Where have all the autopsies gone? A proposal for a centralized autopsy service.

A litany of reasons have been advanced to account for the decrease in hospital autopsy rates. Increased attention has recently been centered on the difficulty hospital and medical examiner morgues are encountering in controlling infectious disease and attempting to comply with federal and state environmental regulatory agencies. The problem has been highlighted by autopsy examinations upon increased numbers of immuno-compromised patients harboring both the HIV and secondary drug resistant tuberculosis organisms. These developments occur at a time when there are budgetary restraints on hospitals and medical examiners' offices facing large expenditures involving morgue reconstruction to comply with ventilatory and infection control procedures mandated by state and federal agencies. Challenging, also, are the liability aspects, as patients and staff are potentially exposed to a variety of infectious agents. A possible solution is presented involving central off-hospital site facilities to which hospital autopsies can be funneled. A community morgue meeting the strict standards of infection control would allow economy of scale from daily use with a full time support staff trained in the protocol of infectious disease control.