Final Exams

Daily News — Sunday, January 1995

For people in the death business, it's not the celebrity drug overdose or the serial killer slayings that stand out, although there have been plenty of those in Los Angeles County. The memorable cases often are of the mundane variety, unremarkable except for how the postmortem findings helped the living.

Vidal Herrera, owner of a private autopsy firm, mentions assisting on autopsies of motorcycle accident victims, research that later led to California's helmet law. David Campbell, spokesman for the Los Angeles County Department of Coroner, remembers a child who choked on a brand of candy that had been recalled by the U.S. Food and Drug Administration. Many parents and stores were unaware of the recall until the coroner issued a public service announcement.

Whether it's unlocking information about an infectious disease or designing seat belts in cars, the autopsy has played a critical role in public health and safety. The autopsy as a tool in criminal investigation has long been central to such popular television shows as “Qunicy, M.E.” and “CSI: Crime Scene Investigation.” Even HBO's reality program “Autopsy” allows the public a glimpse into the morgue. Yet for all the public fascination with the postmortem examination, experts in the study of disease worry that the routine autopsy is dying.

About 2.4 million American die each year, 65,000 of them in Los Angeles County. Only violent, unusual and unattended deaths are sent to the L.A. County Department of Coroner, which performs about 7,000 autopsies annually. The remaining deaths aren't likely to be autopsied, despite the fact that health information valuable to families and medical research can be gleaned from a final exam.

In 1970, hospitals conducted routine autopsies on about half of all deaths. Today, the national average has fallen to less than 6 percent, according to a 2003 report by the Agency for Healthcare Research and Quality.

“We've got such good CT scans, MRIs, that people think we can find anything before death,” days Dr. Kim Collins, professor of pathology and laboratory medicine at the Medical University of South Carolina in Charleston and a chair of the College of American Pathologists' autopsy committee. Still, you learn so much from an autopsy that you can't glean before the person dies.”

Experts cite numerous reasons for the decline in routine autopsies, including fear of litigation and a managed care system focused on reducing costs. Also, many doctors graduate from medical school these days without ever attending an autopsy, which makes them less familiar with all of the benefits, Collins says.

The AHRQ report estimated discrepancies between the suspected cause of death and autopsy findings in up to 23 percent of cases. Identifying the correct cause of death is important, since death certificate data influences what gets funded for medical research. At an individual level, autopsies can uncover infectious and inheritable diseases, improving the odds of treatment and prevention for family members. Autopsies also can provide information that families need to file insurance and legal claims.

With a few hospitals providing autopsies, families in need to answers have little choice but to hire private companies. Herrera, founder of 1-800-Autopsy, which is based in La Crescenta, like to joke that death is a “recession-proof business.” The demand for private autopsy services is only going to increase as baby boomers age, he says.

On a recent morning, Herrera, a burly man with a graying goatee, sat on a tall rolling stool next to a stainless steel autopsy table at VA West Los Angeles Healthcare Center. Rows of glass jars lined the counter. Each contained a human brain cut into cross sections like a loaf of bread. As an autopsy technician, Herrera dissects bodies and removes organs. He also teaches dissection techniques to the medical center's pathology residents.

“This is where it all started,” says Herrera of his business.

A former investigator with the county coroner's office, Herrera suffered a back injury while lifting a body and had to retire in 1984. The man dubbed “El Muerto” by law enforcement colleagues could no longer lift more than 11 pounds and had restrictions on how long he could sit or stand. He couldn't find work for four years.

Then in 1988, the VA medical center wanted to hire him as an autopsy technician and made him a vendor, meaning he worked on an as-needed basis. Herrera figured out ways to work around his back problems. He doesn't lift bodies. And instead of standing at the autopsy table, he scoots around on stool. Soon other hospitals and funeral homes wanted to use his services and 1-800-Autopsy was born.

Since Herrera isn't a medical doctor, the business works as a referral service. If the autopsy request comes from a family or funeral home, Herrera arranges for a pathologist to conduct the autopsy. The average private autopsy costs $3250. Herrera serves as the autopsy technician and provides the supplies needed to collect the tissue.

Families often call because they suspect a problem, like medical malpractice or nursing home neglect. Whether or not the examination confirms their suspicions, the autopsy can give the families a sense of closure, Herrera says.

“We're here to tell them the truth,” he says “It motivates me because there are answers there. There is a way to help society.”

Even with an autopsy, some mysteries still go to the grave. One of the more confounding cases in Campbell's time at the county coroner's office involved a man who died on Halloween after taking his daughter trick-or-treating. One minute the man was home watching television and eating candy with his daughter. The next minute he was dead.

“We did an autopsy, toxicology, tested the candy — we did everything we could imagine at the time,” Campbell says.

The final ruling? A natural death of undetermined cause.