Doctors Say More Autopsies Needed Coroner Says Pathologists Just Trying To Earn More

Spokane County’s coroner and the doctors who perform most of his autopsies are at it again, this time over how often autopsies are conducted.

The pathologists say Coroner Dexter Amend is ordering far fewer autopsies than needed, a complaint Amend insists is a ploy for more income.

Meanwhile, Pathology Associates Inc. has raised its autopsy fee to help make up the difference.

Since Amend, 74, took office in January, the number of autopsies has dropped dramatically.

The retired urologist even has refused to order autopsies requested by homicide detectives.

“There will be death certificates signed that are not accurate because the true cause of death has not been determined,” warned Larry Hatch, president of Pathology Associates.

The coroner and pathologists already are on shaky ground. The doctors occupy office space at the county morgue at Holy Family Hospital - space Amend wants for his own. Last week, Amend publicly complained he can’t even get a key to the morgue.

Amend called the latest dispute over autopsies “a bunch of baloney.”

“I’m not going to do an autopsy when it’s not necessary just to get in a minimum number of what (pathologists) think it ought to be,” he said. “The taxpayer pays for autopsies.”

Before Amend took office, doctors performed 254 autopsies in 1994. In the first half of this year, autopsies have been performed in 82 of 1,968 deaths - a rate of about 4 percent.

There is no state standard for autopsies. But Donald Reay, King County’s chief medical examiner, says he conducts autopsies in about 10 percent of all deaths, a common rate in metropolitan areas.

Autopsies in Spokane County are performed in all obvious homicides and sudden infant death syndrome cases, Amend said. He includes young people who die without an obvious cause, accidents involving more than one person and, often, people who die in institutions, such as hospitals.

But Spokane police Lt. Jerry Oien said he has “serious, serious questions” about how cases are being chosen for autopsy.

Amend has denied homicide detectives three autopsies they requested “so we can feel comfortable foul play wasn’t involved,” Oien said.

In one case, a man was found dead in his home a day or two after friends said he had hit his head on a sidewalk while drunk, Oien said. The friends told investigators they took the man home and put him to bed after he had fallen, Oien said, but detectives wanted an autopsy to rule out foul play.

Without proper autopsies, the county may someday find itself embroiled in lawsuits when disputes arise over cause of death, said Hatch.

The average cost of an autopsy is about $1,000, said Hatch. He notified Amend of a 5 percent fee increase in a June 30 memorandum.

The increase, Hatch said Thursday, is partly designed to make up for the drop in income because of fewer autopsies.

While Amend called the increase “unrealistic,” County Commissioner Phil Harris said the first increase since 1992 is probably justified.

Harris wasn’t so sure about the pathologists’ complaints about the drop in autopsies.

“If they know that much about what the coroner should do,” he said, “maybe they should run for coroner.”

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