Autopsy Pathology

Report of Death

A report of all deaths should be made to the Autopsy Service by telephone within 15 minutes of the patient's death, call 847-3570. In effect, this means immediately. A written Report of Death form (on the back of the Autopsy Permit) is to be filled out and sent to Health Information Management as soon as possible.

Admissions and Discharges of Bodies from within Fletcher Allen to Autopsy Service/Morgue

Identification of the Deceased: It is paramount that all bodies admitted to or discharged from the Morgue be properly identified. Proper identification and tagging of bodies must be accomplished prior to transport of the deceased to the Morgue. Appropriate Forms and tags are in the "Death Packets" available on floor or in Distribution. Proper identification consists of: full name, date of birth and Medical Record Number (if available).

Labels or tags affixed to shrouds, sheets, or clothing, or labels stuck directly to the body are NOT sufficient. Tags or bracelets must be affixed by or in the presence of someone who can positively identify the body. Tags should be affixed to the toe (or wrist in case of double amputees).

Valuables and Personal Effects

 Dentures should accompany the body to the Morgue and should be placed in a labeled denture cup. All personal effects, including removable jewelry, should be removed at bedside and placed in the custody of security or given to a family member. Any valuables which cannot be physically removed from the body must be noted on the Morgue Control Form. Transport: To facilitate transfer of the body to the Autopsy Room storage facility, two attendants should accompany the body whenever possible.

Admission and Discharge Sheet: Persons admitting or discharging a deceased patient should complete the Morgue Control Sheet in the notebook located in the Autopsy Room receiving area. Any non-removable personal effects and infectious disease precaution especially known or suspected tuberculosis and Jakob-Creutzfeldt Disease should be specifically itemized on the Morgue Control Sheet. Positioning of Body: The body should be oriented face up, headfirst into the storage facility completely covered by a sheet to prevent drying.

Admission of a Body from Outside Fletcher Allen

1. Proper identification must be provided by red tag or other device.

2. If not identified, or if red tag unavailable, admit body as "John Doe or Jane Doe" and refer case to Medical Examiner on call.

3. Include infectious disease precautions if known.

4. Fill out Morgue Control Form and position body as above.

Medical Examiner Cases

Information required when reporting a case to the Fletcher Allen Regional Medical Examiner:

Full Name of Patient

Address of Patient

Sex, Age, and Date of Birth

Marital Status and Occupation

A Clinical History Including: Date and Time of Injury and Date and Time of Death

Relevant Therapy and Procedures

Name of Family Physician

Name of Ambulance Squad and/or Police Investigation Unit

Consultation with the Medical Examiner:

If it is unclear whether the patient is a medical examiner's case, call the Chief Medical Examiner's Office (24 hours a day). A telephone consultation with an Assistant Medical Examiner takes only a few minutes and can assure that the case is handled smoothly. (Telephone 1-888-552-2952).

Hospital Deaths to be reported to a Medical Examiner:
Vermont State law requires that the following deaths be reported to the Medical Examiner: deaths ".... from violence, suddenly when in apparent good health, when unattended by a physician, by casualty, by suicide, as a result of injury, when in jail, or prison, or mental institution, in an unusual, unnatural or suspicious manner, and in circumstances involving a hazard to public health, welfare, or safety..."

In short, if the death of the patient is in any way related, even remotely, to an accident or injury, burn, homicide or suicide, or if the cause of death is undetermined, call the Assistant Medical Examiner (Telephone 1-888-552-2952).

Any deaths in Fletcher Allen, which are thought to be non-natural, should be reported. There is no 24-hour rule in Vermont. Deaths in the Emergency Room and in the Operating Room are not required to be reported, unless known or suspected to be non-natural. If you have trouble determining whether or not a death is non-natural, then call the Chief Medical Examiner Office (Telephone 1-888-552-2952).

Any trauma patient whose family wishes to donate kidneys or other organs should be reported to the Medical Examiner before death and donation. To obtain legal clearance from the Chief Medical Examiner and from the State's Attorney, Telephone 1-888-552-2952 and ask for the the Assistant Medical Examiner.

What to Tell the Family About Medical Examiner Cases:

Reporting a case to the Chief Medical Examiner does not mean that an autopsy will automatically be performed. Therefore, in cases reported to the Medical Examiner, inform the patient's family that there will probably be a Medical Examiner's investigation, which may include an autopsy, but if an autopsy is not performed by the Medical Examiner, the hospital would like permission to perform an autopsy. (Autopsy permission is not required for a Medical-Legal autopsy).

Hospital Autopsy Permits

It is the policy of the Fletcher Allen Medical Staff that autopsy permission be sought on ALL patients whenever appropriate. That is, in all patients whose deaths are natural, and all patients with non-natural deaths released by the Medical Examiner, unless the family or patient wishes to donate the body for scientific purposes. (See the Anatomical Gifts section). Do not obtain autopsy permission in those cases. Autopsy and donation of the body for scientific purposes are mutually exclusive. If an autopsy is to be performed, permission is required on all adults, live born infants, and all stillborn infants greater than 20 weeks gestational age (or weighing greater than 400 grams if gestational age is unknown).

Instructions are attached to the Autopsy Permission Form. Copies of the Fletcher Allen permission form can be obtained from any of the clinical floors or the Emergency Room. Copies are also available during the day from the Autopsy Service (802-847-3570) or from the autopsy secretary (802-847-3566).

Complete Autopsy Versus Restricted

Complete Autopsy:
An unrestricted or complete autopsy includes: cranial, abdominal, thoracic, and pelvic contents. It may include spinal cord, lower extremities, or the posterior portion of the globe of the eyes. It does not include the face or distal upper extremities. Non-routine examinations should be specified explicitly on the permit (e.g. "Eyes may be removed for examination" or "Includes examination of facial tumor"). Consult with the pathologist on call if you have questions about the wording of permits.

Restricted Autopsy:
An unrestricted autopsy is always preferable. A partial autopsy often yields partial information. If the family wishes to restrict the extent of examination, determine exactly what parts of the body the family does not wish to have examined and state these restrictions as specifically as possible. For example, "No brain examination" is much less restrictive than "Chest and abdomen only". By wording the restriction in this way one can reduce or eliminate a family's distress concerning the autopsy without unnecessarily limiting the information to be gained from the procedure. If you have questions, call the pathologist on call (847-5121 or 1-800-991-2799).

Special Examinations and Procedures: If you think special procedures (such as electron microscopy, immunofluorescence microscopy, or viral cultures) are needed, do not put these on the permit. Rather, write them into a note attached to the permit or at the end of the medical record and call the pathologist. If the family or clinician has specific questions, they should be written on the permit or communicated to the pathologist via the medical record or by telephone. A problem that is obvious to you, may not be apparent to the pathologist from a quick reading of the chart. Fetal, Stillborn and Neonatal Deaths

Report of Fetal Death Form:
All spontaneous stillbirths over 20 weeks gestational age require a yellow Department of Health form (Report of Fetal Death) rather than the usual birth and death certificates. Report of Induced Abortion Form: All induced terminations of pregnancy require a Report of Induced Abortion Form. Autopsy: A completely filled out autopsy permission form is required on all infants greater than 20 weeks gestational age (or 400 grams weight if the gestational age is unknown).

Infants less than 20 weeks gestational age (or under 400 grams weight if gestational age is unknown) can be sent to Surgical Pathology for examination without an autopsy permission form (see Hospital Disposition below). If the remains are to be returned to the family for burial, the Pathology Department MUST be notified either on the disposal permit accompanying the specimen, or by telephone (Autopsy Service 847-3570).

Hospital Disposition: The family may elect to have the hospital dispose of intact stillborn fetuses, identifiable fetal remains, and live born neonates up to term. In these cases a hospital disposition form and cremation permit must be filled out. These are available on the obstetrics and pediatric floors. The forms should include the name, address, and telephone number of the family, and whether or not the family wishes to have the remains returned to them at a later date. Both forms and the remains should be sent to the lead autopsy technician on the Autopsy Service.

Anatomical Gifts:

IMPORTANT: Non-Natural Deaths Require Medical Examiner Permission

Whole Body: This must be pre-arranged with the Department of Anatomy and Neurobiology of the University of Vermont (656-2230, available 24,7). If the family or patient has arranged to donate the body to the University as an Anatomical Gift, do not get autopsy permission. These procedures are mutually exclusive. Organ Donation Including Eyes: Center for Donation and Transplant at 847-8454

Death Certification

Questions about death certification may be addressed to the Autopsy Attending or the Pathology Resident on call (847-9585). If the body is to be autopsied, the pathologist performing the autopsy will complete the death certificate.

If manner of death is anything but natural (i.e.,accident, homicide, suicide, undetermined), the case should be reported to the hospital Regional Medical Examiner (call office of Chief Medical Examiner, 1-888-552-2952, 24 hours a day). In the case of a stillborn infant, no birth or death certificate is required. Instead, fill out the yellow Department of Health form entitled Report of Fetal Death.

Viewing of the Bodies of Deceased Patient

Viewing of bodies of deceased patients is encouraged to take place on the clinical floor where the patient died. The personnel and surroundings there are familiar to the patient's family. There is also a viewing area in the autopsy facility for viewing of both hospital and Medical Examiner cases.

If the patient's body has already been transferred to the Autopsy Facility, and the family requests a viewing, call the Chaplain on call (pager 121 0369) and the Administrative Nurse Coordinator (ANC).

How to Obtain an Outpatient Autopsy Consultation: Guidelines for Fletcher Allen Physicians

Outpatients and patients that have died at affiliated hospitals may be autopsied by the Fletcher Allen Autopsy Service. This includes Emergency Room patients. No charge is made for the autopsy of these patients, either to the patient's bill, to the family or the physician. This service is offered as a courtesy to all Fletcher Allen physicians. Examples of such cases include:

1. A patient with cancer who dies outside the hospital under the Hospice Program.

2. A patient followed by you in your office practice who dies of natural causes at home, or in a nursing home.

3. Stillbirths or neonatal deaths in which the mother has been studied in the Fletcher Allen High-Risk Obstetrical Clinic.

4. Any of your patients who have been followed extensively by specialists at Fletcher Allen.

Requirements for all Outside Autopsy Cases:
All outside cases must be discussed in advance with the autopsy attending on call at Fletcher Allen. The autopsy attending may be contacted weekdays through the Anatomic Pathology Office (802-847-3566) and evenings and weekends through the Fletcher Allen switchboard (802-847-0000), Fletcher Allen Medical Records (802-847-2846) or Provider Access Service (802-847-2700 or 1-800-639-2480).

1. All outside cases must be accompanied by a signed and witnessed autopsy permission form, preferably the Fletcher Allen permit or with the essential information of the Fletcher Allen permit form.

2. All outside cases must be accompanied by appropriate clinical history (usually place, date and time of death), complete copies of the record of the present illness and summaries of previous pertinent hospitalization.

3. All bodies sent to Fletcher Allen for autopsy must be identified by a toe tag or similar method of identification, tied to the body and also on any outside wrapping.

4. All outside cases must be accompanied by a copy of the Death Certificate completed by the patient's physician, unless other arrangements are made in advance with the autopsy attending.

Autopsy Permission Forms:
Copies of the Fletcher Allen Autopsy Permission Form can be obtained from any of the clinical floors or Emergency Room of FAHC. Faxed or original copies are available during the day from the Autopsy Service (802-847-3570) and from the autopsy secretary (802-847-3566).

Transportation of Body for Autopsy:
Transportation of outside cases is usually provided by a local funeral home chosen by the patient's family or the outside hospital. Charges for transportation on these cases are borne by the family or the outside hospital. If the case is a neonate or stillborn, and the laboratory courier between hospitals is deemed appropriate, there is no charge for this transportation.

Autopsy Check List For Inside Cases:

1. Witnessed signed autopsy permit.

2. Clinical Records (copies).

3. Completed and signed Death Certificate.

4. Body Identification with toe tag.

5. Clinical Attending to contact Autopsy Attending on call.