According to state law, county medical examiners:
• Make pronouncements of death and sign death certificates.
• Investigate suspicious deaths and notify police about suspected foul play.
• Perform autopsies for crime victims, and in unexpected or violent natural deaths and child deaths.
In 2012, the Hamilton County Medical Examiner's Office:
• Was notified of 1,900 deaths, not including hospital or hospice deaths.
• Investigated 450 suspicious or unexpected deaths.
• Performed 140 autopsies on victims of crime or unexplained death.
Hamilton County commissioners will meet one-on-one with Mayor Jim Coppinger and administration in June to discuss individual budgets. After that, Coppinger's office will create a balanced proposed budget to present to commissioners for an up or down vote. The new fiscal year begins July 1.
Last year, the Hamilton County medical examiner probed 140 deaths that police deemed suspicious.
The office is an important link in the chain of solving crime and identifying public health threats.
But if the Hamilton County Commission doesn't agree to fork over $260,000 more than last year to the medical examiner's office, the county no longer will be able to perform autopsies.
Those bodies instead will be shipped 135 miles away to Nashville, delaying investigations and frustrating families looking for answers.
"The big delay is having two investigators, a crime scene investigator and another investigator, going up to Nashville with the body to collect evidence -- like if there's a bullet found," said Tim Carroll, a criminal investigator with the district attorney's office who investigated homicides with the Chattanooga Police Department for 20 years. "You can spend an entire day doing that, instead of going right down the street."
For seven years the medical examiner's office hasn't met standards -- operating on provisional licenses and waivers from the state. Dr. James Metcalf inherited the problem when he came into the job last year.
To comply with state requirements, the office needs to hire four assistants, purchase office equipment, replace its security system and purchase additional vehicles.
A law passed in 2007 requires all medical examiner offices that perform autopsies in Tennessee to be accredited by the National Association of Medical Examiners, a professional standards organization of physicians and death investigators. All others have to contract with accredited facilities for autopsy services.
According to NAME's website, Hamilton County is the only major metropolitan area in Tennessee that isn't accredited.
The medical examiner offices in Davidson and Shelby counties have the accreditation -- as do the University of Tennessee's Regional Forensic Center in Knoxville and the William L. Jenkins Forensic Center in Johnson City. Nashville is covered by the state's Chief Medical Examiner's Office.
Hamilton County Commission Chairman Larry Henry said commissioners have heard Metcalf's request, but it's too early in the budget process to say how much money he will get.
"This is not anything that's real unusual with the medical examiner, as we've had budget requests in the past. It may not be the full amount that he's asking, but I'm sure there will be a compromise," Henry said.
When the law was passed, the local medical examiner was Frank King.
County Mayor Jim Coppinger said King was given a three-year grace period from the state to become a forensic pathologist -- another national requirement -- and to achieve the rest of the accreditation for the office. But King never did.
King retired last year after a 26-year career, and Metcalf was appointed to succeed him.
Tennessee's law is part of a nationwide effort to improve and standardize best practices for medical death investigations, Metcalf said.
The office was granted a provisional license in 2009, but that lapsed in 2010, according to NAME records.
Metcalf is only performing autopsies now because the county sought a two-year waiver from the General Assembly that exempts it from the national requirements until the office can get accredited.
If inspectors came today, the office wouldn't pass, and those inspectors likely will come some time after next year's budget is passed. Metcalf is asking to hire just three of the four needed positions, he said.
Metcalf hopes the inspectors will work with him if he can show progress toward their mandate.
"We are hoping that will not be an all-or-nothing thing," Metcalf said.
Still, if Metcalf can't get any of the requested money and can't make any of the changes, inspectors won't certify him and the state will pull his autopsy rights.
At that point, each body sent to Nashville will cost the county $1,400. Last year, the cost of having all Hamilton County autopsies performed in Nashville would have been $196,000.
Travel expenses would only add to that cost.
"There's a lot of logistics involved that people don't realize. And the costs of changing those logistics stack up," Carroll said.
Aside from pocketbook problems, having the medical examiner who performed autopsies nearby can help investigators solve cases more quickly.
If detectives have questions about an autopsy report, or a specific finding by Metcalf, they can go speak to him. Getting information from medical examiners in Nashville doesn't happen so quickly, Carroll said.
Also, the turnaround on results of laboratory tests from the state tend to take months. Metcalf currently contracts with a private lab, which can return toxicology or sexual assault kits in a matter of weeks.
Those test results can be important to public safety, Carroll said.
"That turnaround is important, especially if you are going to make an arrest based on those results. But if you don't have that -- if you don't have an identification to make an arrest -- you're waiting on lab results," he said.
On the prosecution side of things, Carroll said having easy access to Metcalf during a trial saves the court time.
Typically, medical examiners who performed specific autopsies are called to testify in court. It's easier for Metcalf to drive downtown than it is for the court to subpoena a Nashville doctor -- who is probably subpoenaed by many other courts.
"I hope they don't have to start sending autopsies to Nashville, because it's inconvenient for everybody," Carroll said.
On the other hand, if all Metcalf's needs are met, Hamilton County could see dividends.
If staffed and accredited, Metcalf's office intends to become a regional forensic center, performing autopsies not just for Hamilton but surrounding counties as well -- for a fee.
Contact staff writer Louie Brogdon at lbrogdon@times freepress.com or 423-757-6481. Follow him on Twitter at @glbrogdoniv.