Number of Autopsies Performed Are Plummeting

autopsiesThere are many reasons to perform an autopsy which is an internal and external examination of a body usually aimed at determining the cause of death.

During an autopsy, the pathologist studies the circulatory, respiratory and renal systems using surgical techniques, laboratory analysis of tissue, fluids and other specimens and reviews medical records. By these activities a medical examiner can often indicate the precise reason for a loved one’s death. Once this is known, it is often possible to work backwards and think about the loved one’s condition in the weeks and months prior to his or her death.

If at all possible, you should hire a medical expert to review all of your loved ones medical records and any autopsy records available with these questions in mind:

• Was there wrongdoing or a misdiagnosis that should have been detected?
• Did this wrongdoing or oversight contribute to the death?
• If the condition had been detected and treated earlier, could the outcome have been different?
• Was the death preventable?

If the answer is “yes” to one or more of these questions, you may have a wrongful death case or medical malpractice case.

Autopsy Rate Dropping

Public Broadcasting System (PBS) Frontline, National Public Radio (NPR) and ProPublica, an independent, non-profit news organization which describes itself as producing investigative journalism in the public interest, extensively researched the use of port-mortem examinations in the U.S. and found the system of death investigation “deeply flawed.” They discovered the rate of autopsies performed on the 2.5 million Americans who die each year is rapidly plummeting. One survey found that 63% of Louisiana hospitals had not performed any autopsies in a year.

Fifty years ago half of all those who died were autopsied. It was considered the “ultimate medical audit.” Now the Center for Disease Control and Prevention (CDC) estimates about five percent of those who die in the U.S. are autopsied. Hospitals used to have to perform a certain amount of post-mortem examinations to retain their good standing, but today they are not required to offer or perform any autopsies. Even at teaching hospitals the rate of autopsy is only 20 percent and at private and community hospitals—which make up 80 percent of medical facilities nationwide–the overall hospital autopsy rate is less than one percent, the PBS study found.

Why This Is Happening and What It Means

• Some say medical facilities and doctors shy away from autopsies fearing they may reveal more cases of malpractice. When diagnostic errors go undiscovered, physicians practice with a false sense of security, the study revealed. Doctors and hospitals often can’t say for certain how patients are dying.

• Opportunities are lost to learn about the effectiveness of medical treatments and the progression of disease. In addition, the reliability of health statistics is jeopardized by inaccurate information on death certificates.

• There is growing confidence among physicians that diagnostic tools such as CT scans and MRIs which can identify many ailments are superior to an autopsy. The fact that autopsies were used by Greek physicians as early as the 5th century seems to have little significance. Yet researchers show study after study reveals doctors make a high rate of diagnostic errors despite the increasingly sophisticated imaging equipment. A study by the federal Agency for Healthcare Research and Quality found when patients were autopsied major errors were found in one of four cases relating to the principle diagnosis or underlying cause of death. In one of 10 cases, the errors were serious enough to have actually led to the patient’s death.

• The CDC found that only 2.3 percent of people 60 and older who died in hospitals in the U.S. were autopsied although 684,000 elderly persons died in the year studied (2008). This represents a lost opportunity to learn about age-related diseases, according to pathologists.

Financial Reasons

The financial incentive to avoid autopsies is also powerful. Medicare and private insurance do not pay directly for autopsies. Medicare bundles payments into an overall quality assurance payment that the hospitals receive whether they conduct autopsies or not. Insurers at one major company told the researchers an autopsy is not reimbursed by their company “because it is not a procedure that prevents or treats a sickness or injury.”

Yet pathologists say there are far-reaching consequences for U.S. healthcare in performing a low number of autopsies and many benefits to performing post-mortem examinations including:

• Saving lives through enhancing understanding of disease and how to keep people healthier longer. According to the Encyclopedia of Death and Dying autopsies helped discover or clarify 87 diseases or groups of diseases from 1950 to 1983.

• Identifying public health emergencies such as anthrax attacks and public health hazards such as defective infant cribs.

• Discovering hereditary illness. A University of Kentucky College of Medicine pathologist, Dr. Gregory J. Davis, claims 40 percent of U.S. autopsies reveal disease states previously unknown to physicians.

• Uncovering genetic or environmental causes of disease that could affect family members who are still alive.

• Providing legal evidence, not just for homicide cases, but for a work hazard that may lead to compensation for a family or death benefits from veterans’ compensation. Evidence of medical malpractice could also provide grounds for a lawsuit.

• Removing uncertainty about the cause of death may release delayed payment of insurance benefits in some cases and provide needed closure to families that their loved one received high quality medical care.

There are basically two types of autopsies—clinical and forensic. Clinical autopsies, also known as “pathological autopsies,” diagnose the disease that has caused death even if the disease is already known. These autopsies are aimed at further advancing scientific knowledge of the patient’s condition and are performed when foul play is not suspected. They are often done in a hospital setting.

Forensic autopsies, also known as “medico-legal autopsies,” are done to provide answers about a death under suspicious circumstances; a sudden, unexpected death; a death with no witnesses, or other evidence that indicates possible foul play. Medical examiners recognize five manners of death—accidental, suicide, homicide, natural and undetermined.

Autopsies can be requested or required. Typically, an autopsy is required when there is suspicion of foul play such as homicide or death by trauma. In fact, these types of death are those most often autopsied on a national basis.

The police do not have to have family permission to perform an autopsy in the above circumstances, or if an autopsy is performed for “public health purposes.” In the latter case, the person may have died as the result of a disease that may threaten the general public. Some states require autopsies for the death of an infant or young child. Inmates may also be autopsied if they died from murder, suicide, illness, accident, or any unexplained death.

Requesting an Autopsy

A family can also request a local medical examiner to perform an autopsy or may seek a private autopsy. They may even request an autopsy not be done due to the religious beliefs of the deceased. In Ohio you may be able to block or limit an autopsy on your body if before your death you fill out a Certificate of Religious Belief that affirms that an autopsy or dissection of your body violates your religious beliefs. The certificate should be given to the coroner as soon as possible after your death.

Surviving family members may also request an autopsy when:

• There’s a possibility the decedent had a genetic disease or condition
• The decedent is an organ or tissue donor
• The decedent was under the care of a physician and the question of medical malpractice and a possible wrongful death suit has been raised.

On the other hand, the decedent may express before death a desire for an autopsy and may issue a personal directive to that effect. Permission from a doctor, next of kin, or another legally designated party will probably still be necessary for a nonmedicolegal autopsy, otherwise survivors could sue for damages based on mental anguish they allege was suffered for an autopsy performed without legal approval or one that was more extensive than authorized.

In Ohio the following parties can make a written request to the coroner for an autopsy—the surviving spouse of the decedent; or any child of the decedent over 18 if there is no surviving spouse. Parents of the decedent (with each having an independent right) would be next in line followed by brothers and sisters (whole and half-blood) of the deceased, provided there is no surviving spouse or children. If all of these parties have not made a request for an autopsy, or do not survive the decedent, the representative of the estate (the executor or the administrator) may request a complete copy of the coroner’s records pertaining to the decedent.

For various reasons an insurer may also request the coroner’s records on the deceased and medical or scientific groups, if members of the family are sympathetic to their cause, may ask to have the deceased autopsied to aid in research for certain conditions like Alzheimer’s. These types of post-mortem exams, if consented to by next-of-kin, are voluntary autopsies usually performed by private medical professionals, not by a local medical examiner working for the county.

Autopsy Records

Autopsy records are public records in Ohio and can be obtained with a few exceptions, for example suicide notes are not released in most cases. A person may receive a copy of a record by making a demand in writing to the coroner’s office and paying a minimum record retrieval and copying fee. Journalists can also get certain information from the coroner by making a written request stating why granting the request would be in the interest of the general public. Refer to Ohio Revised Code Section 313.10 for further information.

It is recommended that an autopsy be performed within 24 hours of death before organs can deteriorate. Also embalming can interfere with toxicology and blood cultures. Autopsies performed on decomposed or exhumed bodies, even those who people who died several years ago, can still provide vital new information depending on the deceased’s state of decomposition, how many years the body has been buried and under what conditions. A preliminary autopsy report can usually be provided within 24 hours of completing the examination. Full results can take up to six weeks or longer.

A private autopsy can cost between $3,000 and $5,000. For a smaller fee, a physician may review an autopsy report and medical records of the deceased and provide an expert opinion of the cause of death. The National Association of Medical Examiners website provides a list of resources to help private parties find autopsy providers. In addition, The College of American Pathologists has a list of board-certified pathologists who perform autopsies in several states. Local medical examiners can also be contacted as well as medical schools. Seek referrals from hospitals, funeral homes or attorneys.

If you are having any difficulties in scheduling an autopsy for your loved one, or a physician or hospital personnel are trying to convince you that you do not need one, this is one reason it is important to retain an attorney as soon as possible.

We offer free consultations with our experienced Ohio attorneys to answer your questions and provide professional legal guidance. Please contact us at any time by calling 1-888-459-0765, chat with one of our 24-hour live chat representatives or send us a website message.

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