Amid budget boost, Jacksonville-area Medical Examiner raises concern

Jacksonville, FL — The District Four Medical Examiner's Office is one of the departments in Mayor Lenny Curry's $1.2 billion City budget proposal that got everything they asked for, according to the Administration.

But, despite that, the Medical Examiner is warning that the office will lose its full accreditation and move down to provisional status. That is a concern that the accrediting body itself tells WOKV may be a little premature.

Accreditation history

District Medical Examiner Dr. Valerie Rao says the office has been here before. In order to first gain accreditation, they had to improve their facilities, which Rao says her staff did through their own muscle- painting, decorating, and more. She says they then spent a couple of years improving standard operating procedures, before finally getting fully accredited through the National Association of Medical Examiners. She says the accreditation went down to provisional, though, when the MEO faced a critical space problem, largely fueled by a spike in drug-related deaths.

“That broke my heart, but that’s why I came to the City and said ‘Please, please we have to get that accreditation back’, and we did, once the facility was updated,” Rao told the City Council Finance Committee, as part of her office’s recent budget hearing.

The City Council ultimately approved $206,000 for modular office space, an outdoor walk-in morgue cooler, and morgue equipment to deal with the space concerns, and Rao says they got their full accreditation back.

Finding an interim ME

Now, Rao is preparing to resign. Initially, she was planning to leave in July, but then agreed to stay on until the end of the year.

“The only reason I wanted to stay until the end of December was hoping that we would get the Chief, and I would walk away knowing that the office was going to be accredited,” she says.

Rao’s resignation letter to Governor Rick Scott says she is looking forward to “family time”, leading her to leave office. Citing the will of her family, Rao has gained permission to leave at the end of this month, instead of December. As it stands, there is no interim ME that has been identified.

“That immediately brings us back down to provisional,” Rao says.

The District Four Medical Examiner’s Office serves Clay, Duval, and Nassau counties, as well as Columbia and Hamilton. As such, Fourth Circuit State Attorney Melissa Nelson and Third Circuit State Attorney Jeff Siegmeister have been designated to name an interim. Nelson’s Office tells WOKV that process is ongoing, but not subject to Sunshine Law, meaning it is not required to be done in the public eye. We have requested insight on a timeline for their decision, but none has been provided at this point.

National Association of Medical Examiners Inspection and Accreditation Committee Chair Dr. Barbara Wolf tells WOKV she expects an interim will be named in close correspondence with Rao’s departure. She says NAME would not look to demote the office, as long as a board certified forensic pathologist takes over in a short period of time. If the timeline is prolonged, however, like lasting several months, then she says they would consider demotion to provisional accreditation.

Even if the status goes to provisional, though, Wolf says that would not affect the work the MEO does or the service they’re able to provide. NAME’s Policies and Procedures Manual says provisional status can be maintained for up to a year, or potentially longer if an extension is requested, as long as certain conditions are met, including showing a good faith effort to seat a new ME. Conversion to full accreditation can be requested at any time, but there must be documentation that the deficiencies- in this case the loss of an ME and lack of an interim- have been remedied.

NAME says accreditation with them vouches for the “quality, integrity, and credibility” of the MEO. They say it further increases credibility of courtroom testimony, networking and information exchanges, enhanced attraction to retain professional staff in a competitive market, and more.

Permanent ME search

While the discussions on an interim take place, Nelson and Siegmeister have also assembled a Search Committee, to come up with recommendations for a new permanent Medical Examiner. That Search Committee consists of various legal, law enforcement, political, medical, and funeral home parties from across the MEO’s area of responsibility, and it meets in public.

The Search Committee has had two meetings so far, during which they’ve discussed the challenges they expect to face with this search, according to meeting minutes posted online. Search Committee participants have discussed that there are dozens of open positions in various jurisdictions, a declining number of practicing forensic pathologists, and an increased workload because of the opioid epidemic.

“There is not a single day we don’t get a drug-related death,” Rao says.

To try to make the Fourth District MEO more competitive, the Search Committee boosted the ceiling on the salary range, which was initially proposed as $210,000-$300,713. According to the meeting minutes, the City has budgeted $280,000 for the position, but the Search Committee has now increased the ceiling to $343,000.

Rules governing the Florida Medical Examiners Commission say interview packages from the candidate interview process must be assembled by the Search Committee, and submitted to the Commission within 90 days of the Search Committee being appointed. More time can be requested for this process. Then, within six months of the vacancy opening- which is September 1st in this case- the Commission must nominate one or more candidates, which could include candidates who were not put forward by the Search Committee. The Governor then makes the final decision and appointment of a District Medical Examiner.

Other budget boosts

While those efforts are ongoing, the City is also looking at some long-term solutions for the operational and infrastructure challenges the MEO has faced.

“There was nothing that was denied the Medical Examiner for her budget request,” says Curry’s Chief Administrative Officer Sam Mousa.

The budget proposal, which the Finance Committee appeared to support, adds two positions and funds another that was previously unfunded. There is also more than $150,000 for a new Case Management System, and an additional 2,080 part-time hours. Additionally, the City is budgeting $153,700 for a consultant to provide services until the new ME is appointed.

The budget additionally lays the groundwork for a new facility, in funding $500,000 in the proposed Capital Improvement Program to start programming and site selection. The current facility was built in 1968, and has since had a second story added and undergone a renovation. Even with those changes, the City says the MEO has outgrown the space- and the population only continues to grow.

“During the past six months, the MEO has been at capacity several times for normal/workload/processing space,” says the CIP.

The total project cost is estimated at $24.5 million. The CIP proposes borrowing $500,000 in the upcoming fiscal year for land acquisition and site prep, and more funding in the years to follow.

“We’ve enhanced, tremendously, the Medical Examiner’s Office,” Mousa says.

The Finance Committee has yet to closely consider the CIP projects- that comes at a later hearing.

The City also continues to try to combat the opioid crisis through a special pilot program. While organizers say there has been success among those enrolled in the program, City Councilman Bill Gulliford pointed out that the relatively small scale means the impact isn't on the broader community yet. The City Council is considering an expansion of that pilot program, as part of the overall City budget proposal.

WOKV continues to work through the Mayor’s budget proposal, to see how your tax dollars are being spent. Stay with us as we learn more.