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GUY RAZ, HOST:

For the past year, ProPublica, PBS "Frontline" and NPR have probed America's deeply flawed system of death investigation. Today, we bring you a story about the decline in hospital autopsies. A half-century ago, autopsies were an integral part of American health care, performed on roughly half of all patients who died in hospitals.

But as ProPublica's Habiba Nosheen reports, today, autopsies are only conducted in roughly 5 percent of patients. And experts say that's a troubling trend.

HABIBA NOSHEEN, BYLINE: Jeffrey Schaler's voice echoes through the large speakers inside a historic church in Baltimore. Dressed in a black suit, Schaler stands under the stained-glass windows in front of an audience of 100 or so, to pay tribute to his wife.

(SOUNDBITE OF MEMORIAL SERVICE)

DR. JEFFREY SCHALER: Thank you all for coming here today. If Renee were alive right now and could see what her friends and colleagues have done and feel towards her, she would surely be in tears long before I finish this sentence.

NOSHEEN: Renee Royak-Schaler was a 64-year-old professor, and a cancer researcher. As her husband shares at her memorial, last May, she unexpectedly collapsed and was rushed to the hospital, where she died.

(SOUNDBITE OF MEMORIAL SERVICE)

SCHALER: Renee died from a pulmonary embolism. The only reason we know this now is because her friends and colleagues here at the University of Maryland School of Medicine paid for, and conducted, an autopsy.

NOSHEEN: The autopsy showed that cancer was all over her body, and had caused the pulmonary embolism.

SCHALER: Not knowing, to me, has always been worse than knowing the truth, and we know the truth, which is what happened as a result of the autopsy. Even though that's still painful, there's a sense of peace.

NOSHEEN: But federal records show that few Americans receive that sense of peace when a loved one dies at a hospital. Currently, American hospitals have no obligation to provide an autopsy when a patient dies. If there is evidence of foul play or suspicious circumstances, a government-assigned coroner or a medical examiner may review the case, but they rarely intervene in hospital deaths.

DR. GEORGE LUNDBERG: My name is Dr. George Lundberg. I am a pathologist. Autopsies used to be the standard in hospitals. They've gone down so far now that there are large numbers of hospitals that do almost no autopsies at all.

NOSHEEN: Hospital autopsies used to be mandated by the Joint Commission, an agency that works on the government's behalf to accredit hospitals in the U.S. Until 1971, hospitals had to autopsy at least 20 percent of the patients who died in their care. But they're no longer required to meet a quota. Dr. Lundberg puts it this way.

LUNDBERG: The people who pay the bills say, well, why would I want to pay money for an autopsy on a patient who's already dead? I mean, my money is supposed to be spent on people while they're alive.

NOSHEEN: Health insurance companies don't pay for autopsies because they say they pay for the care for the living patient, not the dead. Families can opt to pay for an autopsy out of pocket, but that can be expensive. Besides providing closure to the families, there is another reason why autopsies might be important. Studies show that doctors make diagnostic errors in about 25 percent of cases. And without autopsies, the errors remain unknown.

According to Dr. Lundberg, that has broad implication for public health in America.

LUNDBERG: Death certificates are used all the time to establish what the leading causes of death are. This is kind of the benchmark for how one develops a public health agenda, and a spending agenda.

NOSHEEN: Robert Anderson manages the mortality statistics for the Center for Disease Control and Prevention, the CDC. Anderson says flawed information about the ways Americans are dying on death certificate may be leading officials to allocate medical research dollars in the wrong way.

ROBERT ANDERSON: You put inaccurate information, you know, into the statistics, you're going to get bad statistics. So you put garbage in, you're going to get garbage out.

NOSHEEN: Some experts say that to reverse this troubling trend, the Joint Commission needs to go back to mandating a minimum rate of autopsies. But that's not likely to happen anytime soon.

DR. PAUL SCHYVE: No, we're not taking any action at this point to try to increase the number of autopsies.

NOSHEEN: That's Dr. Paul Schyve. He heads up the quality program for the Joint Commission, which accredits hospitals.

SCHYVE: If we had unlimited resources, then it would be a different picture. But we all know we don't.

NOSHEEN: Dr. Schyve says technology may be the answer.

SCHYVE: Particularly in recent years, there has been a big advancement in the type of diagnostic capabilities that people have, to be able to diagnose and understand what's going on inside a patient without the autopsy.

NOSHEEN: But experts like Dr. Lundberg don't agree, and say that even with the advancement in technology, sometimes errors in medicine can only be learned on the autopsy table.

For NPR News, I'm Habiba Nosheen.

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