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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 11 findings
F1
Page 169
The Coroner has enlarged its morgue space and has built an adjacent building with a 500 slab capacity for the storage of bodies.
F2
Page 169
The Coroner transfers unclaimed remains to Los Angeles County+USC Hospital for cremation services and no longer performs these services.
F3
Page 169
The Emergency Operations Plan provided to the CGJ was a comprehensive plan adopted on March 22, 2011. The EOP appeared to be a plan written and adopted by a state wide organization. Many of the positions of responsibility are not specific to the personnel currently employed by the Coroner. Even though job descriptions are specified, actual responsibilities are difficult to determine.
F4
Page 169
The EOP does not provide training or continued education programs with key per- sonnel. Continued formal training is a key component for success in implementation of the EOP.
F5
Page 169
The position of Director is scheduled to become vacant as of March 2012 due to the retirement of the current Director. The Chief Medical Examiner is also scheduled to retire at the end of 2012. However, the Succession Plan does not provide the search progress, the qualifications, or the possible candidates for the filling of vacant positions at the Coroner nor does it provide a direct succession plan for the key posi- tions such as the Chief Medical Examiner or Director.
F6
Page 169
The Coroner currently uses an antiquated, non-web based, non-secure file man- agement system that can no longer be upgraded. Intake of bodies and evidence is currently tracked manually, not electronically. This leaves evidence open to error in criminal cases and identification matters. These handwritten documents are filed in individual folders in cabinets. Currently, in the event of a fire or flood, all records could be lost or destroyed.
F7
Page 167
The Coroner Forensic Science Laboratories have been accredited since 1993. New requirements for accreditation are being adopted by ISO and the need for a special- ist to ensure the accreditation process is met is critical.
F8
Page 169
Budget restrictions have eliminated the replacement of vehicles in the last three years and several vehicles have exceeded the 100,000 mileage marker.
F9
Page 169
The Coroner has no power back-up generators to use in the event of power outages.
F10
Page 169
The Antelope Valley Regional Office of the Coroner is over 25 years old. It does not meet the need for Coroner services in the high desert.
F11
Page 169
The Coroner’s security system should be updated in light of the extreme sensitivity of the Coroner’s forensic operations. 2011–2012 LOS ANGELES COUNTY CIVIL GRAND JURY FINAL REPORT 149 CORONER
Recommendations 9
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R1Page 167The Los Angeles County Office of the Coroner should assign specific employees to act as the Department Emergency Coordinator, Public Information Officer, Opera- tions Section Chief, Logistics Section Chief, Finance/Administration Section Chief, and Coroner Representative to the County Emergency Operations Center. These positions should be filled by other specific, capable, and qualified employees in the event that those assigned employees are no longer employed by the Coroner or un- able to perform the assigned duties.
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R2Page 167The Los Angeles County Office of the Coroner should provide ongoing training for all employees on a regular basis.
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R3Page 167The Los Angeles County Board of Supervisors should begin an immediate search for a replacement of the Chief Medical Examiner prior to the retirement of the current Chief Medical Examiner in 2012.
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R4Page 167The Los Angeles County Office of the Coroner should seek the necessary fund- ing for the adoption of the Electronic Case File System (ECFS) necessary for the Coroner to track and manage coroner case documents, including evidence, photo- graphs, and other related objects or materials.
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R5Page 167The Los Angeles County Office of the Coroner should create a Senior Criminalist position dedicated to quality assurance to ensure a successful ISO Laboratory Ac- creditation.
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R6Page 167The Los Angeles County Office of the Coroner should purchase four additional vehicles necessary for the Coroner to provide the services necessary for the County.
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R7Page 167The Los Angeles County Office of the Coroner should seek and purchase/pursue three generators for the Coroner for use in case of power outages during emergency situations.
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R8Page 167The Los Angeles County Office of the Coroner should upgrade or replace the An- telope Valley Regional Office.
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R9Page 167The Los Angeles County Office of the Coroner should establish a keyless card entry system for security of the building used by the Coroner.