Autopsy Service

Frequently Asked Questions

A. Referrals to the Office of the Chief Medical Examiner

The Office of the Chief Medical Examiner has jurisdiction over all deaths occurring under the following circumstances:

1. All forms of criminal violence or from an unlawful act or criminal neglect.
2. All accidents (motor vehicle, industrial, home, public place, etc.)
3. All suicides
4. All deaths which are caused or contributed to by drug and/or chemical overdose or poisoning.
5. Sudden death of a person in apparent good health
6. Deaths which occur unattended by a physician and where no physician can be found to certify the cause of death. In this context, “unattended by a physician” means not treated by a physician within thirty-one days immediately before death.
7. Deaths of all persons in legal detention, jails or police custody, including any prisoner who is a patient in a hospital, regardless of the length of hospital stay.
8. Deaths which occur during diagnostic or therapeutic procedures or from complications of such procedures.
9. When a fetus is born dead in the absence of a physician or midwife. Stillbirths in the hospital need not be reported to OCME unless there is a history of maternal trauma or drug abuse or the case has some other unusual or suspicious circumstance. Neonatal deaths from prematurity and its complications must be reported if the premature delivery was caused by maternal trauma or drug abuse.

Hospital deaths from natural causes, in which a diagnosis has been made with reasonable medical probability, despite the fact that the patient survived less than 24 hours in the hospital, need not be reported to OCME.

The physician who pronounces the patient’s death in cases fitting any of the categories listed above in A1 should not ask the family for permission to conduct an autopsy. Instead, the physician should call the Office of the Chief Medical Examiner at (212) 447-2030 and speak to the Medical Examiner on Duty, who has the authority to decide whether or not the Office of the Chief Medical Examiner will accept the case.

Whether or not the Medical Examiner accepts the case, the physician obtains the ME’s case number and the medicolegal investigator’s name and records it in the patient’s medical record.

If the ME accepts the case, the physician fills out UHB Form 2005, “Medical Examiner’s Hospital Report,” which is available in the Admitting Office.

If the ME refuses a case, the physician records that fact in the patient’s medical record, along with the medicolegal investigator’s name and, if provided, the ME case number, and should seek permission from the patient’s next-of-kin to perform an autopsy, according to the procedures in Sections C. and D. below

B. Criteria for Downstate Medical Center, University Hospital of Brooklyn Autopsies

New York State law requires that the medical staff attempt to get permission for autopsy in all cases of unusual deaths and deaths of medical-legal and educational value.

To satisfy this requirement, it is recommended that autopsy be requested in the following types of cases:

1. Deaths in which the cause of death or a major diagnosis is not known with reasonable medical certainty on clinical grounds.
2. Deaths in which an autopsy may help to allay concerns of the family and/or the public about the death to provide reassurance to them regarding the same.
3. Deaths which are unexplained or unexpected, following dental, medical or surgical diagnostic procedures or therapies, and which are not accepted for autopsy by the Medical Examiner.
4. Deaths of patients who participated in clinical trials approved by an institutional review board.
5. Deaths in which the Medical Examiner is called but declines the case.
6. Deaths in pregnant females.
7. All neonatal and pediatric deaths.
8. Known or suspected deaths arising from environmental or occupational hazards.
9. Deaths which may have genetic implications for the surviving family members.

C.Guidelines for Obtaining and Documenting Autopsy Consent or Refusal

When a patient dies, the pronouncing physician is responsible for seeking consent to autopsy, which must be in writing [fax is acceptable] and on the UHB form “Consent to Autopsy” in the manner described in Section D below, “Documentation of Consent to Autopsy.”

In seeking the next-of-kin’s consent to autopsy, the physician may use all or part of the following language, which has been recommended by the American College of Pathologists, if the physician finds it useful:

“The patient’s other doctors and I think that the cause of death was _____________. It is your privilege to have an autopsy performed, if you choose. This is a service that the hospital provides, free of charge, to help us answer any questions that you or the doctors might have about his/her disease or the care he/she received. It is important to help us learn more about [this disease] for the sake of patients in the future. The autopsy need not delay your funeral preparations, and even a complete autopsy will not disfigure the body, should you want a viewing. Would you like us to perform an autopsy?.”

When seeking consent for autopsy, the physician should refer to the following list in order of priority to determine the family members who are authorized to consent. Authorization from persons lower on the list may not be obtained if those who are higher on the list are available at the time of death. For family members who have the same relationship to the deceased patient, it is preferable for both or all to sign the consent to autopsy, unless they are estranged or unavailable to sign. Telephone consent for autopsy is not permissible. However, a next-of-kin who expresses his/her telephone consent to autopsy but is unavailable to sign a consent form, may give telephone approval to allow another relative to sign the consent form in his/her place.

1. The spouse or domestic partner who has registered a domestic partnership;
2. The children (18 years of age or older);
3. The grandchildren (18 years of age or older);
4. The parents;
5. The brothers and sisters (18 years of age or older);
6. The grandparents;*

*Great grandparents, uncles, and aunts who are 18 years of age or older; and

Other persons, 18 years of age or older, who would be entitled to share in the estate of the decedent

If there is doubt as to who constitutes next of kin, or if there appears to be none, call or page the Hospital Director of Admissions or the Risk Manager or the Administrator on Duty.

If there is disagreement among next of kin who bear the same family relationship the Ethics consultation service may be consulted to attempt to mediate the dispute.

D. Documentation of Consent to Autopsy

The form, “Consent to Autopsy,” must contain the name of the deceased patient, restrictions to autopsy, if any, special examination, if any, the signature of the authorized next-of-kin (see B.) and his/her relationship to the deceased. The signature of a witness who is employed by SUNY Downstate Medical Center is also required.

• This signed consent must then be brought to the Admitting Department for approval by the Director of Admissions to ensure that the consent is proper. During off hours, the AOD will approve all requests for autopsy.

The physician who pronounces the patient as having expired is also responsible for writing a brief note in the patient’s medical record. This note should include the date and time of death, family member who was notified of the patient’s death (or efforts made to notify a family member) and status of a request for autopsy. The physician’s pager number should be included to allow the autopsy pathologist to communicate with the physician before and after the autopsy.