Manager: Chelsea Nelson
A preliminary anatomic diagnosis (PAD) is available within three working days of the autopsy. PAD is distributed electronically. No information will be released by the Department of Pathology directly to the family. The final autopsy report is not completed until approximately two months after the autopsy and is distributed electronically in the same manner as the PAD.
Authorization for Autopsy
In all cases except stillbirth deaths, one physician (intern or resident) attending the deceased patient will be responsible for securing proper autopsy consent, after fully explaining the nature and scope of the autopsy to the members of the family. In the case of stillborns, it shall be the task of the physician attending the mother to assume the above duties. Securing proper autopsy consent includes three steps:
- Obtaining correct authorization,
- clarifying any restrictions to the autopsy, and
- conveying all information to the pathologist by means of an Autopsy Status Form.
Obtaining Correct Authorization
Requesting consent from the proper authority presents the most frequently encountered problem for the attending physician. Generally, it is the next-of-kin who must sign the permit. In particular, while the Arkansas statutory authority does not provide for a priority oriented list of relatives for right of custody of the deceased body and right to consent to autopsy, the Arkansas courts indicate such an approach is required. With that in mind, the following list of relatives should be referred to in order of priority stated for consent. This list presumes mental competency and adulthood of each person.
- Son or Daughter
- Either parent or guardian
- A brother or sister
- Grandparent, grandchildren, uncle or aunt, nieces or nephews
- Great grandparent, great uncle or great aunt
- Any other next-of-kin, i.e., cousins, etc.
- A friend or person charged by law with the responsibility for burial.
Complications may arise that require contacting the resident or staff performing the autopsy.
These circumstances include:
- Autopsy consent from a minor spouse will be accepted if he or she is capable of understanding the nature of the autopsy.
- Autopsy consent will be accepted from a minor married mother or father for his/her child.
- An unmarried minor mother may authorize an autopsy for her child, but consent of the unmarried minor’s parent’s be secured in addition to the mother’s consent. Consent from one parent is acceptable but consent of both parents’ is preferable. If the surviving spouse is not living with the deceased at the time of death in the normal relations of marriage, he or she possesses the right of consent. Only if it can be documented that the surviving spouse waives the right, should consent be obtained from the next person on the priority list. A couple who is legally divorced has relinquished all rights of kinship to each other.
- “Common Law” marriages are not recognized in the State of Arkansas.
- If the parents of a child are divorced or separated, consent should be obtained from the parent who has custody of the child.
- If any member of a kinship class of persons, objects to an autopsy, the objection will invalidate the consent of another member of the class. For example, if the daughter of the deceased consents to an autopsy, but the son of the deceased objects, the autopsy must not be performed.
Clarifying Any Restrictions to the Autopsy
The only acceptable restrictions are…
- Limited To The Central Nervous System
- Limited To The Thorax
- Limited To The Abdomen
- Limited To The Thorax And Abdomen
Any other restrictions must be approved by the pathologist or an autopsy will not be performed. Where there are no restrictions, write NONE in the appropriate space.
Completing the Autopsy Status Form
The Autopsy Status Form consists of a front sheet which contains information directed toward the attending physician obtaining consent and is to be removed prior to obtaining the appropriate signatures. The next sheet (which will be the front sheet on the form received with the body) has a Side A and a Side B. Side A will be completed if the autopsy is refused; Side B will be completed if the autopsy is granted. On the lower half of Side A, there is a body receipt section to be filled out by the funeral home at the time of the release of the body. On Side B, if any restrictions are listed other than the ones mentioned in the section, “Clarifying any Restrictions to the Autopsy” , the autopsy will not be done. In most cases one authorized signature is sufficient. Consult the “Legal Priorities of Next-of-Kin” if you have any questions regarding the legality of the permit. In the section labeled, “To be answered by the person obtaining the consent”, if a “yes” is marked for either question, the autopsy will not be performed. Under the Witness section, one of the witnesses may be the same as the attending physician obtaining consent.
The last sheet of the Autopsy Status Form is the “Problem Oriented Autopsy” request sheet. It will be removed from the consent sheet prior to obtaining appropriate signatures, but will be submitted along with the signature page. This page must be filled out by the attending physician. The permit must by completely filled out with all necessary information and witnessed personally by the attending physician and another person. When the person authorizing the consent is present, his or her signature must be obtained. When the authorization is obtained by telephone, the attending physician must obtain the permission from the grantor and the witness must listen to the telephone conversation and sign the permit.
A Mediocoloegal case is defined by Arkansas Statute as:
“As upon the death of any person from violence, whether apparently homicidal, suicidal, accidental, or industrial, including but not limited to death due to thermal, chemical, electrical, or radiation injury and death due to criminal abortion, whether apparently self-induced or not, suddenly when in apparent good health, or in a prison, jail or penal farm, or in any suspicious or unusual or unnatural manner….”
Any death falling within these circumstances must be reported to the appropriate County Coroner’s Office (the county in which the death occurred) by the physician in attendance. In addition, all D.O.A.’s and patients dying within 24 hours of admission to the hospital must be reported to the coroner. The pathology resident should make certain that all such cases have been properly reported prior to beginning an autopsy. In any such cases, an autopsy is only to be performed at UAMS after release of the case by the coroner.
If, during the autopsy, the pathologist should discover any information that would bring the case within the ambit of the above Mediocolegal jurisdiction, the pathologist will notify the coroner. The State Medical Examiner performs Mediocolegal autopsies at the request of a coroner or law enforcement agency.
Policy regarding Dead on Arrival and ED Deaths
Emergency Room deaths may be divided into three major categories:
- Category 1: D.O.A. – Coroner’s cases. Coroner must be notified of death.
- Category 2: Dying in the E.D. – Coroner’s cases. Coroner must be notified of death. Even if a patient dies within 24 hours after admission to the UAMS Medical Center, the coroner must be notified.
- Category 3: D.O.A. or dying in the E.D. and released by the coroner.
Only patients who have been hospitalized at UAMS, or patients seen in the past year for major illness as an outpatient are eligible for autopsy.
All bodies must physically be taken to the Morgue, along with all personal effects, and appropriate log entries must be made before release of the body to anyone, including the Medical Examiner.
If a patient is not eligible for autopsy and the family desires a private autopsy at the family’s expense, they should be placed in contact with the Director of the Autopsy Service for approval and determination of cost.
Responsibilities of Hospital Personnel in Transferring a Body to the Morgue
- The body must be tagged with the correct patient identification information and placed in a postmortem body bag with the correct patient identification attached to the zipper.
The following items should accompany the body to the morgue:
- UAMS Morgue Log Sheet
- Signed death certificate
- Autopsy Consent (unless pending)
- A properly completed Autopsy Status Form (delivered to the Morgue as soon as possible)
- Personal Effects – clearly labeled with the patient’s name and identification number (try to give these to a family member first)
- Transport services should be called to transport the body to the morgue. The Chief Lab Tech must always be notified of delivery. During normal business hours, the Morgue Attendant may be reached at 501-686-6414. Outside normal business hours and on holidays, the Chief Lab Tech may be reached at 501-686-6230.
- If the patient was on Blood and/or Body Fluid Isolation Precautions, expires and an autopsy is not requested, the Department of Nursing is to notify the Morgue staff of the diagnosis, stating only that the deceased was under Blood and Body Fluid Isolation Precautions.
Special permission must be obtained from the Director of the Autopsy Service. If permission is granted, the Department of Pathology requires that a member of the primary patient care team accompany the family member or members to the Morgue and remain with them during the viewing of the body.
Infectious cases should be clearly identified by nursing personnel in the following manner:
- Clearly mark identification tag as “Infectious Case”.
- In cases of blood and body fluid infections, the pink “Blood and Body Fluid Precautions” form should be placed on the identification tag and Autopsy Status Form.
Bodies Containing Radioactive Isotopes
If a patient containing less than 5 mc of radioactive material dies in the hospital, no special precautions are necessary.
- If a patient dies in the hospital and contains more than 5 mc of radioactive material, the doctor signing the death certificate must inform the pathologist and the Radiation Safety Office (RSO) of this fact. The “Report of Radioactivity to Funeral Director” form must accompany the body to the Morgue.
- If the body contains more than 30 mc of radioactive material, the doctor signing the death certificate must notify the RSO who will prepare a special statement for the funeral director.
Disposal of Stillborns and Newborns
Disposal of stillbirths and live birth remains shall be by cremation and require a signed authorization by the mother before discharge if the parent(s) do not choose a funeral home for disposition. Absent an authorization, UAMS shall retain the remains for three (3) months before cremation. Stillbirths and live birth remains may be autopsied in accordance with policy ML.3.09.
- A signed authorization (MR II) for disposal is required for ALL stillborn fetuses and live birth remains, irrespective of weight or gestational age, when the parent or legal guardian does not accept responsibility for burial.
- For completion of the Authorization for Disposal, the consent of the parent or legal guardian must be obtained. The signature of the mother is required. When the mother is an unmarried minor, she may authorize an autopsy and/or disposal of the infant. It is desirable that an additional consent be obtained and recorded from one of the minor’s parents.
- An Autopsy Permit is required as outlined in Policy ML.3.05, Authorization Required For Autopsy when autopsy of a stillbirth or live birth remains is requested by one of the attending physicians. The Department of Pathology will only perform an autopsy on a stillborn infant 20 weeks gestation or more. Stillbirths less than 20 weeks will be sent to Surgical Pathology for examination.
- A Certificate of Fetal Death must be completed on all stillbirths 20 weeks of gestation or greater or having a weight of 350 grams or more.
- Stillbirths and live born remains may have arrangements for cremation. The cremated remains shall be separately identifiable. The containers will be returned to UAMS and stored for a period of three months. If the parents have made no contact to take possession of the remains, UAMS will dispose of them.