The resignation of both the chief and deputy medical examiners for Grand Traverse, Leelanau and Benzie counties could result in an overhaul of the department – including hiring Western Michigan University to provide services for the region. Officials hope the changes could eventually lead to the creation of a regional medical examiner office in northern Michigan, allowing autopsies to take place locally instead of downstate.

Medical Examiner Dr. Nicole Fliss submitted her resignation effective December 31. Fliss has held her position since late 2014, when Grand Traverse, Leelanau and Benzie counties entered into a joint agreement to pay for her services following the death of long-time medical examiner Dr. Matthew Houghton. Michigan law requires each county to have an appointed medical examiner, responsible for issuing death certificates, signing off on cremations, ordering autopsies, and investigating violent, suspicious, unnatural or unexpected deaths.

Fliss, who also maintains a private practice, cited workload demands as the reason for her resignation. In 2016, an estimated 1,200 cremation permits were issued in the tri-county area; 430 death cases were either reviewed or investigated, while an estimated 52 autopsies were ordered. Factors including regional population growth, increasing traffic and visitors, and a growing opiate epidemic have led to a rise in annual deaths, according to county health department records. “The time and energy required for this position has grown beyond my ability,” Fliss wrote in her resignation letter.

Deputy Medical Examiner Kari Young is also resigning effective December 31, according to Grand Traverse County Health Officer Wendy Trute. The departures leave the three counties with two weeks to find a new medical examiner.

Trute will go before county boards this week with a proposal to hire the Western Michigan University Homer Stryker M.D. School of Medicine (WMed) to take over as medical examiner for Grand Traverse, Leelanau and Benzie counties. WMed already provides autopsy services for the region; it also serves as medical examiner for five other Michigan counties.

The proposal calls for WMed to use a secure video conferencing network to provide remote services from its team of pathologists in some death cases, potentially reducing the number of bodies that have be transported out of the area. Local case investigations would also be overhauled, with WMed training and deploying local investigators who meet national accredited standards instead of relying on EMTs to perform those services. WMed would also provide cremation certificates twice-daily by fax to area funeral directors, and would issue death certificates via the state’s web-based application.

Grand Traverse County Deputy Administrator Jennifer DeHaan says the proposed arrangement is “an innovative solution to a problem that will bring in technology through tele-medicine, as well as regional partnerships to enhance services to both citizens and law enforcement agencies.” Leelanau County Administrator Chet Janik and Benzie County Administrator Mitch Deisch have also both signaled their support for a 90-day agreement with WMed as “an interim solution to not having a medical examiner,” according to Trute. Entering into a shorter three-month agreement will buy each county time to fully weigh the pros and cons of moving forward with a long-term contract with WMed, says Trute.

Trute says the partnership will lead to higher quality services and staffing efficiencies, but it will come at a higher cost – at least initially. WMed’s proposed three-month contract will cost just over $135,000, with Grand Traverse County paying 70 percent (roughly $97,000) and Leelanau and Benzie paying 15 percent each (roughly $19,000). The 2016 budget for all three counties for medical examiner services was about $420,000 – or $105,000 for three months. But Trute notes WMed’s proposal includes some upfront training and implementation costs, and that new technology and efficiencies could lead to savings long-term.

“Some of these cost savings are not realized during the first 90 days due to time needed to hire and train staff,” she says. “Additional savings (would) be realized for 2018.”

The arrangement could also buy the counties time to explore a larger long-term goal of creating a regional medical examiner office. In order to perform autopsies locally – instead of outsourcing them to Kalamazoo, as happens now – the region would need to hire a forensic pathologist. But only 500 total forensic pathologists are working in the U.S., a shortage that has created fierce demand for those positions. The region would need the caseload to justify such a hire – typically up to 250 autopsies a year – and a facility large enough to handle that number of cases.

Trute says tri-county officials could solicit neighboring entities – like Antrim, Kalkaska and Otsego counties – to join in a regional partnership that would support such an office. “(A regional office) is more of a three-to-five year goal…but we are aggressively looking at it," she says.