He and Other Free-Lancers Now Carve Up Business Hospitals Have Abandoned 

By Greg Jaffe

Ten minutes after her mother’s death in April, Melody Pulley says, a nurse handed her a white plastic bag filled with her mother’s belongings and whisked her from the room. The doctor said Ms. Pulley’s 65-year-old mother had died of pneumonia. But Ms. Pulley, a portrait photographer, still had questions she wanted to ask. When she requested an autopsy, she says, the physician at Antelope Valley Hospital in Lancaster, Calif., told her it wasn’t’ necessary. So Ms. Pulley dialed 1-800-AUTOPSY and bought one.

Personal Service

For $2,500, a private pathologist not only performed the autopsy, which entails cutting open the corpse to examine vital organs and fluids, but spent an hour answering Ms. Pulley’s questions. When he was finished, the physician gave her his beeper number.

"I really felt like the doctor was listening to me and my concerns" Ms. Pulley says today. "Every time I paged him, he returned my call. My doctor doesn’t do that. Not even my pool man does that." For decades, autopsies have been a staple of detective stories and a grim rite of passage for young doctors in training. But these days, the post-mortem providers are becoming yet another casualty of cost cutting in the health-care industry. Today, only about 5% of all hospital deaths are autopsied, down from a peak of 42% in 1965, according to the Archives of Pathology and Laboratory Medicine.

With hospitals increasingly refusing to perform the procedure, which traditionally has been done at no charge to the patient’s estate, an odd new market niche has opened up: the free-lance autopsy. Vidal Herrera, who is in this business, tools around Los Angeles in a white van emblazoned with the easy-to-remember 800 number Ms. Pulley called. His company slogan: "We give the dead a voice." He says Autopsy/Post Services, Inc., which he founded in 1989, expects to do 1,000 autopsies this year. In Fort Lauderdale, Fla, Abdullah Fatteh, who was a deputy Broward County medical examiner from 1974 to 1980, distributes fliers to funeral homes and hospitals with the message, "Need an autopsy? (I have) personally performed over 6,000." And in Sacramento, Calif. Pathology Support Services Inc. began advertising autopsies on the radio this year.

At least half a dozen such health-care entrepreneurs in the U.S. performed more than 3,000 free-lance autopsies last year, usually in mortuaries and usually in the $2,000 to $3,000 price range. The numbers are tiny compared with the tens of thousands of autopsies done by county coroners in cases where foul play is suspected or by hospitals, which still do autopsies to determine cause of death in unusual or complicated cases. But there is plenty of business to go around. Dr. Fatteh says demand for his services is so strong that it is cutting into his free time, which he spends working on diet candy bars that he claims may prevent cancer and heart disease. Still, he like his work, "I enjoy the challenge and the mystery of the autopsy," he says. "Only we can determine the ultimate truth."

Mr. Herrera, whose California license plate is AUTOPSY spelled backward, says he is considering a national radio and television ad campaign. He also would like to start a school for autopsy technicians, who assist doctors and typically learn their trade on the job. "I want my name to be synonymous with death." he says. So just what is it that impels people in a time of need to think of Mr. Herrera? The usual answer: They suspect something. One family suspected poisoning. Mr. Herrera’s pathologist found that the deceased, a Los Angeles man who had AIDS, died of a morphine overdose. He turned the case over to the authorities; a spokeswoman for the district attorney’s office says that the Los Angeles County coroner is reviewing the autopsy results.

Some suspect that a death was caused by negligence. When Corona, Calif., resident Ofelia Corral’s husband died of an apparent heart attack last summer, she was critical of the treatment she received in an emergency room. She called a lawyer-and arranged for an autopsy from Mr. Herrera, who confirmed that the cause of death was a massive coronary. She has filed a suit in San Bernardino County Court against the hospital and her husband’s doctor. But quite often what families really want from an autopsy is some attention. "If doctors sat down with us and said this is what we tried and this is what happened, it would be a huge help,’ says David Kessler, the author of "The Rights of Dying." "But the medical establishment doesn’t like talking about dead people." In Ms. Pulley’s case, an autopsy found that her mother did die of pneumonia, just as her doctor had said. "I wanted someone to take the time to explain to me in terms I could understand." she says. 

Calls for Help

Most of the for-profit autopsy firms realized only by chance that there were people out there willing to pay for whatever peace of mind an autopsy brings. Pathology Support Services, the Sacramento outfit, manages morgues and autopsy facilities for coroners and teaching hospitals. About eight years ago, its owner, Robert Wood, began getting calls from individuals seeking his help. Soon, Mr. Wood’s company was doing as many as four free-lance autopsies a week and today runs radio ads asking, "Do you have questions about a loved one’s death?" Others had the same idea, Dr. Fatteh, of Fort Lauderdale, says he made the transition into free-lancing autopsies when the Food and Drug Administration told him to top selling the smoking-cessation tablets he had invented unless he could prove that they worked.

Fortunate Discovery

In Los Angeles, Mr. Herrera discovered the role that might be played by free-lance autopsies while chatting with pathologists at the Veteran Administration Hospital where he had apart-time job as an autopsy technician. When he took that job, he was an unemployed Acura salesman. "No one else wanted to give me a job." says Mr. Herrera.

Today, he employs three full-time assistants and has an agreement with 14 pathologists to perform autopsies for him. (States regulate who can perform autopsies, which in most cases are left to doctors.) The perpetually upbeat 45-year-old has gone from taking the bus to his job in the basement of the VA Hospitals to pulling in an annual income "in the six figures," he says. But while satisfied customers say the free-lancers help them deal with death, some doctors and pathologist question whether customers are getting good work. "The quality of autopsies done by hospitals is very high," says Henry Schneiderman, chief of physicians for Hebrew Home & Hospital in Hartford, Conn. and a frequent contributor to pathology journals. "There is no indication that these for-profit autopsy firms are anywhere close to that." Such criticism, however, doesn’t seem to bother Mr. Herrera and his fellows, who are uniformly exuberant about the future in a country where more than two million people die each year. "We’re in a recession-proof business," Mr. Herrera says.