Hospital-based autopsy requests should come from physicians, not patient families
Hospital-based autopsies at Lutheran are performed solely to help answer physicians’ clinical questions about the processes leading to a patient’s natural death. Armed with additional information revealed by the autopsy, physicians can answer questions that might be posed by the patient’s family.
Increasingly, patient families are stepping around that process.
“We’re receiving requests for autopsies directly from families, which forces us to check back around with the physician to determine what prompted the request and whether clinical questions actually remain about the patient’s death,” said Mathew Rumery, MD, medical director for Lutheran’s Lab.
Rumery asks physicians to explain the process and purpose of an autopsy to families when they ask about the possibility of requesting one. If no clinical questions remain about their loved one’s death but the family still insists on an autopsy, they can be referred to the county, which can perform the autopsy for a fee.
For more information about Lutheran’s capabilities in performing autopsies, as well as the differences between types of autopsies, please see the below summary written by Sarah Mengshol, MD, Pathology, who performs autopsies at Lutheran.
Hospital-based vs. forensic autopsy
The goal of a hospital-based autopsy is to identify and clarify the processes leading to a patient’s death. Hospital-based autopsies are performed in cases of natural death only. A forensic autopsy is performed by the county’s medical examiner/coroner if the patient’s manner of death is in question (cases of possible accidental death, suicide or homicide).
Post-mortem toxicology and laboratory tests are not performed in a hospital autopsy. Hospital autopsies are performed to answer a clear clinical question, not just cause of death, and may not be able to answer questions regarding remote events or accidents.
Family questions
The goal of a hospital-based autopsy is to clarify recent medical events that may have led to death. These questions usually can be answered by the clinical workup. If a family has questions or is requesting an autopsy, a discussion with the clinical team should occur before an autopsy is pursued. Their questions might be answered with the information already known.
Extent of hospital-based autopsy
During an autopsy, the internal organs of the chest, abdomen, pelvis and brain are examined, and samples are taken to review under the microscope. Small samples of tissue may be retained for future study. This examination may help identify the cause of death or clarify a clinical or radiographic finding. For example, it may identify changes confirming a heart attack/myocardial infarction or clarify whether a mass was cancer or infection.
Routine autopsy does not include an evaluation of specialized organ systems, such as the eyes, oropharynx, spinal cord or neuromuscular system. If the evaluation of a specialized organ system is desired, this request must be reviewed with pathology to see if this is possible. Such requests may be referred to an outside center.
Postmortem organ donation (eyes, skin, long bone) usually does not affect the autopsy. These tissues are harvested before the autopsy.
Complete vs. limited autopsies
In a complete autopsy, the pathologist is given permission to examine all of the internal organs as needed, including the brain, to identify cause of death or answer the clinical question. The pathologist may use clinical discretion and examine only certain organs as needed to answer the question posed. For example, if the cause of death is identified in the examination of the heart and lungs, the pathologist may choose not to examine the brain.
In a limited autopsy, the consenting family member limits the examination to specific organs (such as, heart and lung only) or excludes examination of specific organs (such as, no brain examination).
During an autopsy, the body is treated with dignity and respect. In general, a viewing of the body is still possible after an autopsy. If there are specific concerns, please relay these to the pathology staff prior to the autopsy.
Autopsy consent
Legal next of kin must provide consent to perform a hospital autopsy. If the coroner takes jurisdiction and chooses to perform a forensic autopsy, this becomes a matter of law enforcement and consent is not required.
Legal next of kin, dictated by state statute, is listed below in descending order. This may differ from power of attorney, which expires at death.
Surviving spouse (married or separated, but not divorced)
Adult children (oldest to youngest, including adopted)
Father or mother
Brother or sister
Grandfather or grandmother
Uncle or aunt
Legal guardian
Other person accepting legal responsibility for funeral arrangements
If a person of equal class objects to an autopsy, the autopsy will not be completed, even if a valid permit exists. If any question exists as to the validity of the consent, an autopsy will not be completed.
Autopsy consent forms
Autopsy consent must be witnessed. If the consent is obtained in person, the signature of the consenter must be witnessed by one person. If consent is obtained verbally/over the phone, two witnesses must speak to the consenter and sign the form. Consents also need to include the relationship of the consenter to the deceased, legible printed names for all signatures, and the date.
A member of the clinical team should be identified as the contact for the pathologist and the family. The clinician’s name and correct contact information is required on the autopsy consent. Without listing the treating physician involved, it can be difficult to provide the appropriate follow-up and explanation of the autopsy findings to the family, in the context of the care provided to patient prior to death.
The autopsy consent form must indicate the scope of the autopsy requested: complete or limited. If consent for limited autopsy is obtained, then the limitations must be listed on the form.
Timeline
Preliminary results usually are available within a few days of the procedure, but the final report may take up to 60 business days for release. Per HIPAA guidelines, the Pathology Department cannot release results directly to family members. They can obtain copies from hospital medical records or by contacting the treating clinician.
Cost
The cost of a routine hospital autopsy is covered by the hospital. If specialized testing is requested, such as genetic testing, this cost may be relayed to the patient’s family. This would be discussed with the family and arrangements made before testing is performed.
Physicians with additional questions about this process can contact Rumery at Mathew.rumery@imail2.org.