A Public Death: Six Reasons for Access to Death Certificates and Autopsies
I am lobbying the Association of Health Care Journalists to help me make the case that death certificates and autopsies are important public records that should not be hidden by state or federal laws. I first made my case to members of the AHCJ Right to Know Committee at the organization’s annual conference in Atlanta in April. Then the committee’s co-chair, accomplished health writer Irene Wielawski, asked me to explain why access to these records would have a public benefit. The first part of what I told her – the case to for public access – is below. The second part – how journalists can make that case – will run Friday.
Context: Different states – and different counties – have different rules about who can see and access death certificates or an autopsies. For example, Alaska, New York, Tennessee and Virginia bar death record access to all but a few people (family members and lawyers mainly). By contrast, in Massachusetts, North Carolina and Wisconsin, death certificates are publicly available. The desire to keep the circumstances of a death private is understandable, and many states have codified the concept of death being a “family matter” into their state code – except when there is a crime. But these same states make exceptions for insurance companies, scientists, creditors, physicians and a host of others. Reporters – and the rest of the general public – remain barred from seeing them.
Why it matters: Reporters who have been able to gain access to death and autopsy records have written stories about, among other things, medical errors, patient safety, painkiller abuse, physician discipline, infectious diseases and the trade in human body parts. Many of these stories have led to changes in laws and policies that have had a tangible public benefit. They have put dangerous physicians out of business, and they have opened to public scrutiny harmful and unethical health practices. There is no easy way to determine exactly how many lives have been saved because of stories like these, but consider that one physician alone who had his license taken away because of stories that relied on death certificates and autopsies was found responsible for the deaths of two patients, including an infant.
The challenge: Health writers have to show how public access to death certificates and autopsy reports could lead to a broader public benefit. They also need to document how they are being prevented from writing these important stories that could have a public health impact. Why should private lives segue into public deaths? Here are six reasons:
1. To identify patterns of medical errors and establish best practices to reduce them. Andy Rooney died and the only information that was provided by doctors following his death was: “serious complications following minor surgery.” When Congressman John Murtha died, the public was told he died from “complications of surgery.” In both cases, medical errors were likely an issue. Had Rooney and Murtha died in states that allow access to death certificates and autopsies, the public would be able to know more about exactly what led to their deaths. Michael Millenson at Forbes wrote about how reporting on Rooney’s death could be used to highlight that 12 years after the Institute of Medicine’s “Do No Harm” report, there are still too many medical errors, in part because of “the cult of secrecy that keeps on killing patients.”
2. To track healthcare-associated infections and help health care facilities – and patients – take steps to protect themselves. Seattle Times reporters Michael Berens and Ken Armstrong – 2012 Pulitzer winners – wrote one of the first comprehensive investigations of the MRSA epidemic in 2008. It relied heavily on death certificates and it found that, “Over the past decade, the number of Washington hospital patients infected with a frightening, antibiotic-resistant germ called MRSA has skyrocketed from 141 a year to 4,723. These numbers don't appear in public documents. Washington regulators don't track the germ or its victims, and Washington hospitals do not have to reveal infection rates.” The stories prompted a new state law that passed the typically divisive state legislature unanimously and required that hospitals screen high-risk patients for MRSA.
3. To assess the effectiveness of law enforcement and other public safety systems. Levi Duclos, 19, died while hiking. His family thinks he might have been saved had Vermont State Police launched a search when the family first called 911. Instead, they said their policy was to wait until the next morning. Duclos was found dead, killed by hypothermia. Duclos’ death certificate, which is a public record in Vermont, establishes this fact. It also shows that he had no other injuries. He did not fall and suffer a brain injury. He was not found drowned in a nearby stream. He likely died because he became too cold and that leads directly to the question of whether he could have been saved by an earlier search. But, in Vermont, autopsy records are not public, so reporters and watchdogs are not allowed to independently review the actions of the Vermont State Police. Death certificates and autopsy reports also can be crucial for checking the accuracy of claims made by police to justify a shooting death, sometimes referred to as “suicide by cop.”
5. To expose flaws in physician oversight. Freelancer journalist Lawrence Smith has written extensively about the misdeeds of Dr. Jack Mark Levine. After allegations of sexual misconduct and medical errors over three decades, Levine lost his license to practice medicine in Ohio, Illinois and West Virginia. He was the target of malpractice suits from multiple patients that resulted in, by his own admission, $1.2 million in payments between 1991 and 2000. But his paper trail disappears in West Virginia because death certificates in some counties are not a public record.
I used death certificates and autopsy reports to write about lax physician oversight by the Medical Board of California. The stories led to new state laws that sped up the process for handling patient complaints, added members of the public to the medical board and ended a secret program that allowed doctors with drug addictions to retain their licenses. When one of the doctors I featured regained his license, I used autopsy records to explain how the doctor had negligently caused another patient death. The doctor’s license was taken away again.
6. To uncover abuses in nursing homes. Robin Erb of the Detroit Free Press used death certificates and autopsies – which are a public record in Michigan – to write about dangerous conditions in nursing homes that led to the deaths of patients. Erb also was able to show that nursing home staff frequently failed to report suspicious deaths to the county medical examiner. “Sometimes, a death that was caused, or most likely was caused, by staff oversights and blunders wasn’t reported to the county medical examiner at all,” Erb said.
Next: What reporters can do to show the benefits of public access
Image by Steven Damron via Flickr