investigate and certify any death that falls in the fulluwitig
categories:
a. Criminal violence suspected
b. Suicide
c. Accidental (motor vehicle, boating, aircraft, diving,
• snorkeling, swimming, electrocution, et cetera)
d. Suddenly when in apparent good health
e. Unattended by a practicing physician (over 30 days)
f. Suspicious or unusual circumstances
9
r
g• Gunshot
h. Sudden infant death syndrome (SI DS)
i. Suspected poisoning
,--� j. Drowning
k. Abortion
1. In prison or police custody
m. In slate institution
•
n. Diseases constituting a threat to public health
o. Disease, injury, or toxic agent resulting from employment
u
p• Unexpected death associated with diagnostic or therapeutic
procedure
q. When body is to be cremated, dissected or buried at sea
r. Unclaimed bodies
s. When a dead body is brought into a new medicolegal
jurisdiction without proper medical certification
2. To take charge of the dead body upon direct notification of such death.
1-le or his duly authorized associate medical examiner or forensic
investigator shall respond to the scene upon request by proper
authorities whenever possible and appropriate. The dead body shall
not be disturbed unless permission is granted by the Medical Examiner or his designee.
I
3. To Conduct an investigation of circumstances surrounding the death in
conjunction with proper authorities.
4. To conduct all necessary examinations of the dead body which could
include performance of any autopsy and retention of whatever tissues
and biological,specimens that he deems are necessary.
5. To take possession of any object or article which, in his opinion, may
be useful in establishing the identify of the deceased and/or the cause
and manner of death.
6. To reduce his investigation and findings in writing and shall keep such
records in his Office.
7. To administer oath and have the power of subpoena.
D. SPECIFIC TASKS In order to effect above general requirements, the
specific duties itemized below describe in greater detail how duties are
._. accomplished and the responses to be made.
1. Answering telephone
i_.
a. Mode- telephone, digital pager, cellular telephone, radio
_ 10
b. Source of calls- Police,Sheriff, Navy, FBI, Highway Patrol,
National Forestry or Park Service, Coast Guard, NTSL', FAA,
funeral homes, family or acquaintances of deceased,
attorneys, insurance Companies, private investigators,
newspaper reporters, TV or radio reporters, physicians,
nurses, et cetera.
c. Nature of.calls
1. Request for oral information- toxicology results, cause of
death, mechanism of death, et cetera
•
2. Request for written information or reports - autopsies,
• statistical reports, death certificates, et cetera
3. Questions about previous cases
4. Requests for immediate scene investigations
5. Notification of deaths
6. Cremation, dissection, or burial at sea approvals
7. Scheduling depositions
8. Electronic depositions
9. Request for testimony as expert witness in court
10. Other questions or considerations
2. District Medical Examiner shall initiate such phone calls as are
necessary to carry out his duties, including but-not limited to the
following:
a. To whom:
1. Law enforcement agencies
2. Funeral homes
3. Witnesses, family, friends
4. Personal physicians or dentists
5. Attorneys
6. Others
b. Nature of calls
1. Case investigations
2. Scheduling exams or autopsies
•
3. Answering digital pager.
4. Returning phone messages
5. Calling secretary for information
6. Changing appointment limes
7. Calling for toxicology results past due
3. Subpoenas
a. Received at Office
b. If conflicts in scheduling, would necessitate phone calls to
reschedule
11
`l• Automobile travel
a• Scene investigations - up to 60 miles distant, one way,
immediate response always requested, day or night, seven
days a week- performed by Medical Examiner, associate
medical examiner, or forensic investigator appointed by
Medical Examiner.
b. Autopsies usually scheduled within 24 hours, may be 50
miles away where performed
c. Florida Association of Medical Examiners (FAME)
Conferences - usually at least once annually, in Florida, 50-
300 miles one way
d. Depositions
e. Court trial witnessing, usually 40-50 miles each way
f• Grand Jury, usually 50 miles each way, usually less than one
week's notice
5. Autopsies/Examinations
a. Time 2-4 hours, not counting travel, for autopsy, 1/2 to 1
hour for post morlem examination
b. X-rays, sometimes taken by Medical Examiner
c. Photographs
d. Collection of toxicology specimens, and/or esoteric tests
(DNA probes)
e. Gathering of some trace evidence - fluids, hair, particles,
clothing,jewelry, el cetera
f• Preparation of bones and teeth for anthropological studies
g Microscopic examination after preparation by
histolechnologist
h. Collection of insects at scene to better estimate poll modem
interval
6. Generation of reports
a. Handwritten
1. Labeling tubes, photographs and x-rays
2. Notes during autopsy
3. Nines dluriiil; telephone
4. Correspondence .
5. Preparing rough drafts on statistical reports,
correspondence, contracts, et cetera
6. Keeping case log
7. Keeping cremation log
ti. Completing death certificates
9. Budgets
10. Other reports requested
12
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLOIUDA
ETHICS CLAUSE
warrants that he/it has not employed, retained or
otherwise had act on his/its behalf any former County officer or employee in violation of Section 2
of Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of
Ordinance No. 10-1990. For breach or violation of this provision the County may, in its
discretion, terminate this contrlact without liability and may also, in its discretion, deduct from the
contract or purchase price, or otherwise recover, the full amount of any lee, commission,
percentage, gill, or consideration paid to the former County officer or employee.
(signature)
Date: 2 j)G1 /.4 ,
STATE OF l LU1e.i/7A. •
COUNTY OF ty)or,r p e
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Rohe r i J 7n(//15-/pwho, alter first being sworn by mc, affixed his/her signature
(name of individual signing) in the space provided above on this /Gi Lb day of
l it-mg , 19 W ./
I_ �-
NOTARY 1't 13LIC •
�ri;.�i•. Cnbii 0Rf1Ti itt
9 . MY TRELT0SG3und..4.1r90 0
I . My commission expires:77clr/Urit,IJL1./4 / 9 !8 € Exoa,�a
OMB -MCP FORM Il l
i_.
I • .
I _
OFFICE OF TIIE MEDICS EXAMINER
I DISTRICT SIXTEEN -- MONROE COUNTY
I FISHERMEN'S HOSPITAL* MAR/1TI-ION KEY, FLORIDA 33050
TELEPHONE 305-7,3-5533 EXT.591
, 'r
I
Line MONROE COUNTY Budget FY'97 Indented Item total
Item Expense subtotals amounts
1 310 Professional services-all other, medical examiner
178,190
and associate medical examiner
I316 Professional services-medical/surgical, $ 7,996
toxicology/radiology
I340 Contractual services-other, investigator/dicncr $ 48,066
/transport/livery services/funeral supplies
400 Travel and per diem $ 7,496
410 Phone& postage/freight $ 7,716
I 440 Rentals-all, Dig Pine Key facility $ 25,661
Hospital storage $ 1,200 $ 26,861 //��
•/, .�G, •far :.it&451 Risk Management $ 5, 0-�
460 Repair and maintenance $ 710
490 Miscellaneous expenses - all
I Secretary $ 3,953
Film $ 1,327
- Biomedical waste $ I,25 I
Supplies $ 3,087
Expenses $ 1852
ii Ilistotcchnologist $ 6,458 $ 17,928
510 Office supplies $ 1,517
I__
G40 Capital 40 I I outlay
$ 1,25,1
GRAND TOTAL •
•
Sao /70
Robert J. Nelms, Jr., M.D.
• Medical Examiner, l)istrict Sixteen
Monroe County, Florida
Auditor's Notes: Risk Management was changed to $2,157, which
changed the total to $299,891.
1
i .
e
1UN/rjn/counbud3.wpd/04I0596
VII. Auditee Responses
MEMO
From: Dr. R. J. Nelms, Jr., M.D., Medical Examiner
jI ' To: Internal Audit Department, Monroe County
Subject: Responses and comments to draft Preliminary Audit Report of Medical
Examiner's Office
The following comments are cross-referenced to the,"Audit Findings," paragraphs A-I
with subparagraphs 1 - 3: _. - - -- -- -
A. 1. No comment.
'- 2. In my opinion, revenue from any civil litigation, civil depositions, civil
consultations, etc., should not go to the county. .
B. It is my personal opinion that this is all a waste of valuable time, for me and
i anyone else involved. It appears to assume that I am totally unresponsive to
everyone around me.
C. 1. I agree with"recommendations." Under"Findings," paragraph 2 is
inaccurate. I agreed to reduce the total budget by $38,394, not my
salary. The paragraph also does not reflect how much the total budget
was decreased compared to the previous year.
2. Time sheets do not reflect all times, or how many nights or weekends
called, or the fact that we are always on call, 24 hours a day, 7 days a
week. I believe time sheets are a waste of time, they cause diversion of
mental concentration, and are demoralizing.
D. 1. Concerning"recommendation#1." a contract would limit my flexibility
in dealing with the corporation, or corporations, or individuals
performing the,services, and would be of no advantage to the county.
- Concerning"recommendation#2," the flat fees were based on a two-
_ year study for"appropriateness" from 1988 and 1989, then averaged
monthly, similarly to M.E. salaries. Workload has increased from 110 to
140 autopsies, but flat rate has only been adjusted for inflation, not the
workload. W.S.Enterprises'has provided the work of 3 employees
working or on call 24 hours per day, 7 days per week, 52 weeks per year.
2. Travel expenditures are well documented on travel vouchers, and do not
adequately cover the cost of maintaining a vehicle now. Vehicle used
cannot be used for anything else due to odor of decomposed bodies.
E. 1. No comment.
2. I disagree that my cellular is used for convenience when a standard
phone is available. This would be a rare exception, usually involving a
long distance medical examiner call out of the 305 exchange, which the
hospital will not pay for. Also, the need for three cellular phones is easy
' to explain: one for the medical examiner, one for the associate ma cal
examiner, and one for the forensic investigator/diener/livery service.\\
I�
MEMO p.2
•
3. I agree that the payment of late fees is not appropriate if the county's
reimbursement to me from the previous month is not late.
1 F. No comment.
G. I agree that the county should provide a decent and adequate facility as
provided for by law.
H. 1. If the county will require any particular documentation, and will be
specific,.I will be obligated to require the same documentation from all
entities providing any and all services in same category, or else body
cannot be moved or removed at all. I would question whether the county
would really want to become involved, since there is a"hold harmless"
clause in the Medical Examiner contract with the county.
2. I would have to keep on file copies of the annual inspection of all
companies removing or moving bodies, not just W.S.Enterprises, or I
will not be able to allow the body to be removed at all, and the body.will
have to remain at the scene. I can foresee all kinds of difficulties with
this, whereas now everything is functioning smoothly with all entities
cooperating with each other voluntarily. Why fix it if it isn't broken?
3. If a removal log is required by the county, then all services and
companies doing removals in this county, even if from another county,
will be required to submit a"removal log" to this office. Again, this is
more work for everyone and will result in problems that do not exist
now.
I. I agree.
Respectfully submitted,
R. . Nelm Jr. M.D.
Medical Examiner, District Sixteen
RJN/rjn/budgmemo.doc/07 1 097
•
MEMORANDUM
TO: Danny L. Kolhage
Clerk of the Court
FROM: James L. Roberts
County Administrator _
DATE: July 14, 1997
SUBJECT: Preliminary Audit Report- Medical Examiner's Office
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
The County has reviewed the preliminary audit report provided by your internal
auditor on May 22, 1997. In an effort to respond appropriately to that audit, the County
was in contact with Dr. Robert Nelms, Jr. , the Medical Examiner, to obtain information.
It is our understanding that Dr. Nelms is obligated to respond separately to the draft audit
and that he has done so by providing hand written comments on the draft.
Since Dr. Nelms has submitted those comments from his perspective, and since
many of those pertain directly to his responsibilities for the operation of his function and
reporting requirements, rather than providing an item by item further explanation, the
' discussion below is intended to be the Administration's response. The Clerk should be
reassured that the County will address the issues raised and attempt to have new systems
in place within the next fiscal year.
The County will pursue the contract with the Medical Examiner based upon the
following:
• The Medical Examiner should continue to be an independent contractor.
• The contract should be performance based, with the scope of services to be provided
by the medical Examiner being defined specifically therein and/or by reference to
applicable statutes and codes.
• The Medical Examiner should be allowed to subcontract for services as he deems
necessary and be ultimately responsible both operationally and financially for any
such subcontracts.
• All work performed and services provided by the Medical Examiner and/or any of his
subcontractors are to be in compliance with applicable federal, state, and local laws,
ordinances, regulations and rules.
• Compensation provided under the agreement should be intended to cover the
anticipated normal activities/work load of the Medical Examiner based upon past
statistics and reasonable projections, and should be disbursed through pro rata
monthly payments. In the event of a disaster or occurrence unusual in nature or
magnitude, the Medical Examiner should petition the Board of County
Commissioners for reimbursement of all extraordinary expenses and compensation
due to the disaster.
• The Medical Examiner should develop a schedule and customary fees which he will
charge for specific services. Such fees should be retained by the Medical Examiner,
• thus reducing the overall County funding for medical examiner activities.
• The County should continue to provide an appropriate facility for medical examiner
activities.
It is, of course, the County's obligation to provide an appropriate facility for the
Medical Examiner. The present facility on Big Pine Key appears to be in the process of
being sold or leased by the present owner. That structure is part of the property including
a cemetery. The owner has indicated to the County that any deal would be for the entire
property, thereby requiring the County to become the owner of the cemetery. Because of
the values involved and because of that last obligation, the County will not be pursuing
the acquisition of that property. However, discussions will continue in the event that
other arrangements can be developed. In the interim, the County is operating on an
extended lease for the Medical Examiner.
In addition, the County is looking at longer term solutions. One possibility is to
develop a new facility on a parcel in Marathon. In the near future, the Administration
will be discussing with the Board of County Commissioners the possible purchase of the
site in Marathon for other government services. There would be room on that site for a
medical examiner facility.
In addition, there is always the possibility of locating the medical examiner
facility near the detention facility on Stock Island. Already, the Public Works Division is
looking into costs associated with these options.
Therefore, the Administration is taking affirmative steps to address the issues in
the audit. In those areas where Dr. Nelms feels some of the requirements may be
onerous, the Administration will work with him to satisfy the requirements and comply
with the appropriate laws and regulations.
James L. Roberts
JLR:dlf
cc: Jim Hendrick, County Attorney
Kirk Zuelch, State Attorney
Sandee Carlile, Finance
MEMORANDUM
TO: Sandra Mathena, Internal Auditor
FROM: Rob Wolfe, Chief Assistant County Attorney
DATE: May 28, 1997
RE: Preliminary audit of the Medical Examiner's Office
With regard to the first item requested from the County Attomey's Office, on page
8, concerning the reporting and disposition of revenues, Suzanne Hutton has already
prepared the suggested changes and forwarded same to the County Administrator's
Office. See attached.
With regard to the second item, on page 27, concerning the inconsistency
between Chapter 63-1636 and current practice. Chapter 63-1636 is not a County
ordinance, but rather a special act of the Legislature. Sec. 406.17, F.S., part of the
Medical Examiner's Act, provides, among other things, that special acts inconsistent
with Chap. 406, F.S., are superseded. Under Sec. 406.08, F.S., the BCC is authorized to
establish the medical examiner's fee schedule. In doing so, the Board is not restricted
to any specific amount. In my opinion, this is an inconsistency with the specific fees in
Chapter 63-1636. Therefore, Chapter 63-1636 is superseded by Chapter 406, F.S. Any
,�- other mandates in Chapter 63-1636 that are inconsistent with current County
procedures, etc., authorized by Chapter 406, F.S. (whether directly or by implication),
are likewise inconsistent with the general law and so are also superseded. As a result, I
do not think any action is needed from this Office or the BCC on this auditor item.
RW:aa