Autopsies Dying in cash-strapped U.S.

By Sandra Bartlett, NPR website, February 5, 2011
Many underfunded and understaffed medical examiner and coroner offices have stopped doing autopsies in some categories of deaths. In some states suicides are not autopsied, in others people who die in car accidents, and many jurisdictions have stopped performing autopsies on people over the age of 60 unless it is an obvious violent death. In Oklahoma, for example, they lower the age limit to 40.

An investigation by NPR, PBS Frontline and ProPublica found concerns among law enforcement and health care professionals over the trend to assume the elderly always die of natural causes. They fear there's a quiet epidemic of what they call "gray homicides" going undetected and unpunished.
When 80-year-old Elmore Kittower died while living at Silverado it was assumed he died of natural causes and no one asked for an autopsy. Silverado is one of the nation's most high-end homes for dementia patients, located 90 minutes outside Los Angeles. Patients pay $7,000 per month for a semi-private room there.
But the day after Kittower was buried, his widow received an anonymous call from someone who worked at Silverado, saying her husband's death was likely caused by a staff member who beat him.
The police were called, and according to Los Angeles Deputy District Attorney Robin Allen, the anonymous caller provided enough information to warrant exhuming the body and performing an autopsy.
"When I read the coroner's report, I knew we had a serious case here," Allen says. "I knew that I had somebody, Mr. Kittower, who had suffered horrific abuse. He had multiple rib fractures at different stages of healing. He had a sternal fracture. He had a fracture to his larynx, to his toes."
Yet when the sheriff's office and paramedics first arrived at Silverado, they didn't consider any foul play.
"There are just assumptions, I think, that people sometimes wrongfully make about the elderly — that they're always going to have bruising, they're always going to fall," Allen says.
But Kittower was bedridden from a stroke, so it's unlikely his injuries were caused by bumping into things or falling.
Craig Harvey, the chief death investigator for the Los Angeles County Coroner's Office, says they can't investigate deaths if they aren't alerted to them. In the case of a home like Silverado, it would be up to a doctor or ambulance staff to call the coroner.
"There's no way that we can look at every case we should probably be looking at," Harvey says. "When you only see 1 in every 3 cases, the possibility that a homicide's going to be missed are pretty great."
Harvey says the suspicion that homicides of the elderly were being missed prompted the county to put together a team to review deaths. The team includes the coroner's office, law enforcement, social services and a geriatrician.
Unlike what you see on CSI, many suspicious deaths aren't properly investigated.
Allen says once the team started looking they found a lot of elderly people dying under suspicious circumstances.
"I normally have at least 15 active cases on my caseload at any time," she says. "It is amazing how many more cases we had than when I entered this unit five years ago. ... The level of seriousness and complexity of the cases has taken on an additional dimension as well."
Allen says it is hard to prove murder or neglect in the elderly because they have many medical problems. But she says that doesn't mean coroners and medical examiners should simply stop doing autopsies on older people.
In the investigation into Kittower's death, Allen says she had a lot of evidence showing caregiver Cesar Ulloa had beaten and abused him.
"Because [Kittower] had a blood clot dislodge and that wound up killing him, we couldn't say to a medical certainty ... that the physical violence that he had suffered shortly before his death caused the clot to dislodge," she said. "I realized that we really weren't going to be able to charge a homicide."
But the more she thought about Kittower and what he had suffered, she decided to charge Ulloa with torture. A jury agreed that's what happened to Kittower and four other residents. Ulloa was sentenced to life in prison.
With autopsies falling into the proverbial ditch, simply because of the fiscal blight that attends every U.S. city, county and state government, what is the future of human life in the U.S.?
With the availability of weapons, the increasing hunger among the increasing number of unemployed, the rising costs of post-secondary education, and the inability (unwillingness) to fund what we have come to consider normal municipal and governmental expenses like autopsies, what kind of society is the U.S. going to be looking at over the next few decades?
Certainly, it is not a society in which many of us would choose as a place to call 'home.'
Especially vulnerable to this blatant societal 'sin of omission' are the elderly, about whom there are already too many untrue stereotypes, based, unfortunately on false assumptions.
Now, if our deaths are not even going to be investigated in many U.S. states, how long will it be before even our lives won't matter, as well as our deaths?