Post - Mortem - issues
So I need advice professional advice but before that care to read this first!
A guy, who is an intravenous drug abuser, comes to the hospital ill and pale claiming that he vomitted blood. A scope was performed after having resuscitated him and revealed a non bleeding ulcer in the stomach. A few hours later maybe 2-3 hours, the patient collapses and needs intubation. We managed to resuscitate him but only to collapse again after 15hours and passes away this time. There were no indication of rebleed. As cause of death could not be ascertained, we asked for a clinical post-mortem to ensure the cause of death.
This is where the issue starts! The pathologist refused to do the post mortem saying that
1. His hepatitis and HIV status were not known
2. A clinical post mortem is to be done by the surgeon as it means the surgeon wants the post mortem for his own learning and interest. - is that true?
3. A post mortem for identifying cause of death is a decision between the police and pathologist, therefore the managing team that is us just have to make a police report. The police will then reconsider the need for post mortem and if needed then they will discuss with the pathologist who will either do a post mortem or just give a possible cause of death!
Question: If this the way, why do or order for a post mortem? By Law, will this hold in court?
December 4th, 2006 at 11:55 am
George, i’m not sure what the issue is.
I’ve never made a police report for a patient who died from an unknown cause. We usually just refuse to issue a medical cause of death certificate. The police will have to issue an order for a post-mortem examination if there’s no medical cause of death given.
What will hold up in court? Why should this issue go to court? Why is professional advice needed? Care to elaborate?
December 4th, 2006 at 12:16 pm
The issue is:
1. why should we make a police report for an unknown cause of death especially when it is not medico-legal type of case? I have never done so until reaching Selayang
2. can the pathologist refuse a PM on the basis of the deceased HIV or Hepatitis status let alone assumption?
3. I had a young lady who had both thoracic and abdominal injuries. We proceeded with laparotomy which was a simple liver laceration and decided to proceed with a thoracotomy when she flat-lined - - I asked for a PM - I got the run around and at the end the pathologist did a surface PM — that is recorded the external injuries and diagnosed polytrauma!! No proper PM. Is this okay in the court?
December 4th, 2006 at 1:21 pm
OIC. Thanks for clarifying.
1. No need. Just refuse to sign the cause of death.
2. I don’t think the pathologist should refuse on any ground besides medico-legal grounds, e.g. no consent or police order.
3. OIC, will a surface PM hold up in court? I think that is up to the discretion of the court. Not every case needs a full autopsy.