Any patient who dies in a hospital is entitled, at no charge, to an autopsy to determine the cause of death. If family members refuse permission for the autopsy, the physicians caring for the patient are then required by law to determine the cause of death. I recently came upon an article in the New York Times written by a woman whose previously well sister passed away in a hospital of septicemia (see: The Autopsy, a Search for Reassurance). In this article, she raises the issue of the need for an "independent" (i.e., private) autopsy. This article requires additional discussion. Below is an excerpt from it with boldface emphasis mine:
If I could have arranged for an independent autopsy by a pathologist outside the hospital where my sister died, I might have done it. But at the time, I had no idea how to go about it and felt too dispirited to try. Recently, I typed “autopsy expert” into a search engine and found Dr. William Manion, a pathologist and lawyer in New Jersey....Some clients hire him because they want to sue doctors, he said in an interview, but others are just looking for peace of mind. Some are upset because they feel doctors didn’t take the time to explain what happened....Similarly, he said that people whose relatives died of undiagnosed, advanced cancer sometimes recalled symptoms from a few months back that they might have overlooked or dismissed. He tells them that the cancer must have been there for a long time, and that they couldn’t have done anything....As for my concern that a hospital might try to cover its mistakes in an autopsy report, Dr. Manion didn’t buy it. Pathologists based in hospitals are reliable, he said, in part because they have to pass muster with various accrediting groups....The Web site for the College of American Pathologists keeps a list of board-certified pathologists who perform private autopsies. Most charge $3,000 to $5,000....But it’s important to decide quickly; Dr. Manion says an autopsy is best performed within 24 hours of the death, before organs deteriorate too much.
By New York Times standards, this particular article leaves much to be desired. Its fundamental flaw, in my opinion, is that the author turns to an individual, Dr. Manion, who derives financial gain from referrals away from hospital pathologists for a general assessment of them. He, in turn, describes hospital-based pathologists as "reliable," in essence damning them with faint praise. I have personally spent more than four decades in pathology and been involved with thousands of autopsies. I have never seen a single instance where an autopsy report was less than totally objective in terms of the cause of death, particularly in cases of potential malpractice. I have also been personally involved in numerous lively discussions with clinicians, including many surgeons, about autopsy findings. In the final analysis, the objective judgment of the pathologist about the cause of death of a patient has always held sway. The veracity of an autopsy report goes to the very core of the practice of the specialty.
I will also defend the right of any family to choose to have an autopsy performed by an "independent" and qualified pathologist without a relationship to the hospital where the patient died. In most such cases, the patient and family have had an uneasy relationship with hospital medical staff or administrative personnel. They may feel that they want to "do the best thing" for their relative or may be in a litigious frame of mind, with or without good cause. I agree with Dr. Manion that in the majority of such cases, the treating physicians have been uncommunicative or perceived by the family as uncaring -- this is frequently the basis for their mistrust of all of the hospital physicians. However, I would advise families seeking an independent pathologist to take some care that the individual selected is well trained and board-certified.
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