Popular legal shows on TV suggest that every suspicious death is followed by an autopsy. It would seem common sense for an investigation to be conducted when someone dies for reasons that are unknown. However, each Chicago medical malpractice lawyer at our firm knows that this fictional belief in the universal use of autopsies is far from reality. Unfortunately, there remain very lax, uneven, and dysfunctional systems of postmortem medical examination. As a result, when it occurs in our area many mysterious deaths stay mysterious, often covering up instances of Illinois medical malpractice.
According to a new comprehensive investigation by ProPublica the vast majority of unexplained deaths never receive an autopsy at all. The Centers for Disease Control and Prevention found that autopsies are conducted on less than 5 percent of patients that died in hospital. Fifty years ago, that rate high ten times higher, with half of all hospital deaths resulting in a complete medical audit to determine exactly what happened to the patient. Teaching hospitals have the highest rate of autopsies (around 20%), whereas the majority of hospitals have rates near zero. This downward trend is well documented and is thought to have a variety of causes. Insurers rarely cover them, for one thing. Beyond that, hospitals are often loathe to perform them, because they worry that the results will uncover medical malpractice as a cause of the death. There is a belief among some that it is often best to just bury a mistake instead of exposing it to scrutiny.
It would seem natural for those deaths which are sudden or unexpected to trigger an autopsy. But, more and more that is not the case, including in our area. Any Illinois medical malpractice attorney knows that these declining autopsy rates have far-reaching consequences. For example, some believe that many diagnostic errors ultimately go unstudied, because victims are buried without anyone ever becoming aware of exactly what they were suffering from that caused their death. Many opportunities to learn from these errors are lost. In addition, the efficacy (or lack of efficacy) of some treatments methods cannot be tested because incorrect information ends up on death certificates. That information is subsequently used to skew crucial health statistics. Currently hospitals are not required to conduct any number of autopsies to remain in good standing with Medicare and Medicaid.
The lack of autopsies has led some to argue that more automatic reporting requirements need to be set up. However, it is unclear if forcing hospitals to report certain deaths to a coroner’s office would do much good. That is because even when deaths are reported, most medical examiner’s offices rarely investigate hospital deaths. In addition, most new hospitals are built without a place for an autopsy to be conducted. The reimbursement system from federal sources usually provides for autopsy payments only as part of a general “quality assurance” benefit. This means that hospitals get paid the same amount whether an actual autopsy is conducted or not. A 2003 panel recommended that CMS change is process to pay directly for autopsies or otherwise incentivize raising the autopsy rates. However, those proposals gained little traction and were soon tabled.
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