 Welcome to Sheboygan County government working for you my name is Adam Payne County administrator and co-host of this program with Chairman Roger Distruty and as you know every month we strive to bring a different program or department and generally a department head to talk about it here to so you can get a better flavor for the roles and responsibilities of your Sheboygan County government and today we're very pleased to have Mr. David Lafine back who used to be our coroner so that name probably rings the bell but is now our new medical examiner welcome Dave. Thank you very much. Please begin by sharing a little bit about your background and setting the stage. Well I'm a Sheboygan data born and raised here in Sheboygan married 41 years and two children for grandchildren so I've been around here all for a long time. Born and raised here though. Born and raised. So did you go to the school in Sheboygan or Plymouth or Falls or? Sheboygan schools. In the city of Sheboygan. Very good. And elected coroner a little over 28 years ago. Correct. What was it that made you interested in pursuing being coroner? Well by profession I'm a registered nurse and at that time some of the local physicians talked to me. They wanted someone with some background in medicine to be the coroner so I took it and I thought well I'd enjoy doing it. I like people. Medicine is my my background. Just the feeling of being able to help people in a time of need. In a unique area I mean Sheboygan County has 18 departments and the corner or now medical examiner is one of those departments and as Dave has heard me share a number of times I always find our discussions when we discuss the annual budget one of the more fascinating discussions because then we'll generally get into your unique role and responsibilities and it is a unique area. We don't have people standing in line at the door to be coroner or now medical examiner and fortunately we've had you now for 28 years. It's one of those fields you have to you have to have a feeling for it you have to be able to deal with a lot of circumstances that most people don't want to deal with. They don't want to they don't want to deal with death and sometimes the trauma that's involved with death. I can only imagine the different investigations and the work you've done. Well the County Board as Roger Distrudi certainly knows because he helped lead the charge and you helped suggest or recommend it you were looking at retiring from being coroner. Not necessarily looking for another four years and the County Board for a number of years had been considering going from the elected coroner role to the appointed medical examiner role. Counties could have both. Please talk a little bit about well what's the difference between an elected coroner and an appointed medical examiner. The difference well first of all Wisconsin's a unique state in that the allow or pass legislation many many years ago to allow Lee medical examiners Lee medical examiner meaning someone who does not have a medical degree that opened up the position for counties who you have their choice between an elected official or an appointed official. By state statutes counties with populations of over 500,000 have to have a medical examiner. The other counties have the option. When you someone who desires to be a coroner you have to take out the local papers nomination papers and that depends on the size of your county on how many signatures you have to have here in Chavoy County with our population just over a hundred some thousand you have to have a minimum of 500 so that means anybody that wants to be corner you Roger you could have taken out paperwork got 500 signatures got your name on the primary ballot there's other opposition they had to do the same he who got the most votes moved to the general election if there was no contender then the person that person would become county corner for four years and that would just proceed year after four year term after four year term and this this past year after ending 28 years I didn't know if I wanted to go another four years as you had mentioned and I feel very strongly that should have someone who has background medical background a nurse other persons that are in the medical field otherwise the eclectic system you would have to you could be John Joe John Doe off the street could be anybody anybody you couldn't you know I don't want to degrade any profession but you could you could be the corner and not even be able to understand the circumstances going on and I felt strongly that I did not want that to happen couldn't change it but I recommended to the county board as you know that they go to a medical examiner system which other counties in shabu in Wisconsin are doing out of the 72 I believe we now have 36 or 37 counties that are medical examiners it's becoming more and more probably right that way the county has the option and holds a direction for that position right right and the reason that Dave is before us today is after the county board made the decision to go to a medical examiner and allow us to point someone with qualifications specially a medical background what have you to be an effective medical examiner then Dave approached me and said you know I'd be interested in helping with this transition I don't know for how long but I certainly know the job and there was no question about that so we feel fortunate to have someone with 28 years of experience a medical background helping us with this transition and of course when Dave decides to retire or we we part ways obviously the county board and I as county administrator will be in position to hire and appoint a medical examiner with a medical background so I think it was a real positive direction so back to the key question of difference in responsibility you mentioned the qualifications can be quite difference between a corner and a medical examiner what about the general work that you do responsibilities are the same we do the same thing I'm doing the same thing I did before medical examiner corners the whole idea or premise behind it is to look into certain deaths that are in the state statutes that are described all homicides all suicides all motor vehicle accidents board accidents things like that all unnatural type deaths and there's certain certain deaths such as someone could die from a say congestive heart failure but they fractured their hip two days prior to that because of other weakened condition by state statutes we have to look into that death also so position or job wise nothing changes difference you is a medical examiner your iPhone that I have a little bit more responsibilities to the county as far as meetings office protocols things like that that a little bit more stricter office practices and then the way I handled it prior to and and with 18 departments we have predominantly appointed department heads but we do have elected department heads like the former corner the county clerk is an elected position the treasurer is an elected position the register of deeds is an elected position the clerk of courts is an elected position and fortunately we have some pretty good people as a whole but the difference between appointed and elected is if one or more of those leaders aren't doing a good job aren't showing up for work aren't meeting their responsibilities they could have a four-year commitment and we really can't do a lot about it until the public votes again and votes them out of office so with the appointed approach you truly have much greater accountability that if someone isn't meeting their obligations are doing the job effectively to make a change great snapshot great overview Roger I'm going to turn it over to you thank you Adam although none of us has a great hope that someone on medical examiner will be at our doorstep death is a fact of life and it affects all of us I'd like to ask you a little bit about the specifics of how you interact with the public you and your staff do and I understand there are five manners of death would you explain that sure sure five manners of death you're talking about is natural death accident homicide suicide and there's one category called undetermined and that's that category is when they're there you can't call something an accident and you can't call it a suicide and you're sure it's not a homicide but you're also sure it's not a natural death so in those cases you you mark it as undetermined rare few and far between but it does happen and how many deaths a year does your office investigate okay years for the past several years we were investigating well over 500 we took a look at the state statutes how they were written how medicine has transpired in the last number of years with the advent of hospice nursing with the advent of nurse practitioners and how physicians handle their office and we I felt after looking at that it was maybe time to take a better look at how we look at the deaths when we have somebody that's in hospice care you know that they're being cared for by hospice nurse they may be in a setting where we used to go such as a CBRF which is an acronym for community based residential facility where they don't have any nursing staff on hand so if someone died there we would always go to those type of deaths now quite a few of those individuals are under hospice care so if that's the case feel very comfortable that the care is good and the medical condition is well documented and the hospice nurse or the nurse practitioner has had direct contact with the physician so I felt it felt it was no longer needed to do those and that was a quite a big number turned out to be little over 300 cases last year that we did not do because of a change which saves the colony money doesn't interfere with families prime time with their their loved ones and family so I think it was a good a good decision how we interact with the families as you asked each each death is unique and individual and each family is unique and individual and you approach these people carefully and and get a feel for how they handle it some are very happy and relieved that their loved one no longer suffers some are completely broken up so you use compassion and and maybe just a touch on the hand to let them know that you care you limit your conversation to what needs to be done others you sit and talk with for nowhere you know I've laughed with families I've cried with families I've prayed with families everybody's unique you know and I think my deputies have the same feeling for this as I do and I think I think it's a good good interaction with them and what would be some of the examples that require you to go into an investigation to determine the cause of death an accidental death why why the accident occurred what type of injuries were involved in the accident if it's a work-related death then you're getting involved with OSHA things like that you do a detailed examination traffic fatalities you're working with the law enforcement on what the injuries were how the accident happened you share information work very closely with law enforcement and things like that maybe not many people are aware of the fact that sheboydon County has a morgue and would you describe it and the upgrade and how often it gets used in a year a morgue is serves two purposes it serves a purpose for a place where we can bring a deceased if we do not have a family on scene to give us direction on a funeral home we use the morgue for autopsies and autopsies are done when you certain certain situations require them if we have a death at the one of the correctional institutes by state statutes we have to do an autopsy we have a young person that for no apparent reason dies there's no family history of any significant health problems no disease process going on will do an autopsy another thing that's happening is as you probably are well aware of this is the drug situation that's increasing throughout the United States and in sheboydon area it's prevalent also so if we have a death with drugs involved the police are looking for information to be provided on the type of drug the amount of drug and with that information it enables them to prosecute the person that's selling the drugs so drug deaths are probably one of the bigger number of deaths that we we investigate and have autopsies for and does more get used for any other purposes besides another purpose would be tissue harvesting tissue harvesting is on on the back of your driver's license where you can indicate that you want to be an organ donor an organ donor is different than tissue harvesting in an organ donor they maintain your life on life supports so you would be in a hospital and then you could that would be where an organ donor would come in a tissue donor is a postmortem someone that's passed away within a certain time frame and people become tissue donors they sign up for it or if we talk to the families and tissue that they take is can be skin and skin is used for cancer patients it's used for burn patients bone they'll take what's called the long bones your femur your humerus the upper arm and then the bone in the leg and they'll use that for bone grafts for cancer patients they also can take ligaments from the knee for athletic injuries transplant of a ligament or a tendon they can't take they don't take the heart that would be an organ donation but what they can take are heart valves the eye bank will come in and they they'll take the corneas for corner cornea transplants and there is no cost to the family when they do that they are giving giving a loving gift of their loved ones tissue for purpose for medical purpose to save and help some other people well Dave thank you for your 28 years as coroner and helping us with the transition to a medical examiner thank you thank you back to you Adam thank you Roger and I imagine our viewers just very quickly understood when I said why talking to you can be so interesting it's a it's a field that most of us don't spend a lot of time thinking about yet alone talking about or getting information so I really find the work you do so important and we're very fortunate as Roger said to have you aboard you mentioned earlier when Roger was asking you about you know the numbers of deaths and used to investigate up to 500 a year and that numbers drop because you made a decision based on what state statutes allow and how the medical field has changed that going to a hospice for example maybe wasn't the best use of time and and I want to compliment you for that because I know board members years ago used to get some concerns every now and then because I can't imagine how challenging it has to be to walk on to a scene where someone has recently died or been killed or in an accident that's got to be tough enough but then to go to a hospice where they're expecting their loved one to pass away emotions are probably high and then here comes the coroner or now medical examiner to ask them what happened and how this played out and of course you were just doing your job but I had I got to believe the people skills that you need to apply in the difficult situations you go into that's challenging work so from this point forward and this started what last year was it I forgot when you've changed the policy we made the change in November of 2013 so 14 was the first full year yeah I'm sure that's I'm sure the our constituents appreciate that because those of us who have been in a hospice situation I mean that's tough enough and I'm sure you don't mind necessarily relying more on the hospice nurse and doctors involved to help you with that as well so again my compliments on that back to the investigation so you have to go and investigate certain situations you talked about the use of the morgue but what else is involved with conducting a death investigation you look at the the whole picture you look at the individual you look at his health history what type of medical conditions he has you take a look at the medications he's on you know are the medications appropriate for his for his health condition you look at the amount of tablets are the are the number of pills in correlation to the when they were prescribed how often they're prescribed so you're looking to make sure that the person isn't being over wasn't being over medicated or undermedicated and when you gather this data Dave then do you have to complete documentation and send that on to the state no there's nothing sent on to the state in that in that part of it we maintain a record it's one set one it's a two-sided record it's one side is all the the documentation of the name the date of birth physician date of death time of death we get all the if the date of death is different than the the pronounced date and time so that's that's all documented for and then we do a brief narrative you know explaining you know John Jones age 66 died at home or wherever had a health history of such and such we just kind of a brief synopsis of the situation and indicate on there what the I'm listening as the cause of death in the manner of death and the importance of a medical background and certainly the importance of having some experience in this field if that's if that's possible if you've been a coroner or medical examiner before so you shared with our viewers the five manners of death or five manners of determining how someone died what about now that a person's passed away what are the four manners that someone is final disposition final disposition that's the word I was looking for thank you final disposition disposition you can either be buried entombed in a mausoleum cremated or donate your body to science which is called scientific thing another thing that the medical examiner's office does is certify the cremation permit we look into if it's not our specific case we look into what the physician indicates as the there's a cause of death we view the body to make sure that there is nothing unusual suspicious sometimes you get someone that had fallen has injuries but the care provider hospice nursing home whatever there may be you know maybe aren't looking at that as the cause of death somebody may be fractured arm or whatever they're not looking at that as a cause of death the don't call us maybe physician will put down something you make comparisons on what what they're putting down and what you see and then final question in a few minutes we have remaining you've you know better than 28 years of experience what have been some of the biggest changes you've seen during your career or some of the biggest challenges I think I would have to say the increase the substantial increase in drug deaths of young persons putting those poisons into their system with total disregard of what could happen or does happen with drugs heroin you know a person can maybe be a heroin user dabbling in it but you never know how much is going to be there to kill you they don't that's not a substance that's controlled and says you have this amount in that that tablet or that cracker rock but they call it you never know the potency and that was that's what gets them and those have got to be the tougher scenes to come upon to sure is you know family members a they maybe suspect that their their son or daughter dabbled with marijuana well then all of a sudden they find some pills or tinfoil wrapped in their pocket and then they become suspicious and you know one thing leads to another and all of a sudden that's it's too late right right well again pretty heavy subject and I certainly hope you got an appreciation for the important work that our medical examiner has done and continues to do and we certainly thank you for your public service Dave well thank you and I don't think think Roger and the whole county board for their confidence in me you know when I decided to retire I had no idea of going on so when when they came along it just forced my hand a little bit and I retired from my other my other full-time job and so you certainly have given us a seamless transition that's for sure and we appreciate it that was the intent and if you have questions if you have any questions or want to talk to Dave more about his roles and responsibilities or learn more about the topic today don't hesitate to give him a call is there a contact a general contact in for a number or go to the website or what's your go to the website the office number is listed there okay if I don't happen to be in the office at that particular time the transfers to the Sheriff's Department and you know they'll get a hold of me very good so look up our Shaboygan County website or certainly you can contact County Administrator or Chairman's Office or County Clerk Sheriff's Department and they'll get you to the right person but thank you for joining us today and I hope you learn something about again the important work of medical examiner next month we're going to be talking about the important work of the County Board and the County as a whole recently Chairman Distruty and I presented the state of the County to the County Board and we had the opportunity to give a little update on WHBL and Chairman Distruty thought it be a good idea and I agreed to provide a state of the County here for our WHBL viewers so next month I guess we'll be the guests Roger or you'll be the the host and I'll be the the guest but we'll tag team and talk a little bit about big picture 18 departments 127 million dollar budget 825 employees implementing about 207 programs across the County what are we doing what have our successes been what are our challenges ahead so until then thank you very much take care and we'll see you next month