HomeMy WebLinkAboutMedical Examiner ExpensesMedical Examiner - Expenses report #13/14-9 April 2014
Medical Examiner – Expenses
To request this information in an alternate format, please call (541) 330-4674 or send email to David.Givans@Deschutes.org
Deschutes County,
Oregon
David Givans, CPA, CIA, CGMA
Deschutes County Internal Auditor
PO Box 6005
1300 NW Wall St, Suite 200
Bend, OR 97708-6005
(541) 330-4674
David.Givans@Deschutes.org
Audit committee:
Jennifer Welander, Chair - Public member
Chris Earnest - Public member
Gayle McConnell - Public member
Jean Pedelty - Public member
Michael Shadrach - Public member
Anthony DeBone, County Commissioner
Dan Despotopulos, Fair & Expo Director
Nancy Blankenship, County Clerk
Medical Examiner- Expenses report #13/14-9 April 2014
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Medical Examiner- Expenses report #13/14-9 April 2014
TABLE OF
CONTENTS:
HIGHLIGHTS
1. INTRODUCTION
1.1. Background on Audit …………………………………………………………. 1
1.2. Objectives and Scope ………………….……………………………..……… 1
1.3. Methodology …………………………………….…………………...…...… 1-2
2. BACKGROUND ………………………………………………………………… 2-3
3. FINDINGS
3.1. Medical Examiner Expenses ……………………………………………… 3-5
3.2. Funeral Establishment Schedule …………………………………………. 5-6
4. MANAGEMENT RESPONSES
Deschutes County District Attorney’s Office ……………………...….. 6-7
Deschutes County Medical Examiner ………………………………….... 7
Medical Examiner- Expenses report #13/14-9 April 2014
HIGHLIGHTS
Why this audit was
performed:
The costs for the Medical
Examiner were reviewed at
the request of the District
Attorney
What is recommended
Recommendations
included:
establishing the types
of anticipated
transportation
expenses to be covered
with the service
provider(s).
having Medical
Examiner review
invoices prior to
payment.
having Medical
Examiner periodically
review the rotation
schedule for fairness
and equity.
Medical Examiner - Expenses
What was found
The Deschutes County Medical Examiner works under the supervision and in coordination with the State
Medical Examiner. In each County there shall be a medical examiner for the purpose of investigating and
certifying the cause and manner of deaths requiring investigation (ORS §146.065). The County pays
costs directly associated with death investigations. The largest variable expense is for the transport of
human remains to the State Medical Examiner’s Office for autopsies.
The District Attorney’s Office is provided a budget by the County to pay for death investigation costs.
Transportation charges invoiced to the Medical Examiner vary. These are expenses for transportation to
the State Medical Examiner's Office (in Clackamas) for autopsies. Currently, the funeral establishments
housing the human remains are tasked with providing transportation. Transportation charges vary by
funeral establishment. Review of charges has been sporadic and focused on irregular charges. There is
some coordination between the Medical Examiner and the District Attorney's Office on these charges, but
the Medical Examiner does not routinely review the expenses and no one is comparing costs charged.
The current rotation schedule for funeral establishments was interpreted incorrectly. In the beginning of
2014, the 2013 rotation schedule was utilized for directing agencies and families to a funeral
establishment (if not directed). Since the rotation schedule was established for odd and even years,
using the 2013 schedule unfairly repeated the months for one funeral establishment. A correction was
suggested that put the funeral establishment back on the original rotation and substituted the months
received by the wrong funeral establishment. The Medical Examiner under state statute has
responsibility for designation of the funeral establishment when not designated by the family or friends.
This designation shall be fair and equitable among the funeral establishments.
Deschutes County Internal Audit
Medical Examiner- Expenses report #13/14-9 April 2014
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1.
Introduction
1.1 BACKGROUND ON AUDIT
Audit Authority:
The Deschutes County Audit Committee authorized the review of the Medical Examiner (ME) Expenses
handled by the District Attorney’s Office in the Internal Audit Program Work Plan for FY 14/15. The District
Attorney’s Office works closely with the appointed Medical Examiner.
Deschutes County is responsible under ORS §146 – Investigations of Deaths, Injuries and Missing Persons
to pay for certain operating costs of the Medical Examiner. These costs have historically been included in
the budget of the District Attorney’s Office.
1.2 OBJECTIVES and SCOPE
Objectives:
Objectives included
a) Review of County expenses for medical examiner program. This also included a review of potential
cost reimbursements from the State.
b) Discussion regarding vendor relationships, which included scheduling and oversight of expenses.
c) Discussion of current schedule of funeral homes assigned by the County Medical Examiner.
Scope:
Work was to be performed in March 2014 on selected records. When possible, trends over five years will be
shown.
1.3 METHODOLOGY
Audit procedures included:
Obtaining selected fiscal and operational data for the medical examiner operation.
Researching appropriate state laws and rules involved in this area.
Reviewing and analyzing fiscal and operational information.
Reviewing selected invoices for the Medical Examiner for transportation costs.
Correspondence and discussions with appropriate County staff (including the Medical Examiner)
We conducted this performance audit in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
DESCHUTES COUNTY
INTERNAL AUDIT
REPORT
Medical Examiner- Expenses report #13/14-9 April 2014
Page 2 of 7
believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on
our audit objectives. (2011 Revision of Government Auditing Standards, issued by the Comptroller General of the United States.)
2.
Background
Graph 1:
Deschutes
County annual
per capita
trends for
County deaths,
ME cases, and
ME autopsies
The Deschutes County Medical Examiner works under the supervision and in coordination with the State
Medical Examiner. In each County there shall be a medical examiner for the purpose of investigating and
certifying the cause and manner of deaths requiring investigation (ORS §146.065). The County is
responsible for certain costs of the Medical Examiner’s Office and currently has a contract with the County
Medical Examiner in order to compensate them for their time. In addition, the County pays costs directly
associated with death investigations. These costs are included in the budget for the District Attorney’s
Office. The largest variable expense is for the transport of human remains to the State Medical Examiner’s
Office for autopsies.
Source: Oregon Health Authority
As indicated above, the overall trends through 2013 indicate a relatively flat if not decrease in the number of
Medical Examiner (ME) cases and a relatively flat number of ME autopsies. These rates of Medical
Examiner involvement mirror but are slightly lower than the statewide averages.
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Graph 2:
Trend in
Medical
Examiner
expenses by
fiscal year
{Source: County financial records}
As indicated above, expenses have declined slightly with the overall decline in medical examiner cases.
Expenses include death investigation costs as well as costs for the operation of the Medical Examiner’s
Office. On average, the County cost per medical examiner case is over $300.
3. Findings The audit was neither designed nor intended to be a detailed study of every relevant system, procedure or
transaction. Accordingly, the opportunities for improvement presented in the report may not be all-inclusive
of areas where improvement may be needed and does not replace efforts needed to design an effective
system of internal control.
A significant deficiency is defined as an internal control deficiency that could adversely affect the entity’s
ability to initiate, record, process, and report financial data consistent with the assertions of management in
the financial statements. Findings would not be considered as significant deficiencies.
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3.1 Medical Examiner Expenses
Table 1:
Service cost
examples by
funeral home
Transportation charges to Medical Examiner vary.
The primary expense outside of the Medical Examiner’s Office is for transportation to the State Medical
Examiner's Office (in Clackamas) for autopsies. Currently, the funeral establishments housing the human
remains are tasked with providing transportation. Transportation charges vary by funeral establishment (See
Table 1). The approaches to charging labor appear to vary in amount and rate by funeral establishment.
The Medical Examiner and District Attorney’s Office do not think there should be body bag charge since
there should have been a body bag provided by law enforcement or one charged to the family when the
remains were moved to the funeral establishment. Charges vary among all of the funeral establishments.
Funeral
Establishment
(Bend)
Transportation Cost
(example)
Labor
(example)
Other
charge
(example)
TOTAL
Funeral
Establishment 1
$520
(appears to be a flat rate)
$210
10.5 hours @
$20/hr.
$730
Funeral
Establishment 2
$520
(appears to be a flat rate)
$160
8 hours @ $20/hr.
$150
(body bag)
$830
Funeral
Establishment 3
$525
(appears to be a flat rate)
$210
10.5 hours @
$20/hr.
$735
Funeral
Establishment 4
$540
(appears to be a flat rate)
$100
2 hours @ $50/hr.
$150
(body bag)
$790
The County is responsible for death investigation expenses incurred by the Medical Examiner. These
charges are varied and follow the requests of the Medical Examiner. It was not clear from the laws and rules
governing Medical Examiner responsibilities and funeral establishment responsibilities that transportation
services are to be provided by the funeral establishments.
In the absence of establishing the services to be paid and at what cost, the County may be paying more that
Medical Examiner- Expenses report #13/14-9 April 2014
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it should.
Review of charges has been sporadic and focused on irregular charges. There is some coordination
between the Medical Examiner and the District Attorney's Office on these irregular charges, but the Medical
Examiner does not routinely review the expenses and no one is comparing costs charged.
It is recommended the Medical Examiner and District Attorney’s office establish the types of
anticipated transportation expenses to be covered with the service provider(s).
It is recommended the Medical Examiner provide a level of review for invoices prior to payment.
Documentation of this might be expedited if the Medical Examiner communicated anticipated
services by human remains and vendor to the District Attorney’s Office. Unusual services or
charges received can be verified with the Medical Examiner.
Note: County Legal Counsel can be a good resource for potential methods to obtain the best pricing
for these transportation services. Resolution might require additional research into the responsibilities
of the funeral establishments for transportation.
3.2 Funeral Establishment Schedule
Suggested fix to rotation schedule for funeral establishments addresses error.
In the beginning of 2014, the 2013 rotation schedule was utilized for directing agencies and families to a
funeral establishment (if not directed). Since the rotation schedule was established for odd and even years,
using the 2013 schedule unfairly repeated the months for one funeral establishment. A correction was
suggested that put the funeral establishment back on the original rotation and subs tituted the months
received by the wrong funeral establishment.
Oregon statute (ORS §146.109) provides the Medical Examiner has responsibility for designation of the
funeral establishment when not designated by the family or friends. This designation shall be fair and
equitable among the funeral establishments. The current rotation schedule was prepared by the Medical
Examiner in 2008. The funeral establishments receiving the human remains are also the ones that have
been used for transportation when an autopsy is required.
In the absence of a change, one funeral establishment will get an additional two months of referr als.
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In the absence of a new schedule, agency staff started using 2013 over again, not realizing the schedule
was presented for odd and even years.
It is recommended the Medical Examiner periodically review the rotation schedule for fairness and
equity. It appears the corrected rotation schedule for 2014 is a reasonable approach to fixing the use
of the 2013 schedule in 2014. It should be made clear the schedule is for odd and even years going
forward.
4.
MANAGEMENT
RESPONSES –
Deschutes
County
District
Attorney’s
Office,
Mary Anderson,
Chief Deputy
County District
Attorney
I would like to say thank you and outline how your involvement helped. The issue
of the funeral homes and the County Medical Examiner was one of custom and
practice dictating procedures. It was troublesome to me that charges were being
set by the vendors and the oversight was through the County Medical Examiner
who was not responsible for the budget.
Your audit helped to clarify roles the roles of the District Attorney’s Office, the
County Medical Examiner and the funeral homes. The audit also identified options
for resolution of the current issues and provides a historical record if the issues and
obligations for the future.
1. It is recommended the Medical Examiner and District Attorney’s office establish the types of anticipated
transportation expenses to be covered with the service provider(s).
Agree. A Letter has been sent and responses are due by June 2014. An annual meeting is to be held with
Medical Examiner in June to go over pricing.
2. It is recommended the Medical Examiner provide a level of review for invoices prior to payment.
Agree. This will be done on a monthly basis when we receive invoices from the funeral Homes. The
Medical Examiner will be contacted with any questions if there is a charge that is not consistent with the price
sheet. Currently, we are contacting the Medical Examiner with any questions.
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County Medical
Examiner,
Dr. Deanna St.
Germain, D.O.
It is recommended the Medical Examiner periodically review the rotation schedule for fairness and equity.
Agree. This is done. The letter indicates the Medical Examiner may change the rotation at any time, but
the current schedule is in place.
A letter was drafted for the Funeral Homes noting the schedule is up to the County Medical Examiner, price
lists were required each year, and the County Medical Examiner would set the price.
No additional comments.
{End of Report}
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