Epilepsy Talk

Autopsies – Where Did They Go? | February 29, 2012

50 years ago, it was pretty easy to find out the cause of a loved one’s death.

Not so anymore.

An investigation published by ProPublica shows that hospital autopsies have become a rarity…

“A half-century ago, an autopsy would have been routine. Autopsies, sometimes called the ultimate medical audit, were an integral part of American health care, performed on roughly half of all patients who died in hospitals. Today, data from the Centers for Disease Control and Prevention show, they are conducted on about 5 percent of such patients.”

Even sudden unexpected deaths do not trigger postmortem reviews. Hospitals are not required to offer or perform autopsies. Insurers don’t pay for them. Some facilities and doctors shy away from them, fearing they may reveal malpractice. The downward trend is well-known — it’s been studied for years.

Now here’s some scary news: Did you know a coroner doesn’t need a medical degree to diagnose the cause of death? An NPR News investigation in partnership with ProPublica and PBS Frontline explored the nation’s 2,300 coroner and medical examiner offices, and found a troubled system that buries its mistakes.

Diagnostic errors, which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics.

In one of 10 cases, the error appeared severe enough to have led to the patient’s death. Plus, hospital autopsies are even rarer when patients older than 60 die in hospitals.

In other words, autopsies are a dysfunctional system in which there are few standards, little oversight and the mistakes are literally buried. In state after state, reporters found autopsies — our final physical exam — conducted by doctors who lacked certification and training. An increasing number of the 2.5 million Americans who die each year go to the grave without being examined at all.

A ProPublica report details “hospitals’ powerful financial incentives to avoid autopsies” and explains that without information from these procedures, diagnostic errors are often missed. This gap not only leads to lost opportunities for improved medical treatment, but skews health care statistics.

The report continues: “An autopsy costs about $1,275, according to a survey of hospitals in eight states. But Medicare and private insurers don’t pay for them directly, typically limiting reimbursement to procedures used to diagnose and treat the living.”

“Medicare bundles payments for autopsies into overall payments to hospitals for quality assurance, increasing the incentive to skip them,” said Dr. John Sinard, director of autopsy service for the Yale University School of Medicine.

“The hospital is going to get the money whether they do the autopsy or not, so the autopsy just becomes an expense” Sinard said.

But finally here’s the “good” news: while most hospitals have drastically reduced the number of autopsies they perform, if you persist in getting one, sometimes you can get it free of charge.

Now, that’s really sick!

Resources:

http://www.npr.org/series/133208980/post-mortem-death-investigation-in-america

http://www.propublica.org/series/post-mortem

http://www.propublica.org/article/without-autopsies-hospitals-bury-their-mistakes

http://www.pbs.org/wgbh/pages/frontline/post-mortem/etc/introduction.html

http://www.nytimes.com/2010/11/25/health/research/25patient.html?partner=rss&emc=rss

http://jama.ama-assn.org/content/305/23/2427.short

http://www.yourmedicaldetective.com/drgrisanti/dangerous_medicine.htm


12 Comments »

  1. I will have to tell you in the 80s in order to be a registered EEG Tech. You had to go to autopsy. I went to 2. One I had done an EEG on it was interesting, very fast, the had fans blowing and you were ruling out the cause of death. It was fast and quick. One patient of died of multiple strokes and the other multiple cardiac arrests.

    Like

    Comment by Toni Robison — March 1, 2012 @ 3:55 AM

  2. So what do you think happened between now and then? How did the frequency and the standards drop so low?

    Like

    Comment by Phylis Feiner Johnson — March 1, 2012 @ 1:38 PM

    • I think you answered that one at the beginning.
      “Insurers dont pay for them”. If they did, I’m sure EVERYONE that died would get one!

      Like

      Comment by Charlie — March 5, 2012 @ 3:17 PM

  3. From 100% to 5%. That’s outrageous!

    Like

    Comment by Phylis Feiner Johnson — March 5, 2012 @ 4:02 PM

  4. Only through an autopsy did we exactly know that our daughter Jane died in SUDEP circumstances. Only with that knowledge can a lot of potential future deaths be avoided. Perhaps this is one of the main reasons we have a lot reported SUDEP deaths in the UK.

    Our daughter actually died in Dublin, Ireland and they took the same line as the UK, which was “unexpected” or “unwitnessed” = autopsy. The UK coroner insisted on following up on the Dublin coroners report. So we were doubly assured of the result.

    More info at http://forjane.co.uk/

    Andy
    PS Thanks for a great post.

    Like

    Comment by andyswarbs — March 27, 2012 @ 6:13 PM

  5. Wow! I never heard of a mini breathing monitor! Even though I’ve written about “Best Seizure Monitors” (which hasn’t been posted yet.)

    While I was writing the article, it seemed interesting that most of the “best” monitors came from or were manufactured in the U.K.

    A bit ironic, yes?

    As for SEDUP, it IS a mystery, but one that nobody is especially interested in solving.

    Could it be the lack of caring or the lack of funds or both? (I guess the two seem to go together.)

    Like

    Comment by Phylis Feiner Johnson — March 27, 2012 @ 9:21 PM

  6. How about life insurance? Insurance doesn’t pay for foul play (suicide).

    Like

    Comment by Tony Murray — August 14, 2013 @ 1:43 PM

    • Nothing “pays” for suicide. And there’s no upside or acceptance.

      Not insurers…the church…the family…etc.

      The blood is on YOUR hands. 😦

      Like

      Comment by Phylis Feiner Johnson — August 14, 2013 @ 5:02 PM

  7. I have Epilepsy, along with other medical conditions. I have told my Son and will tell other family members that I WANT and an Autopsy. If just for my family’s piece of mind. There are to many unanswered questions.

    Like

    Comment by Joanne Read — August 16, 2013 @ 1:39 AM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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