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The San Diego County Medical Examiner’s Office recently received the green light to proceed with the design of a new facility, a regional forensic science complex incorporating the activities of the County Veterinary Laboratory as a co-located agency with common service, education, and research needs. The latter is a rather unique county function that plays an important role in public health surveillance and shares resources with the Medical Examiner’s Office. Both operations at present are located in the county’s operations center strategically positioned in the center of the county bounded by several major highways.
The State of the M.E.’s Office
San Diego County has diverse geography and an equally diverse population. There are approximately 4300 square miles with 75 miles of coast to Imperial County west to east and 70 miles of coast from Mexico to Orange/Riverside Counties south to north. The county reports a census population of about 3 million, largely positioned along the highway system extending from Fallbrook to San Ysidro north to south and San Diego to El Centro, east to west. There are about 20,500 deaths in the county annually and approximately 51% are investigated by the San Diego County Medical Examiner. The scope of responsibility is defined in Government Code 27491 and requires that all homicides, accidents, suicides, deaths in custody, deaths in state institutions, infectious and communicable diseases, environmental deaths, and all natural deaths in which a physician has not been in attendance in the last 20 days be reported and investigated. The bulk of the reported cases are administratively resolved as natural deaths without a public health or public safety issue based on the information provided by family members, health care organizations, funeral homes, and physicians. In these cases, there is a physician willing and able to certify the death. A waive number is assigned to these cases after adequate investigation by one of eighteen Medical Examiner Investigators. Approximately 2700 cases are brought into the Medical Examiner’s Office in Clairemont Mesa situated in the County’s Operation Center. About 2,000 of these transported cases are autopsied. On average, approximately 42% of these cases are sudden unexpected natural deaths, 38% are accidents, 12% are suicides, 6% are homicides, and 2% are undetermined. The number of investigations increases annually and appears to be population density driven. San Diego Association of Government (SANDAG) reports an expected population in San Diego of 4 million by 2020.
The San Diego County Medical Examiner’s Office transitioned from an appointed Coroner’s Office in 1990 and has a staff of fifty-three and a budget of $6.8 million. The Medical Examiner’s operation is in a 1962 vintage building of 16,000 square feet. The building houses six divisions: investigations, pathology, forensic autopsy assistants, toxicology, histology, and administration. It is a round the clock operation relative to investigations and receipt of bodies. Autopsies and medical examinations are carried out daily. The current facility has a body capacity of eighty-two stored in one of three refrigerators, plus the added capacity of an unmarked refrigerator truck. The refrigerator truck is needed on a regular basis for overflow cases. Examination and toxicology space is limited and the current facility is at maximum capacity.
Planning for the Future
Earlier plans for a new Medical Examiner’s Office as recorded in the Kearny Mesa Master Plan published several years ago allowed for 32,000 square feet. Recently, the Public Safety Group of the County made available $2 million for the design of a new Forensic Science Center of approximately 84,000 square feet to house the Medical Examiner’s Office and the County Veterinary Laboratory. Both medical units currently share resources and have a strong collaborative relationship in monitoring the health of San Diego human and animal populations. Support for the new facility came about through an intensive public relations effort on the part of the Medical Examiner to define our functions relative to our many stakeholders rather than as the “county morgue.”
The return on investment is readily qualitated and quantitated by published performance measures tracked by the County in its General Management System (GMS). The Medical Examiner’s Office has a customer satisfaction rating of 99%. Surveys are conducted regularly. Those performance measures and aggressive marketing have validated the importance of this function to a host of municipal and county activities. This recognized value has resulted in broad support for this activity. The County administration is divided into five groups each managed by a Deputy Chief Administrative Officer (CAO): Public Safety, Health and Human Services, Finance and General Government, Land Use & Environment, and Community Services. The Deputy CAOs report to the CAO who reports to the County Board of Supervisors. The Medical Examiner is one of nine departments in the Public Safety Group which includes the District Attorney, Sheriff, Probation, Public Defender, Alternate Public Defender, Child Support Services, Office of Emergency Services, and Citizen Law Enforcement Review Board.
Thirty Year Plan
The Medical Examiner’s Office along with the County Veterinary Laboratory developed a thirty year strategic and operational plan by investigating model structures nationwide that brought together these operations as well as other public health and safety functions such as crime laboratories and public health laboratories. From the Medical Examiner’s Office perspective, existing models included the Maricopa County Medical Examiner’s Office in Phoenix, Arizona; the Sacramento, Orange, and Riverside County Coroner’s Offices in California; the Medical Examiner’s Office in Richmond, Virginia; as well as combined medical and veterinary complexes in New Mexico, Iowa, and Michigan. The strategy was to develop a viable regional forensic science complex that would have the capabilities to address anticipated county needs for the next three decades.
In a competitive bid process that involved ten architectural companies, the contract for this design was awarded to Harley Ellis Devereaux (Prime architectural/engineering firm), DJL+A Consulting, Inc. (Architectural design consultant), and Crime Lab Design (Forensic planning, architecture and engineering). The design is expected to influence the on-going renovation of the San Diego County Operations Center which divides situated operations into three zones: Public Safety, Industrial, and Administrative. The challenge in any design is to provide both public access and security while meeting the service, education, and research needs of both activities. The design is influenced by the accreditations the Medical Examiner has as well as functions required and dictated minimum space requirements. The Medical Examiner is accredited by the National Association of Medical Examiners (N.A.M.E), American Board of Forensic Toxicology, and the American College of Graduate Medical Education.
The Medical Examiner’s Office has an active formal education relationship with University of California at San Diego and Navy providing education and training to medical students, pathology, and family practice residents on an on-going basis. The office also has working arrangements with San Diego State University, Grossmont College, National University, Palomar College, Maric College, and Miramar Community College. The Medical Examiner’s Office provides autopsy exposure to police cadets, paramedics, public defenders, alternate public defenders, probation, and deputy district attorneys. Both the Medical Examiner and Veterinary laboratory have significant educational/training activitiesand the need for adequate conference and public demonstration resources.
The Medical Examiner is also actively involved with organ and tissue transplant activities through Lifesharing, the designated organ procurement organization (OPO) and the San Diego Eye Bank. Approximately 80% of the Medical Examiner’s cases are potential donors. While the organ procurement occurs in a number of hospitals throughout the county, the bulk of the tissues (cornea, skin, bone, tendon, blood vessels, and heart valves) are recovered by Lifesharing and Eyebank personnel at the Medical Examiner’s Office.
A key element of the current design effort is the participation of the Sheriff’s Crime Laboratory. The Crime Laboratory has a vested interest in the forensic science complex because of its comprehensive involvement with the Medical Examiner’s Office in criminal investigations. This effort is shared with local municipal crime laboratories supporting their respective police departments. The plan calls for a new Sheriff’s crime laboratory being eventually co-located with the Medical Examiner’s Office in the designated Public Safety Zone in the County Operations Center. The Medical Examiner has a close relationship with the Sheriff’s Department. The Sheriff provides operational support on a regular basis including search and rescue, helicopter, mounted, and off road resources. The Sheriff also provides Police Officer Standards and Training (POST) training activities for the MEO investigators and Deputy ME’s. There are almost daily interactions with the crime laboratory as well as the Homicide Division. The Medical Examiner’s mobile communication is through the Sheriff’s Communications Center.
San Diego County’s Animal Disease Diagnostic Laboratory was established in 1933 and is the only county-run veterinary diagnostic laboratory in the United States. It serves over 11,000 customers. Stakeholders include the U.S. Navy, USDA, Salk Institute, and Mexican health authorities. The Medical Examiner often has the occasion to bring in animals that have died with their owners in circumstances that make that case a Medical Examiner’s case. The investigation is shared with the county veterinarian. Likewise, the Medical Examiner’s Office provides resources including investigators and laboratory capability upon request to the Animal Disease Diagnostic Laboratory.
||The toxicology laboratory has the capacity to screen, qualitate, and quanitate over 30,000 chemical substances.|
The New Facility
The planned new facility, in addition to expanding existing laboratory and support spaces, will include expanded advanced imaging and molecular diagnostics capabilities. Both agencies will share common use spaces such as conference rooms, library, procedure demonstration suites, and similar needs. The critical mass provided by the co-location of these services is anticipated to expand the scope of operations for both agencies. This expanded capability should benefit a number of county activities that would prefer to have needed services in-house rather than outsourcing as is often the case at present. The greatest need is in expanded toxicology services to include bulk drug screening and environmental toxicology. The latter is particularly driven by veterinary and Department of Agriculture needs.
The planned multistory facility will fundamentally change the skyline of the County Operations Center. Its position within the complex must address both public access and security needs as well as the day to day operations and related activities of agencies in the three zones of the complex. The Medical Examiner’s Office is delighted to have the opportunity of proceeding with this effort and refining the many government relationships and opportunities that the new facility should allow, as well as addressing the expectations of the publicin service, education, and research.
Glenn N. Wagner, DO is the San Diego, CA Chief Medical Examiner. He is a member of the American Academy of Forensic Sciences and the National Association of Medical Examiners. Glenn served in the US Navy, Medical Corps from 1970-2003 and has been Medical Examiner of San Diego since 2003. Dr. Wagner can be reachedat (858) 694-2899 or Glenn.Wagner@sdcounty.ca.gov