Cost of forensic autopsies for county to remain unchanged for 2003-04

By Kathy Helms-Hughes

   Carter County will hold the line in its 2003-04 budget on the amount it pays the James H. Quillen College of Medicine for autopsies, according to County Finance Director Jason Cody.
   During Tuesday evening's budget workshop, Cody passed out copies of a letter from East Tennessee State University's Department of Pathology which discussed the budget for forensic autopsies.
   According to Dr. John B. Schweitzer, chair of the department, Carter is one of eight counties in the First Tennessee Development District that agreed in fiscal year 1997-98 to pay a total of $231,022 to the ETSU Forensic Division. That amount covered both fixed and variable costs associated with meeting the counties' autopsy needs that fiscal year.
   The amount paid by each was apportioned by the counties themselves and was not linked to the number of autopsies ordered per county, according to Schweitzer.
   In 1997-98, counties paid the College of Medicine $231,022 for 209 autopsies. In 2001-2002, the college received the same amount of money for 305 autopsies -- a forensics caseload increase of 46 percent.
   While not all of the counties have had an increase in autopsies, most have, Schweitzer said, and "there is no evident incentive to hold down the numbers of autopsies ordered."
   Cody said that, due to the increasing number, the College of Medicine has encountered issues ranging from a backlog in cases and space shortage in the morgue, to the need for more medical examiners.
   Schweitzer said it is "undeniably true" that some autopsies ordered by the counties "simply are not medical examiner cases," and that others could and should be signed out at the scene of death without ordering an autopsy.
   ETSU's Forensic Division has limited resources to meet the increased demand and this fiscal year is implementing a different method of charging for forensic services, Dr. Schweitzer told County Executive Dale Fair in the letter.
   The counties will continue to appropriate the same $231,022 set in 1997-98, and, in return, will receive the same number of autopsies it received that year, plus an additional 20 percent.
   "What has happened is they're trying to go with a set amount and then basically give you an allotment," Cody said. In 1997-98, Carter County had 18 autopsy cases; in 2001-02, that number rose to 21; in the new fiscal year, the proposed allotment is 22. The county paid $28,063 during each of the prior fiscal years for those autopsies.
   In 2003-04, Cody said, "If we go above that 22 allotment, we get charged an additional fee of $1,000 per autopsy. I know in Sullivan County it's a big issue. They had 71 autopsies the prior year and their allotment this year is only 48. So it becomes a very big issue. Our prior year number was only 21 autopsies, so we're pretty close."
   Cody said he does not expect the county to exceed its allotment.
   Schweitzer said that cases exceeding the allotments require additional expenditures, including overtime for College of Medicine personnel, reagents, protective supplies and more.
   The average amount charged per case just for toxicology and microbiology evaluations is more than $200, or over 20 percent of the $1,000 proposed for additional cases, he said. "The $1,000 figure is also less than what Memphis and Knoxville charge for additional outside cases." Memphis charges $1,500 while Knoxville currently charges $1,300 but is considering an increase, he said.
   Dr. Schweitzer also stated that the Forensic Division is "less interested in generating more revenues than it is interested in reducing the number of cases ordered."
   Cody said autopsies in Carter County now can be ordered by the investigating officer, or, under certain circumstances, by the coroner.
   "Families typically can request one, but unless there are valid reasons, it won't be paid for. The family can pay for it individually if they would like," he said.