The Dying American Autopsy

Before 1970, 40-60% of patients who died in hospitals received an autopsy. In 1970, The Joint Commission, the organization responsible for hospital accreditation, eliminated the requirement of a 20% autopsy rate for in-hospital deaths for hospitals to receive accreditation. In the years since this decision, we have seen drastic declines of autopsy rates. In recent years, less than 5% of hospital deaths are followed up with an autopsy.

In a move that has further contributed to our declining autopsy rates, in 2019 the Trump administration pushed through the Omnibus Burden Reduction (Conditions of Participation) Final Rule. This rule attempted to “cut through red tape” by eliminating redundant, or excessively burdensome regulations that affect hospitals and healthcare providers. A part of this rule eliminated the requirement for hospitals to “attempt to secure autopsies in cases of unusual death and of medical-legal and educational interest”. The Centers for Medicare and Medicaid Services (CMS) and the Trump administration argued that the autopsy requirement was redundant because states have their own autopsy regulations in place. However, the American Society for Clinical Pathology highlighted that only six states have laws requiring autopsies in the case of all unusual deaths.