The Chief Medical Examiner and his staff also indicated that they are not proficient in reviewing and analyzing the financial reports that are produced and distributed to departments by the Controller"s Office on a monthly basis. The Budget Analyst"s reviews of such documents noted that the Medical Examiner"s Office had a balance of $119,875 at the close of Fiscal Year 1995/96, showing that the overall appropriation for the department had been underexpended. To the extent possible, these resources could have been reallocated during the year to provide the Medical Examiner"s Office with the ability to obtain needed equipment, update the Toxicology Laboratory, adhere more closely to Universal Precautions, or request essential staff.

Budget Planning and Requests

As part of the field work for this audit, the Budget Analyst requested information from the budget submissions prepared by the Medical Examiner for Fiscal Year 1996/97. The Medical Examiner"s Office staff was unable to provide any such information. Additionally, the staff was unable to provide any explanation on the origin of the amount of funding requested, justifications for the amounts requested in specific line items, or whether any reallocation of resources was requested or has taken place. Yet, the Medical Examiner"s Office holds that there is a prohibition against requesting new equipment which would allow the replacement of the outdated equipment in the Toxicology Laboratory.

The Annual Appropriations Ordinance indicates that $33,600 has been approved for equipment purchases for the Medical Examiner"s Office for Fiscal Year 1996-97. According to the Administrative Coroner, this is related to completing the planned renovation of the storage and refrigeration units, and is considered a capital outlay. Replacement of a Gas Chromatography/Mass Selective detector (GC/MS) in the Laboratory would also be considered a capital outlay as it would exceed $1,000 in cost and have a useful life in excess of three years. Most importantly, the acquisition of this particular piece of equipment would be considered the "replacement" of existing equipment that has surpassed its useful life, as opposed to the purchase of "new" or "additional" equipment which currently, does not exist in the Laboratory.

The City has a reasonable and fair budget review process. Requests for the replacement of equipment that has surpassed its useful life are evaluated and granted if the need for such equipment is compelling. The Medical Examiner"s Office"s inability to obtain needed equipment replacements is primarily a result of not requesting such replacements. This failure to request equipment replacements is further impacted by a lack of:

• Documentation on problems caused by using this type of equipment far past its useful life;

• Compelling justifications on the benefits of using GC/MS technology to perform drug assays; and

• An understanding of the budget instructions and process.

The staff of the Toxicology Laboratory should begin to document problems with test protocols or results caused by the age of the existing equipment, including the inability to get support and replacement parts from the manufacturers. This documentation should be used as the groundwork in preparing compelling justifications for the replacement of equipment that are submitted as Line Item Explanations during the budget preparation and submission process. Additionally, the Medical Examiner"s Office should gain a better overall understanding of the budget instructions and process in order to take advantage of opportunities to request replacement equipment, fund essential staff positions, and reallocate resources in order to operate as efficiently as possible while accomplishing the stated mission of the Office.

The Use of Management Information for Budget Development and Tracking

During the field work for this audit, the Budget Analyst"s staff requested information on the unit cost of conducting various activities within the Medical Examiner"s Office. Activities such as toxicological test, and autopsies were selected because the Medical Examiner"s Office keeps records on the number of these activities conducted on an annual basis. Additionally, the Medical Examiner"s Office has a fee schedule that was developed for use in billing clients for procedures conducted in non-Medical Examiner cases.

Despite maintaining workload information on the number of autopsies performed and toxicological tests conducted, and developing a detailed fee schedule for various functions, the Medical Examiner"s Office was unable to: 1) provide specific information on the cost of operating Histology, Pathology and Toxicology sections; and 2) the specific cost of conducting in-house autopsies and toxicology tests. The Medical Examiner"s Office staff further indicated that the manner in which the City"s financial system, Financial Accounting Management Information System (FAMIS), tracks budget and expenditure information does not allow the Office to segregate cost data at this level of detail. As such, in-house tracking reports are planned to provide the detailed expenditure information needed.

The in-house tracking reports are to be generated on the Medical Examiner"s Office"s new LAN. This LAN, which has been developed within the last two year. has allowed the Medical Examiner"s Office to migrate from the old WANG system and update both word processing and spreadsheet applications used to develop and monitor information on Medical Examiner"s cases and administrative activities such as budget tracking and the procurement of supplies. However, the Medical Examiner"s Office staff reports that the in-house spreadsheet applications have not been developed.

The Budget Analyst"s staff has determined that the development and implementation of the in-house spreadsheet applications, particularly with regard to monitoring expenditures for specific activities, is extremely important. Without the ability to monitor expenditures in Histology, Toxicology and Pathology, the cost of conducting these activities cannot be accurately determined, and the Medical Examiner"s Office will continue to assert that it is unable to determine the cost of conducting specific types of toxicological tests, autopsies, and external examinations.

Having detailed activity and unit cost information would allow the Medical Examiner"s Office to determine the cost effectiveness of conducting activities in-house as opposed to contracting out such activities, and cost savings that could be obtained by reducing the number of toxicological tests conducted or implementing changes to autopsy protocols.

Conclusions

The Medical Examiner"s Office is divided into three programs, Administration, Investigative Services and Medical Services, which provide forensic medical services for the City and County of San Francisco. The Board of Supervisors of the City approved an expenditure appropriation of $3,242,150 for Fiscal Year 1996/97 to provide the required funding for the resources necessary to accomplish the Medical Examiner"s mission.

Despite having participated in the budget process, the Medical Examiner"s Office staff is unable to provide any information regarding the origin of their budget request, the documentation used to generate the allocations for non-personnel expenditures for the three major programs, or how much of the budget has been expended in the three major programs, year-to-date. The inability to provide such information makes it extremely difficult to determine the unit cost of activities within the three major programs. Additionally, the Chief Medical Examiner and his staff are unwilling to provide estimates on the unit costs of conducting various activities in each of the major programs. The absence of detailed expenditure information also makes it difficult to properly allocate and reallocate resources so that the mission of the Medical Examiner is carried out as efficiently as possible.

Based on information obtained while conducting the field work for this audit, and also from information provided to the Civil Grand Jury for the City and County of San Francisco, the Medical Examiner"s Office needs to replace laboratory equipment that has surpassed its useful life. However, based on an assumption that all budget requests for equipment are prohibited, such equipment has not been requested as part of the regular budget process.

In order to plan more efficiently, and prepare budget submissions that provide compelling and accurate information stating the resource needs of the Medical Examiner"s Office, staff should make greater efforts to understand the financial reports that are provided by the City to monitor budget activities. Additionally, the Medical Examiner"s Office should start documenting problems resulting from using laboratory equipment long past is useful life. By taking these measures, the Medical Examiner"s Office would be able to take advantage of opportunities to request replacement equipment, essential staff positions and reallocate resources in order to operate as efficiently as possible.

Recommendations

To gain a better understanding of the budget process and provide information on the estimated unit cost of activities, the Medical Examiner"s Office should:

IV.1 Develop a better understanding of the information generated by the City"s financial system (FAMIS) and utilize that information to monitor the Office"s budget.

IV.2 Develop in-house expenditure and activity reports that can be used to estimate the amount and cost of various activities such as the cost of conducting toxicological tests, autopsies, and the production of slides and tissue samples.

IV.3 Take greater responsibility for determining how resources are allocated between the three programs by:

• actively participating in the budget process and taking responsibility for the resources requested;

• monitoring budget expenditures to determine whether changes in the existing allocation should be made in order to adequately fund activities in the various programs; and

• reading and understanding the budget instructions, provided by the Controller, so that valid requests for resources are made, and compelling Line Item Explanations are prepared for new or replacement items.

Costs/Benefits

The recommendations in this section can be implemented without adding financial or staff resources to the Medical Examiner"s Office. All financial reports, prepared by the Controller are available to the Medical Examiner"s Office staff, as well as budget instructions. Additionally, the recent migration from the Wang Computer System to a LAN have given the Medical Examiner"s Office the ability to develop the spreadsheet applications needed to monitor workload and expenditures in order to determine an estimated unit cost for specific activities.

Footnotes

1. See City and County of San Francisco -- San Francisco Police Department/Crime Laboratory (SFPD/CL) and San Francisco Medical Examiner/Toxicology Laboratory (SFME/TL) report prepared by the FY 1995-96 City and County of San Francisco Civil Grand Jury.