In the past, autopsies have often served as a kind of “audit” for physicians who treated a patient before death. Although the medical team may have been confident about what caused a death, it could be reassuring to find that the autopsy findings confirmed their diagnosis. On some occasions, the findings did not conform to the diagnosis, which can be a valuable learning tool. As one physician put it, “we can learn a lot from the dead.”

In recent years, autopsies stopped being done routinely as part of the medical care practice, and became reserved for unusual or unexpected deaths or when there were suspicions about criminal conduct. In Washington, each county has a Medical Examiner who conducts autopsies in such cases. If a death does not lead to medical examiner involvement, there are private pathologists who can be hired to do an autopsy by the family of the deceased. Those are often performed in a funeral facility.

The recent trend to not do routine autopsies is concerning to many health care experts. Judy Melinek, MD, a forensic pathologist based in San Francisco, highlighted a [previous NEJM article](https://www.nejm.org/doi/full/10.1056/NEJMp1909017?query=featured_home) estimating that if an average U.S. hospital performed autopsies after all deaths, it would detect class I errors — those that “would have resulted in a change in therapy and might have prolonged survival if identified earlier,” she said — in about 4% of cases, and class II errors — “missed diagnoses that didn’t affect survival but were still clinically important” — in an additional 4%.

The question that often arises when an attorney receives a call about a death that a family member thinks may have resulted from malpractice is “do we have to do an autopsy?” The answer isn’t clear. In many cases, the medical records allow a firm conclusion to be drawn about the cause of death. But in other cases, it is not clear and only an autopsy may provide the information needed to determine whether medical negligence may have resulted in the death.

An example is a case in which a man had a valve replacement procedure and was recovering well on the second post-op day. But he suddenly suffered an apparent cardiac arrest and died, despite strenuous efforts at resuscitation. The cardiac care team was mystified, because all signs pointed toward a good recovery, and there were no vital sign changes that indicated problems.

Because of the unexpected and unexplained circumstances of the death, the local medical examiner did a thorough autopsy. The results were startling: the pathologists found a mysterious resin-type material in the man’s blood vessels throughout his body. Just prior to his arrest, the man had been given a medication to treat his hyperkalemia: Kayexalate. This drug is to only be given orally or rectally and is never given IV. Yet the autopsy findings seemed to indicate that it had been given IV, since none of the material was found in the man’s stomach. That case is in litigation at this time.

If asked whether an autopsy is necessary in a wrongful death case, the answer will depend on how clear the medical facts are in identifying the circumstances of the death.
Families are often reluctant to request an autopsy for may reasons, including cost, and we often tell them that sometimes the autopsy report will include findings that provide a more clear malpractice picture but often will not change the decision about whether there is a viable claim. It is a difficult choice the family has to make.

Read more here: [Should we be Doing More Autopsies?](https://www.medpagetoday.com/pathology/generalpathology/83341)