Naked City

In order to gain national accreditation, the Travis Co. Medical Examiners Office would need more staff, more money, and more stringently defined policies, according to a review conducted by Austin business-management consulting firm SDSM Inc., which was presented to county commissioners on July 21.

The ME's office, which has been in operation since 1977 under Medical Examiner Roberto Bayardo, has a total of 18 employees, far fewer than the number employed by the other major urban counties in Texas and fewer than are employed by other peer counties across the country, given the relative workloads of each office. The Travis Co. ME's office employs just three full-time pathologists – including Bayardo – who perform more than 400 autopsies each year, far exceeding the 350 annual autopsy maximum required by the National Association of Medical Examiners, which has accredited 45 ME offices nationwide. In addition, the office relies heavily on revenue generated through a series of interlocal agreements in order to grow the office's budget. As a result, the report concludes that the ME's staff is harried, in desperate need of upgraded technology (for example, the office is still using dot matrix printers, according to the report), and is operating without a stringent set of policies (many of which have not been updated since 1993). In short, the report concludes that the combination of circumstances increases the "risk potential for mistakes" and the county's "risk exposure."

Although the total ME workload generated inside Travis Co. remains relatively steady (generally between 700-800 cases per year since 2001) and at a level that would keep individual pathologist workloads well below the 350 mark, the office takes on additional autopsy duties through its interlocal agreements with 45 other counties around the state, including Williamson, Hays, Bastrop, and Caldwell counties in Central Texas. The outside county examinations, called Private Autopsies (which also include private examination requests made by individuals), help drive the ME's budget, keeping it nearly revenue neutral for the county by providing roughly 80% of the office's budget. (Bayardo says the office ranks first nationwide in terms of its reliance on outside autopsies to maintain the office budget.) "Private autopsy cases have been a 'lever' that has been used in the annual budget process to obtain additional resources," reads SDSM's report. "Requests for additional staff and equipment have been tied to the generation of new or additional revenue to make the expenditure revenue neutral." Since 2001, the office has conducted more than 3,300 PAs, roughly one-third of the office's annual workload. Travis Co. charges $2,000 for each PA, $300 of which is paid to the pathologist conducting the examination – the majority (52.8%) of which are performed by Bayardo – as additional compensation. In all, the PAs provide roughly $1.7 million of the office's annual $2.1 million budget. (The budget has increased 25% over the last two fiscal years, but only in order to pay for the salary costs of adding one additional toxicologist each year, which has been done to meet "statutory requirements.")

The heavy reliance on outside income to "contain departmental costs" means that the office has "delayed needed resource requests and tried to 'make do'" in all areas. "As a result, staff feels pressured to hurry to finish work within their assigned shifts, which can increase the risk potential for mistakes," reads the report. According to the report, the office's computer system is in need of a major upgrade in order to provide greater information security and to reduce workload. Additionally, the office has failed to devise "up-to-date written policies and procedures" – also a problem associated with the heavy workload. Policies regarding pathology and investigations have not been formally updated since 1993, meaning any changes have been made on an "ad hoc basis, usually in response to a specific event," reads the report. Just last week, the office reported that its preliminary toxicology results in the police shooting death of 18-year-old Daniel Rocha were incorrect, prompting Bayardo to suggest that perhaps the office should be sure to do more complicated gas chromatography and/or blood testing in critical cases such as a police shooting.

At press time, County Judge Sam Biscoe could not be reached for comment. For his part, Bayardo says he agrees with all of the observations and recommendations made in the SDSM report – "I agree with everything, absolutely," he said. Commissioners reviewed the report during a July 21 work session but have not yet taken action on the recommendations.