Survey Regarding Impact of Increased Death Investigations & Opioid Crisis on County Medical Examiner/Coroner Costs in NYS conducted by the New York

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1 Survey Regarding Impact of Increased Death Investigations & Opioid Crisis on County Medical Examiner/Coroner Costs in NYS conducted by the New York State Association of County Health Officials (NYSACHO) Results as of July 31, 2017

2 Rationale for Survey Concern expressed by some counties with Medical Examiners (MEs) or Coroners about spikes in the numbers of unattended death investigations. Speculation that this is largely due to an increase in opioid overdose deaths. Some counties also cite increased suicides and homicides, but question whether these may also be related to the opioid crisis. Some counties indicated the death count exceeds the resources needed to do these investigations. NYSDOH is concerned about the accuracy and timeliness of data on opioidrelated deaths. Reports indicate that necessary resources, such as lab testing, are strained. Need to better quantify the cost impact on ME and Coroner offices.

3 Total of 44 responses from counties outside NYC 35 complete 9 incomplete 33 of 35 that completed the survey identified their county 2 respondents did not report their county

4 Does your county have a medical examiner (ME)? Yes No Unanswered 3 Of the 44 respondents, 27 (61.4%) counties stated that they do not have a ME, and 14 (31.8%) counties stated they do have an ME.

5 Results from Medical Examiner (ME) Counties

6 Is your ME under the administrative oversight of your LHD? ME Counties (N=14) Among the ME counties that answered No, 3 stated that a separate, independent department provides administrative oversight. 2 0 Yes No

7 Is your county experiencing increased costs for unattended death investigations by MEs? ME Counties (N=14) Of the 7 ME counties that answered Yes, 4 stated that the increase is due to the opioid epidemic and 3 counties stated that the opioid epidemic contributes to the increase. 3 ME counties did not respond. 0 Yes No

8 Year that increased in costs for unattended death investigations began. ME Counties (N=14). County Year All 7 ME counties that have experienced an increase in costs indicated the year when they started seeing the increase. Jefferson 2011 Monroe 2012 Schenectady 2013 Erie 2015 Ulster 2015 Onondaga 2016 Westchester 2016

9 2015 and 2016 annual expenditures and 2017 budget for ME services in counties with MEs (10/14 counties responded) * Blank if not reported in the survey

10 ME Services Annual Expenditures (2015, 2016) and Budget (2017) by County Chenango Erie Jefferson $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $80,832 $75,730 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $2,445,714 $2,720,609 $2,929,979 $450,000 $400,000 $350,000 $300,000 $250,000 $200,000 $378,604 $371,675 $371,148 $30,000 $20,000 $10,000 $1,000,000 $500,000 $150,000 $100,000 $50,000 Monroe Onondaga $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 $2,000,000 $3,751,000 $3,490,000 $4,073,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $2,738,765 $2,789,402 $2,827,128 $1,500,000 $1,000,000 $500,000 $1,000,000 $500,000

11 ME Services Annual Expenditures (2015, 2016) and Budget (2017) by County (continued) Rensselaer Schenectady Suffolk $100,000 $90,000 $80,000 $86,750 $87,672 $93,000 $300,000 $250,000 $249,676 $256,284 $282,016 $12,000,000 $10,000,000 $10,894,563 $10,456,834 $10,601,410 $70,000 $60,000 $200,000 $8,000,000 $50,000 $150,000 $6,000,000 $40,000 $30,000 $100,000 $4,000,000 $20,000 $10,000 $50,000 $2,000,000 Ulster Westchester $1,000,000 $900,000 $950,080 $2,500,000 $2,166,473 $2,070,058 $2,335,511 $800,000 $2,000,000 $700,000 $600,000 $500,000 $400,000 $403,539 $491,179 $1,500,000 $1,000,000 $300,000 $200,000 $500,000 $100,000

12 Have you exceeded, or do you anticipate exceeding, the county s 2017 ME budget? Yes No Unsure 11 of 14 ME counties responded 1 county has already exceeded or anticipates exceeding their 2017 budget. 6 of the 11 (54.5%) ME counties responding are unsure if they will exceed their 2017 budget

13 Amount claimed in the last year that ME services were eligible for state aid reimbursement 8 ME counties reported the amount they claimed for ME expenditures under Article Six of the Public Health Law in 2012 County Erie $608,893 Jefferson $47,646 Amount Claimed Monroe Just under $1,000,000 Onondaga $274,002 Rensselaer 2011 budget $50,000 Revenue $18,000 Schenectady $51,262 Ulster Net exp $244,699 State Aid $88,092 Westchester $298,216

14 Do other counties contract with your county for ME services? Of the 13 ME counties that responded, 3 stated that other counties contract with them for ME services. County Erie 4 Monroe 12 Onondaga 5 Number of contracts with other counties

15 Results from Coroner Counties

16 Is your county experiencing increased costs for contractual ME services due to the opioid epidemic? Yes No Not yet, but expect increases this year 4 8 of the 20 (40.0%) Coroner counties responding are experiencing increased costs. 4 of the 20 (20.0%) are expecting an increase this year.

17 Increased costs for contractual ME services due to the opioid epidemic 6 of the 8 Coroner counties that have experienced an increase reported the year when they started seeing the increase. County Year St. Lawrence 2014 Cortland 2015 Wyoming 2015 Chemung 2016 Lewis 2016 Saratoga 2016

18 2015 and 2016 annual expenditures and 2017 budget in coroner counties contracting for ME services (11 of 20 counties responded) * Blank if not reported in the survey

19 Annual Expenditures (2015, 2016) and Budget (2017) for Coroner Counties Chautauqua Chemung Cortland $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $224,991 $247,567 $255,661 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $259,822 $321,989 $278, $155,000 0 $200,000 $180,000 $160,000 $140,000 $120,000 $100,000 $80,000 $60,000 $40,000 $20,000 Genesee $188,894 $143,972 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 Livingston $48,000 $48,000 $36,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 Ontario $294,888 $295,538 $301,139

20 Annual Expenditures (2015, 2016) and Budget (2017) for Coroner Counties (continued) $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 Orleans Saratoga St. Lawrence $80,742 $83,375 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $308,818 $312,680 $282,870 $285,065 $247,086 $254,897 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 Sullivan Wyoming $450,000 $400,000 $350,000 $300,000 $270,366 $328,987 $385,609 $120,000 $100,000 $80,000 $82,751 $90,414 $99,248 $250,000 $200,000 $60,000 $150,000 $40,000 $100,000 $50,000 $20,000

21 Have you exceeded, or do you anticipate exceeding, your 2017 (coroner) budget? Yes No Unsure 10 of the 19 (52.6%) coroner counties responding have already exceeded or anticipate exceeding their 2017 budget.

22 Of the 20 coroner counties responding, 15 stated that they contract to receive ME services. Reporting County Chautauqua Cortland * Franklin * Genesee Hamilton * Lewis Livingston Madison County with which they contract Erie Monroe Jefferson, Onondaga Monroe Onondaga Reporting County Ontario Orleans Saratoga Seneca St. Lawrence * Steuben Wyoming County with which they contract Monroe Monroe Rensselaer Monroe Monroe Monroe These coroner counties contract for autopsies with pathologists at hospitals or other medical facilities, either within their county or in other counties.

23 Budgetary Challenges Facing County Coroner and Medical Examiner Offices Related in Part to the Opioid Epidemic*. Some county Medical Examiner and Coroner offices in NYS may not be at liberty to exceed their annual budget. In at least one case, a county answered NO to whether or not they expect to exceed their ME budget because they are not permitted to exceed their budget. One county reports that it had spent its entire budget for body bags by the end of June; they anticipate being faced with more decedents than they have body bags before the end of If the need for supplies, lab testing, and other Non-Personal Service Costs for ME services exceeds their budget, one county stated that it must curtail service in some manner. If demands on personnel exceed the available staff, county ME or coroner offices are not at liberty to hire more staff. In addition, there is a national crisis in the availability of qualified Medical Examiners and Forensic Pathologists. One county reports that they cannot meet national standards for Medical Examiner Office accreditation because number of decedents per ME far exceeds the accreditation threshold of # of decedents per year per ME. Another is dangerously close to exceeding the accreditation limit. * Based on survey response notes and conversations with some Medical Examiners

24 Conclusions More than half of ME and coroner counties responding to the survey are experiencing increased costs. One ME county expects its 2017 expenses to exceed its 2017 budget by $250,000. The total amount that seven Coroner counties expect to exceed their 2017 budget is $250,000, an average of about $35,700 per county. Many ME and Coroner counties are Unsure if they will exceed their 2017 budgets. There is a general consensus that a significant portion of counties in NYS are facing a resource crisis in handling investigations of unattended deaths due primarily to a spike in the number of such deaths, and believe this spike is due primarily to the opioid crisis. There is a statewide need for more accurate and timely data on opioid-related deaths and the specific drug(s) involved. The coroner/me system is an important source of such data. The challenges facing this system may impact the availability of needed data on the opioid epidemic.