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Nashville firm turning Regional Forensic Center into profitable operation Since Forensic Medical LLC took over the Regional Forensic Center in June, its management is doing what any private company does; developing a plan to increase business, expand the customer base and control costs. After years of publicity and public angst over former medical examiner, O.C Smith, the Shelby County Commission took a cue from Nashville. Forensic Medical has provided medical examiner services to Metro Nashville since 1997, and has delivered better service and substantially lower costs. Since then the company has steadily expanded across Tennessee, setting off a revolution in forensic services. Cities and counties already contract services such as ambulances, fire protection, and nursing home management, just as states contract out prison management and othe services. Forensic Medical is inspiring the same attitude when it comes to investigating deaths and handling the bodies. “We still do the same things, like perform autopsies, meet with lawyers and go to court,” says forensic pathologist Karen Chancellor, chief medical examiner for Shelby County. “One change that we have made is that we have a death investigator who will go to the scene if the victim is still there.” Death investigators have more intense training in their field compared to police officers. Going to the scene of the death allows them to take photos from ansles that serve the medical examiner, and then gather other evidence to assist in the investigation. “If I have a body and specific questions, I can turn to the death investigator and his in-depth training,” Chancellor says. Chancellor and Forensic Medical are rebuilding the staff in Memphis. At one time the facility accepted bodies from much of West Tennessee. O.C Smith had turned it into a modest profit center for the county by changing the fee schedule for other counties. The place was also home to some of the world’s best known experts in fields such as blood spatter patterns, dismemberment, and other subjects critical to the investigation. Today the forensic center only serves Shelby County. It has 18 employees, two pathologists including Chancellor, five death investigators, six autopsy technicians and five clerical people. Despite a national shortage of forensic pathologists, Chandellor expects a new one to join her crew in January, followed by another in March, after a nation-wide recruiting effort. The bodies that had previously come to Shelby County now go to Forensic Medical in Nashville. Chandellor hopes to recapture that business when her staff can handle the volume. Of about 8,000 deaths per year in Shelby County, 3,000 of them are of interest to the Forensic Center. Besides homicides, the medical examiner is interested in any sudden and unexpected death. That includes children who die at home for no apparent reason or adults aged 30-50 who suddenly die by suicide or other causes. It also includes every cremation; an examination or autopsy is the last chance to glean information, and a criminal may use cremation to conceal evidence of a murder. Many people don’t have a doctor, so the only person who can sign the death certificate is the medical examiner. Chancellor has improved efficiency, going from 300 autopsies a year in the past to 700 last year, with just two doctors and two autopsy tables. “Everyone who comes through here is a person and I am their physician,” Chancellor says. Forensic Medical’s history goes back a decade, when Phil Bredesen was mayor of Nashville and facing his own troubled county facility. It had trouble recruiting staff and there and there was a string of bad stories in the press. A fan of privatization, Brendensen approached Associated Pathologists, a Nashville based physician practice with 39 pathologists that today covers 49 hospitals in four states. Some cities at the time were experimenting with contracting autopsies to private practices. Others were like Memphis, in which the services were contracted to the University of Tennessee Health Science Center. In most places the county government, still employs an elected coroner or a hired medical examiner. “Bredesen initiated the concept,” says forensic pathologist Bruce Levy, president and CEO of Forensic Medical. “We had a group of hospital pathologists with an interest of autopsies who thought it was an intriguing concept. This is the first example of the entire process, from time of death until a final ruling is reached by a private entity.” In another twist of public and private service, Levy today also holds the title of Chief Medical Examiner of Tennessee, reporting to internist Kenneth Robinson, Commissioner of the Tennessee Department of Health. Under the initial contact with Metro, Forensic Medical had a flat management fee with no financial incentives to save money. “We were 20% under budget,” Levy says. “A main advantage is that I have control over the office and how its run, without all the bureaucracy, that comes from being psrt of the government. We’re free to do our jobs and use the most efficient means to get the work done.” The business approach, he says, does have an incentive. “My customer is the government,” Levy says. “I want to have a happy government ready to renew the contract.” The greatest barrier to the efficiency in Memphis is the lack of staff, followed closely by the facility on Madison. The main section was built in 1928 as the original Shea ear nose and throat center. Shelby County first contracted medical examiner services in 1959 to the UT Department of Pathology. That duty later shifted to UT College of Nursing. Autopsies were done at UT until the Madison building was acquired 20 years ago, 10 years ago, the facility got an expansion which included a new refrigeration unit to accommodate the increased number of autopsies performed for other counties. The main building has chronic leakage. A plan was floated a year ago in which the state would build a modern forensic facility and lease it to Shelby County, but a site has not been selected. |
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