Epilepsy Talk

Autopsies – Where Did They Go? | April 24, 2022

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!

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Resources:

https://www.npr.org/2012/02/05/146355717/fewer-autopsies-mean-crucial-info-goes-to-the-grave

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

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