by Gina Comparini

In the inconspicuous autopsy area of a Los Angeles hospital, Autopsy Technician Vidal Herrera, pulls open a walk-in refrigerator door and wheels out a stainless steel table with a white body bag heaped onto it. 

As Herrera unzips the bag, Juan Doe's bloated body flops out; an arm falls over the side of the gurney and dangles almost to the floor. The body is covered with sagging, elephant-like skin, but Herrera is more interested in a small portion of the cadaver's vertebrae, near the neck. He cuts the strings that sew the body closed, removes the organs that have been weighed and stored in baggies, and sets them aside so he can get a better grip of the buried spinal column. This procedure requires strength, a noisy, hand-held saw and the precision only experience can bring.

Juan Doe was an obese paraplegic with kidney and liver problems. Found on the floor of a Los Angeles hospital room, his swollen corpse was noted and a death certificate written up kidney failure is the reported cause of death.

Once notified, his family questions the hospital, asking how a paralyzed man can be found on the floor if he can't move. Even if he could move, wouldn't the metal side on the bed keep him from the floor below?

The hospital should perform an autopsy, but the family prefers to seek a neutral party's judgment instead. The body is passed from one doctor to another before it ends up on top of Herrera's autopsy table. Herrera, founder of Autopsy/Post Services, Inc. runs an autonomous, confidential business that - among other services - offers careful examination to find a cause of death. The business was born from desperation after Herrera injured himself in 1988 and was forced to retire his position with the Los Angeles Coroner's Office. Capitalizing on dismal hospital autopsy rates that are down from 41 percent in 1960 to 5 percent in 1997, Herrera and his staff assist over 900 families and lawyers a year with cases of malpractice, misdiagnosis, and wrongful death.

With the manner and cadence of a friend who knows where to find a good time, Herrera removes the chunks of Juan Doe's vertebrae - c-1 through c-7 and thoroughly studies them for imperfections. The smaller section is marred by hemorrhages, caused by a bone that penetrated a membrane covering the skull, called the dura. Hemorrhages, and not temperamental organs. are the reason Juan Doe died. Now his family could have a case to be settled in, but most likely out, of court.

Autopsies are performed to teach medical doctors, track elusive diseases and causes of death, and check-and-balance hospitals for quality care. They are messy and painstaking, taking about 2-10 hours and costing hospitals an average of $5,000 to perform, depending on the difficulty of the case.

Most of the medical community agrees that autopsies are essential when a cause of death isn't known or is suspicious - an autopsy will unequivocally establish a cause of death. However, some doctors feel autopsies don't always expose much that a physician doesn't already know about their terminally ill patients.

"Patients are being treated to closely, and equipment is more sophisticated now." says Brago Schmidt, a pathologist at St. Luke's Hospital in San Francisco. "Of course, if there's the suspicion of foul play, a doctor will request an autopsy be done."

The value and necessity of this ancient profession is well-known, but interpreted differently depending on who is asked. In an editorial for the Archives of the College of American Pathologists, Seth L. Heber, M.D. wrote that a doctor should request a pathologist to examine the tissue and fluids of a corpse after every death, even if the request is denied. That way, the doctor's hands are clean, so to speak.

With this current hospital autopsy rate holding at five percent, this idea lacks support, both in the public and private sector. Sue Turner, an executive assistant at the San Mateo County Coroner's office says her office would like to offer more outreach services to the public, but with a yearly budget under three million dollars, it's a little tough. Meager budgets cause county offices to fall short of their goal for public education, which would include higher autopsy rates. According to Turner, of the 2,500 yearly deaths occurring in San Mateo County, about 800 unnatural deaths are autopsied.

Silvia Olivares, a forensic pathologist who has worked for the coroner in counties across the United States since 1960, says the public is largely in denial about death until it falls in their laps.

"When it happens to their family, suddenly it is expected that the county have a first rate toxicologist, state-of-the-art technology and competent pathologists. But when the budgets are established, it is very hard to obtain revenues for a decent medical examiner and coroner support-which are all things the public needs. Death is inevitable," she says.
 

"Here it says we spend one billion dollars on microwave popcorn a year!" Olivares exclaims, reading over literature from Robert Wood Johnson Medical School, Olivares says the public clamors for coroners services, but not when it counts the most. Considering how much is spent on cigarettes and alcohol, which all contributes to the health care burden, better equipped county medical examiner and coroner's offices is a small price to pay.

In hospitals, a doctor will perform an autopsy if the family requests it, but they aren't encouraged. "Insurance companies, focus more on the living and don't cover the procedure, and autopsies are problematic for hospitals," says Herrera. Fear of malpractice and perceived fear of public hunger for lawsuits are other reasons doctors shy away, since an autopsy can reveal mistakes in their diagnosis and treatment. Literature released in 1994 by the Harvard Medical Review states that of the 2.4 million deaths in the United States, 10.5 percent are malpractice cases and 22 percent are the result of misdiagnosis.

"These are just a few reasons why I'm in business," says Herrera, who has his phone number, 1-800-AUTOPSY, tattooed on his biceps. Part of Autopsy/Post Services, Inc.'s mission is to educate the public about the positive side of death, namely organ, tissue and body donations.

Religious and cultural differences may explain the disproportionate number of donors from different races. According to Salvador Guerrero of the California Transplant Donor Network, 15,859 Caucasians, 3,290 African Americans and 374 Asians donated organs in Northern California during 1995.

"Science and medicine have progressed because of the dead. Spinal and neck injuries, brain surgeries, hearing disorders, prostate operations - all these are very detailed an difficult surgeries that require cadavers for practice," says Herrera.

The sections of Juan Does vertebrae are stored in stock containers with formaldehyde and Herrera's work is done for the day. He has made the body talk. The containers, slides and report will be archived for two years in the event that researchers, family or lawyers want to seek a second opinion.

Herrera zips the bag over the cadavers shocked face and returns it to the refrigerator. From his plastic enclosure, Juan Doe can offer solutions, but more people must look in to his twisted corpse to hear the buzz.