Travelling Autopsies Find Growth Market 

By John Marx Smock
Special to Health Care Weekly Review

AS HOSPITALS AND municipalities around the country cut back on the costly service of providing autopsies, family members of the deceased who feel there are unanswered questions that could be resolved by a post-mortem investigation are not without recourse. They need only to pick up the telephone and dial 1-800-AUTOPSY. For about $2,500, a private pathologist will perform an autopsy on demand, complete with an examination of the vital organs, fluids, tissue sample and a signed affidavit of the findings. Companies such as Los Angeles-based Autopsy/Post Services, Inc. also provides "Post-AIDS" testing, exhumations, organ procurement, crime-scene analysis and photography.

"With the climate now and HMO’s, hardest hit are pathologists," said Vidal Herrera, founder and president of Autopsy/Post Services. "We have bodies flown in from across the country and around the world." Increasingly, hospitals do not offer routine autopsies, which traditionally were offered with no charge to the patient’s estate. Today, only about 5 percent of all hospital deaths are autopsied, down from 42 percent in 1965, according to Archives of Pathology and Laboratory Medicine. With approximately 2.6 million deaths each year throughout the country, post-mortem services have become a booming niche business. Herrera, a one-time autopsy technician at a Veterans Administration hospital, now has three full-time assistants, contractual agreements with about 14 pathologists and a salary "in the six-figure range." Autopsy/Post Services performed more than 900 autopsies last year and this year should top 1,000, he said. His only advertising is the name of the company and easy-to-remember telephone number emblazoned on the side of his white van.

Like Herrera, at least a half-dozen entrepreneurs from Fort Lauderdale, Fla. to Sacramento, Calif. are now in for-profit autopsy business, collectively performing more than 3,000 autopsies each year. Still, this is only a fraction of the total number performed by county coroners throughout the country in cases of unusual deaths or deaths where foul play is suspected. Most for-profit autopsies have one thing in common. The family suspects something. Herrera cannot discuss specific clients; however, in one case a family suspected poisoning, he said. Herrera’s pathologist found that the deceased, a Los Angeles man with AIDS, died from a morphine overdose. The case was given to the authorities and a Los Angeles County Coroner is now reviewing the results. Herrera plans to begin advertising and to expand his business into other states, including Michigan. The nationwide College of American Pathologists has no official position on the for-profit autopsy business and the Michigan State Medical Society (MSMS) seems to be taking a wait-and-see position. "I’m not sure there’s a need," said Cathy O. Blight, MD, pathologist and incoming president of MSMS. "I get calls from the attorney general and lawyers to review cases, but I haven’t seen (for-profit medical examiners) yet in Michigan."

As in most other states around the country, Michigan hospitals have cut back dramatically on the number of autopsies performed each year. The time-consuming and costly process is "problematic for hospitals" said Blight. Counties have also cut back on the service for the same reasons. Michigan is slowly moving toward a regional system of medical examiners intended to be more efficient and provide less variation in quality from county to county, she said. Regulation of the for-profit business concerns Blight. "If these doctors are working outside organized systems, who’s looking at quality issues?" she said. "Where do the records of the examination - slides, samples, documentation-reside? And for how long will they be maintained?"

Because the service is so new, Autopsy/Post Services is subject to almost no state regulation in California. The company voluntarily has one our of every ten cases reviewed by a state pathology organization to ensure quality standards are maintained, said Herrera. His company has received no complaints from customers or the state. Herrera said he is in favor of regulation. He would also like to see more research done based on the funding of for-profit medical examinations. Valuable information is being lost as a result of the scaled-back hospital pathology programs, he said. "It’s sad. They’re missing research opportunities about why people die," he said "The deceased must be protected and given a voice."