I am often asked whether it is absolutely necessary to have an autopsy performed in order to pursue an investigation into a wrongful death claim arising from a suspicious death in a nursing home. The simple answer to this question is no, it not absolutely necessary, but it can be of significant help in determining whether abuse or neglect caused the death of a loved one.

Often the doctor who lists the cause of death of a nursing home resident will list a chronic condition, such as congestive heart failure, as the cause of death unless there has been something extraordinary that he becomes aware of prior to issuing a death certificate. This path of least resistance makes it much more difficult to prove that the death was in fact caused by a lack of proper medical care. Without an autopsy to prove otherwise, this type of case produces a long uphill battle for the family of the loved-one who has died. Studies reveal that nearly half of the listed causes of death on death certificates for older persons with chronic or multi-system disease are inaccurate. (Miles SH. Concealing accidental nursing home deaths. HEC Forum. 2002 Sep;14(3):224-34). The autopsy rate of nursing home residents is only 0.8 percent.(Katz PR, Seidel G. Nursing home autopsies. Survey of physician attitudes and practice patterns. Arch Pathol Lab Med. 1990 Feb;114(2):145-7). In reality, if an autopsy is not requested, the actual cause of death may never be known.

If there is any indication at all, that a nursing home resident may have died as the result of neglect or abuse, an autopsy should be requested. If the doctor or nurse says there is no need to notify the medical examiner, or if the medical examiner declines to do an autopsy, the next of kin should still consider having an autopsy done. Autopsies help answer questions about what really happened.

There are approximately 7000 skilled nursing facilities in the United States and about 13,000 other facilities for long-term care. The deaths of older people now occur much more frequently in nursing homes; studies have estimated that 33% of all elder deaths occur in these settings. (Ferrell B, Coyle N. Textbook of Palliative Nursing. Oxford University Press US; 2006. p. 646). If your loved-one had any of the following conditions before they died, there are questions to be answered.

Bed Sores

Over 1 million people develop bedsores in U.S. hospitals every year. Bedsores are preventable with proper nursing care. Approximately 50 percent of those affected are in a vulnerable age group of over 70. In the elderly bedsores carry a four-fold increase in the rate of death.

Malnutrition/ Dehydration

A report from the Coalition for Nursing Home Reform states that at least one-third of the nation’s 1.6 million nursing home residents may suffer from malnutrition and dehydration, which hastens their death. The report calls for adequate nursing staff to help feed patients who aren’t able to manage a food tray by themselves. This Coalition report states that malnourished residents, compared with well-nourished hospitalized nursing home residents, have a five-fold increase in mortality when they are admitted to hospital. This equates to over 100,000 premature deaths in nursing homes from malnutrition and dehydration in our nation’s nursing homes every year.

Recent Falls, or Infections.

As discussed earlier, since many nursing home patients suffer from chronic debilitating conditions, their assumed cause of death is often unquestioned by physicians. Studies within the medical field itself show that as many as 50 percent of deaths due to restraints, falls, suicide, homicide, and choking in nursing homes may be covered up. (Miles SH. Concealing accidental nursing home deaths. HEC Forum. 2002 Sep;14(3):224-34; Corey TS, Weakley-Jones B, Nichols GR. Unnatural deaths in nursing home patients. J Forensic Sci. 1992 Jan. 37(1):222-7). As I also suggested earlier, many nursing home deaths are attributed, instead, to heart disease. Researchers have found that heart disease may be over-represented in the general population as a cause of death on death certificates by 7.9 percent to 24.3 percent. In the elderly the over-reporting of heart disease as a cause of death is as much as 200 percent. (Lloyd-Jones DM, Martin DO, Larson MG, Levy D. Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med. 1998 Dec 15;129(12):1020-6).

As was said not by lawyers, but by practioners in the field of medicine, “The autopsy is the ultimate “peer review." Yet the autopsy has nearly disappeared from hospitals in the United States and around the world."…Factors that limit performance of autopsy…Medico-legal fears: Understandable concern about lawsuits is a huge deterrent to autopsy in spite of the obvious potential for educational, clinical, and research gains. (Geriatrics. 2008 December; 63(12): 14–18, The autopsy and the elderly patient in the hospital and the nursing home: Enhancing the quality of life, Leslie S. Libow, MD and Richard R. Neufeld, MD).

Simply put, if you have any question regarding the cause of your loved-one’s death while they were a resident in a nursing home, you should request an autopsy. Knowing the answer to that question will provide not only help if you are considering a cause of action against the nursing home, it will also provide peace of mind.