Sometimes there’s no substitute for an autopsy

Autopsies cost a lot of money. At least $2,500.00 each, cost accountants say.

Hospitals rarely do autopsies. Decades ago, the Joint Commission on Accreditation of Health Care Institutions lifted the requirement that hospitals perform autopsies on a certain percentage of people who die in the institution. Autopsy rates plummeted – in part because hospital administrators saw a way to save money.

Medical insurance won’t pay for an autopsy. The insured, who is dead, derives no benefit.Government – the state or county depending on the jurisdiction – pays for autopsies done under the jurisdiction of the coroner or medical examiner. But in these days of budget shortfalls, governments are also clamping down.Many of my colleagues say budget cuts have left their offices understaffed and ill-equipped to handle the volume of deaths reported. Some triage cases and autopsy only the most suspicious cases.

The choices are hard ones. What kinds of low-suspicion autopsies should be cut because of budget constraints? “Obvious” suicides? Traffic fatalities when no charges are anticipated? Vehicular passengers regardless of circumstances? When people die in the hospital following injury, is a review of hospital records adequate? Some offices have answered all these questions in the affirmative. Some go further.

According to a Washington state news article, a medical examiner in that state declined to autopsy the body of a 7-year-old boy because his death was of “low suspicion.” The child had a history of seizures, and seizures are known to cause sudden death. In most cases of epilepsy, no abnormality is found at autopsy anyway, because the abnormal electrical activity in the brain that causes the seizures can’t be detected or measured.

Two years before the boy’s death, his father was found guilty of reckless endangerment because of “deplorable conditions in the home.” The Department of Social and Health Services made sure the place was cleaned up. The boy was returned to his parents, and the case was closed.

The police, aware of the previous investigation, wanted an autopsy, but the medical examiner declined. A blood sample was drawn for toxicology, and the boy’s body was released to his family.

Eleven days later, after the body had been cremated, the laboratory reported an aspirin compound in the child’s system at nearly three times the reported lethal level. Now what?

Was this boy poisoned? The news report doesn’t say where the specimen was drawn from, but a blind needle stick can be contaminated, invalidating results.

Without an autopsy, investigators’ hands were tied.

Without an autopsy, there’s no way to confirm or rule out some competing cause of death. No way to know if some disease or metabolic abnormality contributed to the elevated drug level. No way to know much of anything.

Without an autopsy, the most minimally competent defense attorney could raise reasonable doubt.

I don’t know if this autopsy was declined for fiscal reasons. I don’t even know if the news report is accurate.

I do know this: If you need to order toxicology, you need to do an autopsy. Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland.