When an autopsy is requested, the pathologist first conducts an external examination of the body to look for injuries and signs of disease. Then the pathologist makes two incisions, one at the back of the head and one in the chest and stomach area, and takes samples of organs, tissue and blood, among other things. The pathology team does a microscopic analysis of the samples and may do genetic, drug and other tests as well. They write a report explaining their findings. The whole process takes the better part of a day.
In the case of an unnatural death — a homicide or an accident, for example — the state medical examiner or coroner may require an autopsy. But in cases where there’s no evidence of foul play or unnatural death, the decision to request an autopsy is up to physicians and family members of the deceased.
In theory, the federal government pays hospitals to perform autopsies through the fixed payments it makes to the Medicare program. In practice, however, those funds generally don’t trickle down to the pathology department. But in general if a family requests an autopsy, a hospital will often conduct it at no charge. The hospital can also arrange for one to be conducted elsewhere if it doesn’t perform them. Many hospitals will also perform autopsies on former patients gratis for some designated period of time regardless of where they died.
A small minority of hospitals these days charge families for autopsies, says Gregory J. Davis, a professor of pathology and laboratory medicine at the University of Kentucky. At $3,500 to $6,000 each, this can be a big deterrent. “In essence what they’re saying is, ‘We don’t want to do this,’ ” he says.
Disagreement within the family over whether to ask for an autopsy can create other hurdles. When Alan Schiller’s father died at home in his bed of unknown causes a few years ago at age 85, Schiller, former chairman of pathology at Mount Sinai School of Medicine in New York, didn’t object when his brother said he didn’t want an autopsy to be done. His brother felt, as people often do, that their father had suffered enough and shouldn’t, even in death, have to undergo another procedure. Looking back, however, Schiller has mixed feelings. “I didn’t fight it . . . but I had some guilt,” he says. “We never really knew what terminated my father.”
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: .
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