The dead’s tab: $61,426

Nov. 25--ALBANY -- Albany Medical Center's spot in the heart of the city gives residents quick access to some of the best health care in upstate New York.

But there is a hidden cost to that convenience for Albany County taxpayers -- and there's just no delicate way to put it: They are paying for other counties' dead people.

The helicopters that ferry the most critically ill and injured patients from around northeastern New York to the rooftop of the region's top-tier trauma center also bring with them the obligation for Albany County to pay the tab for their autopsy if they don't survive.

That grim accounting totaled nearly $113,000 from January 2012 to August 2013, according to coroners' records provided by Albany County to the Times Union under the state's Freedom of Information Law.

While that's little more than a rounding error in Albany County's roughly $575 million budget, the fact that officials have broached the decidedly touchy topic at all -- even only casually -- speaks to the level of municipal anxiety and austerity in post-financial collapse, post tax-cap New York.

The $61,426 for 56 outside cases in 2012 accounted for about 10 percent of the coroner's overall $603,000 budget that year.

"People don't realize: If there's a shooting in Troy this evening and they rush somebody to Albany Med and that person passes away, that's our case. We pick up the cost," Senior Albany County Coroner Timothy Cavanaugh said. "We've had people flown in from . Ever since they put the helicopter in, we get that many more."

State law requires coroners to investigate any unnatural deaths, and it applies to very county the same way: Wherever someone is officially declared dead, local taxpayers pay for the autopsy.

A 1966 state comptroller's opinion only reinforced the point, asserting that "the fact that the decedent resided in ... an adjacent county (does) not alter this responsibility."

But communities like Albany that are home to regional trauma centers that accept the most gravely injured are hit disproportionately, Cavanaugh and others contend.

"In one way, it's a great hospital to have," County Attorney Thomas Marcelle said. "In another way, the Albany County taxpayers subsidize the other counties."

Albany County's situation, however, may be unique in a key way: It is the only upstate county with such a trauma center that still uses a coroner system. Unlike Onondaga, Monroe and Erie counties, it does not have a salaried medical examiner on staff to conduct the post-mortem exams.

Medical examiners are trained physicians who conduct physical examinations themselves, while coroners are elected officials -- often funeral directors -- who remove bodies and lead death investigations but frequently have to contract with outside pathologists for autopsies and other post-mortem exams.

In Albany County, whether any particular case calls for a full-blown autopsy is a decision that falls to the pathologists -- also known as coroner's physicians -- hired by the county to conduct the exams. Autopsies usually result from cases of unusual, unexplained or otherwise suspicious deaths.

In Erie County, home to Erie County Medical Center, the $2.9 million-a-year medical examiner's office handles all autopsies, including requests for assistance from smaller neighboring counties that can't afford their own, county spokesman Peter Anderson said.

Onondaga County, home to a regional trauma center at Upstate University Hospital in Syracuse, has a similar arrangement, running its own fully staffed medical examiner's office that also certifies deaths for several surrounding counties, said Ben Dublin, chief of staff to Onondaga County Executive Joanne Mahoney.

"We don't pay for autopsies by the unit," Dublin said, "so it isn't an issue for us."

Madison County, for example, pays Onondaga County a flat fee of $77,000 for up to 70 autopsies a year, with each exam after that costing about $1,300.

By contrast, Albany County pays $765 per autopsy to outside doctors with whom it contracts and an additional $758 to Albany Med in morgue and lab fees for each case -- whether it originated inside the county or not. That's on top of what it pays the county's four elected coroners, who each earn about $20,000 annually.

Over the years, boosters of the coroner system have weathered repeated attempts to convert it into a medical examiner's office. Cavanaugh maintains doing so would be much costlier to taxpayers because even with one or more medical examiners on staff the county would still have to pay people to oversee the removal of dead bodies from homes and accident scenes.

The fate of the office is among dozens of issues currently being weighed by the county's charter review commission, which is charged with recommending changes to the shape and function of county government.

Eric Schmidt, chief coroner in Orleans County northwest of Rochester and president of the New York State Association of County Coroners and Medical Examiners, acknowledged that the topic of who gets stuck with the bill for autopsies occasionally pops up, but he said it's never gone anywhere because no one has a satisfactory alternate solution.

Orleans County contracts with Monroe County each year for access to its medical examiner's office, meaning that whenever a body is found in Schmidt's jurisdiction, his county foots the bill -- even if, he said, the case clearly originated in Monroe County.

"They would come out and dump them out here," Schmidt said. "It was a quite a run there for a while in the mid-1980s."

Albany County Legislator Lucille McKnight, who was involved in more than 2,000 autopsies in a previous career as a histological technician in the morgue, said the county ought to be able to charge the costs of autopsies to people's home counties -- or at least their insurance companies.

"That's a tough subject to talk about, but hey, that's life," she said. "And there's a dollar sign attached to all of those services."

Cavanaugh, a second-generation coroner, however, doesn't hold out much hope for changing it, and Schmidt said most in the business around the state accept that.

"That's just the way the ball is played," Schmidt said. "If the body is here, that's the way it is."

[email protected], 518-454-5445, @JCEvangelist_TU

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