It’s not just housing prices and population on the rise in Clark County. It seems the number of people dying here has also been increasing.
Community Health Director Andrea Pruett said the number of deaths in the county is outpacing the population growth, leading to increased workloads for the county medical examiner’s office. To keep up with demand, the department wants to hire additional staff and has proposed new fees for its services to pay their salaries.
Pruett reviewed the proposed fee structure at the Clark County Council’s Aug. 2 work session.
“Clark (County) is experiencing rapid increases in unnatural deaths. About half of that can be attributed to accidental deaths – falls, overdoses, and transportation-related fatalities,” Pruett said during the meeting. “The increasing deaths rates are what’s driving the need to increase and stabilize our staffing. If we keep our death investigator ratios the same, as we experience more unnatural deaths then we will be ill-equipped and unable to meet the rising demand for services.”
While the county’s population grew by 18 percent since 2012, total deaths – 4,752 in 2021 – rose by 59 percent, Pruett said. Of those deaths, 601 were investigated and determined to be under the jurisdiction of the medical examiner. Pruett noted that is an increase of 71.2 percent from 2012. While 3,243 were investigated and determined not to be under the medical examiner’s jurisdiction, another 908 were not investigated (typically deaths by natural causes).
In Washington, a medical examiner assumes jurisdiction for deaths in certain circumstances and must provide medicolegal death investigation and forensic pathology services to determine cause and manner of death. Examples of when jurisdiction applies includes when someone in apparent good health dies suddenly, there are suspicious circumstances such as homicide or suicide, and deaths of incarcerated persons, premature/stillborn infants or unclaimed decedents.
Without additional funding for the department, Pruett said there could be slower response times, especially if an investigator is needed at more than one scene, as well as longer wait times for completed case reports. Pruett said that would not only frustrate community members waiting for autopsy outcomes but could cost the county its National Association of Medical Examiners accreditation, which in turn could put state reimbursements for exams at risk.
“There’s only so much compression the team will be able to manage until we start impacting other law enforcement, allied service operations, in the community,” Pruett said. “There will be implications for fire, EMS, law enforcement, and chain of custody.”
Under the proposed fee structure autopsy reports would cost $30, block or slide recuts (a near duplicate of original specimens) would cost $25 per slide plus shipping costs, a photo CD would cost $50 and biological specimens would cost $100 plus shipping.
Additionally, a fee of $70 would go into effect for the medical examiner’s office to process a disposition authorization, which is a legal form that details what happens to a body after it is released by the examiner. The fee would not be charged if the costs of cremation are paid for by the county, such as when a person dies with no known relatives.
Clark County hasn’t previously charged for these services, but it’s not unusual for counties to charge fees. King County charges $50 for an autopsy report, Spokane County charges $20 and Whatcom County charges $2 for the first page plus $1 for each page thereafter.
“Out of all the medical examiner counties in the state, at present we are the only county that does not implement or charge some type of fee for medical examiner services,” Pruett said.
Implementing the new fee structure would also allow the medical examiner’s office to reduce the number of death investigations per investigator to a more sustainable level. In 2012, death investigators averaged 557 cases per year. In 2021 they averaged 769 cases. The goal, she said, is to reduce that number to 720 per investigator in 2023.
Not only would the new fees create a sustainable budget for the medical examiner’s office, it would improve community safety by ensuring deaths that might appear natural can be reviewed for potential suspicious activity, Pruett added.
“Every other county is doing this. It makes perfect economic sense,” Councilor Gary Medvigy said.
The next step will be approval of an ordinance adopting the proposed fees. An ordinance will be brought forward to the council for approval but a date for that has not yet been set. If approved, the fees would be included in the 2023 budget process slated to begin this fall.