The Current Organizational Structure

For budgetary purposes the Medical Examiner"s Office is divided into three sections (Medical Services, Investigations and Administration). However, in practice, the organization is structured quite differently. The organizational chart for the Medical Examiner"s Office, as it is currently structured, is displayed on the following page.

As depicted in the organizational chart on the following page, the Chief Medical Examiner has direct management and supervisory responsibility over the Toxicology Laboratory, the Histology Laboratory and the Pathology Section (Autopsies). Of the 39 employees, which equates to approximately 36.51 permanent FTEs in the Medical Examiner"s Office, there are 13 employees who report directly to the Chief Medical Examiner, including the part-time Court Reporter. The Chief Medical Examiner also has indirect oversight over Investigations and Administration, through the Administrative Coroner. Additionally, numerous outside duties require the Chief Medical Examiner"s time. These duties include (1) serving as Medical Director for Igenex Laboratories in Palo Alto, California; (2) periodically appearing in court as an expert witness for other jurisdictions; (3) giving presentations at seminars and conferences; and (4) conducting research and co-authoring articles.

Medical Examiner"s Office Organizational Chart
January 1997

The organizational chart also depicts the Administrative Coroner"s direct oversight responsibilities for property control, budget, purchasing, clerical, billing, medical transcription, payroll, personnel and investigative functions. In addition, the Administrative Coroner manages the Indigent Burial Program. Of the 39 employees in the Medical Examiner"s Office, there are 26 full-time and part-time employees who report directly to the Administrative Coroner.

The current organizational structure of the Medical Examiner"s Office demonstrates the overly broad span of management control for the two top positions in the Department.

Sources of the Problem

The broad span of management control for the two top positions is the result of several factors, including (1) the duties and responsibilities prescribed in the Civil Service position descriptions for the Chief Medical Examiner and the Administrative Coroner; (2) additional activities undertaken by these two employees which are beyond the scope of the Civil Service position descriptions; and (3) the recent chain of events. These factors are described in further detail below.

Duties and Activities of the Chief Medical Examiner and Administrative Coroner

Table VI.1 below (a) summarizes the duties and responsibilities of both the Chief Medical Examiner and the Administrative Coroner positions, as delineated in the Civil Service Commission"s position descriptions; (b) lists the positions which have direct reporting relationships with each of these individuals; and (c) lists the additional activities of the Chief Medical Examiner and Administrative Coroner which are beyond the scope of the Civil Service position descriptions.

Also reflected in Table VI.1 are the Civil Service position descriptions, which were co-authored by the Chief Medical Examiner. These position descriptions encompass a wide range of duties for both the Chief Medical Examiner and the Administrative Coroner and concentrate control of the Department in the hands of two individuals.

In addition to acting as Chief Medical Examiner for the City and County of San Francisco on a 24-hours per day, seven days per week basis, the Chief Medical Examiner participates in numerous other activities. For example, the Chief Medical Examiner currently serves as the paid Medical Director for Igenex Laboratories in Palo Alto, where he appears weekly in order to fulfill his duties. Also, the Chief Medical Examiner periodically: (a) appears in court as an expert witness for other jurisdictions; (b) gives presentations at seminars and conferences; and (c) conducts independent research and co-authors articles.

Table VI.1
Responsibilities and Activities of the
Chief Medical Examiner and the Administrative Coroner

In addition, both the Chief Medical Examiner and the Administrative Coroner have taken personal responsibility for performing certain tasks which could be performed by lower-level staff. For example, the Chief Medical Examiner administers flu shots and other vaccines to City staff on demand and manages the two laboratories. The Administrative Coroner performs various clerical duties such as answering telephones, releasing property to families and other duties which could easily be handled by lower level investigative or clerical staff.

Based on our interviews with current and former staff and our review of the Department"s organization and operations, we do not believe that it is reasonable to expect two individuals to perform such a wide range and large number of duties effectively.

The Recent Chain of Events

Certain events which have occurred in the Department in recent years have also resulted in and/or exacerbated the excessive span of control of the Chief Medical Examiner and the Administrative Coroner. These events include: (a) the elimination of the Forensic Toxicologist position in 1993; (b) the existence of a vacant Senior Management Assistant position; (c) the numerous lawsuits filed against the Department; and (d) the poor publicity which the Department has received. Each of these factors have necessitated additional work and longer hours for the Chief Medical Examiner and the Administrative Coroner.

Elimination of Positions and Vacancies

The Department reports that it was under pressure to reduce its budget for the 1993-94 fiscal year. In response to this pressure, the Medical Examiner"s Office submitted a budget proposal for FY 1993-94 which eliminated the 2458 Forensic Toxicologist, a filled position. As a result, the management and supervisory duties, previously performed by the Forensic Toxicologist, were undertaken by the Chief Medical Examiner. Subsequently, the technical duties were assumed by the Assistant Forensic Toxicologist II position. The Chief Medical Examiner is not qualified to act as chief toxicologist under the guidelines established by the Society of Forensic Toxicologists (SFT) and the American Academy of Forensic Toxicology (AAFT). Also, as noted in Section III (Toxicology), the Chief Medical Examiner does not have sufficient time to properly manage and supervise the toxicology laboratory, given his many other duties and responsibilities.

The Medical Examiner"s Office has an 1844 Senior Management Assistant position that is responsible for performing the following functions: payroll; personnel; purchasing; billing; computer systems; inventory management; processing, storing and releasing a decedent"s personal property; budget preparation and management; probate administration; employee supervision; and interfacing with bereaved families. This position became vacant in the spring of 1994. Some of the functions of this position were thereafter performed by a provisional 1842 Management Assistant, who was subsequently terminated due to allegations of fraud and embezzlement. The remaining functions were absorbed by the Administrative Coroner and the Forensic Lab Manager. During the summer of 1996, the duties of the 1844 Senior Management Assistant position performed by the 1842 Management Assistant were absorbed by the Forensic Lab Manager, the Executive Secretary and a Medical Transcriber. These duties have been added to the regular work performed by the individuals in these positions.

As of the writing of this report, the Department had received approval for a revised position description for the 1844 Senior Management Assistant position in order to better reflect the skills required, and had reclassified an existing employee, who had previously served as the Executive Secretary, to the redefined Senior Management Assistant position. However, this still leaves the Department with a vacant administrative/clerical position and does not completely alleviate the additional workload for other employees.

Litigation Filed Against Department and Other Events

Another factor which has contributed to an excessive workload for both the Chief Medical Examiner and the Administrative Coroner is the litigation filed against the Department by current and former employees and contractors over the past few years. In addition, the Chief Medical Examiner"s accountability for revenues collected for the provision of outside services and the alleged embezzlement of funds by a subordinate employee resulted in two financial audits by the Controller"s Office. These events, along with the allegations regarding the behavior of some of the investigative staff, have diverted the attention and time of the top two administrators from their regular duties While these circumstances are temporary in nature, they have been, and in some cases continue to be, a drain on the Chief Medical Examiner"s and the Administrative Coroner"s time, and have further exacerbated other problems such as the lack of employee supervision and low morale.

The Effects of Broad Span of Control

As a result of vacancies, litigation, and personal management styles, the Chief Medical Examiner and the Administrative Coroner have undertaken responsibilities which are too broad in scope and cannot realistically be performed by two individuals without great difficulty. Specific problems resulting from these broad spans of control are described in further detail below.

The Neglect of Certain Duties

Based on our observations and discussion with staff, the Budget Analyst has determined that it is unreasonable to expect two individuals to carry out all the responsibilities described above in an competent and effective manner (See Table VI.1). During the course of this audit, the Budget Analyst"s staff observed and Medical Examiner"s staff cited many management and supervisory duties, which should be carried out, but due to the overly broad spans of control of the Chief Medical Examiner and Administrative Coroner, are carried out ineffectively or are neglected. Some examples are as follows:

• Pathology staff have expressed concern over the level of supervision and training provided by the Chief Medical Examiner. Based on interviews with staff, the Chief Medical Examiner spends little time in the autopsy room and, as a general rule, does not perform autopsies on a daily or weekly basis.

• Toxicology staff receives inadequate supervision and are not trained in the use of all equipment. Based on our observations and staff reports, the Chief Medical Examiner spends less than five hours per week in the toxicology laboratory, even though he has primary responsibility for managing and supervising this laboratory. This has resulted in (1) insufficient supervisory and administrative oversight to ensure that toxicology personnel are adequately trained and experienced enough to conduct the required work, and that the work is performed accurately; (2) inadequate protocol for reviewing test data results and chain of custody; and (3) the absence of a quality assurance program.

• It is the responsibility of the Administrative Coroner to provide field supervision to the Department"s 11 full-time Investigators and five part-time Drivers. While the Administrative Coroner reports that there is field supervision for investigative staff, no formal reporting procedures are in place in order to document the frequency and duration of field visits and to record the observations made during such visits by the Administrative Coroner.

• The Controller"s audit of the Medical Examiner"s property and revenue accounts revealed a lack of adequate supervision over administrative personnel. According to the Controller"s audit, released in December of 1996, the Medical Examiner"s Office failed to establish proper internal controls, allowing one employee to carry out the incompatible responsibilities of receiving decedents" cash, recording the collection and distribution of the cash, and recording the deposits of the cash into the Office"s property bank account. As a result, the Medical Examiner"s Office could not account for a cash shortage of $20,324 from its decedents" property account. Additionally, the Controller"s audit of the Medical Examiner"s Office reimbursement practices for expert witness testimony was completed during the field work portion of the Budget Analyst"s management audit. While the Controller found that the practices of the Chief Medical Examiner were contrary to state code and policy, all monies due to the City had been accounted for and transmitted. As such, the Chief Medical Examiner was exonerated.

• The general lack of understanding of budget preparation and tracking on part of the Chief Medical Examiner and the Administrative Coroner can be partially attributed to the expansive span of control for these two individuals and the resultant neglect of certain duties.

• Sufficient time has not been dedicated to preparing and updating administrative and procedural manuals throughout the Department. For example, although an administrative guidelines manual does exist, it applies only to investigations. There are no comprehensive procedural manuals for either of the two laboratories (toxicology or histology) or for autopsies.

Lack of Qualifications

As noted earlier, due to the elimination of the Forensic Toxicologist position, the Chief Medical Examiner has undertaken the responsibility of managing and supervising the toxicology laboratory. According to guidelines established for forensic toxicology laboratories by the National Association of Medical Examiners (NAME), the Society of Forensic Toxicologists (SFT) and the American Academy of Forensic Toxicologists (AAFT), a toxicology laboratory should be directed by a chief forensic toxicologist. The Chief Medical Examiner states that he meets the requirements for membership in the society of Forensic Toxicologists.

The Budget Analyst"s Office believes that absence of a full-time chief toxicologist has been a major contributing factor to the existing problems in the toxicology laboratory, cited in Section III: In order to provide better management for the Toxicology Laboratory and to be certain that no questions are raised regarding the credentials of the Medical Examiner the Budget Analyst recommends that the Office of the Medical Examiner obtain membership in the Society of Forensic Toxicologist and that the Toxicology Laboratory becomes accredited by, or complies with the guidelines issued by the Society of Forensic Toxicologists/American Academy of Forensic Scientists.

Illogical and/or Unclear Reporting Relationships

Because there are so many employees directly reporting to so few supervisors, the reporting relationships are unclear, both to the Budget Analyst"s staff and to Medical Examiner"s staff.

For example, although Medical Transcriber Typists work most closely with the Pathologists on a daily basis, these five employees report directly to the Administrative Coroner. The Administrative Coroner has limited, if any, knowledge of medical transcription, does not critique the Transcribers" work on a daily basis and has little basis on which to evaluate their actual job performance.

Another example is the reporting relationship between the Forensic Autopsy Technicians and the Administrative Coroner. The Forensic Autopsy Technicians are responsible for assisting the Forensic Pathologists in performing autopsies, dressing bodies and maintaining the morgue premises. Although they take most of their direction from the Forensic Pathologists, they are evaluated by the Administrative Coroner, who has no medical training and has limited, if any, knowledge of autopsy procedures, does not participate in conducting autopsies and is not responsible for inspecting the service floor or enforcing the use of universal precautions.

Due to the absence of any mid-level managers in the toxicology and pathology laboratories, all laboratory staff report directly to the Chief Medical Examiner. The reason for this is unclear, as the department head should not be responsible for the direct supervision of 11 full-time employees (see Table VI.1).

The Medical Examiner"s Office does have a Forensic Lab Manager, who should be responsible for management and supervision of the laboratories. However, despite the title of "Manager," this individual exercises no authority over other employees and very little authority over the Department"s two laboratories. The duties of the Forensic Laboratory Manager are primarily administrative and clerical in nature and include purchasing chemicals, equipment and supplies for both laboratories, acting as a hazardous materials coordinator, preparing and maintaining reports, operating the volunteer program and ensuring compliance with health and safety standards. [1] In accordance with the position description, the Forensic Lab Manager is responsible for maintaining a quality assurance program for both laboratories. However, based on our observations and interviews with toxicology staff, the existing Forensic Lab Manager spends only one hour per week in the lab to check inventory and verify supply orders. Thus, this position is not being utilized to its full potential and should be required to provide managerial and supervisory oversight of all laboratory functions.

Low Employee Morale

Our interviews with staff of the Medical Examiner"s Office revealed widespread dissatisfaction with the management styles of both the Chief Medical Examiner and the Administrative Coroner. Complaints related primarily to the large span of control of these two positions and the lack of clearly stated policies and procedures. This dissatisfaction with management has been a major contributor to low employee morale, negatively impacting productivity and performance. Although this is a personnel issue, there are structural changes which could be made to the Department which would reduce the span of control for these top two positions, establish clearer reporting and supervisory responsibilities, and thus potentially lessen the friction between existing management and line staff.

Steps to Improving the Medical Examiner"s Office Organization and Operations

In order to improve the operational efficiency of the Medical Examiner, serious consideration should be given to a reorganization of the Office. Under the current structure, broad spans of control, inappropriate and unclear lines of reporting and supervisory authority and duplication of functions with other City Offices exist. By reorganizing the functions and segregating duties (medical and administrative), greater operational efficiency can be achieved.

Through our research and discussions with other jurisdictions and City officials, we identified two organizational systems used by other jurisdictions which, if combined and implemented in San Francisco, would provide certain advantages over the current organizational structure of the San Francisco Medical Examiner"s Office. One system is the combined Public Administrator/Coroner, a model which is utilized by eight other California jurisdictions and which takes advantage of certain commonalties in function, such as fiduciary responsibility and asset management, between the Public Administrator and the Coroner. The second system, currently utilized by the Los Angeles County Coroner/Medical Examiner, would segregate medical functions from other Coroner functions, such as administration and investigations.

Advantages of Combining the Public Administrator and Coroner

Although several California jurisdictions have combined Coroner/Public Administrator offices, San Francisco has a separate Public Administrator"s Office. The Public Administrator (PA), a State-mandated function, is responsible for investigating and probating the estates of deceased residents. Additionally, in San Francisco, the Public Administrator also serves as (a) Public Guardian (PG), who is the probate conservator for seniors at risk and the representative payee for the frail and elderly, and mental health clients, and (b) County Veterans Service Officer, who assists veterans and their dependents in obtaining VA benefits and entitlements. The San Francisco PA/PG Office consists of 41 authorized positions and has an annual budget of approximately $3 million. Overall management and supervision of the Department is the responsibility of the Public Administrator/Guardian and the Assistant Public Administrator/Guardian.

Reasons cited for having a combined Public Administrator/Coroner office include:

• Both the Medical Examiner"s Office and the Public Administrator are responsible for managing the assets of decedents. While the Coroner is responsible for collecting and storing a decedent"s property and releasing that property to the next of kin, the Public Administrator is responsible for investigating and administering a decedent"s assets in cases where the next of kin cannot be immediately identified or located.

• The Medical Examiner and the Public Administrator collaborate on the internment of the county"s indigent dead.

• Consolidation of the two offices results in reduced costs for administrative support functions, such as payroll, budget, personnel and other functions.

An additional benefit of consolidating the Public Administrator and Coroner function in San Francisco is that, as demonstrated by the recent audit of the Medical Examiner"s Office property and revenue funds conducted by the Controller"s Office, the San Francisco Medical Examiner"s Office does not have adequate internal controls in place for the handling of decedents" property. As cited in the Controller"s report, the Medical Examiner allowed one employee to carry out the incompatible responsibilities of receiving decedents" cash, recording the collection and distribution of the cash, and recording the deposits of the cash into the Office"s property bank account. In addition, the Controller cited numerous accounting irregularities in the Medical Examiner"s records.

On the other hand, the Public Administrator"s Office, in its function as conservator for the unclaimed dead, mentally health clients and seniors at risk, is experienced in carrying out fiduciary responsibilities. The PA/PG"s Office has a fiscal support team consisting of nine accounting staff who are supervised by the Assistant PA/PG. As such, the PA/PG has the internal controls in place which the Medical Examiner"s Office is lacking.

Additionally, as cited in Section IV of this report, the Budget Analyst"s Office has observed deficiencies in the areas of budget and planning in the Medical Examiner"s Office. The PA/PG"s Office has staff in place who are responsible for (a) generating and interpreting budget planning documents and financial reports; (b) tracking departmental expenditures; (c) determining resource needs; and (d) allocating resources throughout the Department. Combining the Public Administrator and Coroner functions would allow for the consolidation of budget-related functions for both Offices under the PA/PG, who already has knowledge and expertise in this area.

Because of the commonalty of functions described above, several jurisdictions have combined the Public Administrator and Coroner functions into one office. In fact, in a survey of 37 California counties by the San Mateo County Coroner Office, seven counties reported that they combined Coroner/Public Administrator offices. These counties are: Fresno, Kern, Humboldt, Sutter, Tehama, Trinity and Kings Counties.

The Segregation of Administrative and Technical Duties

As a result of issues relating to the Chief Medical Examiner"s span of control, in 1991, Los Angeles County transferred administrative and management responsibilities from the Chief Medical Examiner to an administrative manager (Director, Department of the Coroner). This Director has primary responsibility for administrative support functions, such as accounting, property, personnel, purchasing, budget management, management information and training, as well as for morgue management, investigations, the toxicology laboratory and the histology laboratory. The Chief Medical Examiner continues to oversee pathology and the residence program.

In Los Angeles, there is no reporting relationship between the Chief Medical Examiner and the Director. However, there is a direct line of communication between the two positions. For example, the Director and the Chief Medical Examiner coordinate on the preparation of the Department"s budget and, when necessary, on issues regarding toxicology, histology, investigations and other areas. This structure relieves the Chief Medical Examiner of some of the burdensome operating details of running a department, thereby enabling him to dedicate more time to his area of expertise.

The Proposed New Structure

The proposed new organizational structure which we are recommending for the San Francisco Medical Examiner"s Office blends aspects of the two systems described above by: (1) combining the PA/PG and the Medical Examiner"s Office and (2) segregating administrative and technical duties. The recommended changes are described in detail below and would reduce the span of control, clearly define duties and establish clear lines of reporting and supervision.

Medical Services Division

Under our proposed reorganization plan, the Chief Medical Examiner would retain control over all medical and technical aspects of the Medical Examiner"s Office. Unlike Los Angeles, where the Director manages the toxicology and histology laboratories, in San Francisco, the Chief Medical Examiner would retain control of toxicology and histology. However, certain administrative and management functions would be transferred from the Chief Medical Examiner to more appropriate staff.

Specifically, there would be only three employees (versus the current 13) reporting directly to the Chief Medical Examiner under the proposed reorganization. Additionally, the Chief Medical Examiner"s duties would be redefined as follows, thereby excluding most administrative functions:

• Establishing standards for the conduct of autopsies, and reviewing and supervising the work of the medical staff; interpreting reports prepared by staff physicians and pathologists; performing autopsies of a more complex nature.

• Reviewing and supervising the work of the chief forensic toxicologist.

• Acting as official spokesperson for the Department on issues related to medical and technical functions.

• Responding to homicide scenes as required and directing activities concerned with the collection and preservation of evidence.

• Meeting with families of deceased to discuss the medical aspects of cases.

• Conferring with medical and investigative personnel in making determinations as to the cause of death; presiding at inquests; testifying in court as an expert witness.

• Developing proposals for and managing research projects.

• Planning and directing the pathology residence program.

• Establishing controls and safety rules for the use of X-ray and other radiation equipment.

• Consulting with other professionals in the field of forensic sciences.

• Other duties relevant to the field of forensic pathology.

The recommended changes within each area of Medical Services are described in detail below.

Toxicology

As noted throughout this report, the Department needs a chief forensic toxicologist on staff to perform more complex toxicological studies, provide supervision of laboratory staff and operate a quality assurance program. Rather than adding a new position to the budget at an annual cost of approximately $85,289 per year (consisting of $72,897 for the salary plus $12,392 for fringe benefits of a 2458 Forensic Toxicologist), the Department could utilize the existing Forensic Laboratory Manager, who, based on a review of her Curriculum Vitae, should have the necessary professional, educational and technical qualifications, to perform these duties.

As cited in Section III of this report, the Society of Forensic Toxicologists/American Academy of Forensic Toxicologists guidelines for toxicology laboratory personnel state that the toxicology laboratory should be directed by a person with sufficient education and experience to assume the required professional, organizational, educational and administrative responsibilities. The existing Forensic Laboratory Manager meets these qualifications, as she has (a) a Ph.D. in pharmacology, (b) a bachelor"s degree in chemistry, and (c) 10 years experience as an assistant forensic toxicologist.

As such, the existing Forensic Laboratory Manager could and should serve as the chief forensic toxicologist for the Department. The position description for the Forensic Lab Manager should be revised to include: (a) management of the toxicology and histology laboratories; (b) supervision of toxicology laboratory staff; (c) performance of the relatively more complex toxicological studies when necessary; (d) maintenance of the quality assurance program; (e) review of cases with pathologists, (f) responsibility for hazardous materials management and safety training; and (g) preparation of budget requests and purchase requisitions for both laboratories. Administrative and/or clerical duties currently performed by the existing Forensic Lab Manager, such as answering the telephone and preparing the annual report, should be delegated to lower level administrative and clerical staff.

The existing Forensic Lab Manager currently earns $57,655 per year, plus $9,800 in fringe benefits, for a total of $67,455. The entry level salary and fringe benefits for the 2458 Forensic Toxicologist position are $85,289 per year. Thus, the additional cost of consolidating the functions of the Forensic Lab Manager and the Forensic Toxicologist positions would be approximately $17,834 annually ($15,242 in salaries plus $2,592 for fringe benefits).

Under the new organization, all toxicology laboratory staff would report to and be evaluated by the Forensic Lab Manager/Chief Forensic Toxicologist instead of the Chief Medical Examiner. The Forensic Lab Manager/Chief Forensic Toxicologist would continue to report directly to the Chief Medical Examiner.

Consolidating the Forensic Lab Manager and the Forensic Toxicologist positions would improve supervision and management of the laboratories at a lower cost than by adding a new Forensic Toxicologist position to the Department"s budget. At the same time, the span of control of the Chief Medical Examiner would be reduced, thereby allowing him to spend more time on other matters more relevant to his field of expertise.

Pathology and Histology

We recommend the following changes in reporting relationships in Pathology and Histology:

• The Forensic Pathologists should continue to report directly to the Chief Medical Examiner. However, the Histology Laboratory staff and Forensic Autopsy Technicians should be directed, supervised and reviewed by the Forensic Pathologists rather than by the Chief Medical Examiner.

• Medical Transcriber Typists should report directly to and be evaluated by the Forensic Pathologists, not the Administrative Coroner.

Additionally, based on an analysis of workload in San Francisco compared to other jurisdictions, we are recommending in Section VII.1 (Staff and Training: Pathology) that two Forensic Pathologist positions be replaced by less expensive qualified staff.

Administration

The Administrative Coroner currently has primary responsibility for management and supervision of administrative support and investigative functions. In order to distribute workload more evenly and to provide for more effective management of the administrative and investigative functions, we are recommending transfers of responsibility away from the Administrative Coroner position to other Medical Examiner"s Office staff and City departments. These recommendations include (1) transferring oversight of the administrative support and investigative functions to the San Francisco Public Administrator/Guardian"s Office and (2) delegating responsibility for supervision of investigative staff to the most senior Coroner"s Investigator (see Investigations below).

The transfer of oversight of administrative support and investigative functions to the PA/PG"s Office in San Francisco would result in the segregation of technical functions and administrative functions, as in Los Angeles County. For example, the Chief Medical Examiner would continue to oversee the Medical Services Division, while the administrative support and investigative functions, as well as administrative duties currently performed by the Chief Medical Examiner and the Administrative Coroner, would become the responsibility of the PA/PG"s Office.

Based on our discussions with the San Francisco PA/PG"s Office and our review of the organizational structures of other counties with combined Coroner/PA offices, we have concluded that the consolidation of the Medical Examiner"s Office and the PA/PG"s Office would allow for the elimination of the Administrative Coroner position, because many of the duties performed by the Administrative Coroner are also performed by the PA/PG. The elimination of this position would result in an annual savings of approximately $86,939 per year (including $74,307 in salaries and $12,632 in fringe benefits). However, because the Administrative Coroner position is currently filled, ongoing annual costs of approximately $21,101, or the difference between the salary and fringe benefit costs of the Administrative Coroner position ($86,939) and a Coroner"s Investigator position ($65,838), would be incurred until this position could be eliminated through attrition.

Under a combined PA/PG/Medical Examiner"s Office, the PA/PG and Assistant PA/PG would assume the following responsibilities currently performed by the Administrative Coroner and/or the Chief Medical Examiner:

• Planning, organizing, directing and evaluating the custodial and functions of the Medical Examiner"s Office, including: (1) accounting of all property and monies acquired through the investigation of deaths; (2) the preparation of payroll, the Medical Examiner"s budget and other administrative support functions; and (3) the preparation of official records and reports.

• Reviewing and inspecting the Medical Examiner"s Office"s operations in accordance with State laws, court policies and sound managerial practices.

• Acting as official spokesperson for the Medical Examiner"s Office on issues related only to administration and investigative functions.

• Directing and reviewing the activities of the senior Coroner"s Investigator in charge of death investigations (see Investigations below).

• Managing the Indigent Burial Program.

As in Los Angeles County, there would be no reporting relationship between the Chief Medical Examiner and the PA/PG. However, there would be a direct line of communication between the two positions. For example, the PA/PG and the Chief Medical Examiner would need to coordinate on the preparation of the Medical Examiner"s Office"s budget and, when necessary, on issues common to both the Coroner and Public Administrator functions, such as investigations and property control.

We recommend that the following changes take place in the process of consolidating the Medical Examiner and the PA/PG"s Office. In some cases, these measures would result in a cost savings to the City.

• The existing 1426 Senior Clerk Typist and the part-time clerical worker (currently classified as a Medical Transcriber) in the Medical Examiner"s Office should be pooled with the staff of four clerical workers in the PA/PG Office. Clerical staff could be assigned work related to either the PA/PG or Medical Examiner functions.

• In order to provide the PA/PG with additional administrative and clerical support under the consolidated department, one 1426 Senior Clerk Typist in the PA/PG"s Office should be reclassified upwards to a 1450 Executive Secretary I. The estimated additional cost of reclassifying this position would be approximately $8,947 per year, which consists of an additional salary cost of $7,647 and fringe benefits of $1,300.

• Because of efficiencies created by pooling clerical staff from each Department, the 1452 Executive Secretary II position in the Medical Examiner"s Office, which is currently vacant, could be eliminated. This would result in an annual savings of $47,894 in salaries and $8,142 in fringe benefits, for a total of $56,036 per year.

• The 1844 Senior Management Assistant in the Medical Examiner"s Office should report directly to and be evaluated by the PA/PG. This employee would continue to perform property control duties for the Medical Examiner. In addition, this employee would provide technical support to the PA/PG in the areas of payroll, personnel, budget preparation and management, purchasing, management information, and other administrative support functions for both the PA/PG"s Office and the Medical Examiner.

• The Senior Coroner"s Investigator responsible for overseeing death investigations for the Medical Examiner"s Office should report directly to and be reviewed by the PA/PG.

In summary, the City would realize the following savings by consolidating the Medical Examiner"s Office and the PA/PG"s Office:

Investigations

In order to improve supervision of investigative staff, the responsibility for oversight and supervision of investigations should be performed separately from the management of administrative support functions. As such, we recommend transferring this responsibility from the Administrative Coroner to the most senior Coroner"s Investigator in the Medical Examiner"s Office.

This Investigator, who serves as bailiff for the Department, currently spends much of his time performing clerical duties, such as answering the telephone, making bank deposits and maintaining office files, which should be delegated to lower level clerical staff. The senior Investigator could then assume some of the Administrative Coroner"s duties, such as providing office and field supervision of investigative staff, reviewing investigative reports, examining property receipts, scheduling inquests, providing in-service training and interfacing with other agencies regarding death investigations.

Rather than adding a new position to the budget or creating a new supervisory classification for Coroner"s Investigators, the Department should pay a supervisory differential premium to the senior Investigator for the performance of the above functions. The amount of this supervisory differential premium should be five percent of base salary, based on the provisions of the existing Memorandum of Understanding (MOU) with SEIU, Local 790, the labor organization which represents the Coroner"s Investigator classification. The estimated additional cost of this supervisory differential premium would therefore be $3,292 per year, or five percent of an Investigator"s salary.

An additional $3,292 in overtime should also be provided per year in order to allow the supervising Coroner"s Investigator to perform spot inspections of Coroner"s Investigators in the field during non-business hours. This would provide approximately 81 hours of overtime per year for field supervision of Coroner"s Investigators. In addition, a formal reporting procedure should be implemented in order to document the frequency and duration of field visits and to record the observations made during such visits by the Senior Coroner"s Investigator.

Under the new organizational structure, all Coroner"s Investigators and Drivers would report directly to the Senior Investigator, who would report directly to the PA/PG. Coroner"s Investigators and Drivers would have the same duties and responsibilities as under the current organizational structure. Although the PA/PG"s Office has a staff of Investigators, the investigative functions of the PA/PG"s Investigators and the Coroner"s Investigators would not be consolidated. Additionally, although under separate reporting structures, there would still be a direct line of communication between Coroner"s Investigators and Pathology staff on matters relating to the determination of cause and manner of death. For example, Coroner"s Investigators could continue to page the on-call Pathologist during non-business hours in order to obtain answers to questions regarding death investigations.

The Proposed Organizational Structure

The new organizational structure for the combined PA/PG/Medical Examiner"s Office, as proposed in this report, is shown on the following page.

Medical Examiner"s Office &
Public Administrator/Guardians Office
Proposed Organizational Structure

In summary, the reassignment of duties from the Administrative Coroner and the Chief Medical Examiner to existing Medical Examiner staff and to other City departments would result in a more equitable distribution of workload throughout the Department, reduce the span of control of the Chief Medical Examiner, and result in a net annual savings in the amount of $109,610 to the City and County, as follows:

In addition, the organizational changes recommended above would be supplemented by improvements in training, as recommended in Section III (Toxicology) and Section VII (Staff and Training), in order to support the new structure and overall efficiencies.

Conclusions

The current organizational structure of the Medical Examiner"s Office illustrates an overly broad span of management control for the Chief Medical Examiner and Administrative Coroner as a result of 1) the extensive duties, activities and supervisory responsibilities undertaken by these two individuals; and 2) recent events related to staffing changes, vacancies and litigation.

As a result of these broad spans of control, problems have arisen, such as: a general lack of supervision of line staff; the neglect of internal controls, policies and other duties; irrational and unclear lines of reporting; and low employee morale.

To improve the overall management and organization of the Medical Examiner"s Office: 1) the Chief Medical Examiner should (a) assume supervisory and management responsibility of the Medical Services functions of the Office in accordance with Recommendation VI.1 of this report; and b) delegate certain management and supervisory responsibilities to more appropriate Medical Examiner"s Office staff, in accordance with Recommendations V1.2, VI.3 and VI.4; and 2) the Administrative Services Director should reorganize the Medical Examiner"s Office and the Office of the Public Administrator/Guardian in accordance with Recommendations VI.5 and VI.6 of this report, for an estimated savings of $109,610 annually.

Recommendations

The Chief Medical Examiner should:

VI.1 Work with the Human Resources Department to revise the position description for the Chief Medical Examiner, in order to provide the Chief Medical Examiner with responsibility for oversight of the medical and technical functions of the Medical Examiner"s Office as well as limited supervisory duties.

VI.2 Work with the Human Resources Department to create a consolidated Forensic Laboratory Manager/Forensic Toxicologist position in the Medical Examiner"s Office and delegate responsibility for management and supervision of the Medical Examiner"s Office laboratories to this consolidated position.

VI.3 Revise reporting relationships in the Medical Services Division in order to delegate supervisory responsibility for Histology Laboratory staff, Pathology staff and Medical Transcriber Typists to the Forensic Pathologists.

VI.4 Transfer responsibility for supervision of the investigative function from the Administrative Coroner to the most senior Coroner"s Investigator in the Medical Examiner"s Office and implement a formal reporting procedure for documenting the frequency and duration of field visits and recording the observations made during such visits by the Senior Coroner"s Investigator.

VI.5 Pending the recommended consolidation of the Medical Examiner"s Office and the Public Administrator/Guardian"s Office by the Director of Administrative Services, (a) transfer management and oversight of the administrative support and investigative functions of the Medical Examiner"s Office to the PA/PG; (b) eliminate the Administrative Coroner and Executive Secretary positions through attrition; (c) create a pool of clerical staff in the combined PA/PG and Medical Examiner"s Office which can be assigned work related to both the PA/PG and Medical Examiner"s Office functions; and (d) coordinate with the PA/PG on matters concerning the Medical Examiner"s Office as needed.

The Public Administrator/Guardian should:

VI.6 Pending the recommended consolidation of the Medical Examiner"s Office and the PA/PG"s Office by the Director of Administrative Services, (a) assume responsibility for management and oversight of the administrative support and investigative functions of the Medical Examiner"s Office; (b) provide direct supervision of the Senior Coroner"s Investigator and the Senior Management Assistant in the Medical Examiner; (c) create a pool of existing Medical Examiner"s Office and PA/PG"s clerical staff which can be assigned work related either to the PA/PG"s Office or the Medical Examiner; (d) file a request with HRD for the upwards reclassification of an existing PA/PG 1426 Senior Clerk Typist to a 1450 Executive Secretary I position; and (e) coordinate with the Chief Medical Examiner on matters concerning the Medical Examiner as needed.

The Director of Administrative Services should:

VI.7 Reorganize the Medical Examiner"s Office and the Public Administrator/Public Guardian"s Office in accordance with Recommendations VI.5 and VI.6 above.

Costs/Benefits

The reassignment of duties from the Administrative Coroner and the Chief Medical Examiner to existing Medical Examiner"s Office staff and to other City departments would result in a more equitable distribution of workload, reduce the span of control of the Chief Medical Examiner and improve overall management and operation of the Medical Examiner.

The City would incur the following additional annual costs by implementing the recommendations included in this report:

However, these additional costs would be offset by the following annual savings to the City:

As such, the overall net savings would be $109,610 per year, as follows:

Footnotes

1. The CAO also made note of this fact it its 1990 study of the Medical Examiner"s Office.