Attitudes Towards Forensic Autopsy Standard B3.7 and the Use ofPhysician Extenders in Select Autopsy Cases

摘要

Studies have demonstrated that autopsy is the gold standard for determining causeand manner of death. Indeed, the current National Association of MedicalExaminers standard B3.7 states that a forensic pathologist (FP) shall perform aforensic autopsy when the death is by apparent intoxication by alcohol, drugs,or poison. Unfortunately, the recent increase in drug-related deaths has led tosome question about the feasibility of maintaining compliance with standardB3.7. We constructed a voluntary survey to address consensus on standard B3.7and the use of supervised accredited pathologists’ assistants (PAs) inperforming select medicolegal autopsies. Additional questions were included tohelp characterize variables related to FP’s workload and experience. Each ofthese variables was predicted to influence FP’s attitudes toward B3.7 and theuse of PAs. Our respondent pool (n = 107) consisted primarily of activelypracticing FPs with administrative responsibilities (42%) and activelypracticing FPs without administrative responsibilities (41%). Sixty-five percentagreed that standard B3.7 is appropriate. Opinion on the use of PAs was splitbetween those who agreed (45%) and those who did not (44%). Tendency to agreewith either B3.7 or the use of PAs was not a function of FP’s individual oroffice workload; however, respondents were more likely to agree with B3.7 ifthey previously experienced a case where internal autopsy findings radicallyaltered diagnosis in an otherwise suggestive overdose case (P < 0.001). Incertain offices and under certain conditions, the use of PAs may be one solutionto ensuring all potential overdose deaths receive an autopsy.