If a patient suddenly or suspiciously dies in a hospital it is the job of a forensic pathologist to figure out how and why. Forensic pathologists are licensed medical doctors specially trained to examine people to determine their causes of death.
There are simply not enough forensic pathologists in the Untied States to meet the current supply and demand. One reason may be that of the 138 U.S. medical schools, only 37 are accredited to train forensic pathology. Just 45 states have accredited medical schools and only 27 of those can provide a direct path for medical students wishing to become pathologists. The few medical schools that actually teach forensic pathology are poorly funded and produce only 30 board certified forensic pathologist a year. [1]
Most people who dream of becoming a doctor probably do not want to perform autopsies for a living. And according to the Scientific Working Group for Medico-legal Death Investigation, the combined lack of motivated medical students, forensic pathology programs and poor funding help explain our nation's low autopsy rate of 8.5 percent.
The shortage of forensic pathologist is most often felt in those rural areas that cannot afford a full-time pathologist. And now, many hospitals are discontinuing the use of hospital autopsies. Hospital autopsies are important to maintain the quality of health care by investigating adverse and unexpected patient deaths. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredits hospitals in the United States. The JCAHO requires that hospitals only maintain a minimum autopsy rate of 20 percent.
Families destroyed by the sudden death of a hospitalized loved one are often forced to fund their own expensive and complicated forensic investigation. That means, either pay for a private autopsy or risk never knowing the true cause of death. Private autopsy in Florida can cost thousands of dollars. The Miami-Dade Medical Examiner charges $5,000 per case for a private autopsy. This does not include laboratory testing, transportation, or storage of the body. Florida Statutes §406.11 places certain types of death under the jurisdiction of the medical examiner, such as criminal violence, accident, suicide, or when a patient in apparent good health dies.
Sadly, the shortage of forensic pathologists is good news for many Florida hospitals and doctors, in my opinion. Without an independent autopsy, many patient deaths go unanswered. In addition, without mandatory autopsies hospitals and doctors miss a valuable opportunity to improve the quality of medical care for us all.
Correction: A previous version of this blog stated there are 130 medical schools in the United States. There are 138 accredited medical schools in the U.S., according to the Association of American Medical Colleges.
[1] Scientific Working Group for Medicolegal Death Investigation -- SWGMDI (http://www.swgmdi.org/images/prc5.is.increasingfpsupply.draftjune2012.pdf)
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