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We sometimes act as though advances in pre-mortem diagnostics have reduced the need for autopsy. But clinical autopsies not only help to establish the true cause of death, aid research, and contribute to medical education; autopsies may also provide insight into how patients' deaths can be prevented in future, and can help relatives with the grieving process by providing an explanation of why the death occurred. The Department of Neurology is committed strongly to doing what we can to facilitate post-mortem examination of the nervous system in patients followed in our clinics, or patients who die on the inpatient service.
Below is information about how to obtain permission for an autopsy, and how to arrange for transportion of the body here if the patient dies elsewhere.
Salient points are:
1. There is no charge for autopsies performed by the Department of Pathology at UMHS on UMHS patients.
2. The Department of Neurology has established an account to pay for transporting the body to UMHS if that is required.
3. A detailed step-by-step guide is outlined in the attached document.
Evidence shows that relatives are most likely to grant consent when clinicians strongly recommend autopsy. I encourage all of you to help us increase the number of autopsies we perform.
Dept. of Neurology Autopsy Procedure; What You Have to Do to Arrange an Autopsy:
1) Autopsies should be prearranged and approved only by an attending neurologist. Residents should solicit the assistance of an attending if they wish to prearrange an autopsy.
2) Autopsies should be discussed in advance with patient and family. Please document prearrangement of an autopsy by dictating a separate note in MiChart. Patients and family should have contact information. During working hours, the attending neurologist who discussed the autopsy with the patient and family should be the contact person. For non-working hours (after 5 pm and weekends), the relevant contact should be the attending neurologist on call. Families should be provided with the phone number for University Hospital paging service – 734-936-6267 and instructed to ask the operators to page the Neurology attending on call about an autopsy.
3) Confirm that the patient is a UM patient and is followed in Neurology – there are occasional autopsy shopping experiences. After speaking to the family and confirming the death, inform them that a second call will be needed to obtain consent. Obtain some basic information – time of death, date of death, location of death. Other important information such as CPI# and DOB should be in MiChart. You will need the name and address of the next of kin.
You need to inquire if death was unexpected or occurred immediately after a hospitalization. If one of the latter, this may be a medical examiner's case and/or require police notification. Patients in hospice care don't require these investigations. Criteria for notifying the Medical Examiner vary from County to County. Appended is a document our Medical Examiner uses for Washtenaw County deaths. Briefly, the Medical Examiner will need to be notified in the case of:
Unexplained, Sudden, or Unexpected Deaths
Death without medical attendance – this overlaps with Unexplained...
Death related to abortion
The great majority of deaths in hospice, nursing homes, hospitalization, etc., will not require Medical Examiner notification.
The Police are/should generally be notified about deaths occurring outside nursing homes, hospitals, and home hospice care. If the Police are notified, the Medical Examiner is generally notified by the Police agency.
You may be called on to act as the physician signing the death certificate. This is usually arranged by funeral directors.
4) Ask the family if they have made funeral arrangements. This is important because funeral directors or their transportation services usually transport bodies for autopsies. Ask the family to have the funeral director page you to confirm arrangements. Get the family call back number! Get next of kin address.
5) Call family back on consent line 734-936-5087. The hospital operator will assist you. Tell the operator that you are obtaining consent for an autopsy. They will request information – you as requesting physician, contact information for family, limitations of autopsy. All limitations need to specified – brain only, brain and spinal cord only, etc. Remind the operator to fax the consent to the morgue.
6) When funeral director calls, tell them the body has to be brought to UM Morgue – most funeral directors around here know how to do this. For funeral directors-transportation services who don't know the Morgue address, the address is:
1500 East Medical Center Dr.,
Dock 5, Room B2H251
Ann Arbor, MI 48109
Bodies should be dropped off. Depending on time of day and how busy the morgue is, sometimes the brain removal can be done quickly and a second (pickup) trip is not required.
7) Tell funeral directors to send an invoice for transportation fees to David's office –
David J. Fink, MD
1500 Medical Center Drive
1914 Taubman Center SPC 5316
Ann Arbor, MI 48109-5316Telephone: 734-936-9070
8) Dictate a short note describing obtaining consent for the autopsy. Include date of death, time of death, location of death, whom you obtained consent from and their contact information. The Neuropathology people need this information.
9) During working hours, contact the Morgue supervisor – Diana French. You don't have to notify anyone in the middle of the night. She has a pager (30951) and is quite approachable. Let her know that this is not a research case – clinical evaluation only.
10) When autopsy report is complete, usually about 2.5 months – send to family.