HomeMy WebLinkAboutResolutions - 2010.02.02 - 10080January 20, 2010
MISCELLANEOUS RESOLUTION #10015
BY; Public Services Committee, Jeff Potter, Chairperson
IN RE: PUBLIC SERVICES/MEDICAL EXAMINER-CONTRACT TO PROVIDE TOXICOLOGY
SERVICES TO BAY COUNTY AND TUSCOLA COUNTY
To the Oakland County Board of Commissioners
Chairperson, ladies and Gentlemen:
WHEREAS the Michigan County of Bay and Tuscola have requested that the County of
Oakland provide toxicology services of tne Oakland County Medical Examiner; and
WHEREAS Pursuant to the Urban Cooperation Act of 1967, 1967 PA 7, MCL 124.501 et
seq., tie aforementioned Counties may enter into this agreement for the purposes of providing
toxicology services only of the Oakland County Medical Examiner's Office; and
WHEREAS the contracts provides that mutual agreement and amendment shad not
become effective prior to the approval by concurrent resolutions of both the Oakland County
Board of Commissioners and Bay and Tuscola County Board of Commissioners; and
WHEREAS The Bay and Tuscola County Board of Commissioners have approved the
request for tox;cology services; and
WHEREAS through their purcnasing podcies. the eluiwneinloiteLl .....uunty hasay " reed to
enter into contract to use toxicoiogy services of the Oakland County Medical Examiner; and
WHEREAS Corporation Counsel has reviewed and approves the contract language
which include to Scope of Services, Fee Schedule, Compensation :o Oakland County for services
performed and guaranteed compliance by the Oakland County Medical Examiner with ali
applicable Federal. State and local laws. ordinances, rules and regulation: and
WHEREAS the Oakiand County Medical Examiner and Corporation Counsel has
reviewed and/or prepared all necessary documents related to the attached contracts between the
counties of Bay and Tuscola and the County of Oakland; and
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners
hereby approves and authorizes the attached Interlocal agreement between the County of Bay and
Tuscola and the County of Oakland.
Chairperson. on behalf of the Public Services Committee, I move adoption of the
foregoing resoiution.
PUBLIC SERVICES COMMITTEE
Public Services Committee Vote:
Motion carried unanimously on a roll call vote
Resolution #10015 January 20, 2010
The Chairperson referred the resolution to the Finance Committee. There were no objections.
2009 INTERLOCAL AGREEMENT
FOR MEDICAL EXAMINER
(TOXICOLOGY ONLY) SERVICES
BETWEEN
OAKLAND COUNTY
AND
BAY COUNTY
THIS INTERLOCAL AGREEMENT (Agreement") is made between the
COUNTY OF BAY, a municipal corporation and political subdivision of the State of
Michigan (hereinafter refereed to as "BAY") and the COUNTY OF OAKLAND
(hereinafter referred to as "OAKLAND"), a municipal corporation and political
subdivision of the State of Michigan.
WITNESSETH:
WHEREAS, the BAY County Medical Examiner's office requires toxicology
services; and
WHEREAS, BAY has requested that OAKLAND provide toxicology services of
the Oakland County Medical Examiner; and
WHEREAS, Pursuant to the Urban Cooperation Act of 1967, 1967 PA 7, MCL
124.501 et seq. , OAKLAND and BAY enter into this AGREEMENT for the purpose of
providing toxicology services of the Oakland County Medical Examiner's Office toBAY.
NOW THEREFORE, for and in consideration of the mutual covenants
hereinafter contained, IS HEREBY AGREED by and between the parties as follows:
AGREEMENT CONTENTS. This Agreement is comprised of the terms
and conditions set forth below, the Exhibits attached hereto, and any other
mutually agreed to and properly executed modification, amendment,
addendum, or change order. The Exhibits listed below are incorporated
and part of this Agreement.
Exhibit A — Scope of Services
Exhibit B — Fee Schedule
II. SERVICES TO BE PERFORMED BY TI-IE OAKLAND COUNTY
MEDICAL EXAMINER'S OFFICE. OAKLAND, through the
Oakland Medical Examinees Office, shall provide BAY with medical
examiner toxicology services. The services to be provided are more fully
Agreement-Medical Examiner Services
set forth in the attached Scope of Services, labeled Exhibit "A", which is
incorporated by reference into this Agreement and made a part hereof
Services provided by the Oakland County Medical Examiner's Office do
not include autopsies, the transport of bodies and/or the remains of
deceased to or from the Oakland County Medical Examiner's Office, or
any other non-toxicological related services. The County of BAY is solely
and exclusively responsible for all non-toxicological medical examiner
services in BAY.
HI. COMPENSATION, OAKLAND shall submit an invoice to BAY
itemizing all amounts due under this Agreement within sixty (60) days of
the completion of a case death investigation. Amounts owing shall be
calculated in accordance with the attached Fee Schedule (Exhibit "B").
BAY shall pay the invoice submitted by OAKLAND within thirty (30)
days of receipt of invoice. Checks shall be payable to "Oakland County
Medical Examiner's Office" arid remitted via first class mail to the
Oakland County Medical Examiner's Office, 1200 N. Telegraph Road,
Building 28E, Pontiac, MI 48341. Except as expressly provided in this
Agreement, OAKLAND is not responsible for any cost, fee, fine or
penalty incurred by BAY in connection with this Agreement.
IV. RESPONSIBILITY FOR MATERIAL, SUPPLIES, FACILITIES
AND SUPPORT PERSONNEL. OAKLAND shall provide all necessary
toxicology-related materials, supplies, facilities and supporting personnel
for the performance of services required under this Agreement.
V. COMPLIANCE WITH THE LAW. The Oakland County Medical
Examiner's Office, while engaging in any activity pursuant to this
Agreement, shall comply with all applicable Federal, State and local laws,
ordinances, rules and regulations.
Vi NONDISCRIMINATION. BAY and OAKLAND, as required by law,
shall not discriminate against a person to be served or an employee or
applicant for employment with respect to hire, tenure, terms, conditions or
privileges of employment, or a matter directly or indirectly related to
employment because of race, color, religion, national origin, age, sex,
disability or genetic information that is unrelated to the individual's ability
to perform the duties of a particular job or position, height, weight, marital
status:
BAY and OAKLAND shall adhere to all applicable Federal, State,
and local laws, ordinances, rules and regulations prohibiting
discrimination, including, but not limited to, the Elliott Larsen Civil
Rights Act, 1976 PA 453 as amended; the Michigan Persons with
Disabilities Civil Rights Act, 1976 PA 220 as amended; Section 504 of the
Federal Rehabilitation Act of 1973 as amended, P.L. 93-112, 87 Stat 394
as amended, the Americans with Disabilities Act of 1990, P.L. 101-336,
Interlocal Agreement-Medical Examiner Services
104 Stat 328 (42 USCA sec 12101 et seq.) as amended, and regulations
promulgated thereunder. Breach of this section shall be regarded as a
material breach of this Agreement.
VII. STATUS OF EMPLOYEES. At no time shall an employee of one
party be considered an employee or agent of the other in the performance
of services under this Agreement. Each party shall be solely and
completely liable for their respective employees' compensation, overtime
wages, expenses, fringe benefits, pension and/or retirement benefits, travel
expenses, mileage allowances, training expenses, transportation costs,
and/or other allowances of reimbursement of any kind, including, but not
limited to, workers' disability compensation benefits, unemployment
compensation, Social Security Act protections and benefits, any
employment taxes and/or any other statutory or contractual right or benefit
based on in any way related to their respective employment relationships.
VIII. LIABILITY. Both parties agree that they will each be responsible for
their own acts, including their own acts of negligence, and the defense of
those acts or actions.
IX. WAIVERS. No failure or delay on the part of either of the parties to this
Agreement in exercising any right, power, or privilege hereunder shall
operate as a waiver thereof nor shall a single or partial exercise of any
right, power or privilege preclude any other or future exercise of any right,
power, or privilege preclude any other or future exercise of any other
rights, power or privilege.
X. RESERVATION OF RIGHTS. This Agreement does not, and is not
intended to impair, divest, delegate, or contravene any constitutional,
statutory andior other legal right, privilege, power, obligation, duty or
immunity of the Parties.
XI. FORCE MAJEURE. Each Party shall be excused from any obligations
under this Agreement during the time and to the extent that a Party is
prevented from performing due to causes beyond such Party's control,
including, but not limited to, an act of God, war, acts of government (other
than the Parties'), fire, strike, labor disputes, civil disturbances, reduction
of power source, or any other circumstances beyond the reasonable control
of the affected Party. Reasonable notice shall be given to the affected
Party of any such event.
XII. AGREEMENT APPROVAL AND AMENDMENT. This Agreement
shall not become effective prior to the approval by concurrent resolution
of the BAY and OAKLAND County Boards of Commissioners. The
approval and terms of this Agreement shall be entered in the official
minutes and proceedings of the respective Boards of Commissioners and
Interlocal Agrecrnent-Medical Examiner Services
3
shall also be filed with the office of the Clerk for both Counties. In
addition, OAKLAND shall file this Agreement and any subsequent
amendments with the Secretary of State for the State of Michigan.
Except as expressly provided herein, this Agreement may be
amended only by concurrent written resolutions of the Parties' Boards of
Commissioners. This Agreement shall not be changed, supplemented, or
amended except as provided for herein, and no other act, verbal
representation, document, usage or custom shall be deemed to amend or
modify this Agreement.
XIII. AGREEMENT DURATION AND TERMINATION. This Agreement
shall be effective on January 1, 2009 and shall continue until December
31, 2009 at which time it shall terminate unless extended by mutual
consent of the parties hereto.
Notwithstanding any other provision of this Agreement to the
contrary, either party may terminate this Agreement prior to the
termination date set forth herein if notice is given in writing to the other
party at least sixty (60) days prior to the date on which such termination
becomes effective. In the event of early termination, OAKLAND shall be
compensated for all services performed up to the effective date of
termination.
XIV. NOTICE. Written notice shall be duly served if personally delivered to
the following or if sent by registered or certified mail to the following
parties and addresses:
For Oakland County:
For Bay County:
With a Copy to:
Bill Bullard, Jr.
Chairperson
Oakland County Board of
Commissioners
1200 N. Telegraph Rd.
Pontiac, MI 48341
Barbara MacGregor
Director
Bay County Health Department
1200 Washington Ave.
Bay City, MI 48708
Martha P. Fitzhugh
Bay County Corporation Counsel
515 Center Ave., Ste. 402
Bay City, MI 48708-5125
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COUNTY OF BAY
4110, rer • glow P•
Pa ck Beson
Chairperson
Bay Board of Commissioners
XV. SUBCONTRACTING OR ASSIGNMENTS. OAKLAND shall not
subcontract or assign the duties of Oakland County's Medical Examiner
under this Agreement without the prior written consent of BAY.
XVI. DISREGARDING TITLES. The titles of the sections set forth in this
Agreement are inserted for the convenience of reference only and shall be
disregarded when construing or interpreting any of the provisions of this
Agreement.
XVII. COMPLETENESS OF THE AGREEMENT. This Agreement and the
additional or supplementary documents incorporated herein by specific
reference contains all the terms and conditions agreed upon by the parties
hereto, and no other agreements, oral or otherwise, regarding the subject
matter of this Agreement or any part thereof, shall have any validity or
bind either of the parties hereto.
XVIII. INVALID PROVISIONS. If any provision of this Agreement is held to
be invalid it shall be considered to be deleted and the remainder of this
Agreement shall not be affected thereby. Where the deletion of the invalid
provision would result in the illegality or uneforceability of this
Agreement, this Agreement shall be considered to have terminated as of
the date in which the provision was declared invalid.
XIX. CONCLUSION. For and in consideration of the mutual promises,
acknowledgements and representations set forth in this Agreement, and for
other good and valuable consideration, the adequacy of which is hereby
acknowledged, the Parties hereby agree to be bound by the above terms
arid conditions.
IN WITNESS WHEREOF, Patrick Beson, Chairperson, Bay County
Board of Commissioners, hereby acknowledges that he has been authorized by a
resolution of the Bay County Board of Commissioners, a certified copy of which
is attached, to execute this Agreement on behalf of the County of Bay and hereby
accepts and binds Bay County to the terms and conditions of this Agreement.
WITNESSED BY:
'&1ifte 0 el By:
APPROVED AS TO LEGAL FORM ONLY
•
9-44:83 4_
14U c-
BAY CO terlocal Agreement-Medical Examiner Services
UN,T1 COlitPQRATION COUNSEL
DATE: L'5/ /...3/ 5
Dated:
By:
WITNESSED BY:
IN WITNESS WHEREOF, Bill Bullard, Jr., Chairperson, Oakland
County Board of Commissioners, hereby acknowledges that he has been authorized by a
resolution of the Oakland County Board of Commissioners, a certified copy of which is
attached, to execute this Agreement on behalf of the County of Oakland and hereby
accepts and binds Oakland County to the terms and conditions of this Agreement.
COUNTY OF OAKLAND
PAQA4 jc7
Bill Bullard, Jr.
Chairperson
Oakland Board of Conunissioners
Dated; _a_12111C
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MEDICAL EXAMINER (TOXICOLOGY-ONLY) SERVICES
SECTION 1. AGREEMENT CONTENTS
EXHIBIT A- SCOPE OF TOXICOLOGY SERVICES
1. Overview:
The Forensic Toxicology Laboratory (Fn..), Oakland County
Medical Examiner (0CME), located in Pontiac, MI, provides routine
postmortem forensic toxicological analyses in support of OCME
death investigations. The some full range of forensic toxicological
services are available on a fee for service basis for Medical
Examiner Offices, Investigative Agencies, and similar entities
engaged in Death Investigation, Accident Investigation, Impaired
Driving Investigation, etc. Case Consultations with the Chief
Forensic Toxicologist are available concerning any case
submission and Expert Testimony is available on a fee basis. All
Case submissions are received, accessioned, and analyzed under
Forensic Chain of Custody standards. Specimens and Case
documentation are maintained under secured conditions for 1 year
and 5 years respectively. It is the goal of the staff of the FTL to
provide our customers with the highest quality toxicology support
services available and to provide those services in the most
expeditious and timely manner possible.
2. Specimen Submission • • [Collection I Su6mision
In an effort to furnish the most meaningful toxicological results, the following specimens
and amounts are recommended for submission for toxicology testing:
a.)StandariToxTand*:
Blood
Urine
• 2,10 nt Grey Top Tubes (w/ preservative)
*1,10 mi. Red Top Tube (no preservative; Serum analyses)
• Indicate Blood source on tube
• Coiled t Femoral or Subelavian Blood in at least 1 Grey Top Tube
• Antemorem blood aid/or serum as available
▪ 1. 45 rnL llip-top vial (no preservative)
Vitreous Fluid •1,10 mL Red Top Tube (no preservative)
(refer to Section 4.) Analysis for Stna' Tox Pane/ Scope of Testing
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6.) Directed . Taticofogy fina57sef t*:
• 210 mL Grey Top 'rubes (w/ preservative)
• 1,10 mL Red Top Tube (no preservative; Serum analyses)
Blood • Indicate Blood sour on tube
• Collect Femoral or Subciavian Blood in at least 1 Grey Top Tube
• Antemortern blood and/or serum as available
Urine
Vitreous Fluid
• 1,45 mt. flip-top vial (no preservaUve)
• 1,10 mL Red Top Tate (no preservative)
Muscle • 1, 45 niL ffip-top vial (no preservative: 50g psoas or as available)
Liver; Brain:
Kidney; Spleen; • 50g Or as avaflable(suOinit in specimen cups in individual 4)-lock
Gastric Contents
bags)
'refer to Section 4.),4n8(ysi5 for Directed Tox Ana&ses Scope of Testing
c)q)ackaging, Documentation, & Sfiipment:
• Specimen Labels
• Zip-lock bags for individual specimens
• Biohazard Bag with Evidence Seal Closure
• Transport Box with Evidence Seal
• Specimen Collection Kit Instructions (Kit Version)
• Toxicology Request Form
• Overnight Shipping Materials
3. guirkanes for Specimen Co(kaion & Suthnission:
a) Specimen Direction
The selection, collection, and preservation of appropriate specimens for toxicological
analyses are important elements in the accurate determination of the presence and
concentration of drugs and in the evaluation of the relative significance of those drugs in the
determination of Cause of Death. Collection of sufficient specimen volumes is especially
critical due to the limited nature of postmortem specimens and the non-replaceable nature of
those specimens; in terms of providing information concerning the behavioral, impairing,
and/or toxic effects of drugs at or around the time of death. These same specimen collection
issues, such as the limited, non-replaceable nature of specimens, apply to postmortem
investigations as well as to investigations involving non-fatal incidents and accidents. In the
case of decedents who survive even a short hospital stay, the submission of antemortem
specimens (e.g., admission and/or other hospital specimens), in addition to postmortem
specimens, can provide valuable interpretive information; these specimens should be labeled
with the date and time of collection to further their interpretive value.
Prompt collection of specimens is important to limit any contamination and/or degradation
of specimens which are more likely to occur with increasing postmortem interval, e.g., the
blood concentration of the antipsychotic drug Olanzapine can decrease up to 50% in only a
matter of hours. Specimens not shipped immediately following collection should be
refrigerated until transport occurs.
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The mechanism of specimen collection can also profoundly influence the interpretive
value of postmortem specimen. For example, collection of blood or urine by means of blind
needle puncture should be avoided, if possible, especially In the event that an autopsy is to
be performed. Such attempts may result in unsuitable toxicology specimens and cause
contamination of crucial evidence such as body wounds, markings, and other prominent
features; cut down to desired collection site will typically provide not only a better quality
specimen but also a greater volume of specimen_ Central blood should never be collected by
scooping from the pericardial sack but preferably by needle puncture from the right atrium or
inferior vena cave to avoid drawing blood from drug tissue depots such as Liver and Lung.
Note that due to postmortem redistribution of many drugs, the interpretation of central blood
concentrations may be problematic. Peripheral blood however, especially when collected
from the Femoral Artery, is largely protected from postmortem redistribution, with Subclavian
blood of similar interpretive value.
Excellent sped mens can easily be obtained at autopsy. The pathologist should select the
toxicology samples during examination of the remains and ensure that specimen tubes and
containers are properly labeled beforehand. In cases of suspected inhalant use, a blood
specimen should be collected in a screw top tube completely filled to the top to prevent the
loss of any volatile compounds from the specimen. In the event that no fluids or organs can
be recovered, 50 grams of muscle (psoas, perispinal, or deep thigh preferred) can be
submitted for Directed Tox Analysis. In even the most severely burned or fragmented cases,
valuable information can often be obtained from only a few grams of dried blood or tissue
(esp. spleen). If in doubt, submit as much tissue as is practical; do not submit fonnalin-fixed
tissue for toxicological ana4rsis.
6.) Specimen Submission
All specimens must be labeled with the sample type (including source if relevant),
Decedent's name, and the Medical Examiner case number. A properly completed Toxicology
Request Form (see attached) must be submitted with each case including any other
documentation pertinent to the case; the more information that is provided with the case
submission, e.g., medical history; drug use history, including both prescription and abused
drugs; scene investigation, the more complete the toxicological evaluation and interpretation
that can be provided.
The loss of specimen Integrity during shipping can result from leaking specimen
containers and subsequent mixing of specimens of different types and from different sources;
such a loss of integrity may result in a biohazard exposure to anyone handling the case
submission during shipping and to the Fr-L Staff upon receipt Therefore, careful packing of
case specimens on the part of the Submitting Agency is imperative. To ensure the safe
transport of specimens the submitter must first ensure that the lid of each specimen container
is tightly screwed onto the container and then each container should be placed into one of the
zip lock bags provided and securely sealed. All of the specimens for submission are then
placed into the biohazard bag, also provided with the shipping materials, and securely sealed.
All submission paperwork may then be placed Into its own zip lock bag and finally placed into
the pouch portion of the biohazard bag. The biohazard bag is then placed into the transport
box, the box is secured using the provided evidence seal containing the requested
information, and finally placed into the overnight shipping pack. Complete the Shipper's form
(note that the OCME FTL will pay the shipping costs) and schedule the package pickup;
shipments must be arranged so that they do not arrive at the FTL on Saturday, Sunday, or a
weekday holiday. Shipping packs should be stored refrigerated until they can be shipped on
a day ensuring their arrival at the FTL on Monday through Friday.
c.) Specimen Disposition
Upon completion of specimen analysis all of the remaining samples will be placed in a
secured 120°C freezer. At the end of that time all specimens will be destroyed. Submitting
agencies may request that samples be returned following the completion of the Final
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Toxicology Report; Note that specimens will not be returned sooner than 30 Days following
the publication of the Toxicology report. Special arrangements may be made for altering the
specimen disposition conditions only by consulting with the Chief Forensic Toxicologist. All
documentation associated with a case submission, including submission paperwork and
analytical data, are maintained under secured conditions for 5 years - at that time only the
Final Toxicology Report will be kept on file.
4. finarysis:
The FTL provides a range of analytical tests applicable to the
detection of therapeutic and abused drugs in the range of biological
specimens commonly encountered in Death Investigations,
Impaired Driving Investigations, Post-Accident Investigations, etc.
The most commonly employed series of tests may be ordered as a
Panel, Standard Tox Panel, or on an individual test basis (Directed
Tox Analyses). Contributors may contact the Chief Forensic
Toxicologist in advance of case submission to solicit
recommendations concerning the scope, availability, and necessity
of testing or choose from the following list of available tests; if the
analysis desired is not listed contact the Chief Toxicologist to
determine availability. A fee schedule is attached.
e Standard Tax Panel
vl Panel includes the following series of Tests primarily utlizing Blood and Urine
sampies:
• Urine immunoassay Drug Screen: Amphetamines, Barbiturates, Benzodiazepines,
Cann abinoids, Cocaine-mtb, Methadone, Opiates, Phencyclidine
• Serum Immunoassay DIVCI Screen: Acetaminophen, Salicylates, Tricyaic
Antidepressants, Carbarnazepine, Phenobarbital, Phenytoin, Valproic Acid
• Blood immunoassay Drug Screen: Amphetamines, Methamphetamines,
Barbiturates, Benzodiazepiries, Cannabinoids, Carisoprodol, Cocaine-mtb,
Fentanyl, Fluoxetine, Methadone, klethylpheniciate, Opiates, Oxycodone,
Phencyclidine, Propoxyphene, Tricyclic Antidepressants,
• Volatiles: Ethanol, Methanol, Acetone, lsopropanol
• Two samples (different Tissue types) will be analyzed based on availability,
e.g. Blood & Vitreous; Blood & Urine, etc.
• Basic Drug Screen: Urine is the sample of choice for this drug screen. In the
absence of urine the following specimen types can be analyzed (in order of
priority): Blood, Muscle, Liver
v/ Positive screen results (Blood): results are confirmed and quantitated in Blood
Positive screen results (Urine): A Blood sample is submitted to appropriate
quantitation procedures for all drugs kientified in the Urine sample. No quantitative
procedures are performed on Urine samples
v/ Positive Blood Ethanol results (k 30 mgla) are confirmed employing an enzymatic
assay
Basic Drug Screen: (GC/MS)
General screen (urine, blood, muscle, liver, etc.) for most therapeutic drugs (e.g.,
antidepressants, antihistamines, analgesics, sedative-hypnotics, etc.) and many drugs
of abuse (e.g., MDMA, inethamphetamine, cocaine, etc.). The detection limit for most
basic drugs with this method is approximately 50 ng/mL. Very potent drugs, such as
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Fentanyl and many of the benzoldiazepines, e.g., Alprazolam, are detectable only in
toxic/lethal concentrations; if the use of such drugs is suspected a directed analysis for
that drug should be specifically requested.
• Acid/Neutral Drug Screen: (Immunoassay; colorimetric)
General screen (serum) for a limited number of therapeutic drugs (most drugs in this
category have fallen into disuse). The drugs most commonly detected using this
screen are: barbiturates (esp. phenobarbital and butalbital), acetaminophen,
salicylates, carbamazepine, phenytoin, and valproic add. Should the use of other
acid/neutral drugs be suspected, e.g.. Gabapentin, a directed analysis for the
suspected drug should be specifically requested.
• Amphetamines: (Immunoassay)
If the use of amphetamine, methamphetamine, MDMA (Ecstasy), MDA,
phenylpropanolamine, pseudoephedrine, ephedrine, ohentermine,
fenfluramine, or phenmetrazine is suspected, this urine screen should be
requested. The immunoassay screen provides a rapid means of
detecting the presence of amphetamine, methamphetamine, MDA, and
MDMA in urine; all members of this drug class are detected using the
Basic Drug Screen.
• Benzodiazepines: (immunoassay)
Although the members of this drug class are also detectable with the
Basic Drug Screen, many of the newer benzodiazepines have
therapeutic and toxic concentrations below the detection limit of that
screen, e.g., midazolam, flunitrazepam (Rohypnol), alprazolam, and
lorazepam. If the use of a benzodiazepine is suspected, the drug should
be noted and this urine assay requested. Note that flunitrazepam use is
detected by the presence of an inactive metabolite (7-
aminoflunitrazepam) that is detectable in blood for only a few hours and
in urine for a maximum of 2-3 days after administration exceeding the
recommended therapeutic dose.
• Cocaine-mtb: (Immunoassay)
Urine drug screen for which Benzoylecgonine (inactive cocaine metabolite) is the target
analyte; Cocaine has a low crossreactivity with this assay but will yield a positive result
when present at high concentrations.
• Opiates: (Immunoassay)
Urine drug screen used to detect the presence of morphine, codeine, 6-
monoacetylmorphine (an indicator of heroin use), hydrocodone,
oxycodone, and hydromorphone.
• Methadone: (Immunoassay)
Urine drug screen used to detect the presence of the analgesic,
Methadone; this drug is indicated for chronic pain and in maintenance
programs for Herein addiction.
• Phencyclidine: (immunoassay)
Urine drug screen for the detection of PCP (Dissociative Anesthetic).
The urine PCP immunoassay employed in this Laboratory yields a
positive result in the presence of Dextromethorphan, therefore a positive
result for this assay is reported as positive for
"Phencyclidine/Dextromethorpharr
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• Volaliles: (Headspace GC, Enzymatic Assay)
The Gas Chromatography procedure screens for ethanol, acetone,
isopropanol, and methanol. Blood, preferably collected in a gray top
tube, is the preferred specimen for quantitating these anolytes and
interpreting the associated behavioral effects, but this analysis can be
performed on any specimen. It is recommended that two different
specimens (esp. blood and vitreous fluid) be used for alcohol analysis in
postmortem cases to facilitate the differentiation of antemortem
consumption from postmortem production of alcohols; vitreous fluid and
urine are the specimens least susceptible to the formation of alcohol as
the body decomposes. The presence of Ethanol in Blood at
concentrations 30 mgkfl_ is confirmed using an enzymatic assay.
inhalants: GC; GC/MS)
This procedure primarily screens for butane, methane, freons, toluene,
benzene, difluoroethane, trichioroethane, and trichloroethylene. If
inhalant abuse is suspected, blood should be collected in a tefion-lined,
screw top, test tube containing NaF(2% in solution) and the tube
completely filled to prevent the loss of these volatile agents. Because
these agents are extremely volatile they are rapidly lost through
exhalation during life and also rapidly lost due to "off-gassing after
death. Specimens must be collected quickly and properly if the volatile
agents are to be identified. Urine may be submitted for volatile analysis
along with blood, but due to the extensive metabolism of these
compounds they are typically not detectable in urine. This laboratory
does not currently perform an analysis for nitrous oxide.
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• Cannabinoids: (Immunoassay)
Delta-9-tetrahydracannabinol, the psychoactive component of marijuana,
is rapidly convened to 11-0H-delta-9-tetrahydocannabinol (also
psychoactive, 11-0H-THC), which in turn is rapidly converted to 11-nor-
9-carboxy-delta-9-tetrahydrocannabinol (THCCOOH; delta-9 THC).
Using this Immunoassay screen these compounds are detectable in
urine for up to 7 to 10 days following last use_ Detection of all three is
possible in the blood, but more difficult due to their rapid metabolism and
clearance from the blood. No interpretation concerning impairment may
be made from the detection of cannabinoids in the urine. Analysis for
cannabinoids is usually of significance in only a limited number of
postmortem cases (e.g., MVA driver) since their presence provides no
information concerning the cause of death.
• Carbon Monoxide: (Spectraphotometry)
Exposure to carbon monoxide is determined by the measurement of the
percent carboxyhemoglobin (%C0Hb). This analysis is preferentially
performed on EDTA preserved blood (purple top), but can be performed
on any hemoglobin-containing (red) fuid, especially from the spleen,
provided sufficient hemoglobin is present; such "tissue fluid" must be
accurately identified as to its source. Carbon monoxide exposure is a
significant factor in fire-related deaths and faulty gas and propane
heaters and stoves and remains a significant mechanism in suicides.
• Other Analyses: On a ease-by-case basis and by specific request the following tests are
available:
. Heavy Metals - mercury, bismuth, antimony, aria arsenic (Reinsch test, calorimetric)
• Cyanide - (ca(orimetric)
• EleCtrOlVteSviirems - (scheduled to go online - Jan/Feb 2008)
• Glucosevi„euu, - (scheduled to go online - Jan/Feb 2008)
'7 Note: Positive results are confirmed and quantitated using an Analyte appropriate
procedure. Confirmations and quantitations are not performed on Urine samples but a
Blooc or Tissue sample will be submitted to a quantitative procedure for those drugs
identified on a urine screen.
lnterlocal Agreement-Medical Examiner Services
13
TEST FEE
Oakland County Medical Examiner
Forensic Toxicoloay_ Laboratory
Fee Schedule
STANDARD TOX PANEL $150.00
Volatiles $20.00
Inhalants $80.00
Alkaline Drug Screen (GC/MS) (Immunoassay) $9000
Acid/NeutralDrug Screen $40.00
Urine Immunoassay Drug Screen (FPIA) $40.04
Serum Immunoassay Drug Screen (FP1A) $40,00
Blood Immunoassay Drug Screen (ELISA) $30.00
Carbon Monoxide $40.00
Cyanide (qualitative) $35.00
Heavy Metals (qualitative) $65.00
Miscellaneous Testing Level 1 $25.00
Miscellaneous Testing Level 2 $50.00
Miscellaneous Testing Level 3 $75.00
Miscellaneous Testing Level 4 $10000
Miscellaneous Testing Level 5 $150.00
Drug Quantitation $100.00
Vitreous (Electolytes ÷ Glucose) $65.00
Case Consultation (Chief Forensic Toxicologist)
Expert Testimony (Chief Forensic Toxicologist) $250.001hr
Interlocal AD-cement-Medical Examiner Services
14
2009 INTERLOCAL AGREEMENT
FOR MEDICAL EXAMINER
(TOXICOLOGY ONLY) SERVICES
BETWEEN
OAKLAND COUNTY
AND
TUSCOLA COUNTY
THIS INTERLOCAL AGREEMENT ("Agreement") is made between the
COUNTY OF TUSCOLA, a municipal corporation and political subdivision of the State
of Michigan (hereinafter refereed to as "TUSCOLA") and the COUNTY OF OAKLAND
(hereinafter referred to as "OAKLAND"), a municipal corporation and political
subdivision of the State of Michigan.
WITNESSETH:
WHEREAS, the TUSCOLA County Medical Examiner's office requires
toxicology services; and
WHEREAS, TUSCOLA has requested that OAKLAND provide toxicology
services of the Oakland County Medical Examiner; and
WHEREAS, Pursuant to the Urban Cooperation Act of 1967, 1967 PA 7, MCL
124.501 et seq., OAKLAND and TUSCOLA enter into this AGREEMENT for the
purpose of providing toxicology services of the Oakland County Medical Examiner's
Office to TUSCOLA.
NOW THEREFORE, for and in consideration of the mutual covenants
hereinafter contained, IS HEREBY AGREED by and between the parties as follows:
AGREEMENT CONTENTS. This Agreement is comprised of the terms
and conditions set forth below, the Exhibits attached hereto, and any other
mutually agreed to and properly executed modification, amendment,
addendum, or change order. The Exhibits listed below are incorporated
and part of this Agreement.
Exhibit A — Scope of Services
Exhibit B — Fee Schedule
II. SERVICES TO BE PERFORMED BY THE OAKLAND COUNTY
MEDICAL EXAMINER'S OFFICE. OAKLAND, through the
Oakland Medical Examiner's Office, shall provide TUSCOLA with
medical examiner toxicology services. The services to be provided are
Interiocal Agreement-Medical Examiner Services
more fully set forth in the attached Scope of Services, labeled Exhibit "A",
which is incorporated by reference into this Agreement and made a part
hereof Services provided by the Oakland County Medical Examiner's
Office do not include autopsies, the transport of bodies and/or the remains
of deceased to or from the Oakland County Medical Examiner's Office, or
any other non-toxicological related services. The County of TUSCOLA is
solely and exclusively responsible for all non-toxicological medical
examiner services in TUS COLA.
III. COMPENSATION. OAKLAND shall submit an invoice to TUSCOLA
itemizing all amounts due under this Agreement within sixty (60) days of
the completion of a case death investigation. Amounts owing shall be
calculated in accordance with the attached Fee Schedule (Exhibit "B").
TUSCOLA shall pay the invoice submitted by OAKLAND within thirty
(30) days of receipt of invoice. Checks shall be payable to "Oakland
County Medical Examiner's Office" and remitted via first class mail to the
Oakland County Medical Examiner's Office, 1200 N. Telegraph Road,
Building 22E, Pontiac, MI 42341. Except as expressly provided in this
Agreement, OAKLAND is not responsible for any cost, fee, fine or
penalty incurred by TUSCOLA in connection with this Agreement.
IV. RESPONSIBILITY FOR MATERIAL, SUPPLIES, FACILITIES
AND SUPPORT PERSONNEL. OAKLAND shall provide all necessary
toxicology-related materials, supplies, facilities and supporting personnel
for the performance of services required under this Agreement.
V. COMPLIANCE WITH THE LAW. The Oakland County Medical
Examiner's Office, while engaging in any activity pursuant to this
Agreement, shall comply with all applicable Federal, State and local laws,
ordinances, rules and regulations.
VI. NONDISCRIMINATION. TUSCOLA and OAKLAND, as required by
law, shall not discriminate against a person to be served or an employee or
applicant for employment with respect to hire, tenure, terms, conditions or
privileges of employment, or a matter directly or indirectly related to
employment because of race, color, religion, national origin, age, sex,
disability or genetic information that is unrelated to the individual's ability
to perform the duties of a particular job or position, height, weight, marital
status.;
TUSCOLA and OAKLAND shall adhere to all applicable Federal,
State, and local laws, ordinances, rules and regulations prohibiting
discrimination, including, but not limited to, the Elliott Larsen Civil
Rights Act, 1976 PA 453 as amended; the Michigan Persons with
Disabilities ivil Rights Act, 1976 PA 220 as amended; Section 504 of the
Federal Rehabilitation Act of 1973 as amended, P.L. 93-112, 87 Stat 394
Interiocal Agreement-Medical Examiner Services
2
as amended, the Americans with Disabilities Act of 1990, P.L. 101-336,
104 Stat 328 (42 USCA sec 12101 et seq.) as amended, and regulations
promulgated thereunder. Breach of this section shall be regarded as a
material breach of this Agreement.
VII. STATUS OF EMPLOYEES. At no time shall an employee of one
party be considered an employee or agent of the other in the performance
of services under this Agreement. Each party shall be solely and
completely liable for their respective employees' compensation, overtime
wages, expenses, fringe benefits, pension and/or retirement benefits, travel
expenses, mileage allowances, training expenses, transportation costs,
and/or other allowances of reimbursement of any kind, including, but not
limited to, workers' disability compensation benefits, unemployment
compensation, Social Security Act protections and benefits, any
employment taxes and/or any other statutory or contractual right or benefit
based on in any way related to their respective employment relationships.
VIII. LIABILITY. Both parties agree that they will each be responsible for
their own acts, including their own acts of negligence, and the defense of
those acts or actions.
IX. WAIVERS. No failure or delay on the part of either of the parties to this
Agreement in exercising any right, power, or privilege hereunder shall
operate as a waiver thereof nor shall a single or partial exercise of any
right, power or privilege preclude any other or future exercise of any right,
power, or privilege preclude any other or future exercise of any other
rights, power or privilege.
X. RESERVATION OF RIGHTS. This Agreement does not, and is not
intended to impair, divest, delegate, or contravene any constitutional,
statutory and/or other legal right, privilege, power, obligation, duty or
immunity of the Parties.
XI, FORCE MAJEURE, Each Party shall be excused from any obligations
under this Agreement during the time and to the extent that a Party is
prevented from performing due to causes beyond such Party's control,
including, but not limited to, an act of God, war, acts of government (other
than the Parties'), fire, strike, labor disputes, civil disturbances, reduction
of power source, or any other circumstances beyond the reasonable control
of the affected Party. Reasonable notice shall be given to the affected
Party of any such event.
XII. AGREEMENT APPROVAL AND AMENDMENT. This Agreement
shall not become effective prior to the approval by concurrent resolution
of the TUSCOLA and OAKLAND County Boards of Commissioners.
The approval and terms of this Agreement shall be entered in the official
Interlocal Agreement-Medical Examiner Services
minutes and proceedings of the respective Boards of Commissioners and
shall also be filed with the office of the Clerk for both Counties. In
addition, OAKLAND shall file this Agreement and any subsequent
amendments with the Secretary of State for the State of Michigan.
Except as expressly provided herein, this Agreement may be
amended only by concurrent written resolutions of the Parties' Boards of
Commissioners. This Agreement shall not be changed, supplemented, or
amended except as provided for herein, and no other act, verbal
representation, document, usage or custom shall be deemed to amend or
modify this Agreement.
XIII. AGREEMENT DURATION AND TERMINATION. This Agreement
shall be effective on January II, 2009 and shall continue through December
31, 2009 at which time it shall terminate unless extended by mutual
consent of the parties hereto.
Notwithstanding any other provision of this Agreement to the
contrary, either party may terminate this Agreement prior to the
termination date set forth herein if notice is given in writing to the other
party at least sixty (60) days prior to the date on which such termination
becomes effective. In the event of early termination, OAKLAND shall be
compensated for all services performed up to the effective date of
termination.
XIV. SUBCONTRACTING OR ASSIGNMENTS. OAKLAND shall not
subcontract or assign the duties of Oakland County's Medical Examiner
under this Agreement without the prior written consent of TUSCOLA.
XV. DISREGARDING TITLES. The titles of the sections set forth in this
Agreement are inserted for the convenience of reference only and shall be
disregarded when construing or interpreting any of the provisions of this
Agreement.
XVI. COMPLETENESS OF THE AGREEMENT. This Agreement and the
additional or supplementary documents incorporated herein by specific
reference contains all the terms and conditions agreed upon by the parties
hereto, and no other agreements, oral or otherwise, regarding the subject
matter of this Agreement or any part thereof, shall have any validity or
bind either of the parties hereto.
XVII. INVALID PROVISIONS. If any provision of this Agreement is held to
be invalid it shall be considered to be deleted and the remainder of this
Agreement shall not be affected thereby. Where the deletion of the invalid
provision would result in the illegality or unenforceability of this
interlocal Agreement-Medical Examiner Services
4
WITNESSED BY: COUNTY OF TUSCOLA
By:
Gerald Petersol
Chairperson
Tuscola Board of Commissioners
,
\ %,K..‘ (n1/4.0 >. By:
Bill Bullard, Jr.
Chairperson
Oakland Board of Commissioners
r L
Agreement, this Agreement shall be considered to have terminated as of
the date in which the provision was declared invalid.
XVIII. CONCLUSION. For and in consideration of the mutual promises,
acknowledgements and representations set forth in this Agreement, and for
other good and valuable consideration, the adequacy of which is hereby
acknowledged, the Parties hereby agree to be bound by the above terms
and conditions.
IN WITNESS WHEREOF, Gerald Peterson, Chairperson, Tuscola
County Board of Commissioners, hereby acknowledges that he has been
authorized by a resolution of the Tuscola County Board of Commissioners, a
certified copy of which is attached, to execute this Agreement on behalf of the
County of Tuscola and hereby accepts and binds Tuscola County to the terms and
conditions of this Agreement.
Dated: ?Al/49/9
IN WITNESS WHEREOF, Bill Bullard, Jr,, Chairperson, Oakland
County Board of Commissioners, hereby acknowledges that he has been authorized by a
resolution of the Oakland County Board of Commissioners, a certified copy of which is
attached, to execute this Agreement on behalf of the County of OAKLAND and hereby
accepts and binds OAKLAND to the terms and conditions of this Agreement.
COUNTY OF OAKLAND
WITNESSED BY:
Dated: g._,/ 0
Interlocal Agreement-Medical Examiner services
5
MEDICAL EXAMINER (TOXICOLOGY-ONLY) SERVJQES
SECTION L AGREEMENT CONTENTS
EXHIBIT A - SCOPE OF TOXICOLOGY SERVICES
1. Overview;
The Forensic Toxicology Laboratory (FTL), Oakland County
Medical Examiner (OCME), located in Pontiac, MI, provides routine
postmortem forensic toxicological analyses in support of OCME
death investigations. The same full range of forensic toxicological
services are available on a fee for service basis for Medical
Examiner Offices, Investigative Agencies, and similar entities
engaged in Death Investigation, Accident Investigation, Impaired
Driving Investigation, etc. Case Consultations with the Chief
Forensic Toxicologist are availat>le concerning any case
submission and Expert Testimony is available on a fee basis. All
Case submissions are received, accessioned, and analyzed under
Forensic Chain of Custody standards. Specimens and Case
documentation are maintained under secured conditions for 1 year
and 5 years respectively_ It is the goal of the staff of the FTL to
provide our customers with the highest quality toxicology support
services available and to provide those services in the most
expeditious and timely manner possible.
2. Specimen Su6mission [Coffectiort Su6rnission Kith
In an effort to furnish the most meaningful toxicological results, the following specimens
and amounts are recommended for submission for toxicology testing:
a.) Standard TatTanerk:
• 2,10 mt. Grey Top Tubes (v" preservative)
• 1,10 rnL Red Top Tube (no preservative; Serum analyses)
Blood • Indicate Blood source on tube
• Collect Femoral or Subclavien Blood in at least 1 Grey Top Tube
• Antemortem blood and/or serum as available
Urine • 1, 45 mt.. flip-top vial (no preservative)
Vitreous Fluid • 1,10 mL Red Top Tube (no preservative)
(refer to Section 4.) AnaOtsis for Sind Tax Pane/Scope of Testing
Interlocal Agreement-Medical Examiner Services
6
6.) DirectearTaticoThily Ana5rses**:
• 2,10 mL Grey Top Tubes (4 preservative)
• 1,10 mL Red Top Tube (no preservative; Serum analyses)
Blood • Indicate Blood source on tube
• Collect Femoral Of Subcfavian Blood irr at least 1 Grey Top Tube
• Anternortern blood and/or serum as available
Urine • 1,45 m1-flip-top vial (no preservative)
Vitreous Fluid • 1,10 mL Red Too Tube (no preservative)
Muscle • 1, 45 a Ilip-top vial (no preservative; 50g psoas or as availabe)
Liver; Brain;
Kidney; Spleen; • 509 or as available(subrnit in specimen cups in individual zip-lock
Gastric Contents bags)
A-J4- (refer to Section 4.) Analysisfor Directed Tar Anabises Scope of Testing
c.)Tacbging, Documentation, & Shipment:
• Specimen Labels ▪ Zip-lock bags for individual specimens
• Biohazard Bag with Evidence Seal Closure
• Transport Box with Evidence Seal
• Specimen Collection Kit instructions (Kit Version)
• Toxicology Request Form
• Overnight Shipping Materials
3. Guide' fines or S ecunen Collection & Sufintission:
a.) Specimen Corkction
The selection, collection, and preservation of appropriate specimens for toxicological
analyses are important elements in the accurate determination of the presence and
concentration of drugs and in the evaluation of the relative significance of those drugs in the
determination of Cause of Death. Collection of sufficient specimen volumes is especially
critical due to the limited nature of postmortem specimens and the non-replaceable nature of
those specimens; in terms of providing inforrnation concerning the behavioral, impairing,
and/or toxic effects of drugs at or around the time of death. These same specimen collection
issues, such as the limited, non-replaceable nature of specimens, apply to postmortem
investigations as well as to investigations involving non-fatal incidents and accidents. In the
case of decedents who survive even a short hospital stay, the submission of antemortem
specimens (e.g., admission and/or other hospital specimens), in addition to postmortem
specimens, can provide valuable interpretive information; these specimens should be labeled
with the date and time of collection to further their interpretive value.
Prompt collection of specimens is important to limit any contamination and/or degradation
of specimens which are more likely to occur with increasing postmortem interval, e.g., the
blood concentration of the antipsychotic drug Olanzapine can decrease up to 50% in only a
matter of hours. Specimens not shipped immediately following collection should be
refrigerated until transport occurs.
InterIocai Agreement-Medical Examiner Services
7
The mechanism of specimen collection can also profoundly influence the interpretive
value of postmortem specimen. For example, collection of blood or urine by means of blind
needle puncture should be avoided, if possible, especially in the event that an autopsy is to
be performed. Such attempts may result in unsuitable toxicology specimens and cause
contamination of crucial evidence such as body wounds, markings, and other prominent
features; cut clown to desired collection site will typically provide not only a better quality
specimen but also a greater volume of specimen. Central blood should never be collected by
scooping from the pericardial sack but preferably by needle puncture from the right atrium or
inferior vena cava to avoid drawing blood from drug tissue depots such as Liver and Lung.
Note that due to postmortem redistribution of many drugs, the interpretation of central blood
concentrations may be problematic. Peripheral blood however, especially when collected
from the Femoral Artery, is largely protected from postmortem redistribution, with Subclavian
blood of similar interpretive value.
Excellent specimens can easily be obtained at autopsy. The pathologist should select the
toxicology samples during examination of the remains and ensure that specimen tubes and
containers are properly labeled beforehand. In cases of suspected inhalant use, a blood
specimen should be collected in a screw top tube completely filled to the top to prevent the
loss of any volatile compounds from the specimen. In the event that no fluids or organs can
be recovered, 50 grams of muscle (psoas, perispinal, or deep thigh preferred) can be
submitted for Directed Tox Analysis. In even the most severely burned or fragmented cases,
valuable information can often be obtained from only a few grams of dried blood or tissue
(esp. spleen). If in doubt, submit as much tissue as is practical; do not submit forrnalin-fired
tissue for toxicological analysis.
6.) Specimen Submission
All specimens must be labeled with the sample type (including source if relevant),
Decedents name, and the Medical Examiner case number. A properly completed Toxicology
Request Form (see attached) must be submitted with each case including any other
documentation pertinent to the case; the more information that is provided with the case
submission, e.g., medical history; drug use history, induding both prescription and abused
drugs; scene investigation, the more complete the toxicological evaluation and interpretation
that can be provided.
The loss of specimen integrity during shipping can result from leaking specimen
containers and subsequent mixing of specimens of different types and from different sources;
such a loss of integrity may result in a biohazard exposure to anyone handling the case
submission during shipping and to the FTL Staff upon receipt Therefore, careful packing of
case specimens on the part of the Submitting Agency is imperative. To ensure the safe
transport of specimens the submitter must first ensure that the lid of each specimen container
is tightly screwed onto the container and then each container should be placed into one of the
zip lock bags provided and securely sealed. All of the specimens for submission are then
placed into the biohazard bag, also provided with the shipping materials, and securely sealed.
All submission paperwork may then be placed into its own zip lock bag and finally placed into
the pouch portion of the biohazard bag. The biohazard bag is then placed into the transport
box, the box is secured using the provided evidence seal containing the requested
information, and finally placed into the overnight shipping pack. Complete the Shipper's form
(note that the OCME FTL will pay the shipping costs) and schedule the package pickup;
shipments must be arranged so that they do not arrive at the FTL on Saturday, Sunday, or a
weekday holiday_ Shipping packs should be stored refrigerated until they can be shipped on
a day ensuring their arrival at the FTL on Monday through Friday.
c) Specimen (Disposition
Upon completion of specimen analysis all of the remaining samples will be placed in a
secured ) 20°C freezer. At the end of that time all specimens will be destroyed. Submitting
agencies may request that samples be returned following the completion of the Final
Interlecal Agreement-Medical Examiner Services
8
Toxicology Report; Note that specimens will not be returned sooner than 30 Days following
the publication of the Toxicology report. Special arrangements may be made for altering the
specimen disposition conditions only by consulting with the Chief Forensic Toxicologist. All
documentation associated with a case submission, including submission paperwork and
analytical data, are maintained under secured conditions for 5 years - at that time only the
Final Toxicology Report will be kept on file .
4. Analysis:
The FTL provides a range of analytical tests applicable to the
detection of therapeutic and abused drugs in the range of biological
specimens commonly encountered in Death Investigations,
Impaired Driving Investigations, Post-Accident Investigations, etc.
The most commonly employed series of tests may be ordered as a
Panel, Standard Tax Panel, or on an individual test basis (Directed
Tox Ana4Ises). Contributors may contact the Chief Forensic
Toxicologist in advance of case submission to solicit
recommendations concerning the scope, availability, and necessity
of testing or choose from the following list of available tests; if the
analysis desired is not listed contact the Chief Toxicologist to
determine availability. A fee schedule is attached.
• aandard Pallet
V. Panel includes the following series of Tests primarily utilizing Blood and Urine
samples:
• Urine Immunoassay Drun Screen: Amphetamines, Barbiturates, Benzodiazepines,
Cannabinoids, Cocaine-mtb, Methadone, Opiates, Phencyclidine
• Serum Immunoassay Drug Screen: Acetaminophen, Salicylates, Tricyclic
Antidepressants, Carbamazepine, Phenobarbital, Phenytoin, Valproic Acid
Inter-local Agreement-Medical Examiner Services
9
• Blood Immunoassay Drug Screen: Amphetamines, Methamphetamines,
Barbiturates, Benzodiazepines, Cannabinoids, Cariaoprodol, Cocaine-mtb,
Fentanyl, Fluoxetine, Methadone, Methylphenidate, Opiates, Oxycodone,
Phencyclidine, Propoxyphene, Tricyclic Antidepressants,
• Volatiles: Ethanol, Methanol, Acetone, lsopropanol
• Two samples (different Tissue types) will be analyzed based on availability,
e.g. Blood & Vitreous; Blood & Urine, etc_
• Basic Drug Screen: Urine is the sample of choice for this drug screen. In the
absence of urine the following specimen types can be analyzed (in order of
priority): Blood. Muscle, Liver
• Positive screen results (Blood): results are confirmed and quantitated in Blood
• Positive screen results (Urine). A Blood sample is submitted to appropriate
quantitation procedures for all drugs identified in the Urine sample. No quantitative
procedures are performed on Urine samples
• Positive Blood Ethanol results (a 30 mg/dL) are confirmed employing an enzymatic
assay
• Basic Drug_Screen: (GC/MS)
General screen (urine, blood, muscle, liver, etc.) for most therapeutic drugs (e.g.,
antidepressants, antihistamines, analgesics, sedative-hypnotics, etc.) and many drugs
of abuse (e,g., MDMA, methamphetamine, cocaine, etc.). The detection limit for most
basic drugs with this method is approximately 50 ng/mL. Very potent drugs, such as
Fentanyf and many of the benzodiazepines, e.g., Alprazolam, are detectable only in
toxic/lethal concentrations; if the use of such drugs is suspected a directed analysis for
that drug should be specifically requested.
• Acid/Neutral Drug Screen: (Immunoassay; colorimetric)
General screen (serum) for a limited number of therapeutic drugs (most drugs in this
category have fallen into disuse). The drugs most commonly detected using this
screen are: barbiturates (esp. phenobarbital and butalbital), acetaminophen,
salicylates, carbamazepine, phenytoin, and valproic acid. Should the use of other
acid/neutral drugs be suspected, e.g., Gabapentin, a directed analysis for the
suspected drug should be specifically requested.
• Amphetamines: (Immunoassay)
If the use of amphetamine, methamphetamine, MDMA (Ecstasy), MDA,
phenylpropanolamine, pseudoephedrine, ephedrine, phentermine,
fenfiuramine, or phenmetrazine is suspected, this urine screen should be
requested. The immunoassay screen provides a rapid means of
detecting the presence of amphetamine, methamphetamine, MDA, and
MDMA in urine; all members of this drug class are detected using the
Basic Drug Screen.
• Benzadiazepines: (Immunoassay)
Although the members of this drug class are also detectable with the
Basic Drug Screen, many of the newer benzodiazepines have
therapeutic and toxic concentrations below the detection limit of that
screen, e.g., midazolam, flunitrazepam (Rohypnol), alprazolam, and
lorazepam. If the use of a benzodiazepine is suspected, the drug should
be noted and this urine assay requested. Note that flunitrazepam use is
detected by the presence of an inactive metabolite (7-
aminoflunitrazepam) that is detectable in blood for only a few hours and
in urine for a maximum of 2-3 days after administration exceeding the
recommended therapeutic dose.
Interlocal Agreement-Medical Examiner Services
70
• Cocaine-mtb: (immunoassay)
Urine drug screen tor which Benzoyleogonine (inactive cocaine metabolite) is the target
analyte: Cocaine has a low crossreactivity with this assay but will yield a positive result
when present at high concentrations.
• Opiates: (Immunoassay)
Urine drug screen used to detect the presence of morphine, codeine, 6-
monoacetylmorphine (an indicator of heroin use), hydrocodone,
oxycodone, and hydromorphone.
• Methadone: (Immunoassay)
Urine drug screen used to detect the presence of the analgesic,
Methadone; this drug is indicated for chronic pain and in maintenance
programs for Heroin addiction.
• Phencyclidine: (Immunoassay)
Urine drug screen for the detection of PCP (Dissociative Anesthetic).
The urine PCP immunoassay employed in this Laboratory yields a
positive result in the presence of Dextromethorphan, therefore a positive
result for this assay is reported as positive for
"Phencyclidine/Dextromethapharf.
• Volatiles: (Headspace GC, Enzymatic Assay)
The Gas Chromatography procedure screens for ethanol, acetone,
isopropanol, and methanol Blood, preferably collected in a gray top
tube, is the preferred specimen for quantitating these anaiytes and
interpreting the associated behavioral effects, but this analysis can be
performed on any specimen. it is recommended that two different
specimens (esp. blood and vitreous fluid) be used for alcohol analysis in
postmortem cases to facilitate the differentiation of antemortem
consumption from postmortem production of alcohols; vitreous fluid and
urine are the specimens least susceptible to the formation of alcohol as
the body decomposes. The presence of Ethanol in Blood at
concentrations 30 mg/dL is confirmed using an enzymatic assay.
• Inhalants: (GC; GUMS)
This procedure primarily screens for butane, methane, freons, toluene,
benzene, diffuoroethane, trichloroethane, and trichloroethylene. If
inhalant abuse is suspected, blood should be collected in a teflon-lined,
screw top, test tube containing NaF(2% in solution) and the tube
completely filled to prevent the loss of these volatile agents. Because
these agents are extremely volatile they are rapidly lost through
exhalation during life and also rapidly lost due to "off-gassing" after
death. Specimens must be collected quickly and properly if the volatile
agents are to be identified. Urine may be submitted for volatile analysis
along with blood, but due to the extensive metabolism of these
compounds they are typically not detectable in urine. This laboratory
does not currently perform an analysis for nitrous oxide.
Interlocal Agreement-Medical Examiner Services
Ii
• Cannabinoids: (Immunoassay)
Delta-9-tetrahydrocannabinol, the psychoactive component of marijuana,
is rapidly converted to 11-0H-delta-9-tetrahydocannabinol (also
psychoactive, 11-0H-THC), which in turn is rapidly converted to 11-nor-
9-carboxy-delta-9-tetrahydrocannabinol (THCCOOH; delta-9 THC).
Using this Immunoassay screen these compounds are detectable in
urine for up to 7 to 10 days following last use. Detection of all three is
possible in the blood, but more difficult due to their rapid metabolism and
clearance from the blood. No interpretation concerning impairment may
be made from the detection of cannabinolds in the urine. Analysis for
cannabinoids is usually of significance in only a limited number of
postmortem cases (e.g., MVA driver) since their presence provides no
information concerning the cause of death.
• Carbon Monoxide: (Spectrophotometry)
Exposure to carbon monoxide is determined by the measurement of the
percent carboxyhemoglobin (%COHb). This analysis is preferentially
performed on EDTA preserved blood (purple top), but can be performed
on any hemoglobin-containing (red) fluid, especially from the spleen,
provided sufficient hemoglobin is present; such "tissue fluid" must be
accurately identified as to its source. Carbon monoxide exposure is a
significant factor in fire-related deaths and faulty gas and propane
heaters and stoves and remains a significant mechanism in suicides.
• Other Analyses: On a case-by-case basis and by specific request the following tests are
available:
• Heavy Metals - mercury, bismuth, antimony, and arsenic (Reinsch test, colorimetric)
• Cyanide - (colorimetric)
• Electrolytes - (scheduled to go online - JaniFeb 2008)
• Grucosevitm„, - (scheduled to go online - Jan/Feb 2008)
I/ Note: Positive results are confirmed and quantitated using an Analyte appropriate
procedure. Confirmations and quantitations are not performed on Urine samples but a
Blood or Tissue sample will be submitted to a quantitative procedure for those drugs
identified on a wine screen.
interiocal Agreement-Medical Examiner Services
12
TEST FEE
Oakland County Medical Examiner
Forensic Toxi
Fee Schedule
STANDARD TOX PANEL $150.00
Volatiles $20.00
Inhalants $80.00
Alkaline Drug Screen (GC/MS) (Immunoassay) $90.00
Acid/NeutralDrug Screen $4000
Urine Immunoassay Drug Screen (FPIA) $40_00
Serum Immunoassay Drug Screen (FPIA) $40.00
Blood Immunoassay Drug Screen (ELISA) $30.00
Carbon Monoxide $40.00
Cyanide (qualitative) $35.00
Heavy Metals (qualitative) $65_00
Miscellaneous Testing Level 1 $25.00
Miscellaneous Testing Level 2 $50.00
Miscellaneous Testing Level 3 $75.00
Miscellaneous Testing Level 4 $100.00
Miscellaneous Testing Level 5 $150.00
Drug Quantitation $100_00
Vitreous (Electrolytes + Glucose) $65.00
Case Consultation (Chief Forensic Toxicologist)
Expert Testimony (Chief Forensic Toxicologist) $250.00/hr
Interlocal Agreement-Medical Examiner Services
13
Silver & Van Essen ..
TJ Litigation &Counseling
SILVER 8/VAN ESSEN-2.C.
116 OTTAWA AVE., NW
GRAND KA?ID5, MICHIGAN 49503
616-988-560C
FAX 6. 5-98R 5606
September 30, 2009
Ms. Mary M. Mara
Assistant Corporation Counsel
Department of Corporation Counsel
1200 N. Telegraph Road, Bldg. 14 East
Courthouse West Wing Extension, 3r d Floor
Pontiac, MI 48341
Re: Tuscola County/Oakland County Toxicology Contract
Dear Mary:
Enclosed for execution by Oakland is the Toxicology Contract, as submitted by Oakland
and approved and executed by Tuscola.
Please return an executed copy to me. If you have any questions or comments, please do
not hesitate to contact me.
Very truly yours,
Dou1as VI. Van/Essen
DWV:ggp
Enclosure
cc w/enclosure:
Jerry Peterson
Gretchen Tenbusch
RECEIVED
Corporation Counsel
Resolution #10015 January 20, 2010
The Chairperson referred the resolution to the Finance Committee. There were no objections.
FISCAL NOTE (MISC. #10015) February 2, 2010
BY: FINANCE COMMITTEE. TOM WIIDDLETON, CHAIRPERSON
IN RE: PUBLIC SERVICES/MEDICAL EXAMINER-CONTRACT TO PROVIDE TOXICOLOGY
SERVICES TO BAY COUNTY AND TUSCOLA COUNTY
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above
referenced resolution and finds:
1. The Michigan Counties of Bay and Tuscola have requested that the County of
Oakland provide toxicology services of the Oakland County Medical Examiner's
Office for the period of January 1, 2009 through December 31, 2009.
2. The interlocal agreement to provide Medical Examiner Services to Bay and
Tuscola Counties was originally established by Miscellaneous Resolution
#07294.
3. This agreement generates an estimated annual revenue of $3,750 (25 cases per
year at $150 per case) of General Fund revenue in the Medical Examiner's Office
Service Fees line item.
4, For FY 2010, three (3) months of the estimated revenue totals $938 which is
incorporated in the FY 2010 budget.
5. The revenue budget for FY 2010, 2011 and 2012 were based on the assumption
that the contracts would be renewed. A budget amendment will be presented in
the future if needed.
6. No budget amendment is recommended at this time.
FINANCE COMMITTEE
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote with Potter absent.
Resolution #10015 February 2, 2010
Moved by Capello supported by Woodward the resolutions (with fiscal notes attached) on the Consent
Agenda be adopted (with accompanying reports being accepted).
AYES: Capello, Coleman, Coulter, Douglas, Gershenson, Gingell, Gosselin, Greimel, Hatchett,
Jackson, Jacobsen. Long, McGillivray. Middleton, Nash, Potts, Runestad, Schwartz, Scott, Taub,
Woodward, Zack, Bullard, Burns. (24)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent
Agenda were adopted (with accompanying reports being accepted).
I HEREBY APPROVEyk f.CIREJOING RESaUTIOU
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I. Ruth Johnson, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true
and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on
February 2, 2010, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at
Pontiac, Michigan this 2nd day of February. 2010.
Ruth Johnson, County Clerk