Public Health Law Map - Beta 5 - Medical and Public Health Law Site

5. Coroner Cases and Autopsies
A death is a coroner’s case if it is unexpected or if there is any possibility that a law
has been broken. Not every death that occurs outside a hospital is a coroner’s case. If
the deceased had a physician who is reasonably certain of the cause of death and is
willing to sign a death certificate, further medical examination may not be required.
The coroner system in the United States is in difficulty. Only the largest cities have
forensic pathologists to act as coroner and do the medical examinations. In small,
rural counties, the coroner may be a physician who has no forensic training, or it may
be the sheriff or the mortician. A physician who is asked to act as county coroner
should try to learn something about forensic medicine and should be quick to ask for
assistance from experts when it is needed. The time of death or the angle of gunfire
may determine whether the person committed suicide or was murdered.
The percentage of deaths that are autopsied has been falling for many years.
Autopsies benefit society by providing information about hidden pathologies and
about the accuracy of medical diagnoses. But they do not benefit the patient, and
they are sometimes opposed by physicians who do not want the accuracy of their
diagnoses challenged. Because of these factors, there is little money available to pay
for autopsies. Even when it is feasible to do an autopsy, many physicians do not
know how to obtain consent. Physicians should be familiar with the state law in their
jurisdictions governing the persons who may consent to an autopsy. If there is any
question of criminal activity, the autopsy may be ordered by a court or the coroner.
6. Disease Registries
Disease registries are a special class of reporting laws. Since the objective is not to
control a communicable disease, there is often no penalty for failing to report to a
disease registry. Most disease registries are statewide and involve either cancer or
occupational illness; some, such as the CDC registry of cases of toxic shock
syndrome, are national. Reporting cases to the registry may be mandatory or
voluntary, but it is always desirable to have a complete registry. These registries are
used to determine the extent of certain problems in the community and to try to
determine causes. If they are inaccurate, they may give false correlations and become
useless for research and prevention.
Consider a cancer registry that contains only half the cases of a particular kind of
cancer. If a local industry tries to determine whether its workers are exposed to
something that causes the cancer, it will look at the rate among its exposed workers
and the rate in the general population. If the company finds all the cases among its
workers but the cancer registry has only half the cases in the general population, then
an exposure that does not cause the cancer will look like it does by a factor of two.
An epidemiologist may know that this is wrong, but the reporter from the local paper
will not.
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