Only an hour old, Olivia Clark died on Oct. 5, 2010. The newborn, whose lungs never fully developed, had little chance of survival. She was not expected to live outside of the womb.
Olivia had polycystic kidneys that made it impossible for her lungs to grow properly, her doctors said. She was born at the University of Washington Medical Center in Seattle, which her parents picked because of her complications.
After her death, Olivia's parents received a bill that included a $50 charge. "There was a little line at the bottom of the bill that said 'King County death tax,'" said her grandfather, Larry Clark, in an interview with KING-TV. "I couldn't believe that a little girl who lived for an hour has got to pay a $50 tax."
The county, however, says that's not completely accurate. "It's a fee for death reviews," said James Apa, a spokesman for Public Health-Seattle and King County, in which the city is located. "Death tax is not accurate. It's a death review process and there's a fee associated with the death review process which pays for medical examiners, experts to review the cause and manner of death as listed by the health care provider to ensure it's correct for the families' sake, healthcare's sake and law enforcement."
"They're mixing words," Clark told ABCNews.com. "They want to call it a fee but a fee by any other name is a tax. If you don't get a service for a fee what is it?"
The $50 fee is countywide. In 2008, King County implemented the new program to ensure that cremations, which are performed after two out of three deaths in the county, were properly reviewed and investigated.
"We were learning and hearing that there were deaths where people were being cremated and then we learned the circumstances surrounding deaths should have been investigated," said Apa.
"We relied solely on health providers to refer deceased patients for further investigation, such as in a sudden or unexpected death, a homicide or complication of medical treatment," Apa wrote in a statement.
However, Apa said, some cases were slipping by. And with cremations the evidence is destroyed immediately. "If we're hearing about cases were deaths were not properly investigated then those are deaths going unsolved and uninvestigated, and that's not good for the families or the community."
In the first two years of the program, the county discovered 347 cases in which the cause of death was inaccurate. Two were homicides and more than half of the deaths were related to the delivery of health care, said Apa. "We proposed to expand because our concern is that we're missing others," says Apa.
In January 2011 the fee was extended to review all deaths, including burials.
"Even in cases where a child was only born for a short period of time, unless we look we don't know what happened in terms of care. That's why it's important," said Apa. "What we found is over the past three years without this review cases will be missed."
Larry Clark said he was not satisfied.
"The county says they're using this fee to investigate all deaths so society knows what these people have died from, but there's no report issued," said Clark. "The death certificate doesn't say anything special. They investigate a few deaths that look suspicious. That's a part of basic government obligations and we shouldn't be charged an extra fee for basic services."
"Whether they live for an hour or they're 93 years old -- what is the medical examiners job? Should it be a separate tax or part of your standard taxes?" asked Clark.
According to Apa, at least six counties in Washington review all cremations and Utah has a similar system. In Utah, a review of a death would happen if a body would potentially not be available for investigation later. For example, a case would be reviewed if there was a cremation, or if a body were to be shipped out of the state for burial.
"The $50 is not the issue," said Clark. "We can afford to pay that. The issue is, is this what government should be doing?"
Says Apa, "Our heart goes out to them in terms of the grief they're experiencing. The medical examiner has an important role to play in these situations to ensure that every family has assurance in knowing that the death of their loved one has been appropriately reviewed and that the cause and manner of death is accurate."
But Clark sees a slippery slope. "Where does this type of things stop?" he asked. "Do they start charging a service fee for the fire department to come out? Where do these service fees start and stop? Is every service of government going to be taxed?"