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Manager: Mike Davis, HT (ASCP) (ext. 501-686-5697)
STANDARD OPERATING PROCEDURES
GENERAL INFORMATION
The Autopsy Service is located in the hospital building, Room MG-660. The telephone
extension for the Autopsy Service is 501-686-6414. The Autopsy Service is staffed
by full-time Pathology personnel on weekdays from 8:00 a.m. to 4:30 p.m. On
Saturdays, Sundays, and holidays, the Autopsy Service is staffed by on call
Department of Pathology personnel. In addition, there is always a staff Pathologist
and Pathology resident on duty 24-hours a day, seven days a week, including
holidays. On weekends and holidays, if there is no answer at extension 501-686-6414,
the Morgue Attendant on call may be reached through the Medical Center operator.
Note: Autopsies will not be started after 3:00 p.m., unless unusual circumstances
exist.
AUTOPSY REPORTS
The family of the deceased should be advised that if an autopsy is performed,
any information concerning that autopsy must come from the primary care physician.
A preliminary anatomic diagnosis is available within 24 hours of the autopsy.
One copy of this PAD is sent to the Medical Records Department and one copy is
sent to the primary care physician (physician's name appearing on the autopsy
permit form) in care of the chairman of the department in which the primary care
physician is located. No information will be released by the Department of Pathology
directly to the family. The final autopsy report is not completed until approximately
three months after the autopsy and is distributed in the same manner as the PAD.
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AUTHORIZATION FOR AUTOPSY
In all cases except stillbirth deaths, one of the physicians (intern or resident)
attending the deceased patient will be responsible for securing proper autopsy
consent, after fully explaining the nature and scope of the autopsy to the members
of the family. In the case of stillborns, it shall be the task of the physician
attending the mother to assume the above duties.
Securing proper autopsy consent includes fulfilling the following three goals:
(1) obtaining authorization from the right person, (2) clarifying any restrictions
to the autopsy, and (3) accordingly conveying all information to the pathologist
by means of an Autopsy Status Form. These goals are more fully explained on the
following pages.
OBTAINING AUTHORIZATION FROM THE RIGHT PERSON
Requesting consent from the proper authority presents the most frequent encountered
problem for the attending physician. Generally, it is the closest next-of-kin
who must sign the permit. In particular, while the Arkansas statutory authority
does not provide for a priority oriented list of relatives for right of custody
of the deceased body and right to consent to autopsy, the Arkansas courts indicate
such an approach is required. With that in mind, the following list of relatives
should be referred to in order of priority stated for consent. This list presumes
mental competency and adulthood of each person. Legal age in the State of Arkansas
is 18 years. With the exception of categories (1) and (3) below, if all persons
in a priority category are minors, then proceed to the next category for authorization.
If the person sought for authorization is legally declared mentally incompetent
and there are no other adults in that category, then proceed to the next category
for authorization.
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R-1 Priority Category:
1. Spouse
2. Son or Daughter (preferably the one who assumes custody
of the body for burial).
3. Either parent or guardian (both parents or guardians
are desirable where possible).
4. A brother or sister (preferably the one who assumes
custody of the body for burial).
5. Grandparent, grandchildren, uncle or aunt, nieces
or nephews (preferably the one who assumes custody of the body for burial).
6. Great grandparent, great uncle or great aunt (preferably
the one who assumes custody of the body for burial).
7. Any other next-of-kin, i.e., cousins, etc. (preferably
the one that assumes custody of the body for burial).
8. A friend or person charged by law with the responsibility
for burial.
Complication may arise in any given instance that may require contacting the
resident or staff performing the autopsy. There are, however, some circumstances
which arise frequently enough the address. These circumstances are discussed
below:
Autopsy consent from a minor spouse will be accepted if he or she is capable
of understanding the nature of the autopsy.
Autopsy consent will be accepted from a minor married mother or father for his/her
child. (Both parents' consent is preferable.)
An unmarried minor mother may also authorize an autopsy for her child, but it
is necessary that the consent of the unmarried minor's parent's be secured in
addition to the mother's consent. Consent from one parent is acceptable but
consent of both parent's is preferable. If the surviving spouse is not living
with the deceased at the time of death in the normal relations of marriage,
he or she possesses the right of consent. Only if it can be documented that
the surviving spouse waives the right, should consent be obtained from the next
person on the priority list. (This person be whomever assumes custody of the
body for burial.) A couple who is legally divorced has relinquished all rights
of kinship to each other.
"Common Law" marriages are not recognized in the State of Arkansas.
If the parents of a child are divorced or separated, consent should be obtained
from the parent who has custody of the child.
If any member of a kinship class of persons, such as children of the deceased,
objects to an autopsy, the objection will invalidate the consent of another
member of the class. For example, if the daughter of the deceased consents to
an autopsy, but the son of the deceased objects, the autopsy must not be performed.
Clarifying Any Restrictions to the Autopsy:
The only restrictions acceptable are:
- LIMITED TO THE CENTRAL NERVOUS SYSTEM
- LIMITED TO THE THORAX
- LIMITED TO THE ABDOMEN
- LIMITED TO THE THORAX AND ABDOMEN
The only restrictions other than those listed above must be approved by the pathologist
or an autopsy will not be performed. Where there are no restrictions, write NONE
in the appropriate space.
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COMPLETING THE AUTOPSY STATUS FORM
The Autopsy Status Form consists of a front sheet which contains information
directed toward the attending physician obtaining consent and is to be removed
prior to obtaining the appropriate signatures. The next sheet (which will be
the front sheet on the form received with the body) has a Side "A"
and a Side "B". Side "A" will be completed if the autopsy
is refused; Side "B" will be completed if the autopsy is granted.
On the lower half of Side "A", there is a body receipt section to
be filled out by the funeral home at the time of the release of the body. On
Side "B", if any restrictions are listed other than the ones mentioned
in the section, "Clarifying any Restrictions to the Autopsy", the
autopsy will not be done. In most cases one authorized signature is sufficient.
Consult the "Legal Priorities of Next-of-Kin" if you have any questions
regarding the legality of the permit. In the section labeled, "To be answered
by the person obtaining the consent", if a "yes" is marked for
either question, the autopsy will not be performed. Under the Witness section,
one of the witnesses may be the same as the attending physician obtaining consent.
The last sheet of the Autopsy Status Form is the "Problem Oriented Autopsy"
request sheet. It will be removed from the consent sheet prior to obtaining
appropriate signatures, but will be submitted along with the signature page.
This page must be filled out by the attending physician.
The permit must by completely filled out with all necessary information and
witnessed personally by the attending physician and another person. When the
person authorizing the consent is present, his or her signature must be obtained.
When the authorization is obtained by telephone, the attending physician must
obtain the permission from the grantor and the witness must listen to the telephone
conversation and sign the permit.
MEDIOCOLEGAL AUTOPSIES
A MEDICOLEGAL case is defined by Arkansas Statute as:
As upon the death of any person from violence, whether apparently homicidal,
suicidal, accidental, or industrial, including but not limited to death due
to thermal, chemical, electrical, or radiation injury and death due to criminal
abortion, whether apparently self-induced or not, suddenly when in apparent
good health, or in a prison, jail or penal farm, or in any suspicious or unusual
or unnatural manner...."
Any death falling within these circumstances must be reported to the appropriate
County Coroner's Office (the county in which the death occurred) by the physician
in attendance. In addition, all D.O.A.'s and patients dying within 24 hours
of admission to the hospital must be reported to the Coroner. The pathology
resident should make certain that all such cases have been properly reported
prior to beginning an autopsy. In any such cases, an autopsy is only to be performed
at UAMS after release of the case by the Coroner. This may be accomplished by
telephone.
Should, during the process of any autopsy, the pathologist discover any information
that would bring the case within the ambit of the above MEDICOLEGAL jurisdiction,
the pathologist should notify the Coroner immediately. The Coroner will advise
as to whether or not he wishes to assume jurisdiction of the case.
Comment: The State Medical Examiner performs MEDICOLEGAL
autopsies on the request of a Coroner or law enforcement agency.
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AUTOPSY POLICY REGARDING DEAD-ON-ARRIVAL
AND EMERGENCY ROOM DEATHS
Policy:
Emergency Room deaths may be divided into three major categories:
Category 1: D.O.A.'s -
Coroner's cases. Coroner must be notified of death. If coroner releases the
body, case goes into Category 3.
Category 2: Dying in the
E.R. - Coroner's cases. Coroner must be notified of death. If the Coroner releases
the body, case goes into Category 3.
Category 3: D.O.A.'s or
patients dying in E.R. and released by the coroner. - These bodies are not automatically
eligible for autopsy.
Patients who die in the E.R. or are D.O.A. may be eligible for an autopsy. As
a guideline, patients who have been hospitalized at UAMS, or patients seen in
the past year for major illness as an outpatient are eligible for autopsy. Then,
and only then, should the autopsy be offered to the family. If the patient has
not been seen at UAMS in the past year, the individual case should be discussed
with the pathologist on Autopsy Service duty.
Comment 1: Any patient dying in the E.R. must be
considered a coroner's case and the coronernotified for jurisdiction. Even if
a patient dies within 24 hours after admission to the University Hospital, the
coroner must be notified.
Comment 2: The bodies of all patients dying in
the University Hospital or E.R., as well as all
D.O.A.'s must physically be taken to the Morgue, along with all personal effects,
and appropriate log entries must be made before release of the body to anyone,
including the Medical Examiner.
If a patient is not eligible for autopsy and the family desires a private autopsy
at the family's expense, they should be placed in contact with the Director
of the Autopsy Service or the Chairman of the Department of Pathology for approval
and for determination of cost.
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RESPONSIBILITY OF HOSPITAL PERSONNEL IN
TRANSFERRING A BODY TO THE MORGUE
2. A properly completed form, entitled "Autopsy Status",
must accompany the body to the Morgue. Side "A" of this form must
be completed if autopsy is refused. Side "B" must be completed if
permission for autopsy is granted. If the Autopsy Status Form cannot be completed
because a final decision has not been made by the family concerning an autopsy,
hold this form on the Ward until a decision is made and then take it to the
Morgue.
3. The patient's complete medical records must accompany
the body to the Morgue, if there is to be an autopsy.
4. The body, an Autopsy Status Form, all the medical records
(if there is to be an autopsy) are taken to the Morgue.
5. Complete Section "A" of the Morgue Log Sheet
located on the reception desk in the Morgue receiving area. If a patient,
who was on Blood and Body Fluid Isolation Precautions, expires and an autopsy
is not requested, the Department of Nursing is to notify the Morgue staff
of the diagnosis, stating only, that the deceased was under Blood and Body
Fluid Isolation Precautions.
The responsibilities in relation to the handling of bodies after hours
and on weekends and holidays are as follows:
6. Notify the morgue attendant on call of a death by calling 686-6414. This is the morgue’s main number and will roll over to the pager or cell phone of the morgue attendant on call. Should this not be effective, call the hospital operator. Arrangements with morgue attendant on call can then be made for placing the decedent in the morgue.
7. If an autopsy is requested on a weekend or holiday,
the Morgue attendant will notify the Resident.
PERSONAL EFFECTS
Please make every effort to give the patient's personal effects to a family
member. If this is not possible, send such effects to the Morgue with the body.
Any personal effect accompanying the body to the Morgue should be clearly labeled
with the patient's name and identification number.
VIEWING OF BODIES
We strongly advise against a family member viewing a body in the Morgue, due
to lack of appropriate facilities for such viewing. If viewing of the body in
the Morgue is absolutely necessary, special permission must be obtained from
the Director of the Autopsy Service. If permission is granted, the Department
of Pathology requires that a member of the primary patient care team accompany
the family member or members to the Morgue and remain with them during the viewing
of the body.
INFECTIOUS CASES
Infectious cases should be clearly identified by the Ward personnel in the following
manner:
1. Clearly mark identification tag, "Infectious
Case".
2. Attach a note on the outside front of
the chart stating the nature of the infectious case.
3. In cases of blood and body fluid infections,
the pink "Blood and Body Fluid Precautions" form should be placed on
the identification tag, chart and Autopsy Status Form.
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BODIES CONTAINING RADIOACTIVE ISOTOPES
Procedure after death of patient:
If a patient containing less than 5 mc of radioactive material dies in the hospital,
no special precautions are necessary.
If a patient dies in the hospital and contains more than 5 mc of radioactive
material, the doctor signing the death certificate must inform the pathologist
and the Radiation Safety Office (RSO) of this fact. The "Report of Radioactivity
to Funeral Director" form must accompany the body to the Morgue.
If the body contains more than 30 mc of radioactive material, the doctor signing
the death certificate must notify the RSO who will prepare a special statement
for the funeral director.
DISPOSAL OF STILLBORNS AND NEWBORNS Disposal of stillbirths and live birth remains shall be by cremation and require
a signed authorization by the mother
before discharge if the parent(s) do not choose a funeral home for disposition.
Absent an authorization, UAMS
shall retain the remains for three (3) months before cremation. Stillbirths
and live birth remains may be
autopsied in accordance with policy ML.3.09.
PROCEDURE:
I. AUTHORIZATION FOR DISPOSAL OF REMAINS/BODY
A. A signed authorization (MR II) for disposal , is required for ALL stillborn
fetuses and live birth remains, irrespective of weight or gestational age, when
the parent or legal guardian does not accept responsibility for burial.
B. For completion of the Authorization for Disposal, the consent of the
parent or legal guardian must be obtained. The signature of the mother is required.
. When the mother is an unmarried minor, she may authorize an autopsy and/or
disposal of the infant. It is desirable that an additional consent be obtained
and recorded from one of the minor's parents.
C. An Autopsy Permit is required as outlined in Policy ML.3.05, AUTHORIZATION
REQUIRED FOR AUTOPSY when autopsy of a stillbirth or live birth remains is requested
by one of the attending physicians. The Department of Pathology will only perform
an autopsy on a stillborn infant weighing in excess of five hundred grams. Stillbirths
less than five hundred grams will be sent to Surgical Pathology for examination.
D. A CERTIFICATE OF FETAL DEATH must be completed on all stillbirths 20 weeks
of gestation or greater or having a weight of 500 grams or more.
E. Morgue personnel will come in after hours to open the morgue and accession
infant remains/body when called by Labor and Delivery. Call hospital operator
for attendant on call.
F. All stillbirths and live born remains will have arrangements for cremation.
The cremated remains shall be separately identifiable. The containers will
be returned to UAMS and stored for a period of three months. If the parents
have made no contact to take possession of the remains, UAMS will dispose of them.
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UAMS
Department of Pathology
4301 West Markham #517
Little Rock AR 72205
501-686-5170
Bruce Smoller, M.D., Chair
For general information or questions about the Department of Pathology
you may contact Linda DePriest, Executive Assistant to the Department Chair. For web page issues you may contact the
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