16th District Medical Examiner Nominating Committee

Meeting – June 8, 2017

The initial meeting of the District 16 Medical Examiner Nominating Committee was held on June 8, 2017 at the Marathon Government Center – BOCC, located at 2798 Overseas Highway, 2nd Floor, Marathon, FL 33050.

The meeting was opened by State Attorney Dennis Ward at 10:19 a.m.

Attendees

Carol Welsh, Chief Kris Digiovanni, Sheriff Rick Ramsay, Patrick McCullah, Hal Leftwich, Cynthia Hall, David Clay, Victor Palacios, Tony Allen, Robert Dean, Alghidak Salama, Mark Wilson, Dennis Ward, Barbara Stroud, Karen Merriam, Roy Bogue and Dr. Stephen Nelson via telephone.

Dennis Ward opened the meeting by stating we had some problems with our past Medical Examiner. A hearing was held to determine whether or not Dr. Beaver’s contract was going to be renewed, the Commission came down and took testimony as to the concerns of our community and recommended that the contract not be renewed.

Interim Medical Examiner

Dr. Beaver’s contract ended the end of May. Both Dr. Beaver and the County have agreed on a one month extension, until the end of June during which time he will work on completing any unfinished medical examinations that need to be performed and finishing outstanding examinations due to things like toxicology and so forth.

We are almost in agreement with Dr. Michael Steckbauer to serve as our Interim Medical Examiner until a permanent Medical Examiner is chosen. Dr. Steckbauer and Ms. Hall are in the process of finalizing the contract. Dr. Steckbauer has served as Interim Medical Examiner under both Dr. Beaver and Dr. Schuermann. Dr. Steckbauer has worked with the staff members of the Medical Examiner’s Office, he has some institutional knowledge, and he knows the county, which will be very effective as he serves as Interim Medical Examiner.

We have given Dr. Steckbauer a copy of the Clerk’s audit so he can see what the concerns were and what County and the Clerk perceived as the deficiencies of the last contract.

This process for acquiring a Medical Examiner is spelled out by Administrative Rule Chapter 11G 5.004 which tells specifically the type of person and the required qualifications for the person we are looking for.

What are we looking for?

A discussion was held as to what we would look for in a new Medical Examiner.

  • We need to make sure that whomever we select needs to have a good relationship with the law enforcement community.
  • Some of the candidates that we’ve seen so far may require us to set up some kind of out county transportation for autopsies and things we perhaps may not want to get in to.
  • We need to have someone who is qualified to sit in and testify and be part of the solution long term is really important.
  • The person needs to be able to deal with all areas of the county in a professional manner.
  • We need to look at funding for the Medical Examiner’s office to have their own van and people to transport the bodies. The county is 120 miles long and it’s very difficult for 1 person to be in two places at once. The funeral homes have always backed them up when they were too busy and it seems to have worked well in the past and they would be willing to help backing them up; however, the ME Office needs to have the funding, the vehicle(s) and the people.
  • Besides the cost of the funeral homes having their employees out assisting the ME Office when they have their own business to run, the funeral homes also don’t want that image – a lot of times people got confused and thought the funeral home employees were employees of the Medical Examiner’s Office. If the Medical Examiner is going to be reflecting our county he needs to understand he is reflecting everybody in the county. The funeral homes will be happy to back up the County; however, the way the funeral home does a removal and the way the Medical Examiner does a removal are two entirely different things.
  • Very important to keep communication open. This is a small county but we all play an intricate part so everyone needs to be informed.
  • It’s critical to have a strong working relationship with Law Enforcement, cooperation, partnership and respect. The Medical Examiner needs to treat people the way he wants to be treated.
  • Build a great collaboration to better serve our community. Florida has a “no denial” policy and we want a “no denials” for the organ procurement agencies to do recovery. We want no denials on the part of the Medical Examiner; there is no reason for a Medical Examiner to deny organ or tissue recovery. If the organs or tissues are damaged, they typically are not suitable for recovery. It should not be an issue, but if it is an issue the State Medical Examiner Commission needs to know about it. The transportation costs for organ or tissue recovery would be borne by the organ procurement agency, not the Medical Examiner.
  • The Medical Examiner needs to be competent per Chapter 406.
  • The county is looking to be able to enter into a reasonable contract. The amount currently set aside for the salary of the Medical Examiner is approximately $220,000 per year plus benefits. The contract will provide funding for the Medical Examiner’s Office (approximately $57,000 per month) which will cover staff (secretarial, transportation and workers/technicians) and expenses. Anything left over is the profit of the Medical Examiner.
    • The County pays all utilities directly; these charges are not taken out of the Medical Examiner’s budget to run the office.
  • We probably need to look at increasing the budget in order to get one to two vans and personnel for coverage to transport bodies. Maybe house one at the north end of the county and the other at the south end.
  • There needs to be contingencies available that the County is aware of to cover such things as a major crash with a number of fatalities and the drug epidemic that everyone is experiencing around the State, which could severely impact the ME budget.
    • Hall stated that there currently is a contingency in place in case of a disaster or an opioid epidemic where the Medical Examiner can go back to the County Commission and ask for more money.
  • Indigent burials and cremations need to be respectful and timely.
  • There needs to be collaboration between hospitals, the funeral homes and Medical Examiner’s office. Beyer’s has been very helpful with temporary storage for bodies.

Applicants / Qualifications

Administrative Rule Chapter 11G 5.004 says to seek applicants from interested candidates who are licensed physicians and experienced practitioners of pathology. Seek those experienced practitioners of pathology who possess the qualifications to take the examination or already possess the primary certification offered by the American Board of Pathology. There is no Administrative Rule requiring that someone must have boards in forensic pathology, just that they possess the primary certification which is anatomical or clinical pathology.

We have advertised at the State and National level that all pathologists subscribe to or receive. The deadline on these advertisements is June 30, 2017. The pool of forensic pathologists is small; there are only about 400 in the country, so we may end up with only a few more resumes.

The forensic pathology board is a one year fellowship in an ACGME accredited program in order to even sit for the board examination. It’s important to have the forensic pathology board for homicides, suspicious deaths, diving accidents which are unique to the Keys. Someone that has knowledge of diving physiology would be helpful.

We did reach out to the lady that was our #2 choice last time. She is currently in Tennessee and undergoing some health concerns and is unable to be considered at this time.

We have a total five (5) applicants so far; however, only two (2) of them are board certified in forensic pathology. Dr. Steckbauer and Dr. Schultz are both board certified forensic pathologists.

Dr. Li does a lot of work here in Marathon and the Upper Keys, but he doesn’t have the forensic component. Dr. Li has boards in anatomic pathology and clinical pathology

Dr. Gillespie has no boards at all. Dr. Gillespie has been out of training for a significant period of time, and his board eligibility to take the examination has lapsed. Dr. Gillespie would not be eligible to take an American Board of Pathology examination unless he was to go back and seek additional (ACGME) Accreditation Council for Graduate Medical Education training in some specialty of pathology or forensic pathology.

The other two (2) candidates are lacking some of the requirements. Dr. Dolan is not a licensed Florida physician nor is he a pathologist. He is an emergency medicine physician; he does not meet the Administrative Rule criteria for this position.

Interviewing Process

The State Attorney’s office did the background checks. Last time interviews were held before the entire Committee. Telephone interviews with one or two of them and face to face with the rest. It’s better to have face-to-face interviews. After the interviews, the Committee critiqued the applicants; good, bad, etc. which narrowed them down to two (2) people, Dr. Beaver and the young lady which ended up as our #2 choice. The Committee talked to some pretty impressive people, it was a very hard choice last time and hopefully we will have the same this time with good people.

There’s a real shortage of getting people to apply. The pool will probably be limited due to the opioid epidemic. Medical Examiners are hiring a lot of associates in order to meet this problem.

For this interviewing process, the State Attorney’s office will do the background check and everyone will come down and be present during the interview process. This will give applicants the opportunity to see the lay of the land, see the Medical Examiner’s Office. If the applicant chooses not to come, that probably tells us a lot about their level of interest.

Current Staff

Currently there are two (2) technicians, one secretary and a part-time bookkeeper. These employees are employees of Dr. Beaver and we are probably going to lose one of the technicians when the Interim Medical Examiner takes over.

Timeframe

At 12:01 a.m. on July 1, 2017 the Interim Medical Examiner will step in, unless Dr. Beaver leaves earlier. Dr. Beaver’s contract will end on June 30, 2017 at Midnight.

The Governor has no timeframe in which to appoint a person to this position.

If we have issues with the Medical Examiner, like we have in the past, who do we bring those concerns to?

  • Nelson responded that any questions or problems should be brought to the Medical Examiner Commission. The quicker they find out about a problem or concern, the quicker it can be solved. Also, surveys are sent out every three (3) years, that’s the term of the gubernatorial appointment for this position, and they really want the people to be totally candid and honest when completing these surveys.

Next Meeting

The next meeting of the District 16 Medical Examiner Nominating Committee will be Wednesday, July 12, 2017 beginning at 10:00 a.m. in the same location, Marathon Government Center, BOCC Chambers, 2798 Overseas Highway, 2nd Floor, Marathon, FL.

The plan is to interview all qualified candidates at this meeting.

The meeting closed at 11:00 a.m.