A hard look at death

Autopsies are in the headlines these days, with Michael Jackson's family getting a second autopsy and results of the Billy Mays examination being released Monday.

But thousands more autopsies are conducted across the country each day out of the spotlight. Many involve grieving family members trying to figure out the process where laws and emotions meet.

Jackson's family immediately ordered a second autopsy after the coroner's office deferred its findings until further lab tests could be conducted.

In Farrah Fawcett's death, her lengthy and public battle with cancer removes nearly all doubt as to her cause of death.

Meanwhile, infomercial phenom Billy Mays died at age 50 on Sunday, shocking many because of his younger age. The preliminary cause of his death was heart disease. The younger the person, the more people question the cause of death — "Tonight Show" sidekick Ed McMahon was 86 and in ill health when he died last week, and there has been much less public speculation about his unreleased cause of death.

But those are just celebrities. Every average Joe's death raises questions. How does the autopsy process work? What if the family doesn't want an autopsy? Who pays for it?

Most deaths don't bring an autopsy

San Joaquin County's deaths in 2008

Of the 4,635 deaths recorded, 2,554 were reported to the Coroner's Office for further review. Of those:

558 full autopsies were conducted.

128 inspections were performed. Medical information about the person's condition, along with a physical inspection of the body, was deemed sufficient.

34 were investigated without the body present. Medical records were reviewed.

1,834 were referred to the person's attending doctor after investigation, and the doctor then signed off on the death certificate.

Source: San Joaquin County Coroner's Office

Deaths in California in 2007

233,467 people died. Of these, 118,406 were male and 115,061 were female.

62,220 people died of heart disease, the most common cause of death. The second leading cause of death was malignant neoplasms, or tumors, with 54,918 deaths.

35,016 people in the 85-89 age range died, the most common. The next most common was the 80-84 age range, with 34,960, followed by 34,754 people age 90 or older.

1,154 children between the ages of 1 and 14 died, the lowest rate. The next lowest rate was those under a year old.

Source: California Department of Public Health (2008 statistics were not yet available)

Like many counties in the state, the San Joaquin County Sheriff is also the coroner. Deputies respond to every unattended death in the county, said Deputy Dave Konecny, who previously worked as a coroner's investigator.

Last year, 4,635 deaths were recorded in the county. Of those, 2,554 were reported to the Coroner's Office, under a law that requires such notification if the death occurred without a doctor on hand, the attending physician wasn't sure of the cause of death, it's a possible suicide, an injury or accident was involved or the death was possibly caused by a criminal act.

Of those, 720 deaths became actual coroner's cases, with 558 of them requiring autopsies to determine cause of death. So only about one death in eight in San Joaquin County legally requires an autopsy.

Some only required visual inspections rather than full autopsies. For instance, Konecny said, if someone has liver problems and dies at home at 2 a.m. with no doctor available, deputies will start the investigation. Once they get medical records, the person's doctor is contacted and jaundice (yellowing skin, a common symptom of liver troubles) is noted, then no full autopsy is needed, other than lab testing.

Many cases require toxicology testing, which means that blood, fluid and tissue samples are sent to a laboratory for extensive testing. That can take several weeks on its own, and then the investigator still has to finish writing a lengthy report.

When families have doubts

Sometimes family members want a second opinion about the cause of death, or want an autopsy even when the coroner has determined one isn't necessary. Or sometimes they want to be more involved so they can get a faster answer, rather than waiting weeks for the coroner's report to be complete.

That's when they contact a private pathologist, such as Dr. Robert Lawrence, who runs Stockton-based Delta Pathology.

"Sometimes they don't trust the authorities. Other times they're just anxious to find something so they don't want to wait six weeks for the report," he said.

Until San Joaquin County hired a full-time medical examiner to save money in August 2007, Lawrence conducted most of the county's autopsies for three decades. Over the past 36 years, he has performed more than 8,000 autopsies.

His business has dwindled drastically with the county's change; now Lawrence is usually called by family members. Once the coroner releases a body to a funeral home, the family is free to hire its own pathologist.

Only the legal next of kin may request such an autopsy. In coroner's autopsies, though, family members can't refuse an autopsy because it is the coroner's legal duty to determine cause of death.

Family-paid autopsies are almost always conducted at funeral homes, Lawrence said, because few pathologists have full medical offices where bodies may be stored. Sometimes coroner's offices will allow pathologists to conduct autopsies in the morgue before the body is moved, he said.

The timing: Sooner the better

Most San Joaquin County autopsies are conducted within 48 hours. Some religions dictate that someone be buried within 24 hours, and coroner's officials try to accommodate such situations.

In general, the physical dissection and examination take two to three hours, Lawrence said.

Autopsies vary, depending on the condition of the body, but generally involve opening the torso to inspect and weigh the organs, as well as examining and weighing the brain. Other physical features are noted, including any bruises or cuts, other signs of trauma, and condition of fingernails and body hair.

It can then take another two to three hours for microscopic work, such as gathering samples for lab work. Toxicology test results generally take three to six weeks.

As for timing after death, the sooner the better, Lawrence said. However, morgues are refrigerated, and bodies can be kept for at least several days.

Even if a body has been buried, the rare exhumation can reveal something — though it happens far less often than on fictional television crime shows. In the case of skeletal remains, forensic anthropologists can sometimes look for bullet fragments or holes, Lawrence said.

Private procedures costly

All autopsies conducted at the request of the coroner are paid for by the county (the taxpayers).

As for private autopsies, that cost is borne by the family. It starts at $5,000, plus travel expenses to the funeral home, Lawrence said. That doesn't include lab testing.

He knows of no fund that helps poor families pay such fees, and said that if the family suspects foul play, they should go to police. Insurance companies don't cover autopsies, unless they actually want the autopsy in an attempt to avoid paying out on a policy — and then the next of kin must agree to it.

Autopsies are conducted by a pathologist, who is a medical doctor. Most are certified by the American Board of Pathologists; it's not required, but most cities want such certification so it doesn't become a legal issue in court.

Becoming a pathologist requires four years of school after medical school, Lawrence said. That includes anatomic (physical dissection) and clinical (laboratory testing) pathology, and then the doctor may conduct autopsies in hospitals.

To work with a coroner, it takes another year of schooling in forensic pathology, which involves autopsies that deal with the legal system.

And there's one final requirement, Lawrence added — a rigorous three-day exam.

Contact reporter Layla Bohm at layla@lodinews.com.

Reader Feedback

jramagic wrote on Jul 4, 2009 8:04 AM:

" One thing for sure- When my time comes to croak, I hope I go out like Malden, Jackson or Mays...just fade out peacefully in my slee...and hopefully at a ripe old age. Not like Fawcett- or worse. "

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