May 6, 2025
By: Dwayne Page
For the second time within a week, the county commission has revised a medical examiner policy regarding how medical death investigators (MDIs) from the ambulance service are to be paid on death calls.
Under the new policy, as adopted by the county commission during Monday night’s special called meeting, four members of DeKalb EMS (EMTs & EMT-IVs) serving as MDIs will receive incentive pay for responding to death calls. One EMS employee will be designated as the “lead MDI” paid an extra $1.00 per hour on his hourly rate while the other three MDIs will get an additional 75 cents per hour. The idea is to have people from different EMS shifts to serve in the role. Qualified non-county (1099 contracted) employees could be called upon to serve for $100 per decedent if EMS MDIs are not available. In recent years, the county has recorded up to 75 death calls per year.
The new policy states in part, “There shall be three regular MDIs and one lead MDI appointed by the Medical Examiner, EMS Director, and County Mayor from the ambulance service. These four individuals will be on a performance-based term of six months to participate as an MDI. An MDI is encouraged to participate within a six-month period. If an MDI has not participated in a six-month period or their performance has been considered less than the desired performance, the Medical Death Investigator can be replaced by request of the Medical Examiner after or during the six-month period. If the four MDIs are unable to take a call, qualified non-county employees may be used paid at a rate of $100 per decedent”.
Commissioners voting for the new policy were Tom Chandler, Daniel Cripps, Sabrina Farler, Myron Rhody, Tony Luna, Greg Matthews, Larry Green, Glynn Merriman, Andy Pack, Beth Pafford, and Mathias Anderson. Commissioners voting against it were Brandon Donnell and Jeff Barnes. Commissioner Tony (Cully) Culwell was absent.
Commissioner Tom Chandler said by offering this incentive pay, MDIs would answer death calls at any time as part of their regular salary. “Roughly ballpark, this policy at a dollar an hour (extra incentive) would give that lead MDI about $2,100 of extra money a year whether they did any death investigations at all. And it doesn’t matter when they went (called out) whether its 3 o’clock in the morning or 5 o’clock in the afternoon. They are getting paid to do death investigations. Their compensation for doing death investigations came as part of their salary,” said Commissioner Chandler.
Commissioner Greg Matthews raised a concern that with this policy, hourly EMS employees serving as MDIs under certain conditions might still earn overtime pay. “If they (MDIs) work their full (EMS) shift and get their full money (salary) and then they answer four (MDI) calls then all four of those calls is overtime and those hours are not figured into this money (incentive pay). We are basing this on an hourly salary based on their regular hours,” said Commissioner Matthews.
“They will get paid when they go out on a call so it could accumulate overtime,” said County Mayor Matt Adcock.
EMS Director Trent Phipps explained to the commission that EMS is trying to avoid tying up an ambulance on an MDI death call.
“On Friday when he (MDI) was on an ambulance call in Murfreesboro and the only other person that was currently being allowed to do it (MDI) was also on an ambulance and answered a call that was way above her training because it was only the second or third one, she had ever done. She was tying up an emergency ambulance trying to sort out a problem. We’re trying to make that not happen,” said Director Phipps.
The commission rejected an earlier proposal 9-3 during the meeting to pay the lead MDI an extra 75 cents per hour and 50 cents per hour more to the three other MDIs and to add four hours of overtime each.
Commissioners voting for that motion were Larry Green, Brandon Donnell, and Sabrina Farler.
Commissioners voting against were Tom Chandler, Daniel Cripps, Myron Rhody, Tony Luna, Greg Matthews, Glynn Merriman, Andy Pack, Jeff Barnes, and Beth Pafford.
During a county commission workshop on April 24, the policy as proposed at that time was to pay medical death investigators four hours (overtime per call) at an hourly rate based off their ambulance service salary. But during the regular monthly meeting Monday night, April 28 the proposed policy, as adopted by the county commission was changed at that time from four hours to eight hours (overtime) that medical death investigators were to be paid. That policy, as adopted by the county commission on April 28, came under fire from Sheriff Patrick Ray who argued that the policy didn’t provide a level playing field between the on-call MDIs and his own on call employees who often have to spend a much longer period of time at a death scene and are not guaranteed eight hours of overtime. The sheriff’s opposition prompted the special called meeting Monday night.
The new policy in its entirety as adopted by the county commission Monday night, May 5 states as follows:
“The DeKalb County Medical Examiner will be appointed by the County Mayor with confirmation by the DeKalb County Commission. The DeKalb County Medical Examiner will serve five-year terms without term limits. The Medical Examiner will serve as the Medical Examiner and Medical Director of the DeKalb County ambulance service serving in the role responsible for death certificates, cremation certificates, ambulance service medical protocols, and any other task even by the County Mayor or County Commission that is pertinent to the Office of Medical Examiner or Medical Director. This policy is to adhere to all provisions set by statute T.C.A. § 38-7-104.”
“The Medical Examiner will be compensated at $100 per decedent. Deputy Medical Examiners or Medical Death Investigators, furthermore, regarded as MDI’s, shall be compensated 75 cents extra to their ambulance service salary as an incentive for conducting medical death investigations. The “Lead MDI” shall make an extra one dollar on their EMS salary to be the lead MDI. This one dollar is not in addition to the 75 cents that a regular MDI would make. There shall be three regular MDIs and one lead MDI appointed by the Medical Examiner, EMS Director, and County Mayor from the ambulance service. These four individuals will be on a performance-based term of six months to participate as a MDI. An MDI is encouraged to participate within a six-month period. If an MDI has not participated in a six-month period or their performance has been considered less than the desired performance, the Medical Death Investigator can be replaced by request of the Medical Examiner after or during the six-month period”.
“If the four MDIs are unable to take a call, qualified non-county employees may be used paid at a rate of $100 per decedent”.
“Non-county employees or non-ambulance service employees may participate as a MDI if they are a licensed emergency medical technician (EMT), paramedic, registered nurse, physician’s assistant or a person registered by or a diplomat of the American Board of Medicolegal Death Investigators and approved by the county medical examiner as qualified to serve as medical investigator (T.C.A. § 38-7-104(f). This individual will be considered a 1099 employee and will be compensated at a rate of $100 per decedent. These MDIs will not be covered under the county’s insurance and will not be offered county benefits. It will be the responsibility of the 1099 contracted employee to self-provide any liability, malpractice, etc. insurances”.