This story notes that “when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.”
So, it is bad news that all of the New England states report low autopsy rates in cases of unexpected deaths. Personally, it’s sad that NC also reports a low rate. The Raleigh News & Observer did a similar same story in 1995.
by Marshall Allen ProPublica, Dec. 15, 2011, 12:36 p.m.by Marshall Allen, ProPublica, Dec. 15
When Renee Royak-Schaler unexpectedly collapsed and died on May 22, no one ordered anautopsy.
Not the doctors at Howard County General Hospital in Columbia, Md., where the 64-year-old professor and cancer researcher was pronounced dead.
Not the Maryland Office of the Chief Medical Examiner, which passed on the case because no foul play was involved.
And not Royak-Schaler’s physicians at Johns Hopkins University School of Medicine who had diagnosed cancer in her hip two days beforehand but acknowledged they didn’t know what had caused her unforeseen death.
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.
As Royak-Schaler’s husband, Jeffrey Schaler, discovered, 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.
What has not been appreciated, pathologists and public health officials say, are the far-reaching consequences for U.S. health care of minuscule autopsy rates.
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 tolearn about the effectiveness of medical treatments and the progression ofdiseases. Inaccurate information winds up on death certificates, undermining thereliability of crucial health statistics.
It was only because of Royak-Schaler’s connections that her case ended differently. Her colleagues at the University of Maryland School of Medicine urged her husband to authorize an autopsy and volunteered to conduct it for free.
In her case, as in so many, the autopsy revealed a surprise: Royak-Schaler, the renowned cancer researcher, had cancer ravaging her body — in her lungs, kidneys ,abdomen and the marrow of her bones. A blood clot, likely related to thetumors, caused her sudden death.
Jeffrey Schaler has wrestled with anger that his wife wasn’t diagnosed sooner but said knowing how she died was better than not.
“There’s a sense of peace that accompanies that knowledge,” he said.
For the last year, ProPublica, PBS “Frontline” and NPR have probed America’s deeply flawed system of death investigation , focusing primarily on forensic autopsies, which are conducted by coroners’ offices and medical examiners when there is suspicion of an unnatural death. State laws vary, but the preponderance of deaths that occur in hospitals are considered natural. Whendeaths are unexplained, unobserved or within 24 hours of admission, hospitalsmay be required to report them to local coroners or medical examiners, but such agencies rarely take hospital cases.
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