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SUBJECT: Autopsies

ORIGINAL: 09/27/2010 APPROVAL: Not Approved Yet

MANUAL: General Nursing Services / Laboratory Surgical Pathology

TABLE OF CONTENTS
1.0 Permit Procedures 2.0 Pathologist Notification 3.0 Coroners Cases 4.0 Autopsy Performance 5.0 Autopsy Records 6.0 Form

1. PERMIT PROCEDURES
1.1 1.1.1 1.2 1.2.1 1.2.2 1.2.3 1.2.4 Attending Physician The attending physician will explain to the next-of-kin the need for an autopsy and will initiate the permit process with the nursing staff. Nursing Department Nursing personnel will notify the Nursing Supervisor immediately, when it is determined that an autopsy will be performed. The Nursing Supervisor will contact the Tehama County coroner to see if the case will be released. The Nursing Department will then request that the mortuary pick up the remains and at the same time will advise the mortuary that an autopsy is pending. The Nursing Supervisor will prepare three copies of the Autopsy Permit for signature by the next of kin. a. All signatures must be original, preferably in blue ink. b. Each copy should be signed separately; do not use photocopies when the permit is signed and witnessed. c. Two witnesses must also sign each copy of the permit preferably in blue ink. d. The execution of the form must be complete, giving the date, time, and identification of signatory, designation of the deceased, and date and time of death. The Nursing Supervisor will obtain the required signatures as determined by circumstances. a. The forms may be signed in the nursing area, the Nursing Supervisors office, the admitting office or at the mortuary. There will be occasions when a signed permit cannot be secured. In this instance, telephone or faxed permission will be obtained from the next-of-kin. a. Telephone permission must be witnessed by two members of the hospital staff, preferably a Nursing Supervisor and the switchboard operator. b. Each employee will sign the Autopsy Permit as an indication that verbal permission was given. c. Verbal permission should be confirmed by an original signed permit. Autopsy Permits The permit must be signed by the person who legally qualifies as the next of kin, in this order: a. Surviving spouse 1

1.2.5 1.2.6

1.3 1.3.1

1.3.2

b. Surviving child or parent c. Sibling(s) d. Other kin with the right to control the disposition of the remains. If there is no next-of-kin, the permit must be signed by the individual legally responsible for the disposition of the remains. a. Attorney-in-fact b. Public administrator Permit Disposition One original is retained in the medical record. One original goes to the Laboratory for the Pathologist. One original accompanies the remains to the mortuary.

1.4 1.4.1 1.4.2 1.4.3

2. PATHOLOGIST NOTIFICATION
2.1 Between the hours of 0800 and 2200, the Nursing Supervisor will advise the Laboratory as soon as possible that a permit has been signed and to which mortuary the remains have been taken. If verbal permission was obtained, this fact should be communicated. The Laboratory will notify the Pathologist on duty (0800-1200) Monday through Thursday , the Shasta Pathology Associates receptionist 1200 1600 Monday Thursday and 0800 1600 on Friday, or the Pathologist who is on-call (Friday 1600-Monday 0800). A notification of a signed permit or the Pathologists copy of the signed permit received in the Laboratory after 1600 hours Sunday through Wednesday will be kept in the Laboratory and given to the on-duty Pathologist at 0800 hours the next morning.

2.2

2.3

3. CORONERS CASES
3.1 3.2 3.2.1 3.2.2 3.2.3 3.2.4 3.2.5 3.2.6 3.2.7 3.2.8 3.2.9 3.2.10 Certain cases of death are under jurisdiction of the Coroner and do not require an Autopsy Permit. These autopsy classes of reportable deaths are listed below.

Non-fetal death No physician in attendance. Medical attendance less than 24 hours. The deceased has not been attended by a physician in the 20 days prior to death. The Physician is unable to state the cause of death. (Unwillingness does not apply.) Known or suspected homicide. Known or suspected suicide. Involving any criminal action or suspicion of a criminal act. Related to or following a known or suspected self-induced or criminal abortion. Associated with a known or alleged rape or a crime against nature. Following an accident or injury (primary or contributory, occurring immediately or at some remote time). 3.2.11 Drowning, fire, hanging, gunshot, stabbing, cutting, starvation, exposure, alcoholism, drug addiction, strangulation, or aspiration. 3.2.12 Accidental poisoning (food, chemical, drug, therapeutic drugs). 3.2.13 Occupational diseases or occupational hazards. 2

3.2.14 3.2.15 3.2.16 3.2.17

Known or suspected contagious disease which constitutes a public hazard. All deaths in an operating room. All deaths where a patient has not fully recovered from an anesthetic. All deaths in which the patient was comatose throughout the period of the Physicians attendance, whether at home or in the hospital. 3.2.18 All deaths in prison or while under sentence. 3.2.19 All solitary deaths. (Unattended by a physician or other person in the period preceding death.) 3.2.20 All deaths of an unidentified person. 3.3 3.3.1 Fetal death If the Physician attending during delivery has not seen the mother prior to birth and has no knowledge of her prior medical history or prenatal condition. 3.3.2 Any stillbirth as a result of an accident. 3.3.3 Any stillbirth in which an accident is in any way contributory to the intrauterine fetal death. 3.3.4. An autopsy permit is not required and the fetus is treated as a surgical specimen, if the a. Fetus weight is less than 500 grams and; b. Fetus gestation is less than 20 weeks. 3.3.5 Fetal remains sent to the laboratory under the provisions of 3.3.4 above will be retained for 3 weeks after examination. Occasionally, the parents will request that the remains be forwarded to a funeral home for disposition.

4. AUTOPSY PERFORMANCE
4.1 4.1.1 4.1.2 4.2 4.2.1 4.2.2 4.3 4.3.1 Morgue There is no morgue at St. Elizabeth Community Hospital. All hospital autopsies are performed in the preparation room of a local mortuary. Remains Upon releasing the body to the mortuary, the mortuary personnel should be advised by nursing personnel that arterial embalming should not be performed prior to the autopsy. Alternatively, the autopsy pathologist may notify the mortuary directly. Clinical history Physician consultation a. The pathologist responsible for coordinating the autopsy, the autopsy pathologist will be designated by Shasta Pathology Associates using a rotational schedule. b. The autopsy pathologist will contact the attending physician to determine the reasons for performing the autopsy and to obtain pertinent clinical history. Medical record review a. A review is performed by the autopsy pathologist. Autopsy Logistics a. The autopsy pathologist will fax (1-877-782-9766) or email (info@regional-pathology.com) the pertinent clinical history and the location of the mortuary where the autopsy will be performed to the contracted forensic pathology group; currently Regional Pathology and Autopsy services. b. The 24 hour page service is 1-877-330-7727. Performance of autopsies The autopsy is performed by a Pathologist board certified in Anatomic Pathology by a contracted 3

4.3.2 4.4

4.5 4.5.1

4.5.2 4.5.3 4.5.4 4.5.5

forensic pathology group; currently Regional Pathology and Autopsy Services, 1-877-330-7727. The autopsy pathologist will notify the contract autopsy service noting the reason for the autopsy and the clinical history. The autopsy pathologist will arrange for the relevant portions of the patients chart to be faxed to the contract autopsy service ((877) 782-9766). Alternatively, the information may be scanned, password protected and e-mailed to info@regional-pathology.com. The autopsy is performed in the preparation room of one of the local mortuaries. The cutting of autopsy tissue blocks, preparation of autopsy slides, examination of autopsy slides, and dictation, typing, and signing of autopsy reports are performed at the contracted autopsy service. Autopsy reports A written preliminary report of the gross pathologic diagnoses is signed and submitted to the St. Elizabeth Community Hospital Health Information Department and to all attending physicians within two working days of the performance of the autopsy. The final written autopsy report is submitted to the St. Elizabeth Community Hospital Health Information Department and to all attending physicians within 60 working days of the performance of the autopsy. The preliminary and final autopsy reports are issued to Shasta Pathology Associates by the contracted forensic pathology group and then forwarded to St. Elizabeth Community Hospital. The autopsy pathologist will review the preliminary and final autopsy reports and report findings to attending physician.

4.6 4.6.1 4.6.2 4.6.3 4.6.4

5. AUTOPSY RECORDS
5.1 5.2 5.3 5.4 The final report is retained in the St. Elizabeth Community Hospital Health Information Department. The slides, blocks and wet tissue are stored at Regional Pathology and Autopsy Services. Autopsy records are retained as per the St. Elizabeth Community Hospital Laboratory Record Retention Policy. Copies of autopsy reports are available by fax from Shasta Pathology Associates. hey can be sent to St. Elizabeth Community Hospital Clinical Laboratory within fifteen minutes of being requested.

6. AUTOPSY FORM
6.1 AUTHORIZATION FOR AUTOPSY.DOC

Physician Champion: Tikoes A. Blankenberg, MD 9.27.10 S. Guiney ORIGINAL 07/09/12 S. Guiney; 9/16/13 T.A. Blankenberg, MD REVISED

AUTHORIZATION FOR AUTOPSY


Patient Name: Date: Time: 1. I am one of the following persons authorized by law to direct disposition o the remains of the above-named person. Patient Spouse Registered domestic partner Child (over the age of 18) Other: 2. I hereby authorize the performance of a post-mortem examination upon the above-named patient. 3. In the hope that the above-authorized examination may benefit others by protecting or preserving their lives and well-being, the undersigned also authorizes the examining physician and surgeon to remove such specimens, tissue, and/or organs, and to retain, preserve, and/or contribute the same for such diagnostic, therapeutic, or other scientific purposes as he/she shall deem proper. 4. This authorization shall be subject to the following restrictions: Parent Brother/Sister Agent appointed in patients power of attorney for health care

5. I understand that the examining physician and other physicians are not employees or agents of the hospital. They are independent medical practitioners. Signature:
(patient/legal representative)

Print name:
(patient/legal representative)

Signature:
(witness #1)

Print name:
(witness #1)

Signature:
(witness #2)

Print name:
(witness #2)

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