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SHRINERS HOSPITALS FOR CHILDREN
Shriners Burns Hospital - Boston

Policy and Procedure

Volume/SectionDate EffectiveI/IMedical Staff Criteria for Requesting Autopsies1/2001Policy NumberValid Through DateRI.2.20File:/  /


Policy Scope
This policy applies to all members of the medical, resident and nursing staffs.

STATEMENT of PURPOSE
The primary mission of the Shriners Burns Hospital - Boston Unit is the care and treatment of acutely burned children.  Consequently, all deaths occurring at the hospital are to be automatically presumed to be medical-legal cases (owing to a proximal cause of death involving trauma), as defined by the Commonwealth of Massachusetts.  All expirations which occur on the hospital premises are to be considered under the legal jurisdiction of the Suffolk County Medical Examiner, unless stipulated to the contrary by the medical examiners office.

A. Policy
The Commonwealth of Massachusetts specifically defines their purview regarding death to include:

following trauma, accidents, suicide, or environmental  exposure.
within 24 hours of admission to a healthcare facility or while in the Emergency Department
of persons suffering from chronic substance abuse or acute intoxication
following hospital accidents
during any surgery or procedure
of children less than two years of age unless the child is in the terminal phase of a well-documented natural disease and death is expected
of persons with no known serious medical conditions (i.e. upon arival)
of a person admitted to the hospital in a coma who never regained consciousness
if pregnant or within 90 days following delivery or abortion.

While proximal-cause-of-death jurisdiction typically applies to events which take place within US territories,  potential complexities in interpretation of these policies may arise when applying them to decedents who sustained trauma outside of the United States.  To prevent any possible confusion, the medical staff is consequently instructed to notify the Suffolk County Medical Examiner of ALL deaths which occur, thus allowing that office to exercise due jurisprudence is determining the correct interpretation of existing statutes.

B. PROCEDURE

Overview:  As per Massachusetts State Law MGL Chapter 38 section 6 "medical files and information" autopsy results are exempt from disclosure under the public record statute, AML GL Chapter4 Section 7 clause 26(c). As such, no one, neither treating physician nor family members, are permitted to access written autopsy information in the above delineated circumstances. Consequently, for purposes of SBH Burn Peer Review, Continuing Medical Education and medical records completion, written autopsy results are unattainable as per Massachusetts State Law.  The SBH Medical Executive Committee encourages the verbal exchange of autopsy results (provided that the Medical Examiner or his/her designee is willing to release these data) for use in the critical discussion of the patient's death for learning and subsequent improvement in the care and treatment of future patients admitted to the Burns Unit.  In carrying out this discourse, the SBH staff should be cognizant of the reality that a the medical-legal investigation of death seeks to answer a different question set than that sought out by academic inquire.  Consequently, the hospital staff is encouraged to share with the medical examiner his/her concerns and/or questions concerning the case so that adequate investigation is performed.  In making these requests, however, it is important for  SBH staff to recognize that the medical examiner may carry out these additional investigations as a courtesy, and they are in no way body to do so.  Thus, fostering a collegial interaction with the Medical Examiner is to be encouraged.

Notification Policy:  Upon determination that a death has occurred within the hospital, the Suffolk County Medical Examiners office is to be contacted within 12 hours.  If the Medical Examiner Accepts Jurisdiction, Dr. Eugene Mark and the MGH Autopsy service are to be concurrently contacted and notified of the expiration.  If the Medical Examiner allows Dr. Mark (a duly deputized Medical Examiner) or his designee to assume jurisdiction of the case and similarly, Dr. Mark or his designee has sufficient resources on hand to accept the case, the body may be transferred to the MGH Autopsy Service for a Deputized Autopsy.  Otherwise, the body is to be transferred to South Mortuary for an autopsy by the Suffolk County Medical Examiners office.

Issue of Permissions for Medical Examiner Jurisdiction Cases:  At no point should the family be contacted concerning their signing of a permission for a State Jurisdiction Autopsy.  Not only is the permission unnecessary, it is in violation of the confidentiality clause concerning AML GL Chapter 4.

Academic Autopsy Procedure: Permission for an academic autopsy to be performed at MGH may be sought if the Suffolk County Medical Examiner relinquishes any and all jurisdiction to the case.  In this circumstance, permission will be obtained by attending physician or designee in collaboration with the nursing shift coordinator if one or more of the following criteria is/are present at the time of death:

Unexpected death after 24 hours of an elective admission
Toxic Epidermal Necrolysis
Stevens Johnson Syndrome
Purpura Fulminans
Any other medical eventuality as determined by the attending physician which would benefit from the information gained by performing a post mortem examination.

Selection of the Next of Kin for obtaining of a autopsy permit:  The attending physician or designee will follow the hospital Next of Kin policy in determining the most appropriate individual(s) to obtain permission for performing a post mortem examination.  In deference to time-to-burial issues intrinsic to some cultures, the attending may wish to consider a limited autopsy, in circumstances where the family requests expedient delivery of the decedent and the clinical question can be reasonably confined to one or several organ systems only.

Notification:  The requesting physician will notify the patient's attending physician, if an academic autopsy is to be performed.

C. OPERATIONAL DEFINITIONS

TermsDefinitionAutopsyPost Mortem Examination



D. REFERENCES
Sources UtilizedHospital Policies and Procedures: as writtenJCAHO
E. SHARED GOVERNANCE
The Department, Collaboratives, Interdisciplinaries of Hospital WideUlysses J. Balis, MDDate:Ronald G. Tompkins, MD, ScDDate:Robert L. Sheridan, MDDate:Janet Mulligan, RN, MSDate:Rosemary Hargreaves, RN, BSNDate:


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