LifeBridge Health - Department of Pathology
|Hours of Operation:
||Monday-Friday: 0730 - 1700 (SHB)
||Monday-Friday: 0800 – 1700 (NWH)
||(Information & Reports)
|Performance of Autopsies
||Daily: 0830 -1400
||No autopsy will begin after 1400 (SHB)
No autopsy will begin after 1500 (NWH)
A. The hospital cannot perform an autopsy in which the case falls under the jurisdiction of the Office of the Medical Examiner. If in doubt, always consult with the Medical Examiner. The Department of Pathology has the right to require that clearance be obtained from the Medical Examiner prior to the performance of any autopsy. Please consult Medical Examiner Case section.
B. The State Anatomy Board will not accept autopsied bodies. The individual consenting for the autopsy assumes responsibility for the disposition of the body.
C. A request for autopsy may be initiated by the patient's family or legal guardian or a physician may approach the family for consent.
D. Mandatory: A death certificate MUST be completed on all patients by the attending physician or house staff officer in attendance at the time of the patient's death. An addendum may be completed if the autopsy reveals additional information relating to the patient's cause of death.
E. Refer to the Patient Care Manual for examples of the appropriate forms to use for autopsy cases.
A. The attending physician or the house officer in attendance at the time of death is responsible for obtaining consent for autopsy.
B. Permission for an autopsy must be obtained from the legal next of kin in the following order:
- Court appointed guardian
- Adult child
- Adult sibling
- Friend or relative with whom the patient has had close contact
C. If the consenting individual is not physically available to provide consent, the consent may be obtained by telephone. A telephonic consent must be witnessed by two licensed hospital employees. The consenting individual must send a telegram to the hospital confirming the telephonic consent.
D. The physician obtaining the consent is responsible for completing the Permission for Postmortem Examination. The following items MUST be completed on the autopsy permission request form.
- Patient name, sex, age, race
- Room number or location
- Date and time of death
- Physician's signature
- Witnessed signature of the individual giving consent
- Clinical abstract completed by clinician with signature
E. Administrative approval must be obtained prior to the performance of the autopsy. The Director of Patient Care Services or the Hospital Operations Coordinator is authorized to sign for administrative approval. The following items must be verified before consent for autopsy is given.
- Permission form is complete and signed by physician
- Consent is obtained from the appropriate individual
- If the consent is telephonic, two witnesses must verify the consent and confirm that a telegram will be sent in follow-up.
- Consenting individual's signature is witnessed (only one witness required)
- Verify if the autopsy is PARTIAL or COMPLETE and if there are any restrictions or family wishes.
- Verify the status concerning the Medical Examiner
F. The body must be appropriately wrapped for transportation
and must be placed in the morgue pending the autopsy. Accurate
identification of both the body directly and the external wrappings must
G. The Department of Pathology will notify the Nursing Office or the Security Office after the completion of the autopsy.
Physician Instructions and Procedures: Adult Patient Demise
A. The physician contacts the family and informs them of the patient's demise.
B. The physician instructs the nursing staff to transfer the body to the morgue.
C. The physician signs the death certificate regardless of whether an autopsy consent is obtained.
D. Death certificate, autopsy permission and organ donation forms are available at the nursing stations.
E. The physician discusses permission for autopsy with the family.
F. The physician indicates to the individual giving consent for autopsy that they are responsible for the burial of the deceased.
G. If autopsy permission is denied, the physician instructs the nursing service to release the body. The law states that 48 hours after death, the State Anatomy Board can exercise jurisdiction over the decision concerning autopsy and burial. The physician takes the steps necessary to have a decision concerning these matters completed within 48 hours.
H. If any tissue or organ donation has occurred, the Anatomy Board will still accept the body for donation. However, if the family wishes for the body to be donated to the Anatomy Board, an autopsy can only be performed if the Anatomy Board gives prior approval.
1st: Spouse; if there is no spouse, be certain that all family members in one of the following categories give consent for autopsy.
2nd: Children; common law states that all children must agree to an autopsy before an autopsy can be performed; however, only one has to sign the consent.
3rd: Parent; both parents must agree to an autopsy but only one has to sign the consent form.
4th: Sibling; all siblings must agree to an autopsy but only one has to sign the consent form.
EXCEPTION: In some circumstances, a legal guardian may take precedence over family members.
EXCEPTION: In some exceptional circumstances, someone who is simply a friend and not a family member may be an appropriate person to authorize an autopsy.
J. If the family member cannot come to the hospital to sign the consent, permission can be obtained by telephone provided that two Sinai employees (physicians, nurses, ward clerks) hear the permission given and are thereby considered witnesses. The family member must agree verbally by telephone to confirm the permission in writing by sending a telegram to the hospital. This telegram should be sent to the physician of record, c/o the nursing service of Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore, MD 21215. The telegram will be incorporated into the patient chart. Both witnesses sign the permission form and state on the form that the telephone permission for autopsy was granted and properly witnessed and that a telegram will follow.
K. After the autopsy permission form is signed by the family member or designate and by the physician, it must be signed by a representative of the hospital administration. The permission with the patient's chart is then taken to the Department of Pathology, Third Floor, Main Hospital (601-5lO3) between the hours of 0830 (8:30 am) and 1700 (5:00 pm) on weekdays (Monday Friday) or to the Nursing Service (x5654) at all other time.
Autopsy - Fetal Demise
Instructions: This procedure must be followed for all perinatal and infant deaths. If the baby weighs <500 grams or is <20 weeks gestation, the nurse must complete only the fetal demise form with the parents. If the baby is >500 grams or >20 weeks gestation, a Permission for Postmortem Examination must also be completed by the responsible physician, signed by the parents and appropriately witnessed. The fetal demise form allows the parents to choose from four options. All four options must be reviewed with the parents. The pink copy of the fetal demise form fully completed with the designated option #14 must accompany the baby when it is delivered to the morgue.
- Autopsy and hospital cremation
- Autopsy and private burial or cremation
- Hospital cremation without autopsy or surgical examination
- Private burial or cremation without autopsy or surgical examination
Distribution of the Fetal Demise Form:
- Autopsy and hospital cremation: Place this form and Permission for Postmortem Examination on the infant's chart and forward to Administration for signature. Then send the form to Pathology which retains the yellow copy. Pathology then forwards the white copy to Medical Records with the patient's chart upon completion of the examination.
- Autopsy and private burial or cremation: Place this form and Permission for Postmortem Examination on the infant's chart and forward to Administration for signature. Then send the form to Pathology. Upon completion of the examination, Pathology places the form in the chart.
- Hospital cremation without autopsy or surgical examination: Forward the yellow copy to Pathology and place the white copy in the infant's chart or mother's chart if the infant does not have a chart.
- Private burial or cremation without autopsy or surgical examination: Forward the yellow copy to Pathology and place the white copy in the infant's chart or mother's chart the infant does not have a chart.
Anatomy Board Case Definition
By law in the State of Maryland, there are three situations in which deceased persons are transferred to the Anatomy Board of Maryland.
- UNCLAIMED BODIES: This situation occurs when no one assumes responsibility for a deceased body. The Department of Social Work will investigate. If, after 48 hours, no one has been found who will assume responsibility for the burial of the deceased and there are no apparent interested parties, the Department of Nursing will notify and release the body of the deceased to the Anatomy Board.
- PRIOR ARRANGEMENT: A patient has made previous arrangements and has willed his/her body to the Anatomy Board.
- NEXT OF KIN: The next of kin initiates the donation of the deceased patient's body to the Anatomy Board.
The Anatomy Board cannot assume control and custody of bodies (claimed or donated) where the death is undergoing investigation by the Office of the Medical Examiner.
Medical Examiner's Case Definition
1. General: The attending physician or house staff officer in attendance at the time of patient death determines if a case is reportable to the Medical Examiner and is responsible for contacting the Medical Examiner's Office. The following list are examples in which the Medical Examiner MUST be notified.
A. Death of a suspicious, sudden or unusual nature involving an apparently healthy person.
B. Death resulting from casualty or accident of any kind including fracture from a fall in an elderly person. Any death occurring, whether directly or indirectly, as the result of a fracture must be reported to the Medical Examiner.
F. Criminal Abortion
H. Therapeutic Misadventure
J. Any dead-on-arrival patient who cannot be pronounced dead by the private physician.
K. Anesthetic death. A death which occurs in the operating room or recovery room is considered an anesthetic death.
CAUTION: If the appropriate disposition of the case is uncertain, consultation with the Medical Examiner's office is recommended.
2. Procedure: If a patient's demise is determined to be a medical examiner's case, the following procedures are followed by the attending physician or house officer present at the death of the patient.
A. Report case to Administration or to the Nursing Supervisor in the absence of the administrator.
B. Report case to the Medical Examiner at 396-3833 and to Police Services at 396-2646.
NOTE: Anesthetic deaths are reported by the anesthesiologist.
C. If possible, obtain a release from the Medical Examiner for autopsy at the hospital.
1. If a final release is obtained, the death certificate is signed by the house officer of record or the private/attending physician.
2. If a release on approval is obtained, the death certificate is signed by the house officer or private/attending physician and countersigned by the Medical Examiner.
3. If an autopsy is granted, permission for postmortem examination must be obtained in the usual manner from the family.
D. Record death of patient, result of conversation with the Medical Examiner and result of conversation with family in the chart as information is obtained in order that it become part of the permanent medical record.
E. Complete death certificate without delay. Ancillary information will be supplied by the mortician (items 23a-25b-Forrn DHMH- 16 60M 7/73).
1. If the case is not released to the hospital, the death certificate is completed by the Medical Examiner.
2. In appropriate cases, the private physician in attendance signs the death certificate.
3. Additional Notes:
A. Since these requirements are specifically delineated by law, it is not possible for the physician to exercise judgment as to whether or not such deaths shall be reported.
B. It is also required that where death is SUSPECTED as being brought about by any of the above circumstances, this case MUST be reported to the Medical Examiner.
C. The Medical Examiner may, if he chooses, release certain cases to the hospital in the following categories.
- Death from acute or chronic alcoholism without manifestation of trauma.
- Death from accidental bums occurring at home.
- Death or sudden death associated with a therapeutic procedure.
- Death following a fracture in elderly persons resulting from a simple fall in the home.<
D. Where these cases are released by the Medical Examiner, regardless of whether an autopsy is obtained or not, the cause of death must be agreed upon between the Medical Examiner and the reporting physician representing the hospital based on direct contact with the Duty Medical Examiner at 396-3833.
E. It is the responsibility of the physician reporting to the Medical Examiner to reveal to the latter all the circumstances relating to the patient's death.
F. In the event of an anesthesia death, the anesthesiologist is required to report the death. If there is a delay in the patient's death following the administration of anesthesia when the anesthesiologist is no longer present, then it is the responsibility of the private/attending physician or house officer to report the case to the Medical Examiner.
WARNING: UNDER NO CIRCUMSTANCES MAY THE OBLIGATION OF REPORTING SUCH DEATHS (OR DEATHS SUSPECTED OF BEING CAUSED BY THESE CIRCUMSTANCES) BE AVOIDED.