Floyd County looks at medical examiner options, including new investigators

By Bob Steenson, bsteenson@charlescitypress.com

The Floyd County supervisors and others are working to make sure the county isn’t without a medical examiner when the new year begins, including considering adding a new kind of death investigator to the county’s resources.

A county medical examiner (ME) performs a number of important duties, including establishing the cause and manner of death for people who die under violent, sudden or unexpected circumstances, working with law enforcement, determining when autopsies are required, signing some death certificates and issuing a permit before any body can be cremated.

In Floyd County over the last 10 years Drs. Paul Royer, David Schweizer, David Schrodt, Joseph Molnar and Janet Tull had been the ME or ME alternates during all or part of that time.

Last July, the remaining four doctors sharing the duty – Royer, Schweizer, Schrodt and Tull – sent a letter to the Board of Supervisors, saying they would no longer provide medical examiner services to Floyd County effective Nov. 1.

County Auditor Gloria Carr said at that time that they were asked to extend the deadline to the end of the year and they agreed. The county medical examiner or examiners are appointed by the supervisors as part of their organizational meeting the first week in January.

At the Board of Supervisors meeting this week, the board discussed options to provide that required county service, including establishing a team of medical examiner investigators – MEIs – who would report to a medical examiner.

At the meeting were Mark Bethel and James Kruse, community health consultants with the Office of State Medical Examiner in Ankeny, who had been invited by Dawn Staudt, the station supervisor for AMR ambulance service in Charles City and Floyd County.

Staudt said she had talked with Dr. Schrodt, who is also the medical director for AMR, and he had said he would be willing to continue in the ME role if the county established MEIs to do the primary field work.

Staudt said there were several AMR employees including herself who would be interested in becoming MEIs. She also said they would put rules in place so that a person responding as an MEI could not also be involved in the ambulance team response for that case.

Bethel said his goal is to keep an ME in place in Floyd County, and one way to do that was with a team of several MEIs who could do the field work and be on call 24/7.

He said state death statistics show Floyd County has had an average of 162 deaths a year over the last several years. Of those, an average of 42 per year required an ME’s involvement, and of those, an average of 26 percent per year were sent to the state office for autopsy. Based on those numbers he recommended the county have a team of about four MEIs.

Sheriff Jeff Crooks asked about the training involved in becoming an MEI.

Bethel, who works with physicians and trains county MEIs throughout the state, said MEIs should have a background in medicine, such as an emergency medical technician (EMT) or a paramedic, or a background in law enforcement.

He said he could work with persons who are interested in becoming MEIs within the next couple of weeks. At a minimum he would like them to come down to the Office of the State Medical Examiner in Ankeny for a day, preferably two days.

The training is free, and he even buys lunch, Bethel said.

Sometime within their first two years they would be expected to take more advanced training over about a week.

“I’m happy to do whatever it takes to serve your county,” Bethel said. “I’ll get them up to speed enough in one day where they’ll know what questions to ask, who to work with, how to work with them, and why. But then it’s going to take several scenes for them to be comfortable.”

Bethel said he had worked about 1,600 death cases, including 1,400 to 1,500 for the state.

“So I have been there, done that. Got the shirt. I have made every mistake possible you can make in the field. I have learned from those. And I give that to the new MEIs,” he said.

When the supervisors had received the letter from the doctors, Chief Deputy Pat Shirley had said that having a medical examiner on the scene of a dead body is valuable, because they notice things that a deputy might not see as important, and they can determine if an autopsy should be performed to establish cause of death and gather other evidence.

Bethel said, “The only way that investigation works from a medical examiner standpoint is if you have a very good working relationship and a level of trust with the county sheriff’s office, with local city police, with DCI,” referring to the state Division of Criminal Investigation.

“I teach county MEIs how to communicate with them, how not to communicate with them. Things that can be missed and things that you absolutely cannot miss,” he said.

“Your take-away from me today is that the medical examiner system for any county in Iowa is an insurance policy for cases that are foul play, that they’re not missed and for keeping people from being misidentified,” Bethel told the supervisors.

A body that is misidentified then released to a family, or even cremated, then later found out to not have been that person, is a worst-case scenario and a guaranteed devastating lawsuit, Bethel said.

The supervisors had briefly discussed a couple of options when they received the doctors’ letter, including sharing an ME with another county or finding retired physicians to do the job. Monday’s meeting was the first time the MEI option had been discussed.

The group briefly talked about compensation for MEIs. Bethel said typically they are paid for being on call, then paid for each incident they are called to.

“I’ve seen anywhere from $85 up to $300, $350,” he said, adding that it’s a good idea to build a system that increases pay as they gather experience, because the longer an MEI is on the job the better he or she becomes at it and they’ll want to hold on to those experienced investigators.

Auditor Carr said that currently the doctors are paid by the Floyd County Medical Center for ME duties, then FCMC bills the county about $125 to $175 per case.

She wondered whether MEIs would be considered county employees or have contracts for services, and how insurance would be handled.

Carr told the supervisors that adding an MEI service could be expensive and they should be prepared for an impact on the county budget.

Supervisor Chair Mark Kuhn said, “We really don’t have an option,” with the current medical examiners unwilling to continue, but one possibly willing to stay on.

“I think we need to talk to Dr. Schrodt and proceed with this appropriately,” he said.

Kuhn asked Supervisor Jim Jorgensen to talk with Schrodt, and asked Carr to investigate how some other counties are handling the situation and to gather some sample contracts for MEIs.

Bethel said he could start training people as early as next week, and Kuhn said they should try to do that. When it was pointed out that next week is the week of Thanksgiving, Bethel said, “Well, if they’re not comfortable with next week then the week after. I’ll make it work. Whatever it takes.”