Episode 77

How to request a private autopsy in Georgia

 

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Schenk: Welcome to episode 77 of the Nursing Home Abuse Podcast: How to request a private autopsy in Georgia.

The Nursing Home Abuse Podcast is dedicated to providing news and information to families whose loved ones have been injured in a nursing home. Here are your hosts, Georgia attorneys Rob Schenk and Will Smith.

Schenk: Welcome to the podcast. I am Rob Schenk.

Smith: And I’m Will Smith.

Schenk: We have a very interesting topic for the podcast today. We’re going to be talking about a family can do with regards to requesting a private autopsy for a loved one that has expired in a nursing home or an assisted living facility. To help us along with this conversation, we’re going to have on the podcast Dr. Virginia Richards, a pathologist. And Will, I think this is the first time we’ve had a medical doctor on the show.

Smith: Yeah, we’ve had nurses, we’ve had PhDs, this is the first MD.

Schenk: Another first for us, episode 77.

Smith: Yeah.

Schenk: Our first, but can you tell us before we get into it a little bit about Dr. Richards there, Will?

Smith: Sure. Dr. Virginia Richards is a board-certified forensic pathologist. She’s worked as the medical examiner for both the state of Virginia, or as we have pointed out before, the Commonwealth of Virginia, and Westchester County in New York. She’s got experience with the nuances of government offices and their general operating procedures.

She recently left public work to found Greenwich Forensic MD, partly in response to the need for private autopsies in the Greater New York area and partly to meet the demands of her young family at home. The majority of her business at the minute is providing expert consultation to law firms for civil claims and criminal prosecution. She’s on the faculty of New York Medical College where she teaches second-year medical students and participates in conferences and learning activities with the National Association of Medical Examiners.

She keeps her hands in public work by occasionally performing forensic autopsies at a nearby ME (medical examiner’s) office on a relief basis. And we are very privileged to have her with us today.

Schenk: All right, Dr. Richards, welcome to the show.

Virginia: Good morning.

Schenk: All right, thanks for being with us today. So Dr. Richards, we’ve kind of asked you to come on because sometimes we’ll have clients ourselves come in the door and they will have had a loved one that has passed away in a nursing home. And they have heard talk about autopsies, public, private autopsies, and in terms of their questions, what would you say to them? What is an autopsy, first of all, and what is the difference between a private autopsy and a public autopsy?

Smith: And remember, Doc, that most of us think about an autopsy based on what we see in Hollywood movies and stuff, so I think we all have a misunderstanding of what we think autopsies are.

Virginia: Right. Right. So an autopsy is just a final medical examination by a medical doctor of a patient who has died, so it’s both an external examination as well as an internal examination for the purposes of diagnosing disease and it’s relevant to determining if there were any injuries.

So a typical autopsy takes anywhere from an hour to several hours, and then the body would be released to the funeral home for whatever arrangements were going to be made. Sometimes family members ask me, “Can we still cremate? Can we still have a viewing?” Autopsies do not prohibit viewings. They don’t alter the face. They don’t disfigure the face. Autopsies don’t prevent a body from being embalmed for burial nor for being cremated. So it really doesn’t impact the final memorial celebrations or whatever is going to be done. It’s just going to delay it a day or two depending on when the body can be examined.

Schenk: So can you walk us through that from a logistical standpoint? And we’ll take your office for an example. So a client calls you – what are the next steps. What are the information that the person needs to give you and how do you act on it from there?

Virginia: Sure. So typically if someone dies at a nursing home, it depends on the jurisdiction and I can’t speak for Georgia so much, but typically the nursing home will report the death to that area’s medical examiner’s office just for record keeping and to make sure that the death isn’t overlooked, but typically a patient who died in a nursing home are not accepted as medical examiner cases unless the death can be related to an accident such as a broken hip, bedrail entrapment, choking on food, something like that, but when patients are in a nursing home, it’s generally assumed they are in medical care and they have pre-existing medical disease and therefore do not meet the requirements for a medical examiner autopsy.

So once the family hears that, that the medical examiner was called, they declined to take the case, then if the family is interested, then they would look at what area a private pathologist will offer private autopsies. You can look online – I think that’s what’s commonly done. Sometimes funeral homes will have pathologists they’ve used in the past they can recommend.

So the family, if they’re told, “Yes, it was called into the medical examiner’s office. The medical examiner is not interested in autopsying your loved one,” then the family should select a funeral home as they would anyways and then they can mention to the funeral director, “We are interested,” and then maybe together they can find a pathologist or two to call.

So that’s when I get the call. Sometimes more often it’s from a funeral home actually reaching out on behalf of the family, and then I’ll take the information from them, the circumstances of what was the reason the person was in the nursing home, the pre-existing medical conditions. And then it’s important for me to know why does the family want to know more about the death. Are they making allegations against the nursing home? What are those allegations?

Schenk: Doctor, how would that affect your examination? Why would it be important to you to know why it’s being done?

Virginia: Well because when I take this first call in, if they have strong suspicions of neglect or abuse, then I typically refer them back to the medical examiner’s office. I ask them to make a claim to the police department, report it and then with that investigation, see if the medical examiner’s office would be interested in taking this under their investigation.

If after that investigation, the police and/or medical examiner still don’t think there’s anything worth pursuing as far as claims of abuse and neglect and the family strictly just wants to know what we call “medical curiosity,” then I’m happy to do those sorts of autopsies.

Sometimes family members will have a loved one who was a resident of a nursing home for many, many years with, say, some sort of dementia that came on early onset that never was clearly diagnosed in life because there often are so many things you can’t officially diagnose until death, so some of these dementias in particular the family would like to know more about. Or was there cancer that came back? Maybe they knew their loved one had cancer. Maybe the cancer came back and it was not detected. Was there cardiac disease that runs in the family? That’s another thing to look into, things that can be inherited, things that would be of interest to the loved ones, the family members.

Schenk: I see. So not to get sidetracked too much, but is that going to be something you’re going to do at every autopsy you perform or do you need to be directed to say, “Hey, can you tell us was this individual a sufferer of dementia or cancer?” or is that going to come out regardless of who you’re doing the autopsy on?

Virginia: Yeah, general autopsies cover all body systems anyway, so most things would be apparent at autopsy, but if there is something in particular, the more information I have before the autopsy, the better, so that maybe I would order some specialized studies in addition to what I see with my eye at autopsy.

Smith: And that brings up a good point, just for those of us who don’t understand the medicine behind this. You’re both making a physical assessment of the different organ structures and also ordering tests, is that how it works?

Virginia: Yes, so like I said, the autopsy itself takes an hour to a few hours, and I can only see what my eye sees. We call that gross pathology. So right away, I’ll see certain things and make notes of those, things I can tell the family later that day even. But that autopsy’s not finished. It can take weeks to months to get more information, and this would be looking at slides under the microscope of the tissues, certain cells I obviously can’t see with my eye, as well as other studies I can order. These special studies I’m referring to vary from pathologist to pathologist as far as what he or she is willing to look into and do. Most medical examiner’s offices also do these studies I’m referring. So depending on what I see with my eye at autopsy will help me dictate, if needed, what additional studies I’ll request.

And then I will wait until those come back and evaluate those and then summarize my findings in a written report. So the family gets the written report when I’m finished, and I’m happy to go through that with them and explain the medical terms so that they can understand the full body findings. So even if they were interested in just the heart, I would also be telling them about some evidence of renal kidney disease that they may not have been aware of also. So I’m not just telling them of the heart, I’m telling them everything that I found.

Smith: So what kind of window do you have to perform an autopsy then?

Virginia: Yes, the timeline is a little bit tight. Obviously the sooner the better. The good thing about a patient who passes away in a nursing home is that they’re not found days later. They obviously are recognized to have passed within hours, I would hope, so that body can then be placed in refrigeration immediately, and that will delay some of the natural unpleasant decompositional effects. So with refrigeration, I think four or five days past death, you can still have a really meaningful autopsy.

Beyond about five days, the natural bacterial flora have started to overtake. The bacteria don’t die, so the bacterial flora start to overtake the tissues and it really kind of alters the appearance of what I see with my eyes but also how things look under the microscope. So it’s not the best examination but you can still get meaningful information from it beyond four or five days after death, but obviously the sooner the better.

Schenk: Is it common in your experience to perform autopsies after the state has already performed one? And if so, does that affect your findings at all?

Virginia: So I have never done a second autopsy. I don’t have anything against them. I know there are pathologists who do that. I don’t know how much additional information they would find, but there’s certainly nothing to prohibit that, to answer your question about that. A state autopsy can be finished up with a private autopsy afterwards. Once the state or county autopsy is finished, the body is released to the funeral home. What the family chooses to do after that is up to the family. They can have another independent pathologist come in. I do know just anecdotally from hearing other pathologists say they have on occasion found things that were helpful for the family, but I don’t have any personal experience with that.

Schenk: But I guess another question would be the state is not doing anything different than what you’re doing. An autopsy is going to be an autopsy and have the goals, the same goals as public.

Virginia: Exactly, to understand the disease and injuries if there are injuries.

Smith: I guess a question that a lot of us have is in the world of law, for example, I have many friends and colleagues who are public defenders and employed by the state. There is a common misconception that has some truth to it that if you get a public defender or somebody who’s employed by the state, it’s not necessarily as beneficial as if you pay a private attorney. In the world of medical examiners, is there some truth to that as well that the medical examiners for the state are extremely backed up, they don’t have a lot of time or there’s not as much incentive to search things out, or is that not the case at all.

Virginia: I don’t think you can make a generalization. Like anything, there are good pathologists, whether working for a public organization or privately. Really, if the family gets the autopsy report and reading it or discussing it with the state or county pathologist, those medical examiners should be available to talk over the phone if not in person with the family about their findings, and if the family still thinks, “Okay, well maybe this isn’t out of width,” then that’s this family’s choice to pursue another opinion. That does happen that the family sometimes thinks, “Well that pathologist didn’t do a thorough enough job,” but I think in general, you can’t say the county or state medical examiners are not doing a sufficient job because there are excellent ones.

Smith: That’s good to know.

Schenk: So let’s circle back to this, the timeline. The funeral home, again in the hypothetical, is contacted by your office.

Virginia: Yeah.

Schenk: So what happens next? What do you need from the family in terms of paperwork? How is it logistically to get to where you’re conducting the autopsy?

Virginia: Right. So for me personally on my website, I have a form that they can print out, which is a consent that the family is authorizing me to do the autopsy and it explains what an autopsy involves so they’re not surprised that yes, I will be removing the brain and looking at it and certain things like that, but they’re signing that as well as authorizing or confirming that they are going to pay. And then I do the rest of the communication with the funeral home as far as the timing and the location of the autopsy. The family doesn’t need to get involved with that sort of logistical thing.

But often, especially in these nursing home deaths, I’ll request the records from the nursing home as well as any other hospital if the patient had been recently discharged from the hospital. That, for private autopsies, that authorization does need to go through the next of kin, so I have a medical release form on my website that they can print out and sign and they submit it and get the medical record and they would give them to me, but that doesn’t have to happen before the autopsy because that could take weeks.

Schenk: Yeah, I was going to say because sometimes that could take a long time to get medical records.

Virginia: Right, so I would certainly go ahead and do the autopsy, but before starting the autopsy, I do need to have their signed consent. So that’s my personal way that I do that. I don’t know all the private ones do that.

Schenk: Sure. Where generally do the private autopsies take place? Do generally the pathologists have their own offices where that happens or do they go to the funeral home?

Virginia: Less commonly do they have their own. I know there are some very large, private businesses that have just grown over the years, and I’m very inspired by these people who have been able to do that – they do have their own labs. But more commonly, these private autopsies can happen in funeral homes as well as in some hospital autopsy rooms, so a combination of those things.

Schenk: So aside from the consent and the medical release…

Smith: Well with the consent, I have a question. Do you ever have issues where the next of kin, and there may be several, have differing opinions on whether an autopsy should be performed?

Virginia: I haven’t encountered there in the private business yet, but in medical examiner work, yes. There was always a family member who did not – the one biggest thing I want to point out is for medical examiner autopsies, there is no family consent. The family is not consented. They’re not asking the family can we do this. They are taking jurisdiction of the body for purposes of their investigation, whereas private, by the time they’ve reached out to me, it’s pretty clear that the family does want it. So I haven’t another more distant relative call me up and say, “Don’t do it.” So no, I haven’t encountered that yet.

Schenk: Okay. So going through the timeline, so you’ve got the information that you need. You’ve conducted the autopsy. Now you’ve generated the report. Can you kind of walk us through what’s on the report and how you relay that information to the family?

Virginia: Right. So again, the report probably wouldn’t come out for at least a month, but right after the autopsy, later that day or the next day, I make a call to the family and say this is what I’ve found, some big key items that I saw with my eyes, but in the autopsy report, it goes starting with the external exam of body characteristics, any injuries if I do see injuries, and then what I call marks of therapy, so for instance, an IV catheter in the arm or tape over the arm where the catheter had been there, and then intratracheal tube, that sort of device that I’m making comments of in the process of documenting what I see, but by seeing marks of therapy, it means that any bruising or abrasions in that area are just thought to be from medical treatment, not from any foul play or anything like that.

Then I move onto the internal examination, and I go kind of by organ systems with the thoracic organs, the lungs and the hearts, and then onto the abdominal tissues and organs. And then I don’t typically examine the arms and legs internally – I just make observations of them externally unless there is a fracture. And then the brain. And then if there are histology, which are the microscopic slides, then I will make descriptions of what the slides are showing.

Schenk: Got you. So Dr. Richards, okay, so let’s put ourselves in the position of a loved one of a person that’s died in a nursing home, and they’re looking and they’ve made the decision to have a private autopsy done for whatever reason. Maybe the state won’t do an obligatory examination, been passed on, but they want to know XYZ about the cause of death. What are your recommendations for them to find a pathologist to do a private autopsy? Are there compare websites? Is there some type of online resource they can use?

Smith: Is there an organization or association?

Virginia: Yes. There is a National Association of Medical Examiners. That’s NAME – in fact their website is www.theNAME.org. This is a professional association – I’m a member of it. And on that website, there is a link for private autopsies as well as forensic consultations, and if anybody from outside of my area calls and reaches out to me, I often refer them there because you’ll see there are pathologists from all over America who may or may not be available to do an autopsy at that time.

Schenk: Sure.

Smith: And what exactly is your jurisdiction so our listeners understand that?

Virginia: Well I’m licensed in New York and Connecticut, but as far as private autopsies, I would only do New York City, Westchester County in some of Long Island and then some of Fairfield County, Connecticut, for actually doing the autopsy. For reviewing autopsies, I could do anywhere in America. I don’t have to be licensed in that state. However, if it’s going to go to trial and I need to testify, then I would prefer to stay in the Northeast as far as traveling. It doesn’t make sense for me to fly to Hawaii to testify when there are great pathologists in Hawaii.

Schenk: So for our listeners that might not know, what do you mean when you say review a report to testify in trial?

Virginia: Right. So another aspect of my job is to offer consultation. So the autopsy already happened, whether it was at a medical examiner’s office or at a hospital or private pathologist, and now the family member or law firm rather – actually I get a lot of law firms representing either defendants or plaintiffs – to review what the autopsy showed and any evidence supporting or against what they’re claiming.

Schenk: Sure. Is there any particular advice you would offer family members who are thinking about having a private autopsy done that we haven’t already covered?

Virginia: Well I just want to really emphasize that they should start out by sitting down with the nursing home staff. The more they can communicate, the better because sometimes I think that a lot of their feelings are maybe things that were misunderstood, so sometimes family members will call me and just talking over the phone, I kind of talk them out of an autopsy, because a lot of what they’re feeling at the time may be emotionally driven, and when they have time to discuss with maybe the nursing supervisor, they realize that they weren’t quite clear on what was happening at the time. So a good first start would be to talk with the actual nursing home staff.

But if after that communication, they still feel strongly, then yes, act quickly. Go ahead and find a funeral home to work with, and they can be the family’s liaison in communicating with a pathologist.

Schenk: Very good.

Smith: Outstanding.

Schenk: Well Dr. Richards, thank you so much for coming on the podcast. This is a lot of very useful information for our listeners and we appreciate you sharing that with us.

Virginia: Well you’re absolutely welcome.

Schenk: All right, fantastic. Well Dr. Richards, I think that’s all the questions. Fantastic.

Smith: Yeah, thank you very much for being on.

Schenk: Thank you so much.

Smith: Thank you, Doctor.

Virginia: Thank you. Bye-bye.

Schenk: Bye-bye. A lot of great information.

Smith: That’s really interesting because I think that a lot of people – and I know this from talking with clients and potential clients and family members – have a strange fascination with autopsies that you think, “Well let’s just do an autopsy,” you know what I mean? And that’s not always necessary and it’s interesting to find out the process by which they’re done and when they should be done and requested.

Schenk: So yep, absolutely. I totally agree with that.

Smith: Well hashtag smiley face.

Schenk: Hashtag smiley face. Hashtag…

Smith: Speaking of smiley faces, I hope that everybody has a good Emoji Day.

Schenk: Which is tomorrow.

Smith: Which is tomorrow – World Emoji Day.

Schenk: I would have to say that my most commonly used Emoji is with Daniela and it’s the one with the X’s in the eyes and the tongue sticking out, like you’ve made a joke but it’s maybe crude. That emoji – you know what I’m talking about?

Smith: Yeah.

Schenk: Will’s most used emoji is the flexed bicep.

Smith: Right, right, right. No, my most used emoji is the smiley face because I feel like when I say something that may be taken the wrong way or I’m being kind of a jerk or aggressive, me putting a smiley face on there, I can say something like, “Hey, that’s a really good idea,” smiley face…

Schenk: I would still say you’re being a jerk. But at any rate, smiley face and a period at the end of this, because this concludes this episode of the Nursing Home Abuse Podcast. Will, again I ask you, so someone is approaching you on the street, he jerks you on the collar and says, “I want to listen to your podcast.” What do you respond with?

Smith: Well the first thing that I say is, “You can download the audio and the MP3 on the website, which is NursingHomeAbusePodcast.com, but you can also go to anywhere where podcasts are frequently listened to and downloaded, and that’s Stitcher, iTunes, Spotify, Podcast Puppy, anywhere where you listen to your typical podcast. We’ll be there.”

Schenk: And he says, “I don’t like to listen. I like the full audio-visual. Can I watch it?”

Smith: Absolutely. First of all, you can watch it on YouTube. You can go to our website, NursingHomeAbusePodcast.com. Is there another place I can’t think of?

Schenk: I’m sure somewhere else is out there.

Smith: Yeah, but our YouTube channel, Schenk Smith YouTube.

Schenk: Yeah, and there’s a new episode every Monday morning. We appreciate you listening through all this and with that, we will see you next time.

Thanks for tuning into the Nursing Home Abuse Podcast. Nothing said on this podcast either by the hosts or the guests should be construed as legal advice, nor is intended to create an attorney-client relation between the host or their guest and the listener. New episodes are available every Monday on Spotify, iTunes, Stitcher or your favorite podcast app, as well as on YouTube and our website, NursingHomeAbusePodcast.com. See you next time.


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