Is the autopsy report public record? That was a question I had at the beginning of this project, but didn’t research that intensively. Here’s a little more of the low down:
Autopsy reports are generally public records. There are exceptions for (1) deaths from natural causes not referred to the coroner and (2) reports pertaining to criminal litigation, and others as directed by court order or subpoena.
California law bars the copying of photographs taken for the coroner at the death scene. They are available for use only in a criminal action or proceeding that relates to the deceased, or as a court permits. So getting the photographs that accompanied Patty Vance’s medical examiner’s report is out of the question. I can’t say if photographs exist. They should. And probably it’s for the best that I don’t see them.
Most states exempt from disclosure law enforcement investigatory records. And often the autopsy report is considered one of these records. Just as it is considered a medical record in some states, which precludes it from being public information and is governed by privacy laws.
Whether a particular document can be withheld under this exemption in a particular state will depend on the circumstances. In addition, the scope of the investigatory records exception varies among the states. Some of the variations include whether the exemption:
1. is limited to active investigations or prosecutions (such as in Louisiana, La. Rev. Stat. Ann. § 44:19);
2. gives law enforcement agencies discretion to release investigatory records (such as in Mississippi, Miss. Code § 25-61-12) or entirely prohibits their disclosure (such as in Vermont, 1 Vt. Stat. § 317); or
3. restricts access only when certain factors exist, such as when disclosure would (a) interfere with enforcement proceedings; (b) constitute an unwarranted invasion of a suspect’s, defendant’s, victim’s, or witness’s personal privacy; (c) deprive someone of a fair trial; (d) disclose a confidential source or investigative technique; or (e) endanger the life or physical safety of law enforcement personnel (for examples, see laws in Alaska, Idaho, Illinois, and Kansas (Alaska Stat. § 40.25.120, Idaho Code §§ 9-340B(1) and 9-335, 5 ILCS 140 § 7(1), and KSA § 45-221(a)).
Some states also have statutes prohibiting disclosure of a record when disclosure would invade a person’s privacy. For example, Hawaii, Illinois, and Kansas prohibit disclosure of records that would constitute a clearly unwarranted invasion of personal privacy, and Kentucky law requires a court order before disclosing a record that would constitute a clearly unwarranted invasion of personal privacy (Haw. Rev. Stat. § 92F-13(3), 5 ILCS 140 § 7 (1)(b), KSA § 45-221(a), and Ky. Rev. Stat. § 61.878(1)(a)).
Other provisions may be relevant to whether these records can be disclosed in some states. For example, Washington prohibits disclosing information revealing a victim’s identity, without the victim’s authorization, if it would endanger a person’s life, safety, or property, and Florida prohibits disclosure of information containing a person’s confession until completion of the person’s criminal case (RCW § 42.56.240 and Fl. Stat. § 119.07).
Are autopsy reports available to the public? The cause and manner of death is a matter of public record and can be released, unless release of such information will hinder or harm an ongoing criminal investigation [Iowa Code 22.7(41)]. The remainder of the information contained within an autopsy report is confidential and treated as a medical record.
Obtaining California Autopsy Reports. … The pathologist then prepares a written autopsy report. An autopsy report is public record in California unless it is deemed to be confidential under public-records exemptions because it is being used in a pending criminal case.
What’s in a coroner’s report vs. autopsy report?
A coroner’s report is the report produced further to an investigation by a coroner identifying the deceased person, the date and place of death, and the causes and circumstances of death.
A coroner’s report is the report produced further to an investigation by a coroner identifying the deceased person, the date and place of death, and the causes and circumstances of death. In some cases, the report may also contain recommendations aimed at preventing similar deaths. This document is public and available to anyone who requests it.
Autopsy reports are appended to the coroner’s report. Other appended documents include the toxicology report, the medical record and the police report. Coroners use these documents to produce their reports. Access to these appendices is restricted and is allowed only if applicants can show that the requested document will be used to uphold their rights.
An Overview of Death Investigation
At all death scenes there are two scenes: location(s) of the incident and the body itself. If a crime is suspected, the incident will belong to the investigating law enforcement agency; and the body, together with all items on or about it, will belong to the medical examiner’s office. The agencies will work independently of each other with overlapping goals. The death investigator has certain responsibilities and a duty to pursue those responsibilities. The body is exclusively under the custody and control of the death investigator. Until they arrive on scene, no other person can touch, move, or remove the body or those items on or about it. The assessment includes complete photography, documenting wounds and injuries, or lack thereof, rigor and livor mortis, body position and relationship to the scene, and condition of the body due to postmortem interval and environment. If the body has been moved, possibly to a remote area, there will be another crime scene at the place the death actually occurred.
Medical records are a very important component of a death investigation and may be referred to in the autopsy report. In addition to medical history, these records may include mental health history, prescription and medication history, family history, and social history. It is important for the medical history to be shared with the forensic pathologist at the time of autopsy or as soon thereafter as possible. What might be seen as a fall and head injury at autopsy may instead be a spontaneous bleed with previous history and consequential falls.
Autopsies are valuable and are a component of a complete investigation, if one is performed. All violent, suspicious, unnatural, and unattended deaths are investigated (these account for a small percentage of reported deaths). A preliminary investigation, statute, and protocol will dictate if an autopsy is performed. The authorization of the autopsy depends on the circumstances of the death and the protocol of the medical examiner’s office. The autopsy consists of the gross external examination (detailed examination and documentation of the body), gross internal examination (detailed examination and documentation of the organs and internal body structure), toxicology tests, and microscopic examinations. The external examination is head to toe and includes measurements of all wounds, scars, marks, tattoos, and condition of the body and structure.
The internal examination is what is often thought of when “autopsy” is mentioned. This surgical procedure includes the in situ examination of the organs, removal of them with weights, and complete external/internal examination of the organs. This examination also includes the assessment of bullet trajectory, wound tracts, ligature markings, etc. One area of specific forensic pathologist training is wound (all injuries and trauma) examination. Specimens of each organ are collected for microscopic examination, part of the anatomical and clinical certifications preceding a pathologist’s forensic certification. At the conclusion of the autopsy the functions of the forensic pathologist and death investigator temporarily separate into two different tasks. The death investigator will submit his report, detailing the findings of his scene investigation, evidence review, and medical records review. The forensic pathologist will review the death investigator’s report and case file to finalize his autopsy report and certify the Cause and Manner of Death.
Autopsy reports are not casual or interesting reading material. They are very informative when reviewed with all concurrent investigative reports and evidence. All autopsy reports follow a general format as approved by the National Association of Medical Examiners (thename.org). Although they may differ in appearance, the general content format consists of: Diagnoses, Toxicology, Opinion, Circumstances of Death, Identification of the Decedent, General Description of Clothing and Personal Effects, Evidence of Medical Intervention, External Examination, External Evidence of Injury, Internal Examination, Samples Obtained – Evidence, Histology and Toxicology, and Microscopic Examination. When the autopsy report is reviewed by the lay person their focus is on the first four items, as these are the summary of the remaining medical details of the report. It is important to review the report and all of the information contained therein for the complete picture. It is also important to understand what is in an autopsy report before we can begin to decipher all the latent and patent information it contains.
Circumstances of Death
This section consists of one to two paragraphs briefly describing the perimortem circumstances as known at the time of autopsy. Autopsies are often performed within 24–48 hours of discovering the body, with the full medicolegal and law enforcement investigation ongoing, medical records have likely not yet been received or reviewed. This narrative is important because it summarizes initial investigative findings and hearsay reports of witnesses, it also includes evidence found at the scene, such as: projectiles, syringes, paraphernalia, disarray of the scene, vomitous, etc.
Death certificates and autopsy reports contain personal identifying information and clinical information protected under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. These documents are used, for example, by the families of the deceased for settling estates, bereavement and closure, and genetic counseling of relatives. Insurance companies, public health and law enforcement officials, and the legal community also have legitimate claims to this information. Critical ethical questions have not yet been settled about whether and when this information should be public and under which circumstances making this kind of information public incurs benefits, harms, or both. Additional considerations include which organizations—the media, academic institutions, or government agencies, for example—are best suited to interpret these questions and respond to them.
Legally, ethically, and clinically relevant, however, is that MEs and coroners are not “covered entities” under HIPAA. To be clear, all MEs are forensic pathologists in appointed positions, while coroners are elected officials. State-to-state variations abound: sixteen states do not have laws requiring coroners to have specific training requirements, and four states require them to be physicians though not necessarily pathologists .
AMA Journal of Ethics:
For example, in some states (e.g., Kentucky ), if a death is determined to be a coroner’s case, an ME or coroner has the authority to order an autopsy without obtaining consent from the deceased person’s survivors and to release information about the cause and manner of that person’s death to the public. Is this ethically appropriate, particularly considering the legal, ethical, and professional standards that typically apply to patients’ rights to have their PHI protected? Which protections should be afforded to the deceased and to a deceased person’s loved ones? How much value should be attributed to survivors’ distress?