My father, left, on my wedding day 1970
Today I was wrapping Christmas gifts and thinking about
autopsies. These two activities don’t seem to go together, do they? One reason I am thinking about death and autopsies at Christmas time because my father died on December 25, 1977. The attending physician would not release his body until we made a decision on permitting him to order an autopsy.
Let me back up. Another reason I am thinking about autopsies is that I also read an article today about the drastic decline in autopsies. Called, “Without autopsies, hospitals bury their mistakes”, it identifies the trend of a drastic decline in autopsies, from 50% of hospital deaths 50 years ago to 5% now. Why such a drop? Lack of reimbursement for the procedure, no Joint Commission mandate to do them, and fear by hospitals and doctors that an autopsy will reveal medical malpractice are reasons that are cited.
What are the medical consequences of not getting an autopsy? For one, the medical team does not learn from their mistakes, or even that a mistake has occurred. The feedback loop is gone. They don’t learn about the effectiveness of the treatment they ordered. They don’t learn how diseases progress.
What are the medical legal consequences of not getting an autopsy? We in the legal world know that proving causation can be infinitely more difficult without an autopsy. Several times a year we ask attorneys, “Was there an autopsy?” And a few times a year we have discussions with attorneys about the effectiveness of digging up a body and performing an autopsy several months after death. Will an autopsy, even if done, provide the answers about the cause of death? Not always. Earlier this month a pathologist told me four causes of death that will not show up on autopsy.
When I was a student nurse, I saw autopsies being done. When I edited chapters on autopsy medical records and forensic medical records for Medical Legal Aspects of Medical Records, I helped the authors sort through after death photographs to include as figures in the chapters. As legal nurse consultants, we routinely read autopsy reports and sometimes see photographs included with records that flow through our office. Legal nurse consultants can slip into the mask that allows us to dispassionately read these reports and look at the photographs.
But in 1977, when I sat in a conference room at Atlantic City Medical Center with my father’s attending physician on the phone, I had only my student nursing experience watching autopsies. My 56-year-old father developed back pain around Thanksgiving, and saw a chiropractor. A week later, when the back pain was still strong, he woke up one day and could not urinate and could not move his legs. At the hospital, he was diagnosed with metastatic cancer that had metastasized to his spine and lung. The primary site was unknown. Four short weeks later, he was dead. The tumor in his lungs suffocated him. When my grandfather walked into his son’s hospital room on Christmas Day, he found him dead. We felt like we had been hit by a truck. There was no time to prepare.
My father’s attending physician argued that we should agree to the autopsy because the primary site was unknown. My grandfather said, “No.” He passed the phone to my husband, who also said, “No autopsy.” Then I took charge of the phone call. I told the attending physician that I had seen autopsies done, and that my father would not have wanted that done to his body. The attending physician continued to argue with me, telling me that cancer was one of the leading causes of death. “There is nothing you can say that will change our minds”, I told him. In a situation in which we felt out of control, refusing the autopsy gave us some tiny sense of being in charge. The lack of the autopsy did not change of his children’s lives in terms of routine healthcare or monitoring.
However, if someone I loved died today and I was suspicious about the cause of death, I know I would have to fight to get the autopsy done, pay for it out of my pocket, and use the knowledge to understand what occurred.
There is one other point I want to make about my father’s death. After he and my mother got divorced, he lived with his parents. His mother died of malignant melanoma in 1976. My grandfather was a controlling man who did not want to see his son date or travel. A week before my father was diagnosed with back pain, he told me that after his father died, he would travel, date, and really enjoy his life. He never got those opportunities, and his father lived for five more years after his son’s death.
When my father died, I learned at the age of 27 that life is short, and the only day you can count on is today. By dying at age 56, my father missed out on seeing so much of life and having family experiences – grandchildren and great grandchildren. Don’t make the mistake of thinking you have endless time. Life is now.
Pat Iyer MSN RN LNCC is president of Med League and the mother of two sons, one of whom her father was not alive to meet. Her firstborn son was 2 years old when her father died.
Healthcare fraud is big business, which costs the US Government and Americans huge dollars. There are several federal statutes that tie into making fraud a crime. These criminal statues include 
