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Post Mortem
Death Investigation in America

Autopsy 101

The rate of autopsies -- the gold standard of death investigations -- has plummeted over the decades. Our investigation found that an increasing number of the 2.5 million Americans who die each year go to the grave without being examined at all. Here's why this is troubling to experts.

Why Get an Autopsy?

Medical experts and pathologists consider autopsies -- the external and internal examination of a body after death using surgical techniques, microscopy, laboratory analysis and medical records -- the ultimate quality assessment tool in understanding the exact cause and circumstances of a death. Though the public is perhaps most familiar with autopsies through "who-dunnit?" episodes of popular forensic science TV shows and high-profile celebrity death investigations, the College of American Pathologists [CAP] recommends that an autopsy be performed at every death, and experts say that competent autopsies can be beneficial in a wide range of circumstances:

  • Saving Lives: Autopsies can enhance our understanding of diseases and how we die, and contribute critical medical knowledge. Forensic pathologists have identified public health emergencies, such as the anthrax terrorist attacks or other lethal infection diseases, as well as public health hazards, such defective cribs that kill babies.
  • Discovering Hereditary Illness: Autopsies can help family members learn whether a relative died from an undiagnosed or misdiagnosed illness or disease that may be hereditary. Dr. Gregory J. Davis at the University of Kentucky College of Medicine says that 40 percent of autopsies performed in the U.S. reveal disease states previously unknown to physicians, in large part because the autopsy employs techniques that cannot be used on the living.
  • Providing Legal Evidence: Most of us think of autopsies in relation to homicide cases, but there are other ways in which autopsies can provide evidence for legal action. For example, if an autopsy determines a death to be the result of a work or environmental hazard, it may lead to compensation for family. If an autopsy reveals evidence of medical malpractice, it may be the grounds for a lawsuit.
  • Easing the Stress of the Unknown: Autopsies can also be an important way for families and loved ones to seek reassurance or peace of mind after a death.

How to Get an Autopsy

In some instances, a person may have specified his or her desire for an autopsy, perhaps in conversation or by signing a personal directive. Most states require permission from a doctor, next of kin or other legally-designated party for the private autopsy to be performed.

But with regard to circumstances in which autopsies are required, the laws differ state to state. In certain cases, such as when there is suspicion of foul play, or when a death may be the result of an infectious or contagious disease with dire public health consequences, a medical examiner or coroner can legally order an autopsy without the permission of next of kin or other legally designated party. But these laws, as well as their implementation, vary. For example, according to the Virginia Office of the Medical Examiner, the cases that most often fall under its jurisdiction are deaths that occur when a patient is not under the care of a physician, sudden and unexpected deaths or suspected violent deaths (or deaths where violence cannot be ruled out). You can contact your medical examiner's office to inquire about the laws in your state.

They Are Expensive

Autopsies are not covered under Medicare, Medicaid or most insurance plans, though some hospitals -- teaching hospitals in particular -- do not charge for autopsies of individuals who passed away in the facility. A private autopsy by an outside expert can cost between $3,000 and $5,000. In some cases, there may be an additional charge for the transportation of the body to and from the autopsy facility.

For a smaller fee, you can also have an outside expert, or a doctor (if a hospital death is involved), review medical records and autopsy reports. Because autopsies can tell us more about how we die and how to keep people healthier longer, some argue that they are a public good and should be paid for by the government.

Timeliness Is Critical

Forensic pathologist Dr. Stephen J. Cina says that autopsies are best if performed within 24 hours of death, before organs deteriorate, and ideally before embalming, which can interfere with toxicology and blood cultures. But autopsies performed on decomposed or even exhumed bodies can still provide vital new information, depending on the extent of decomposition.

Autopsies usually take two to four hours to perform. Preliminary results can be released within 24 hours, but the full results of an autopsy may take up to six weeks to prepare.

Where To Get One

  • The National Association of Medical Examiners has this list of resources to help find private autopsies providers.
  • The College of American Pathologists also provides a list of board-certified pathologists that perform autopsies for a fee in 18 states.
  • Individuals can also contact local medical examiners and medical schools to perform autopsies, or obtain word-of-mouth referrals from hospitals, funeral homes and attorneys.

What a Second Autopsy Can -- and Can't -- Reveal

Because timeliness is critical, if you suspect foul play in the first autopsy, do not trust the first medical examiner or would like a second opinion for quality assurance, you must make the choice of whether or not to have a second autopsy performed fairly quickly after the first autopsy, and usually without its full results.

Alabama forensic pathologist Dr. Jim Lauridson, who is often called on to perform second autopsies, says that a second autopsy very often finds information not discovered in the first autopsy. Even so, he says there are certain limitations because organs have often already been removed and dissected, and the fluids necessary for an evaluation are now no longer available.

Additionally, certain tissues can be retained by the pathologist at the time of the first autopsy and may not be available for examination. But a second autopsy often looks at parts of the body that were not examined in the first, and the incorporation of its results, with those of the first autopsy and other available medical and investigative records, can depict a far more thorough and comprehensive picture of the cause and manner of death.

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Posted Feburary 1, 2011

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