2015-16 Civil Grand Jury Interim Report

Recommendations 25

• R1
  The DMEC Workload With more than 10 million residents, Los Angeles County is the most populous county in the nation. It covers 4,752 square miles and, significantly, is congested with nearly 8 million registered vehicles.11 DMEC’s sole facility is located in downtown Los Angeles, although there are three satellite facilities out of which a handful of investigators operate.12 No one is allowed to touch or move a body at an accident or crime scene unless the Coroner gives them permission to do so or until a Coroner’s Investigator arrives.13 The CGJ has been informed that the average time for an investigator to travel through traffic from the downtown headquarters to a death scene in most areas of the county is usually 30 to 90 minutes and sometimes nearly three hours. Thus, distance and population density both affect the effective conduct of DMEC’s work. DMEC processes about 9,000 – 10,000 bodies and performs about 4,000 autopsies per year. While its workload is comparable to that of the medical examiner offices in New York City (all boroughs are organized under one medical examiner) and Cook County (Chicago), which report performing more than 5,000 and about 3,700 autopsies per year, respectively, those other jurisdictions are physically smaller, serve smaller populations, and employ more critical staff per capita than DMEC. California Department of Motor Vehicles Forecasting Unit: total for 2014 was 7,719,360. https://www.dmv.ca.gov/portal/wcm/connect/add5eb07-c676-40b4-98b5- 8011b059260a/est_fees_pd_by_county.pdf?MOD=AJPERES 12Two investigators are assigned to a small office in Lancaster, CA, four investigators are assigned to office space in Lomita, CA, and two investigators are assigned to an office in the San Fernando Police Department. In Lancaster there is a small office and non- working refrigerated space that could accommodate six bodies. In some cases, because of lack personnel, DMEC must depend on a local funeral company to transport bodies from Antelope Valley to the Los Angeles office, the only location in the county where autopsies are performed. Neither the Lomita nor the San Fernando offices contain anything other than desks for the investigators who work there. These regional offices allow DMEC to more rapidly respond to a scene of death which mitigates traffic obstructions. Cal.Govt.Code § 27491.2 (b) “For purposes of inquiry, the body of one who is known to be dead from any of the causes or under any of the circumstances described in Section 27491 shall not be disturbed or moved from the position or place of death without permission of the coroner or the coroner's appointed deputy. Any violation of this subdivision is a misdemeanor.” 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT 7 Table 1: Population Served Per Critical Staff Member Population Population Area served per served per Population Total Served in Forensic Coroner served per Population Square Pathologist Investigator * Toxicologist Served Miles Los Angeles 434,700 222,200 769,200 10,000,000 4,752 New York 242,800 293,100 386,400 8,500,000 303 (5 Boroughs) Cook County 385,700 337,500 385,700 5,400,000 945 (Chicago) *Put another way, each of the 46 investigators in Los Angeles County can be said to “cover” 103 square miles, while 29 investigators in New York each cover 10.5 square miles and 16 investigators in Cook County each cover 59 square miles. The Medical Examiner-Coroner informed the CGJ that DMEC, despite severe understaffing, is committed to provide a 48-hour turnaround time with regard to preliminary results in cases in which it accepts jurisdiction.
• R2
  The Investigation and Examination Process According to the standard of care applied by medical examiners across the country autopsies are completed within 48 hours of death. The forensic pathologist cannot begin an autopsy or even an external examination, however, until the investigator completes a report detailing the scene at which a body is found, including personal effects gathered there. In each case determined to be within the jurisdiction of DMEC, the deceased is taken to DMEC’s facility and examined by a deputy medical examiner to determine the cause and manner of death. That physician assesses whether an autopsy and/or laboratory tests are required as part of the investigation. At its present rate DMEC takes on average much longer than 90 days to complete final autopsy reports, the minimum standard for completion required by NAME for full accreditation of a forensic death investigation facility. This substantial period of time can be attributed to a lack of sufficient staff, including professional and direct and indirect support personnel. During an autopsy the decedent’s body is examined for external wounds. A detailed internal examination is conducted during which organs are examined and weighed. Bodily fluids are collected. Tissue samples are taken and retained to determine if there 8 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT is a presence of drugs, poison, and/or disease(s) and to preserve DNA. Forensic pathologists work closely with law enforcement but conduct their investigations independently to reach scientific conclusions as to cause of death. Moreover, toxicology samples are very time and temperature sensitive. A body lying on ninety (90) degree asphalt will begin to decompose within an hour. Samples retrieved more than two weeks after death likewise will have degraded and therefore may not be optimally reliable.14 The DMEC toxicology lab currently requires six or seven months to analyze samples taken in routine autopsies,15 jeopardizing accreditation of the entire facility. The Forensic Laboratory standards, which are international standards of analysis, are higher now than were expected even five years ago. They are much more time consuming and labor intensive than previous standards. DMEC continues to have on average more than 400 bodies stored in its crypt and is incapable of meeting, in the vast majority of its cases, the minimum acceptable standard autopsy report completion time of 90 days. Some 160 bodies await external examination and/or autopsy, and more than 250 additional bodies are stored for further testing (about 10 percent of the number), to be identified (delayed because there are not enough coroner investigators to do the statutorily-required work), or have been abandoned by survivors and therefore are left for final disposition by Los Angeles County.
• R3
  Accreditation DMEC has maintained its accreditation -- a measure of acceptable standards in management, personnel, operations, procedures, instruments, physical site, and safety -- although it currently is so far behind the minimum standards that losing accreditation is a likelihood in 2016.16 Such accreditation has been attained by only 82 medical examiner or coroner offices, including DMEC, out of the more than 2,000 counties across the nation. Los Angeles County DMEC worked hard to attain this elite status among peer facilities. The volume of cases for which DMEC is responsible overwhelms a staff that is significantly smaller than recommended in standards set by NAME. The budget provided to DMEC also has been flat in the past two fiscal years and the CEO’s recent proposed budget reduces the level of funding for FY 2016-2017. 14 “Factors such as delay in autopsy, sampling technique, and specimen preservation contribute more to inaccuracies associated with toxicological testing than do the testing procedures themselves, but procuring and storing toxicology specimens under optimal conditions mitigate these factors.” Dr. G. G. Davis and the National Association of Medical Examiners and American College of Medical toxicology Expert Panel on Evaluating and Reporting Opioid Deaths, “National Association of Medical Examiners Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid Drugs,” (March 2013), p.
• R4
  DMEC needs additional staff across the board: investigators, doctors, laboratory professionals, and direct and indirect support personnel. There is insufficient staffing to cover the workload, much less routine illness or accidents and no staffing cushion to absorb additional workload during catastrophic events and extended leaves of absence.
• R5
  DMEC prioritizes cases in a particular order.  First, cases involving infants and young children, because their bodies rapidly decompose.  Second, homicides.  Third, unidentified individuals.  Fourth, all others.
• R6
  The budget reflects investment in DMEC of about $3.55 per resident of the county.
• R7
  DMEC strives to provide quality services to all of its customers, including decedent’s families, funeral directors, law enforcement, courts, the District Attorney, the Public Defender, and other justice agencies, foreign consulates, and the news media, in a timely, accurate, efficient, and usable manner.
• R8
  The workload/caseload of DMEC in Los Angeles County compares with that in other very large urban counties, including New York City (all five boroughs) and Cook County (Chicago). Although their service areas are physically smaller and they serve smaller populations, those jurisdictions employ more critical staff per capita than DMEC.
• R9
  The professional field of forensic pathology is quite small and very few medical students pursue residencies, and later careers, in the field.
• R10
  There are numerous job listings for forensic pathologists across the nation that offer starting salaries comparable to those offered in Los Angeles County, but the workload is much less (as is the cost of living).
• R11
  There is a vacancy in the most senior budgeted investigator position, Chief of Coroner’s Investigations. 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT 17
• R12
  There are three vacancies in the most senior positions in the forensic laboratory.
• R13
  Los Angeles County does not engage in recruitment battles for scarce professionals by offering bonuses or other incentives.
• R14
  DMEC will lose its professional accreditation, and expose the County and DMEC to attacks on their credibility in criminal cases, if the workload cannot be handled by staff in a timely manner.
• R15
  Los Angeles County might preserve at least a “provisional” accreditation for DMEC if NAME examiners, expected to inspect DMEC in August 2016, are aware that concrete steps have been taken by Los Angeles County and by DMEC to permanently rectify severe staffing deficiencies.
• R16
  Due to traffic congestion and distance from the medical examiner’s facility in downtown Los Angeles, travel times for investigators to the scene of a death can vary widely, but are generally 30 to 90 minutes and sometimes more than three hours. Law enforcement and paramedics must wait for DMEC staff to arrive on scene.
• R17
  Two DMEC investigators are located in the Antelope Valley and work out of a small building (about 4,000 square feet) adjacent to the now closed High Desert Hospital. Bodies are no longer able to be refrigerated prior to transfer to DMEC’s Forensic Science Center in downtown Los Angeles because that equipment is not operating. In the rear of the hospital there is an autopsy suite, out of use for at least 10 years.
• R18
  Ambulances are prohibited by law from transporting deceased individuals.
• R19
  In New York City mortuary services, including autopsy facilities, are located in Manhattan, Brooklyn, and Queens. The medical examiner there is in the process of reopening similar facilities in the Bronx and Staten Island.
• R20
  DMEC sends hundreds of bodies per year to private facilities for cremation at a net cost of about $350 per body.
• R21
  The ODA morgue staff is overworked in both transport and administrative positions. There are unfilled, budgeted positions available for additional staff.
• R22
  The Los Angeles County morgue would continue to be located in LAC+USC Medical Center regardless of which department is responsible for its operation.
• R23
  Only two of five existing retorts in the county crematory are operational. One of these lacks a functioning thermostat. DHS workers at the crematory are able to process only two bodies per day. 18 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT
• R24
  DHS has a policy of contracting with private crematories if the diminished capacity at the county crematory results in a backlog of ten or more bodies.
• R25
  The crematory floor is overdue for replacement. VI. REQUEST FOR RESPONSE California Penal Code Sections 933(c) and 933.05 require a written response to all recommendations contained in this report. Such responses shall be made no later than ninety (90) days after the Civil Grand Jury publishes its report (files it with the Clerk of the Court). Responses shall be made in accord with Penal Code Sections 933.05 (a) and (b). All responses to the recommendations of the 2015-2016 Civil Grand Jury must be submitted on or before July 15, 2016, to: Presiding Judge Los Angeles County Superior Court Clara Shortridge Foltz Criminal Justice Center 210 West Temple Street Eleventh Floor-Room 11-506 Los Angeles, CA 90012 Responses are required from: Board of Supervisors: IR2.1, IR2.2(a), IR2.2(b), IR2.2(c), IR2.3(a), IR2.3(b), IR2.3(c), IR2.4, IR2.5, IR2.6, IR2.7(a), IR2.7(b), and IR2.7(c). Department of Health Services: IR2.6. Department of the Medical Examiner-Coroner: IR2.1, IR2.2(a), IR2.2(b), IR2.2(c), IR2.3(a), IR2.3(b), IR2.3(c), IR2.4, and IR2.5. VII. ACRONYMS BOS Board of Supervisors CEO Chief Executive Officer CGJ Civil Grand Jury DHS Department of Health Services DMEC Department of the Medical Examiner-Coroner ODA Office of Decedent Affairs MOU Memorandum/Memoranda of Understanding NAME National Association of Medical Examiners 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT 19 VIII. COMMITTEE MEMBERS Victor Lesley Co-Chair Molly Milligan Co-Chair Rene Childress Judy Goossen Davis Sandy Orton Heather Preimesberger Stephen Press Arun Sharan Bob Villacarlos 20 2015-2016 LOS ANGELES COUNTY CIVIL GRAND JURY INTERIM REPORT