P.A.G.E. Shares Info Regarding Proposed Eastern Idaho Forensic Pathology Center

• Idaho autopsy rate is 3rd lowest in the nation: https://legislature.idaho.gov/wp-content/uploads/OPE/Reports/r2303.pdf?fbclid=IwAR23XtTXElIJ1gf9VD1XSKV1jYBB4VzUH6jJpiJUxmCkPaf5IcCF6eeNLgk
• Drug-overdose deaths are increasing. Federal cases (Fentanyl and trafficking) cannot be prosecuted without autopsy and toxicology reports. Most Idaho counties are not ordering autopsies/toxicology on drug overdose deaths. It is UNKNOWN how many more autopsies would be ordered with the proposed Eastern Idaho Forensic Pathology Center as each county must budget for their anticipated autopsies. All east Idaho counties could save (minimal) amounts on time/travel expenses by no longer going to Boise.
• It is time-consuming for Coroners to transport bodies to Boise for autopsies. A full-day trip usually. (Special circumstances may require more than one day.)

• NEW Forensic Center was originally touted to be self-supporting.
  • Revenue (income) = Expenses (salaries, benefits, operational, maintenance, etc.)
• Original 2022 Plan = Use $2M (County ARPA funds) + $900K (State contribution) toward constructing a NEW Forensic Center for handling autopsies in east Idaho vs. Boise.
  • Different locations/buildings were considered.
  • Construction estimates vary widely, including a consultant (SMITHGROUP) who estimated a cost of $9M.
• Current County Estimate = $3.5M (ARPA) for new construction that’s fully outfitted with required, specialized equipment
• NEW Forensic Center Job Creation = 2.5 jobs
  • ONE Forensic Pathologist: out-of-state recruit
  • ONE FT Administrator
  • ONE PART-TIME Medical Assistant.
  • Currently, software is anticipated to be used in lieu of a paid transcriptionist.
• ESTIMATED SALARIES:
  • Forensic Pathologist = $390K – $420K
    • Starting Salary estimate is $300K + Benefits (+approximately 40%). The County has been recruiting for this position for approximately 9 months and hasn’t secured a candidate yet.  This estimated salary is tied to a lower case load of 120-200. Caseloads higher than 200 typically demand a higher salary range]
  • Full-Time Administrator + Benefits (adding approximately xx%) = UNKNOWN
    • $50K minimum. The consultant is currently paid $4.5K/month or $54K/year with no benefits.
  • Part-Time Medical (Forensic) Assistant = UNKNOWN
    • $35K minimum. Contracted Assistant is currently paid $300/autopsy + $50/hr for any work over 4 hours.
• Estimated GRAND TOTAL OF STARTING SALARIES = $475K -$500K (minimum)
• Bannock County averages 2.25 autopsies per month =27 autopsies per year
• (2022=25 / 2023=30)
• Entire east Idaho region averages 76 autopsies per year (per Ada County)
• County is estimating higher @ 100-120 during 1st year of operation for entire region.
• SMITHGROUP Report (procured by the County) estimated autopsies per year based on population growth estimates and calculated only 105 autopsies/year @ 25+ years out.
• Time/Travel = Gas + Employee per diem (average should be less than $200 per trip)
• Boise Autopsy Fee = $2,300/each + lab expenses + required transportation time/travel
• Estimated Savings w/proposed NEW Forensic Center for Coroner and occasionally a Sheriff deputy in time/travel = UNKNOWN
• Bannock County Recommended Autopsy Fee = $2,300/each (to be competitive with Boise)
• Actual Eastern Idaho Forensic Pathology Center Autopsy Cost = UNKNOWN
• stimated Eastern Idaho Forensic Pathology Center Autopsy Cost = at least $6.85K/autopsy (per current estimates). Two (2) completed recently via Contractor = $6.5K/each (includes a Forensic Pathologist + medical assistant @ $250 + Portneuf facilities use fee @ $95 + unknown supplies, etc.)
• Boise built a $32M facility for 3 forensic pathologists carrying a caseload of 750 autopsies. They average about 1 autopsy per doctor per day + hours of paperwork. (Some autopsies can take much longer, so this is just an average.)

THE PLAN:

• Bannock County contracted with Portneuf Medical Center to use their morgue to begin serving local counties agreeing to use our autopsy services.
• Bannock County has been unable to recruit a forensic pathologist yet. Instead, partnering with Locums Obstetrics to perform autopsy services as needed. The cost of the first two recent autopsies topped $6850 each.
• 5 county contracts are pending as counties await an established fee schedule before signing contracts.
• Plans are to shift to a higher-cost “subscription plan” contract in which counties would agree to a set annual price based on their population.Annual fees and which counties will/will not contract for this service is unknown. Unknown, too, is how much revenue will be generated via a “subscription-based” versus “pay-as-you-go”contract.
• Other eastern Idaho counties are NOT contributing to the upfront costs of building or equipping such a facility.

THE RISKS/QUESTIONS:

• A $3.5M investment in a forensic facility makes it nearly impossible for the County to walk away at some point in the future if the “per autopsy” costs aren’t able generate sufficient supporting revenue or be competitive with Boise.
• It is unlikely the County would ever recoup the $3.5M from Forensic Center revenues. The goal is for the center to become self-sustainable.
• If the State were to take it over, would Bannock County Taxpayers recoup the costs of their initial investment of $3.5M+ in ARPA Funds or would the building be handed over?
• Actual subsidization amounts needed are currently unknown. The program could take a decade (or more) to become self-sustaining, requiring Bannock county taxpayer’s financial help in the interim. Bannock County taxpayers would be locked into subsidizing the cost of autopsies for all of Southeast Idaho, along with those local counties who agree to sign contracts, for an unknown duration. The subsidization amount appears to be a minimum of $300K but could be much more.
• The State of Idaho has not committed any financial support to date other than the original $900K, which may be needed toward construction and special equipment. If not used, it could potentially help subsidize the program for 1-2 years.
• Once the number of local autopsies surpasses the 200-220 mark (at an unknown future date), a second high-paid Forensic Pathologist is required, increasing costs.
• County property tax increases are capped at 3% per year. Thus, any taxpayer subsidization dollars required for a forensic facility would reduce spending available for other Bannock County needs (i.e. employee salaries, infrastructure upkeep, etc.)
• It is UNKNOWN whether other Counties may/may not be able to contract for higher budget amounts typical in subscription plans since budgets are set annually. Depending upon subscription amounts (which are proposed to be set based on population), why would any County contract for more autopsies than they might need in a given year versus pay-as-you-go?
• There’s no guarantee a forensic facility can be designed, built and equipped for $3.5M.  Estimates (from a procured expert) were as high as $9M.

THE MATH:

100 autopsies x $2.3K each = $230K in revenue
120 autopsies x $2.3K each = $276K in revenue
150 autopsies x $2.3K each = $345K in revenue
200 autopsies x $2.3K each = $460K in revenue

KNOWN COSTS:

Estimated Salaries = $475K – $500K (at minimum)
Operational Budget = $_____________?
Ongoing Maintenance = $_____________?
Estimated TOTAL =  $_____________? ($600K at minimum?)

03/21/2024 – Bannock County Work Session: