MEDICAL EXAMINERS COMMISSION MEETING Sawgrass Marriott Resort & Beach Club 1000 PGA Tour Boulevard Ponte Vedra Beach, Florida August 13, 2008 10:00 AM ATTENDANCE: Chairman Stephen J. Nelson, M.D., called the meeting of the Medical Examiners Commission to order at 10:00 AM at the Sawgrass Marriott Resort & Beach Club, in Ponte Vedra Beach, Florida. He welcomed everyone to the meeting and asked Commission members, staff, and audience to introduce themselves. Commission members present: Stephen J. Nelson, M.D., District Medical Examiner Ken Jones, Department of Health Bruce A. Hyma, M.D., District Medical Examiner Hon. Mark E. Kohl, J.D., State Attorney Robert J. Krauss, J.D., Attorney General‟s Office Commission members absent: Mariana Caballero, L.F.D., Funeral Director Honorable Grady C. Judd Jr., Sheriff Commission staff present: Victoria Marsey Branch Ocampo Doug Culbertson District Medical Examiners present: Jon R. Thogmartin, M.D. (Dts. 5 & 6) E. Hunt Scheuerman, M.D. (Dt. 16) Vernard I. Adams, M.D. (Dt. 13) Marta U. Coburn, M.D. (Dt. 20) Russell S. Vega, M.D. (Dt. 12) Marie A. Herrmann, M.D. (Dt. 7 & 24) Other District personnel present: Larry Bedore (Dt. 8) Anthony S. Clark, M.D. (Dt. 2) Barry Appleby (Dts. 7 & 24) Kelly Cobb (Dts. 7 & 24) Bill Pellan (Dts. 5 & 6) Suzanne Utley, M.D. (Dt. 12) Noel Palma, M.D. (Dts. 5 & 6) Cathy Weldon (Dt. 8) Joshua D. Stephany, M.D. (Dt. 9) Sara H. Irrgang, M.D. (Dt. 9) Daniel L. Schultz, M.D. (Dt. 12) Guests present: Jody Brandenburg, L.F.D. Dave Casey Robin Sheppard, L.F.D. Jaclyn Bell Kelly Cobb Lesley Lang Jean Hess Bruce Goldberger, Ph.D. Ken Cohrn, DDS Seyed Mirmo, M.D. Lynne Hanas A MOTION WAS MADE, SECONDED, AND PASSED UNANIMOUSLY FOR THE COMMISSION TO APPROVE THE AGENDA AS WRITTEN IN THE MEETING PACKET. A MOTION WAS MADE, SECONDED, AND PASSED UNANIMOUSLY FOR THE COMMISSION TO APPROVE THE MINUTES OF THE MAY 28, 2008 MEDICAL EXAMINERS COMMISSION MEETING. MEC Meeting Minutes August 13, 2008 Page 2 ISSUE NUMBER 1: INFORMATIONAL ITEMS Ms. Marsey informed the Commission that staff is still awaiting the Gubernatorial Appointments for Districts 15-24. These are all reappointments except for District 16 which will be addressed as a separate agenda item and District 24 which is an appointment for Marie A. Herrmann, M.D. Staff has been told the appointments office should be briefing the Governor within the next week or two. Ms. Marsey stated that the 14th Judicial Circuit State Attorney has named Michael D. Hunter, M.D. as the Interim District 14 Medical Examiner as of July 1, 2008 and staff is awaiting the gubernatorial appointment. Ms. Marsey announced that the 2007 Drugs in Deceased Persons Report was released in June. Each DME was provided a copy which is also available on the MEC website. It remains a very popular report and was covered in The New York Times, Harper’s magazine, and other media outlets. Ms. Marsey reported that staff is still awaiting the Gubernatorial Appointments for the Commission vacancies. Dr. Nelson has completed two terms as a DME representative and Ms. Caballero as the Funeral Director representative. Mr. Bob Dillinger previously resigned as the Public Defender representative. Staff expects to hear about these vacancies at the same time as the District Medical Examiner reappointments. Ms. Marsey also informed the audience members if they were still interested in applying, they should do so immediately. Dr. Nelson briefly shared with the Commission and the audience that the Federal Government decided to not disband the Armed Forces Institute of Pathology (AFIP) at least until a replacement facility has been designated by the Department of Defense. The AFIP is still available for consultations. Ms. Marsey informed the Commission that the 2007 Annual Workload Report has been completed and that it is available on the MEC website. Ms. Elizabeth Porter, the MEC County Commissioner representative, has resigned her position as a Columbia County Commissioner in order to run for the Florida House of Representatives District 11 seat. Her resignation opens a vacancy on the MEC and staff will be soliciting input from the Florida Association of Counties for possible candidates. Ms. Marsey also recommended to the audience to encourage their local County Commissioners to contact staff in order to apply for the MEC position. ISSUE NUMBER 2: RESOLUTION FOR ELIZABETH PORTER Dr. Nelson reported that staff had prepared a resolution honoring Ms. Elizabeth Porter, who served the Medical Examiners Commission as the County Commissioner representative. Dr. Nelson read Ms. Porter‟s resolution into the record: RESOLUTION WHEREAS, Florida Statutes, Chapter 406, also known as “The Medical Examiners Act”, created the Medical Examiners Commission by legislative enactment in 1970 and, WHEREAS, the Medical Examiners Commission plays a vital role in support of Florida‟s criminal justice system, in service to the families of the deceased by determining the cause and the manner of death, and by protecting the public health of the citizens of Florida and, WHEREAS, Ms. Elizabeth Porter was the elected County Commissioner for Columbia County in the State of Florida, where she served in that capacity for four years since she was initially elected in the year 2004 and, WHEREAS, Ms. Elizabeth Porter was appointed to the Medical Examiners Commission in March, 2006, where she has represented the concerns of Florida‟s County Commissioners over her term until she left her elected position and, MEC Meeting Minutes August 13, 2008 Page 3 WHEREAS, as the result of Ms. Porter‟s years of experience in public service, her keen insight, and highly respected judgment concerning the most critical of medical examiner activities posed within Florida, Ms. Porter was frequently called upon by the Medical Examiners Commission Chairman to participate in probable cause panels which have dealt with matters of the utmost importance to the Medical Examiners Commission, WHEREAS, Ms. Porter has not only earned the reputation as being an invaluable resource for the Medical Examiners Commission, but she has, above all, earned the reputation as being respectful in her judgments and fair-minded in expressing any admonishments or censures that have occurred during her tenure. NOW THEREFORE, let it be resolved that the Medical Examiners Commission, on behalf of Florida‟s medical-legal community, and the citizens of the State of Florida for whom she served so capably, does hereby recognize and commend Elizabeth Porter for her dedication, her exemplary service, her pleasant yet professional demeanor, and the invaluable guidance she has offered to Florida‟s District Medical Examiner System in her position as County Commissioner Representative on the Medical Examiners Commission. PASSED AND RECORDED, in the official minutes of the Medical Examiners Commission meeting on this Wednesday, the 13th day of August, 2008, in Ponte Vedra Beach, St. John‟s County, Florida. Ms. Porter was unable to attend the meeting; therefore staff will ensure delivery of her resolution. ISSUE NUMBER 3: PREGNANCY ASSOCIATED MORTALITY REVIEW Anthony J. Clark, M.D., presented a report regarding the Pregnancy Associated Mortality Review (PAMR). The purpose of PAMR is to reduce Florida‟s maternal mortality, improve identification of maternal deaths, identify system issues/gaps in care, and to develop action plans. A copy of Dr. Clark‟s presentation was provided to each district to raise awareness of these types of deaths and to request that medical examiner‟s take jurisdiction in related cases. ISSUE NUMBER 4: FIREFIGHTER AUTOPSY PROTOCOLS & STATE FIRE MARSHAL FIREFIGHTER FATALITY INVESTIGATIONS Chief Dave Casey presented Firefighter Occupational Safety & Health Responsibility and Authority to the Commission and audience on behalf of the State Fire Marshal‟s Office. He provided background on firefighter standards and training. He also informed the Commission of the recently released Firefighter Autopsy Protocol. He educated the audience and Commission on hydrogen cyanide (HCN) which is now believed to be the leading cause of fire fatalities but is commonly mistaken with Carbon Monoxide poisoning. He encouraged the medical examiners to call if they have any questions. Dr. Nelson commented that at first he was concerned that a medical examiner was not consulted in the writing of the Protocol but reassured Chief Casey that it is in line with what Florida medical examiners do routinely. ISSUE NUMBER 5: CHILDREN’S HEART VALVE DONATIONS E. Hunt Scheuerman, M.D., made a presentation to the Commission and audience to encourage Infant and Child Heart Valve Donations. He explained how this type of donation is life saving like transplantation and how these cases are not as successful with other techniques available for adults. A protocol for infant and child heart valve donations was developed in Virginia and is applicable in Florida. Dr. Scheuerman recommended that Florida medical examiners become familiar with the Virginia Protocol to help save lives. ISSUE NUMBER 6: DISTRICT 16 VACANCY Bruce A. Hyma, M.D., announced that the District 16 Search Committee met on July 30th and chose Dr. E. Hunt Scheuerman to become the new District 16 Medical Examiner. State Attorney Mark E. Kohl has appointed Dr. Scheuerman as the Interim District Medical Examiner effective on September 1st. The Commission briefly discussed the background information. MEC Meeting Minutes August 13, 2008 Page 4 A MOTION WAS MADE, SECONDED, AND PASSED UNANIMOUSLY FOR THE COMMISSION TO RECOMMEND TO THE GOVERNOR THAT DR. E. HUNT SCHEUERMAN BECOME THE NEW DISTRICT 16 MEDICAL EXAMINER. Dr. Scheuerman was directed to complete the Gubernatorial Appointment Questionnaire for staff to forward to the Governor. ISSUE NUMBER 7: UNIDENTIFIED DECEDENTS, DNA AND CODIS Ms. Marsey addressed an issue brought before the Commission at the May meeting regarding inconsistencies within the FDLE laboratories when processing DNA requests. Staff met with W. David Coffman (FDLE‟s Chief of Forensic Services), who will serve as the DNA contact person for questions regarding submitting unidentified deceased STR DNA samples to FDLE. He said the FDLE labs will process requests labeled as Unidentified Human Remains to compare against the Florida Offender Database. Staff also learned recently that samples submitted to the University of Texas or the FBI will now be compared at a national level to the Missing Persons Database and the CODIS Offender Database. Staff will be sending an updated Unidentified Deceased Persons Survey Packet to each district office to identify what methods are working throughout the state. A revised list of resources available to Florida medical examiners will also be provided. The Commission congratulated Barry E. Lipton, D.D.S., a Board-certified forensic odontologist in Largo, who frequently assists in unidentified death cases, for receiving the 2008 FBI Assistant Director‟s Award for “Exceptional Public Service” related to his work with CJIS, NCIC, and the National Dental Image Repository Review Panel. ISSUE NUMBER 11: DEATHS CAUSED BY HAZ MAT INCIDENTS Director Craig Fugate, Office of Emergency Management, informed the Commission that Hazardous Material related deaths need to be reported. In most cases, these deaths involve diesel fuel; however information regarding the cause of death is not reported from the scene incident reports. He proposed, when a hazmat is involved that the cause and manner of death only be determined by the medical examiner and that would be reported to the Department of Emergency Management. Currently, the only information being recorded is that a death occurred and that a hazmat was present. Dr. Nelson agreed that medical examiners should be able to provide this information easily as it is all public record information. ISSUE NUMBER 10: ANY OTHER BUSINESS TO COME BEFORE THE COMMISSION Dr. Nelson informed the audience of an email exchange between himself and Mr. Ken Kramer, a researcher for the Citizens Commission for Human Rights of Florida. Mr. Kramer has requested that antipsychotics and antidepressants be added to the drugs tracked in the Drugs in Deceased Persons Report due to their black box death warning labels. Mr. Kramer is concerned that there are not any statistics on these types of drugs. Dr. Nelson asked the Commission and audience if antipsychotics and antidepressants should be added to the drugs tracked by the Commission. Dr. Hyma stated his district does collect the data but has not seen more than the occasional death caused by these types of drugs. Dr. Nelson asked the audience if they are seeing a significant number of deaths with antidepressants or antipsychotics in their toxicology results. Dr. Thogmartin said he believed that most of the drugs in the Commission‟s report were added because they are controlled substances and the use was inappropriate. Antipsychotics and antidepressants are not controlled substances. Dr. Adams said he doesn‟t believe it is an issue in his district and the drugs tracked are of interest to the Office of Drug Control. Dr. Adams recommended for Mr. Kramer to contact the Office of Drug Control. Dr. Schultz was concerned this method of collecting data will not be sufficient for Mr. Kramer and suggested that death certificate information might be more appropriate. Mr. Jones said Mr. Kramer can request large amounts of information from the Office of Vital Statistics through a data use request. MEC Meeting Minutes August 13, 2008 Page 5 Dr. Nelson concluded the discussion by stating antidepressants and antipsychotics would not be added to the Drugs in Deceased Persons Report as it does not seem to be an issue at this time. ISSUE NUMBER 8: 2008 EDUCATIONAL CONFERENCE Bruce A. Goldberger, Ph.D., welcomed everyone to the 35th Annual Florida Association of Medical Examiners Educational Conference. He mentioned where registration was taking place and to make sure to pick up the Conference materials. ISSUE NUMBER 9: 2009 EDUCATIONAL CONFERENCE Dr. Goldberger announced tentative dates for the 36th Annual Educational Conference would be August 12-14, 2009 in Sarasota, Florida. The host will be the District 12 Medical Examiner, Russell S. Vega, M.D. ISSUE NUMBER 10: ANY OTHER BUSINESS TO COME BEFORE THE COMMISSION (continued) Dr. Hyma mentioned to the Commission about „in custody‟ deaths when the inmate has been released from „in custody‟ to hospice care. He explained it is an option to be selective in taking the case if that inmate is not „in custody‟ at the time of death and they are under hospice care for a terminal illness not under the care of the Department of Corrections. He brought it up as an idea in a time of budget constraints. Mr. Jones offered an update on the Electronic Death Registration System. Initially a pilot was planned for 2008 but budget issues have delayed it until 2009. He hoped to be able to offer more information by the next Commission meeting. Dr. Hyma offered some words of encouragement for Mr. Jones to continue working diligently on this project. With no further business to come before the Commission, the meeting was adjourned at 11:24 AM.
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