SB 1189: Postmortem examinations or autopsies: forensic pathologists.
- Session Year: 2015-2016
- House: Senate
- Latest Version Date: 2016-09-28
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains. Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would authorize trained county personnel who are necessary to the performance of an autopsy to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent at the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner or medical examiner to consult with the licensed physician and surgeon in the determination of the manner of death. The bill would require the coroner to conduct an evaluation pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
The bill would require, for health and safety purposes, that all persons in the autopsy suite be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains. Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would authorize trained county personnel who are necessary to the performance of an autopsy to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent at the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner or medical examiner to consult with the licensed physician and surgeon in the determination of the manner of death. The bill would require the coroner to conduct an evaluation pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
The bill would require, for health and safety purposes, that all persons in the autopsy suite be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains. Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of Public Health Care Services in any case where an infant has died suddenly and unexpectedly.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would authorize trained county personnel who are necessary to the performance of an autopsy to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent at the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner or medical examiner to consult with the licensed physician and surgeon in the determination of the manner of death. The bill would require the coroner to conduct an evaluation pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
The bill would require, for health and safety purposes, that all persons in the autopsy suite be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains. Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of Health Care Services in any case where an infant has died suddenly and unexpectedly.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner to consult with the licensed physician and surgeon in the determination of the manner of death. The bill would require the coroner to conduct an evaluation pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.
The bill would require, for health and safety purposes, that all persons in the autopsy suite be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy and the cause and manner of death be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner to consult with the licensed physician and surgeon in the determination of the manner of death.
The bill would require, for health and safety purposes, that all persons in the autopsy suite have current bloodborne pathogen training be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would provide that police and other law enforcement personnel who have completed the specified training may require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite at the discretion of the forensic pathologist, but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved with the care and custody in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a postmortem examination or autopsy, as specified, forensic autopsy and the cause and manner of death be determined by a licensed physician and surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology. surgeon.
This bill would also require blood and urine specimens collected from a patient at the time of admission to a hospital, if the patient is admitted under specified circumstances, to be retained until the patient is discharged from the hospital. The bill would require the specimens to be released to the coroner if the patient dies prior to discharge.
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The bill would require, for health and safety purposes, that all persons in the autopsy suite have current bloodborne pathogen training and personal protective equipment, as specified. The bill would provide that police and other law enforcement personnel who have completed the specified training may be allowed into the autopsy suite at the discretion of the forensic pathologist, but would prohibit law enforcement personnel directly involved with the care and custody of an individual who died incident to due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined.
This
The bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This
The bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that the results of a postmortem examination or autopsy, as specified, and the cause and manner of death be determined by a licensed physician and surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology.
This bill would also require blood and urine specimens collected from a patient at the time of admission to a hospital, if the patient is admitted under specified circumstances, to be retained until the patient is discharged from the hospital. The bill would require the specimens to be released to the coroner if the patient dies prior to discharge.
This bill would require, for health and safety purposes, that all persons in the autopsy suite have current bloodborne pathogen training and personal protective equipment, as specified. The bill would provide that police and other law enforcement personnel who have completed the specified training may be allowed into the autopsy suite at the discretion of the forensic pathologist, but would prohibit law enforcement personnel directly involved with the care and custody of an individual who died incident to law enforcement activity from being inside the autopsy suite during the performance of the autopsy.
This bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a coroner conducting a postmortem examination or autopsy on conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that the results of a postmortem examination or autopsy conducted by a coroner or deputy coroner be subject to review and signed approval by a licensed physician and surgeon who is duly qualified as a specialist in pathology. If the coroner and pathologist disagree about a cause of death, this bill would require that the cause of death be subject to review and signed approval by a separate qualified pathologist. This bill would authorize a coroner who is a qualified pathologist to review and approve his or her own postmortem examination or autopsy. By imposing additional duties upon local officials, this bill would create a state-mandated local program. autopsy, as specified, and the cause and manner of death be determined by a licensed physician and surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology.
This bill would also require blood and urine specimens collected from a patient at the time of admission to a hospital, if the patient is admitted under specified circumstances, to be retained until the patient is discharged from the hospital. The bill would require the specimens to be released to the coroner if the patient dies prior to discharge.
This bill would require, for health and safety purposes, that all persons in the autopsy suite have current bloodborne pathogen training and personal protective equipment, as specified. The bill would provide that police and other law enforcement personnel who have completed the specified training may be allowed into the autopsy suite at the discretion of the forensic pathologist, but would prohibit law enforcement personnel directly involved with the care and custody of an individual who died incident to law enforcement activity from being inside the autopsy suite during the performance of the autopsy.
This bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a coroner conducting a postmortem examination or autopsy on an unidentified body or human remains.
Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.
This bill would require that the results of a postmortem examination or autopsy conducted by a coroner or deputy coroner be subject to review and signed approval by a licensed physician and surgeon who is duly qualified as a specialist in pathology. If the coroner and pathologist disagree about a cause of death, this bill would require that the cause of death be subject to review and signed approval by a separate qualified pathologist. This bill would authorize a coroner who is a qualified pathologist to review and approve his or her own postmortem examination or autopsy. By imposing additional duties upon local officials, this bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. Only individuals who are directly involved in the investigation of the death of the decedent may be present during the performance of the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome, also referred to as SIDS, is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that the public interest is served by research and study of sudden infant death syndrome and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours or as soon thereafter as feasible, cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Public Health. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code.
(e)The protocol shall be followed by all coroners throughout the state when conducting an evaluation as part of an autopsy required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the coroners findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples shall be provided to a central tissue repository designated by the State Department of Public Health.
(f)The State Department of Public Health shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i) Consent of any person is not required before undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other law, except as otherwise provided in this section, in any case in which the coroner, before the beginning of an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall neither perform, nor order the performance of, that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the coroner shall not order an autopsy to be performed, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy, the coroner may cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other law, the coroner may, in the course of an autopsy, authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a licensed physician and surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a forensic autopsy shall only be determined by a licensed physician and surgeon.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause of death is determined. At the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon, trained county personnel who are necessary to the performance of an autopsy may take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For purposes of this section, the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner or medical examiner shall consult with the licensed physician and surgeon in the determination of the manner of death.
(e)For health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(f)(1)Only individuals who are directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
(2)If an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved in the death of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(3)Notwithstanding paragraph (1), individuals may be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy.
(g)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
(h)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. Only individuals who are directly involved in the investigation of the death of the decedent may be present during the performance of the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome, also referred to as SIDS, is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that the public interest is served by research and study of sudden infant death syndrome and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours or as soon thereafter as feasible, cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Public Health. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code.
(e)The protocol shall be followed by all coroners throughout the state when conducting an evaluation as part of an autopsy required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the coroners findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples shall be provided to a central tissue repository designated by the State Department of Public Health.
(f)The State Department of Public Health shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i) Consent of any person is not required before undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other law, except as otherwise provided in this section, in any case in which the coroner, before the beginning of an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall neither perform, nor order the performance of, that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the coroner shall not order an autopsy to be performed, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy, the coroner may cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other law, the coroner may, in the course of an autopsy, authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a licensed physician and surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a forensic autopsy shall only be determined by a licensed physician and surgeon.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause of death is determined. At the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon, trained county personnel who are necessary to the performance of an autopsy may take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For purposes of this section, the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner or medical examiner shall consult with the licensed physician and surgeon in the determination of the manner of death.
(e)For health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(f)(1)Only individuals who are directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
(2)If an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved in the death of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(3)Notwithstanding paragraph (1), individuals may be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy.
(g)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
(h)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. Only individuals who are directly involved in the investigation of the death of the decedent may be present during the performance of the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome, also referred to as SIDS, is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that the public interest is served by research and study of sudden infant death syndrome and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours or as soon thereafter as feasible, cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Public Health. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code.
(e)The protocol shall be followed by all coroners throughout the state when conducting an evaluation as part of an autopsy required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the coroners findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples shall be provided to a central tissue repository designated by the State Department of Public Health.
(f)The State Department of Public Health shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i) Consent of any person is not required before undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other law, except as otherwise provided in this section, in any case in which the coroner, before the beginning of an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall neither perform, nor order the performance of, that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the coroner shall not order an autopsy to be performed, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy, the coroner may cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other law, the coroner may, in the course of an autopsy, authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a licensed physician and surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a forensic autopsy shall only be determined by a licensed physician and surgeon.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause of death is determined. At the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon, trained county personnel who are necessary to the performance of an autopsy may take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For purposes of this section, the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner or medical examiner shall consult with the licensed physician and surgeon in the determination of the manner of death.
(e)For health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(f)(1)Only individuals who are directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
(2)If an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved in the death of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(3)Notwithstanding paragraph (1), individuals may be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy.
(g)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
(h)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. Only individuals who are directly involved in the investigation of the death of the decedent may be present during the performance of the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome (SIDS) syndrome, also referred to as SIDS, is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that the public interest is served by research and study of sudden infant death syndrome, syndrome and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours, hours or as soon thereafter as feasible, cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Health Care Services. Public Health. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code. The protocol shall be developed and approved by July 1, 1990.
(e)The protocol shall be followed by all coroners throughout the state when conducting the autopsies an evaluation as part of an autopsy required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the coroners findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples must shall be provided to a central tissue repository designated by the State Department of Health Care Services. Public Health.
(f)The State Department of Health Care Services Public Health shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i)No consent Consent of any person is not required prior to before undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other law, except as otherwise provided in this section, in any case in which the coroner, before the beginning of an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall neither perform, nor order the performance of, that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the coroner shall not order an autopsy to be performed, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy, the coroner may cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other law, the coroner may, in the course of an autopsy, authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a licensed physician and surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a forensic autopsy shall only be determined by a licensed physician and surgeon.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause of death is determined.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For purposes of this section, the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the licensed physician and surgeon in the determination of the manner of death.
(e)For health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(f)(1)Only individuals who are directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
(2)If an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved in the death of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(3)Notwithstanding paragraph (1), individuals may be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy.
(g)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist prior to the completion of the investigation of the death.
(h)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. No person Only individuals who are directly involved in the investigation of the death of the decedent may be present during the performance of an autopsy without the express consent of the licensed physician and surgeon who is conducting the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome (SIDS) is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that public interest is served by research and study of sudden infant death syndrome, and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours, or as soon thereafter as feasible, cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Health Care Services. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code. The protocol shall be developed and approved by July 1, 1990.
(e)The protocol shall be followed by all licensed physicians and surgeons coroners throughout the state when conducting the autopsies required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the licensed physician and surgeons coroners findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples must be provided to a central tissue repository designated by the State Department of Health Care Services.
(f)The State Department of Health Care Services shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i)No consent of any person is required prior to undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other law, except as otherwise provided in this section section, in any case in which the licensed physician and surgeon, coroner, before the beginning of an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall not perform neither perform, nor order the performance of, that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner or licensed physician and surgeon is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the licensed physician and surgeon coroner shall not perform the procedure, order an autopsy to be performed, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy, the coroner may cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other law, the coroner may, in the course of an autopsy, authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a licensed physician and surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a forensic autopsy shall only be determined by a licensed physician and surgeon.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause and manner of death is determined.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For purposes of this section, the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the licensed physician and surgeon in the determination of the manner of death.
(d)
(e)For health and safety purposes, all persons in the autopsy suite shall have current bloodborne pathogen training be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(e)
(f)(1)Police and other law enforcement personnel who have completed training as described in subdivision (d) may Only individuals who are directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite at the discretion of the forensic pathologist. suite.
(2)Notwithstanding paragraph (1), if If an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody in the death of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(3)Notwithstanding paragraph (1), individuals may be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy.
(f)
(g)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist prior to the completion of the investigation of the death.
(g)
(h)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)For purposes of inquiry the coroner shall, within 24 hours or as soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome and, in all other cases, the coroner may, in his or her discretion, take possession of the body, which shall include the authority to exhume the body, order it removed to a convenient place, and make or cause to be made a postmortem examination examination, or cause to be made an autopsy thereon, and make or cause to be made an analysis of the stomach, stomach contents, blood, organs, fluids, or tissues of the body. The detailed medical findings resulting from an inspection of the body or autopsy by an examining licensed physician and surgeon shall be either reduced to writing or permanently preserved on recording discs or other similar recording media, shall include all positive and negative findings pertinent to establishing the cause of death in accordance with medicolegal practice and this, along with the written opinions and conclusions of the examining physician, licensed physician and surgeon, shall be included in the coroners record of the death. The coroner shall have the right to retain only those tissues of the body removed at the time of the autopsy as may, in his or her opinion, be necessary or advisable to the inquiry into the case, or for the verification of his or her findings. No person may be present during the performance of a coroners an autopsy without the express consent of the coroner. licensed physician and surgeon who is conducting the autopsy.
(b)In any case in which the coroner knows, or has reason to believe, that the deceased has made valid provision for the disposition of his or her body or a part or parts thereof for medical or scientific purposes in accordance with Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code, the coroner shall neither perform nor authorize any other person to perform an autopsy on the body unless the coroner has contacted or attempted to contact the physician last in attendance to the deceased. If the physician cannot be contacted, the coroner shall then notify or attempt to notify one of the following of the need for an autopsy to determine the cause of death: (1) the surviving spouse; (2) a surviving child or parent; (3) a surviving brother or sister; (4) any other kin or person who has acquired the right to control the disposition of the remains. Following a period of 24 hours after attempting to contact the physician last in attendance and notifying or attempting to notify one of the responsible parties listed above, the coroner may perform or authorize the performance of an autopsy, as otherwise authorized or required by law.
(c)Nothing in this section shall be deemed to prohibit the discretion of the coroner to conduct autopsies cause to be conducted an autopsy upon any victim of sudden, unexpected, or unexplained death or any death known or suspected of resulting from an accident, suicide, or apparent criminal means, or other death, as described in Section 27491.
SEC. 2.Section 27491.41 of the Government Code is amended to read:27491.41.(a)For purposes of this section, sudden infant death syndrome means the sudden death of any infant that is unexpected by the history of the infant and where a thorough postmortem examination fails to demonstrate an adequate cause of death.
(b)The Legislature finds and declares that sudden infant death syndrome (SIDS) is the leading cause of death for children under age one, striking one out of every 500 children. The Legislature finds and declares that sudden infant death syndrome is a serious problem within the State of California, and that public interest is served by research and study of sudden infant death syndrome, and its potential causes and indications.
(c)(1)To facilitate these purposes, the coroner shall, within 24 hours, or as soon thereafter as feasible, perform cause an autopsy to be performed in any case where an infant has died suddenly and unexpectedly.
(2)However, if the attending licensed physician and surgeon desires to certify that the cause of death is sudden infant death syndrome, an autopsy may be performed at the discretion of the coroner. If the coroner performs causes an autopsy to be performed pursuant to this section, he or she shall also certify the cause of death.
(d)The autopsy shall be conducted pursuant to a standardized protocol developed by the State Department of Health Services. The protocol is exempt from the procedural requirements pertaining to the adoption of administrative rules and regulations pursuant to Article 5 (commencing with Section 11346) of Chapter 3.5 of Part 1 of Division 3 of Title 2 of the Government Code. The protocol shall be developed and approved by July 1, 1990.
(e)The protocol shall be followed by all coroners licensed physicians and surgeons throughout the state when conducting the autopsies required by this section. The coroner shall state on the certificate of death that sudden infant death syndrome was the cause of death when the coroners licensed physician and surgeons findings are consistent with the definition of sudden infant death syndrome specified in the standardized autopsy protocol. The protocol may include requirements and standards for scene investigations, requirements for specific data, criteria for ascertaining cause of death based on the autopsy, and criteria for any specific tissue sampling, and any other requirements. The protocol may also require that specific tissue samples must be provided to a central tissue repository designated by the State Department of Health Services.
(f)The State Department of Health Services shall establish procedures and protocols for access by researchers to any tissues, or other materials or data authorized by this section. Research may be conducted by any individual with a valid scientific interest and prior approval from the State Committee for the Protection of Human Subjects. The tissue samples, the materials, and all data shall be subject to the confidentiality requirements of Section 103850 of the Health and Safety Code.
(g)The coroner may take tissue samples for research purposes from infants who have died suddenly and unexpectedly without consent of the responsible adult if the tissue removal is not likely to result in any visible disfigurement.
(h)A coroner or licensed physician and surgeon shall not be liable for damages in a civil action for any act or omission done in compliance with this section.
(i)No consent of any person is required prior to undertaking the autopsy required by this section.
SEC. 3.Section 27491.43 of the Government Code is amended to read:27491.43.(a)(1)Notwithstanding any other provision of law, except as otherwise provided in this section in any case in which the coroner, licensed physician and surgeon, before beginning an autopsy, dissection, or removal of corneal tissue, pituitary glands, or any other organ, tissue, or fluid, has received a certificate of religious belief, executed by the decedent as provided in subdivision (b), that the procedure would be contrary to his or her religious belief, the coroner shall not perform that procedure on the body of the decedent.
(2)If, before beginning the procedure, the coroner or licensed physician and surgeon is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the coroner licensed physician and surgeon shall not perform the procedure, except as otherwise provided in this section, for 48 hours. If the certificate is produced within 48 hours, the case shall be governed by this section. If the certificate is not produced within that time, the case shall be governed by the other provisions of this article.
(b)Any person, 18 years of age or older, may execute a certificate of religious belief which shall state in clear and unambiguous language that any postmortem anatomical dissection or that specified procedures would violate the religious convictions of the person. The certificate shall be signed and dated by the person in the presence of at least two witnesses. Each witness shall also sign the certificate and shall print on the certificate his or her name and residence address.
(c)Notwithstanding the existence of a certificate, the coroner may at any time perform cause an autopsy to be performed or any other procedure if he or she has a reasonable suspicion that the death was caused by the criminal act of another or by a contagious disease constituting a public health hazard.
(d)(1)If a certificate is produced, and if subdivision (c) does not apply, the coroner may petition the superior court, without fee, for an order authorizing an autopsy or other procedure or for an order setting aside the certificate as invalid. Notice of the proceeding shall be given to the person who produced the certificate. The proceeding shall have preference over all other cases.
(2)The court shall set aside the certificate if it finds that the certificate was not properly executed or that it does not clearly state the decedents religious objection to the proposed procedure.
(3)The court may order an autopsy or other procedure despite a valid certificate if it finds that the cause of death is not evident, and that the interest of the public in determining the cause of death outweighs its interest in permitting the decedent and like persons fully to exercise their religious convictions.
(4)Any procedure performed pursuant to paragraph (3) shall be the least intrusive procedure consistent with the order of the court.
(5)If the petition is denied, and no stay is granted, the body of the deceased shall immediately be released to the person authorized to control its disposition.
(e)In any case in which the circumstances, manner, or cause of death is not determined because of the provisions of this section, the coroner may state on the certificate of death that an autopsy was not conducted because of the provisions of this section.
(f)A coroner shall not be liable for damages in a civil action for any act or omission taken in compliance with the provisions of this section.
SEC. 4.Section 27491.46 of the Government Code is amended to read:27491.46.(a)The coroner shall have the right to retain pituitary glands solely for transmission to a university, for use in research or the advancement of medical science, in those cases in which the coroner has required an autopsy to be performed an autopsy pursuant to this chapter, and during a 48-hour period following such autopsy the body has not been claimed and the coroner has not been informed of any relatives of the decedent.
(b)In the course of any autopsy performed by the coroner, autopsy, the coroner may remove cause to be removed the pituitary gland from the body for transmittal to any public agency for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs, if the coroner has no knowledge of objection to the removal and release of the pituitary gland having been made by the decedent or any other person specified in Section 7151.5 of the Health and Safety Code. Neither the coroner nor the medical examiner authorizing the removal of the pituitary gland, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of the pituitary gland pursuant to this section, shall incur civil liability for the removal of the pituitary gland in an action brought by any person who did not object prior to the removal of the pituitary gland, nor be subject to criminal prosecution for removal of the pituitary gland pursuant to the authority of this section.
Nothing in this subdivision shall supersede the terms of any gift made pursuant to Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code.
SEC. 5.Section 27491.47 of the Government Code is amended to read:27491.47.(a)Notwithstanding any other provision of law, the coroner may, in the course of an autopsy, remove and release or authorize the removal and release of corneal eye tissue from a body within the coroners custody, if all of the following conditions are met:
(1)The autopsy has otherwise been authorized.
(2)The coroner has no knowledge of objection to the removal and release of corneal tissue having been made by the decedent or any other person specified in Section 7151 of the Health and Safety Code and has obtained any one of the following:
(A)A dated and signed written consent by the donor or any other person specified in Section 7151 of the Health and Safety Code on a form that clearly indicates the general intended use of the tissue and contains the signature of at least one witness.
(B)Proof of the existence of a recorded telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code in the form of an audio recording of the conversation or a transcript of the recorded conversation, which indicates the general intended use of the tissue.
(C)A document recording a verbal telephonic consent by the donor or any other person specified in Section 7151 of the Health and Safety Code, witnessed and signed by no fewer than two members of the requesting entity, hospital, eye bank, or procurement organization, memorializing the consenting persons knowledge of and consent to the general intended use of the gift.
The form of consent obtained under subparagraph (A), (B), or (C) shall be kept on file by the requesting entity and the official agency for a minimum of three years.
(3)The removal of the tissue will not unnecessarily mutilate the body, be accomplished by enucleation, nor interfere with the autopsy.
(4)The tissue will be removed by a coroner, licensed physician and surgeon, surgeon or a trained transplant technician.
(5)The tissue will be released to a public or nonprofit facility for transplant, therapeutic, or scientific purposes.
(b)Neither the coroner nor medical examiner authorizing the removal of the corneal tissue, nor any hospital, medical center, tissue bank, storage facility, or person acting upon the request, order, or direction of the coroner or medical examiner in the removal of corneal tissue pursuant to this section, shall incur civil liability for the removal in an action brought by any person who did not object prior to the removal of the corneal tissue, nor be subject to criminal prosecution for the removal of the corneal tissue pursuant to this section.
(c)This section shall not be construed to interfere with the ability of a person to make an anatomical gift pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing with Section 7150) of Part 1 of Division 7 of the Health and Safety Code).
SEC. 6.Section 27520 of the Government Code is amended to read:27520.(a)The coroner shall perform or cause to be performed an autopsy on a decedent, for which an autopsy has not already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner shall perform the cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(b)The coroner may perform or cause to be performed an autopsy on a decedent, for which an autopsy has already been performed, if the surviving spouse requests him or her to do so in writing. If there is no surviving spouse, the coroner may perform the cause an autopsy to be performed if requested to do so in writing by a surviving child or parent, or if there is no surviving child or parent, by the next of kin of the deceased.
(c)The cost of an autopsy requested pursuant to either subdivision (a) or (b) shall be borne by the person requesting that it be performed.
SECTION 1.SEC. 7.Section 27522 is added to the Government Code, to read:27522.(a)A forensic autopsy shall only be conducted by a licensed physician and surgeon. The results of a postmortem examination or forensic autopsy and the cause and manner of death shall only be determined by a licensed physician and surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology. surgeon.
(b)For purposes of this section, a postmortem examination or autopsy includes, but is not limited to, the following items, if physically feasible:
(1)Procedures described in subdivision (b) of Section 27521.
(2)An analysis of the blood, vitreous fluid, urine, bile, stomach contents, other tissues or bodily fluids, or organs of the body.
(3)The examination or removal, or both, of the internal organs of the body.
(4)The retention of any organs or tissues of the body as part of the investigation of the death.
(5)Any laboratory analysis, chemical testing, or imaging performed as part of the investigation of the death.
(c)If a patient is admitted to a hospital with a life-threatening injury, or is under the influence of an intoxicating substance, as determined by the attending physician at the hospital, or was in the custody of a law enforcement agency within 24 hours of admission to the hospital, blood and urine specimens collected from the patient at the time of admission shall be retained until the patient is discharged from the hospital. If the patient dies prior to discharge, the specimens shall be released to the coroner.
(b)A forensic autopsy shall be defined as an examination of a body of a decedent to generate medical evidence for which the cause and manner of death is determined.
(c)For purposes of this section, a postmortem examination shall be defined as the external examination of the body where no manner or cause of death is determined.
(d)For health and safety purposes, all persons in the autopsy suite shall have current bloodborne pathogen training and personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(e)(1)Police and other law enforcement personnel who have completed training as described in subdivision (d) may be allowed into the autopsy suite at the discretion of the forensic pathologist.
(2)Notwithstanding paragraph (1), if an individual dies incident to due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual shall not be involved with any portion of the postmortem examination, nor allowed inside the autopsy suite during the performance of the autopsy.
(f)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist prior to the completion of the investigation of the death.
(g)This section shall not be construed to limit the practice of an autopsy for educational or research purposes.
SEC. 2.SEC. 8.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The results of a postmortem examination or autopsy and the cause and manner of death shall be determined by a licensed physician and surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology.
(b)For the purposes of this section, a postmortem examination or autopsy includes, but is not limited to, the following items, if physically feasible:
(1)Procedures described in subdivision (b) of Section 27521.
(2)An analysis of the blood, vitreous fluid, urine, bile, stomach contents, other tissues or bodily fluids, or organs of the body.
(3)The examination or removal, or both, of the internal organs of the body.
(4)The retention of any organs or tissues of the body as part of the investigation of the death.
(5)Any laboratory analysis, chemical testing, or imaging performed as part of the investigation of the death.
(c)If a patient is admitted to a hospital with a life-threatening injury, or is under the influence of an intoxicating substance, as determined by the attending physician at the hospital, or was in the custody of a law enforcement agency within 24 hours of admission to the hospital, blood and urine specimens collected from the patient at the time of admission shall be retained until the patient is discharged from the hospital. If the patient dies prior to discharge, the specimens shall be released to the coroner.
(d)For health and safety purposes, all persons in the autopsy suite shall have current bloodborne pathogen training and personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(e)(1)Police and other law enforcement personnel who have completed training as described in subdivision (d) may be allowed into the autopsy suite at the discretion of the forensic pathologist.
(2)Notwithstanding paragraph (1), if an individual dies incident to law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual shall not be inside the autopsy suite during the performance of the autopsy.
(f)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist prior to the completion of the investigation of the death.
SEC. 2.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The results of a postmortem examination or autopsy conducted by a coroner or deputy coroner are subject to review and signed approval and the cause and manner of death shall be determined by a licensed physician and surgeon who is duly qualified as a specialist in pathology. a forensic pathologist, preferably a diplomat of the American Board of Pathology.
(b)The results of any of the following items are subject to review and signed approval pursuant to subdivision (a): For the purposes of this section, a postmortem examination or autopsy includes, but is not limited to, the following items, if physically feasible:
(1)Procedures described in subdivision (b) of Section 27521.
(2)An analysis of the stomach, stomach contents, other organs, blood, vitreous fluid, urine, bile, stomach contents, other fluids, or tissues of the body. tissues or bodily fluids, or organs of the body.
(3)Other chemical testing associated with inquiry into the circumstances, manner, and cause of death.
(c)The pathologist, as defined in subdivision (a), may conduct his or her own analysis and include the results in the postmortem examination or autopsy report. If the coroner and pathologist disagree about a cause of death, the cause of death is subject to review and signed approval by a separate qualified pathologist, as defined in subdivision (a). The second pathologist may conduct his or her own analysis and include the results in the same report.
(d)A coroner who is a qualified pathologist may review and approve his or her own postmortem examination or autopsy.
(3)The examination or removal, or both, of the internal organs of the body.
(4)The retention of any organs or tissues of the body as part of the investigation of the death.
(5)Any laboratory analysis, chemical testing, or imaging performed as part of the investigation of the death.
(c)If a patient is admitted to a hospital with a life-threatening injury, or is under the influence of an intoxicating substance, as determined by the attending physician at the hospital, or was in the custody of a law enforcement agency within 24 hours of admission to the hospital, blood and urine specimens collected from the patient at the time of admission shall be retained until the patient is discharged from the hospital. If the patient dies prior to discharge, the specimens shall be released to the coroner.
(d)For health and safety purposes, all persons in the autopsy suite shall have current bloodborne pathogen training and personal protective equipment in accordance with the requirements described in Section 5193 of Title 8 of the California Code of Regulations or its successor.
(e)(1)Police and other law enforcement personnel who have completed training as described in subdivision (d) may be allowed into the autopsy suite at the discretion of the forensic pathologist.
(2)Notwithstanding paragraph (1), if an individual dies incident to law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual shall not be inside the autopsy suite during the performance of the autopsy.
(f)Any police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity shall be made available to the forensic pathologist prior to the completion of the investigation of the death.
SEC. 2.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)The results of a postmortem examination or autopsy conducted by a coroner or deputy coroner are subject to review and signed approval by a licensed physician and surgeon who is duly qualified as a specialist in pathology.
(b)The results of any of the following items are subject to review and signed approval pursuant to subdivision (a):
(1)Procedures described in subdivision (b) of Section 27521.
(2)An analysis of the stomach, stomach contents, other organs, blood, urine, other fluids, or tissues of the body.
(3)Other chemical testing associated with inquiry into the circumstances, manner, and cause of death.
(c)The pathologist, as defined in subdivision (a), may conduct his or her own analysis and include the results in the postmortem examination or autopsy report. If the coroner and pathologist disagree about a cause of death, the cause of death is subject to review and signed approval by a separate qualified pathologist, as defined in subdivision (a). The second pathologist may conduct his or her own analysis and include the results in the same report.
(d)A coroner who is a qualified pathologist may review and approve his or her own postmortem examination or autopsy.
SEC. 2.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
|
Date
|
Status
|
|---|---|
| Aug 11, 2016 | Read second time. Ordered to third reading. |
| Jun 2, 2016 | Read third time. Passed. (Ayes 24. Noes 14. Page 4121.) Ordered to the Assembly. |
| Jun 2, 2016 | Read third time. Passed. (Ayes 24. Noes 14.) Ordered to the Assembly. |
| Jun 13, 2016 | Referred to Com. on PUB. S. |
| Jun 22, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on PUB. S. |
| Jun 28, 2016 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 28). Re-referred to Com. on APPR. |
| Aug 3, 2016 | August 3 hearing postponed by committee. |
| Aug 3, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on APPR. |
| Aug 10, 2016 | From committee: Do pass. (Ayes 19. Noes 0.) (August 10). |
| Jun 2, 2016 | In Assembly. Read first time. Held at Desk. |
| Aug 19, 2016 | Ordered to third reading. |
| Aug 19, 2016 | Read third time and amended. |
| Aug 19, 2016 | Read third time and amended. (Ayes 73. Noes 0. Page 5955.) |
| Aug 23, 2016 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 23, 2016 | Read third time. Passed. Ordered to the Senate. |
| Aug 23, 2016 | Read third time. Passed. (Ayes 79. Noes 0. Page 6077.) Ordered to the Senate. |
| Aug 24, 2016 | Assembly amendments concurred in. (Ayes 38. Noes 1.) Ordered to engrossing and enrolling. |
| Aug 30, 2016 | Enrolled and presented to the Governor at 1:30 p.m. |
| Apr 25, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 2.) (April 20). |
| Feb 19, 2016 | From printer. May be acted upon on or after March 20. |
| Mar 3, 2016 | Referred to Com. on HEALTH. |
| Mar 17, 2016 | Set for hearing April 13. |
| Mar 28, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Apr 6, 2016 | April 13 set for first hearing canceled at the request of author. |
| Apr 7, 2016 | Set for hearing April 20. |
| Apr 13, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH. |
| Apr 25, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 6. Noes 2. Page 3646.) (April 20). |
| Feb 18, 2016 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
| Apr 26, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| May 13, 2016 | Set for hearing May 23. |
| May 23, 2016 | May 23 hearing: Placed on APPR. suspense file. (Ayes 7. Noes 0.) |
| May 24, 2016 | Set for hearing May 27. |
| May 27, 2016 | From committee: Do pass. (Ayes 5. Noes 2. Page 4005.) (May 27). |
| May 27, 2016 | From committee: Do pass. (Ayes 5. Noes 2.) (May 27). |
| May 27, 2016 | Read second time. Ordered to third reading. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 24, 2016 | Unfinished Business SB1189 Pan Concurrence | Senate Floor |
Passed |
|
| Aug 23, 2016 | SB 1189 Pan Senate Third Reading By IRWIN | Assembly Floor |
Passed |
|
| Aug 19, 2016 | SB 1189 Pan Senate Third Reading Amendment Set #1 | Assembly Floor |
Passed |
|
| Aug 10, 2016 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 28, 2016 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Public Safety |
Passed |
|
| Jun 2, 2016 | Senate 3rd Reading SB1189 Pan | Senate Floor |
Passed |
|
| May 27, 2016 | Do pass | Senate Standing Committee on Appropriations |
Passed |
|
| May 23, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 20, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Federation of State and County Municipal Employees | * Support | Aug 10, 2016 |
| California District Attorneys Association | * Support | Aug 10, 2016 |
| California Hospital Association | ** Against | Jun 2, 2016 |
| California Society Of Pathologists | ** Support | Jun 28, 2016 |
| California State Coroners' Association | * Against | Jun 28, 2016 |
| California State Coroners' Association | * N/A | Jun 28, 2016 |
| California State Sheriffs' Association | * Against | Jun 28, 2016 |
| California State Sheriffs' Association | * N/A | Jun 28, 2016 |
| California State Sherrif's Association | * Against Unless Amend | Aug 10, 2016 |
| College of American Pathologists | ** Support | Jun 28, 2016 |
| Consumer Attorneys Of California | ** Support | Aug 23, 2016 |
| Medical Board of California | ** Support | Aug 23, 2016 |
| National Association of Medical Examiners | ** Support | Aug 23, 2016 |
| Union Of American Physicians And Dentists | ** Support | Aug 23, 2016 |
| Ventura County District Attorney's Office | ** Support | Jun 28, 2016 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
UNFINISHED BUSINESS
Bill No: SB 1189
:
SENATE HEALTH COMMITTEE: 6-2, 4/20/16
AYES: Hernandez, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SENATE FLOOR: 24-14, 6/2/16
AYES: Allen, Beall, Block, De León, Glazer, Hancock, Hernandez, Hertzberg, Hill, Hueso, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Pan, Pavley, Roth, Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Cannella, Fuller, Gaines, Hall, Huff, Moorlach, Morrell, Nguyen, Nielsen, Stone, Vidak
NO VOTE RECORDED: Galgiani, Runner
ASSEMBLY FLOOR: 79-0, 8/23/16 - See last page for vote
SOURCE: Union of American Physicians and Dentists
DIGEST: This bill requires a forensic autopsy to only be conducted by a licensed physician. Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes. Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
Assembly Amendments (1) permit trained county personnel who are necessary to the performance of an autopsy, at the direction and supervision of a coroner, a medical examiner (ME), or a licensed physician and surgeon, to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent; (2) permit only individuals who are directly involved in the investigation of the death of the decedent to be present during the performance; (3) require the manner of death, for purposes of this bill, to be determined by the coroner or ME examiner of a county. Requires the coroner, if a forensic autopsy is conducted by a licensed physician and surgeon, to consult with the licensed physician and surgeon in the determination of the manner of death; (4) permit individuals to be permitted in the autopsy suite for educational and research purposes at the discretion of the coroner and in consultation with any licensed physician and surgeon conducting an autopsy; (5) require all persons in the autopsy suite to be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment, rather than requiring them to have current bloodborne pathogen training; (6) require an autopsy in any case where an infant has died suddenly and unexpectedly to be conducted pursuant to a standardized protocol developed by the Department of Public Health, rather than the Department of Health Care Services; and (7) delete some conforming changes that were made in the Senate to other portions of the Government Code that references autopsies.
Existing law:
- Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Requires a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent.
- Imposes certain requirements on a coroner conducting a postmortem examination or autopsy on conducted at the discretion of a coroner, ME, or other agency upon an unidentified body or human remains.
- Permits a county Board of Supervisors to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of ME, as specified, and requires the ME to be a licensed physician and surgeon duly qualified as a specialist in pathology.
- Makes it a crime for any person to practice or attempt to practice, or to advertise or hold himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or to diagnose, treat, operate for, or prescribe for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended license as a physician or without being authorized to perform the act pursuant to a certificate, punishable by a fine up to $10,000, by imprisonment, or by both the fine and either imprisonment.
This bill:
- Requires a forensic autopsy to only be conducted by a licensed physician and surgeon. Requires the results of a forensic autopsy to only be determined by a licensed physician and surgeon.
- Defines a forensic autopsy as an examination of a body of a decedent to generate medical evidence for which the cause of death is determined. Permits trained county personnel who are necessary to the performance of an autopsy, at the direction and supervision of a coroner, an ME, or a licensed physician and surgeon, to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent.
- Defines a postmortem examination as the external examination of the body where no cause of death is determined.
- Requires all persons in the autopsy suite to be informed of the risks presented by bloodborne pathogens and that they should wear personal protective equipment, as specified.
- Permits only individuals who are directly involved in the investigation of the death of the decedent to be present during the performance.
- Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
- Requires police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the physician and surgeon who conducts the autopsy prior to the completion of the investigation of the death.
- Makes conforming changes to other portions of the Government Code that references autopsies.
- Prohibits this bill from being construed to limit the practice of an autopsy for educational or research purposes.
Comments
- Author’s statement. According to the author, autopsy reports are valuable documents that should be accurate and unbiased. A medically trained physician or surgeon, particularly one trained in forensic pathology, is best equipped to determine the cause of death and provide an accurate report. Clarifying that a medically trained professional should be the one who conducts the autopsy also leaves out ambiguities in current law. Equally important is the safety of the coroners and others in the autopsy room. By requiring all personnel to wear protective gear and to get proper training in blood borne pathogens, health risks and contamination of the results are significantly reduced. SB 1189 ensures that coroners are protected and able to conduct precise autopsy reports.
- Sheriff-coroner vs. coroner/ME. Fifty of California’s 58 counties have sheriff-coroner offices, which means that the two offices are consolidated and the sheriff also serves as the coroner. The other eight counties (Calaveras, Inyo, Los Angeles, Sacramento, San Diego, San Francisco, San Mateo, and Ventura) have a coroner or ME that is separate from the sheriff. Counties that do not have a separate ME or coroner either contract with another local agency for sheriff-related cases (for example, Marin has an interagency agreement with Napa to perform that county’s autopsies), contract with a private independent pathologist, or employ a physician that is not a fulltime pathologist, but does this work on a case-by-case basis. Nothing in statute requires a coroner’s autopsy to be performed by a physician, but most (if not all) counties follow National Association of Medical Examiners (NAME) standards, which call for physicians to conduct autopsies. In those counties that have abolished the coroner’s office and instead provide for an ME (San Francisco, San Diego, Ventura, and Los Angeles), the ME has the same powers and duties of a coroner, but the ME is required to be a physician.
- Ventura County ME investigation. In May 2015, Ventura County relieved their ME of three years of his duties after it had come to light that in some cases, he was not actually performing postmortem exams, but his signature still appeared on death certificates. According to a special report published in December 2015 by the Ventura County Star, records show 17 postmortem exams were performed during the ME’s two-week vacation in May. A part-time contract pathologist was listed as the pathologist on 13 of the death certificates and the ME’s name was on four. Those four died, received postmortem exams, and their bodies were released for burial or cremation before the ME returned from his vacation, but their death certificates show that he certified cause of death for three of the men. Emails exchanged between the ME and his staff show that he directed an assistant without a medical license to perform procedures on the men's bodies. For two men, he instructed staff by email to cut open their abdomens to take samples from internal organs. A whistleblower initiated a complaint to the District Attorney’s (DA’s) office, which commenced an investigation. The DA’s investigation revealed that non-physician staff at the ME’s office had performed these functions at least one other time as far back as 2013. The investigation also revealed that the ME had been contracting out his services while working for Ventura County to a private company that provides pathology and autopsy services, as well as Santa Barbara and Monterey counties. The conclusion of the DA’s report states that the investigation “…exposed the need for legislation to clarify whether the performance of an autopsy is included in the “practice of medicine.” Clarification is also necessary to define the terms “autopsy” and “partial autopsy” and to clearly define the qualifications and training required for forensic examiners who conduct such procedures. The legislature must reconcile existing law that allows non-physicians to serve as coroners.”
- Performance of autopsies. California statute does not define the term “autopsy,” but a 1970 opinion of the California Attorney General states that an autopsy is “a form of postmortem examination in which a dead body is examined and at least partially dissected for the purpose of ascertaining the cause of death, the nature and extent of lesions of disease, or any other abnormalities present.” This meaning seems to align with other definitions of the term, however there is dispute in the field regarding what specific actions constitute an autopsy and regarding the dividing line between collecting samples and performing an autopsy. The Ventura County report consulted with San Bernardino’s Chief Medical Examiner (Frank Sheridan, MD) to provide an expert opinion as to the practice of pathology, the definition of “autopsy” and the “practice of medicine.” Dr. Sheridan opined that the following actions do not constitute the practice of medicine and need not be performed by a licensed physician: extracting vitreous fluid from the decedent’s eye, extracting blood from vessels, extracting urine from the bladder with a needle, and making an incision in the quadriceps muscle to collect a sample of tissue. Dr. Sheridan also stated there was no consensus within the field of pathology that the aforementioned procedures, which could be accomplished without opening any internal cavities, would constitute performance of an autopsy. He indicated these types of procedures could be performed by a pathologists’ assistant without a physician present.
Dr. Sheridan opined that an autopsy occurs when an internal cavity is opened and organs are examined and/or samples taken for the purpose of determining the cause or manner of death. He considers such actions to be the practice of medicine. He feels there is consensus within the field of pathology on these points. However, he is not aware of any law that specifically requires such actions be performed by a licensed physician, nor is he aware of any law that specifically prohibits a pathologists’ assistant from cutting into the body and obtaining samples without a physician present. Dr. Sheridan based his opinions in large part on the NAME standards. However, he acknowledged that there is debate within the field of forensic pathology as to whether these standards should be considered best practices guidelines or requirements that must be followed. He stated that pathologists in smaller counties, with smaller budgets, do not believe they can comply with NAME standards because of the costs involved in doing so.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Assembly Appropriations Committee:
- The Department of Consumer Affairs reports that this bill will have no fiscal impact.
- Potential minor reimbursable mandated costs, but so minor that it is doubtful a mandate claim will be submitted.
Union of American Physicians and Dentists (source)
Consumer Attorneys of California
Medical Board of California
National Association of Medical Examiners
Three individuals
OPPOSITION: (Verified 8/23/16)
None received
ARGUMENTS IN SUPPORT: The Union of American Physicians and Dentists write that elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases. NAME writes that determining the cause and manner of death should be performed by a medical professional with the expertise to make those medical diagnoses. NAME furthers states that MEs and forensic pathologists and deaths in custody or associated with law enforcement personnel are some of the most highly contentious deaths and can generate a tremendous amount of public interest, and all affected parties must be able to trust that the professionals investigating these deaths are free of undue influence from the law enforcement personnel who may have been involved in that individual’s death. Consumer Attorneys of California writes that it is a conflict of interest to allow the law enforcement personnel, a potential defendant in a civil or criminal action, to be allowed inside the autopsy room during the performance of an autopsy.
ASSEMBLY FLOOR: 79-0, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Gordon
8/23/16 20:06:40
**** END ****
SENATE THIRD READING
STR Bill Id:SB 1189
Author:(Pan and Jackson)
As Amended Ver:August 19, 2016
Majority vote
SENATE VOTE: 24-14
Committee | Votes | Ayes | Noes |
Public Safety | 7-0 | Jones-Sawyer, Melendez, Lackey, Lopez, Low, Quirk, Santiago | |
Appropriations | 19-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Daly, Eggman, Gallagher, Eduardo Garcia, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood, Chu |
SUMMARY: Requires that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. Specifically, this bill:
- Provides that a forensic autopsy shall only be conducted by a licensed physician and surgeon, and the results of a forensic autopsy only be determined by a licensed physician and surgeon.
- Defines a "forensic autopsy" to mean an examination of a body of a decedent to generate medical evidence for which the cause and manner of death is determined.
- Defines "postmortem examination" to mean the external examination of the body where no manner of death is determined.
- States that the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the physician in determining the cause of death.
- Allows trained county personnel who are necessary to the conduct of an autopsy, at the direction and supervision of a coroner or medical examiner, or a licensed physician or surgeon, may take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent.
- Provides that for health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by blood borne pathogens and that they should wear personal protective equipment, as specified.
- States that only persons directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
- Provides that if an individual dies due to the involvement of law enforcement activity, law enforcement directly involved with the death of that individual shall not be involved with any portion of the post mortem examination, nor allowed into the autopsy suite during the performance of the autopsy.
- States that at the discretion of the coroner and in consultation with the licensed physician and surgeon conducting the autopsy, individuals may be permitted in the autopsy suite for educational and research purposes.
- Requires that any police reports, crime scene or other information, videos, or laboratory test that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity be made available to the forensic pathologist prior to the completion of the investigation of the death.
- States that the above autopsy protocol shall not be construed to limit the practice of an autopsy for educational or research purposes.
- Makes conforming changes to other provisions of law relating to the conduct of an autopsy.
EXISTING LAW:
- Requires coroners to determine the manner, circumstances and cause of death in the following circumstances:
- Violent, sudden or unusual deaths;
- Unattended deaths;
- When the deceased was not attended by a physician, or registered nurse who is part of a hospice care interdisciplinary team, in the 20 days before death;
- When the death is related to known or suspected self-induced or criminal abortion;
- Known or suspected homicide, suicide or accidental poisoning;
- Deaths suspected as a result of an accident or injury either old or recent;
- Drowning, fire, hanging, gunshot, stabbing, cutting, exposure, starvation, acute alcoholism, drug addiction, strangulation, aspiration, or sudden infant death syndrome;
- Deaths in whole or in part occasioned by criminal means;
- Deaths associated with a known or alleged rape or crime against nature;
- Deaths in prison or while under sentence;
- Deaths known or suspected as due to contagious disease and constituting a public hazard;
- Deaths from occupational diseases or occupational hazards;
- Deaths of patients in state mental hospitals operated by the State Department of State Hospitals;
- Deaths of patients in state hospitals serving the developmentally disabled operated by the State Department of Development Services;
- Deaths where a reasonable ground exists to suspect the death was caused by the criminal act of another; and
- Deaths reported for inquiry by physicians and other persons having knowledge of the death.
- Requires the coroner or medical examiner to sign the certificate of death when they perform a mandatory inquiry.
- Allows the coroner or medical examiner discretion when determining the extent of the inquiry required to determine the manner, circumstances and cause of death.
- Requires the coroner or medical examiner to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has not already been performed.
- Allows the coroner or medical examiner discretion to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has already been performed.
- Specifies that the cost of autopsies requested by the surviving spouse or other specified persons are borne by the requestor.
- Requires that discretionary autopsies include the following:
- All available finger and palm prints;
- Dental examination;
- Collection of tissue including hair sample and (deoxyribonucleic acid) DNA sample, if necessary;
- Notation and photographs of significant marks, scars, tattoos and personal effects;
- Notation of observations pertinent to the time of death; and
- Documentation of the location of the remains.
- Provides that a coroner shall within 24 hours, or a soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome, take possession of the body, and make or cause to be made a postmortem examination or autopsy thereon, and the detailed medical findings resulting from an examination of the body or autopsy by an examining physician must either be reduced to writing, or permanently preserved, as specified.
- Defines "sudden infant death syndrome" to mean the sudden death of an infant that is unexpected by the history of the infant and where a thorough postmortem fails to demonstrate an adequate cause of death.
- Requires that an autopsy conducted where it is suspected that the cause of death is sudden infant death syndrome be conducted pursuant to a standardized protocol developed by the State Department of Public Health (SDPH). The protocol shall be developed and approved by July 1, 1990.
- Requires that all coroners, throughout the state, follow the established protocol when conducting autopsies where the suspected cause of death is sudden infant death syndrome, and requires a coroner to state on the certificate of death that sudden infant death syndrome was the cause of death when the findings are consistent with the definition of sudden infant death syndrome.
FISCAL EFFECT: According to the Assembly Appropriations Committee, "The Department of Consumer Affairs reports that this bill would have no fiscal impact.
"Potential minor reimbursable mandated costs, but so minor that it is doubtful a mandate claim will be submitted."
COMMENTS: According to author, "Autopsy reports are valuable documents that should be accurate and unbiased. Current law presents grey areas which could undermine public confidence in autopsy findings by allowing non-medically trained individuals, who are often elected or appointed, to conduct the autopsies. Current law also allows law enforcement involved with the death of the individual inside the autopsy suite during the procedure which could create the appearance of influence on the findings and create public distrust in our criminal justice system. Not only do families deserve to know what happened to their loved ones, but the public and juries need to trust that they received accurate objective information to make the correct verdict on a criminal case. SB 1189 is important to clarify and codify the best practices taking place in an autopsy room to guarantee an objective and trustworthy autopsy system."
Please see the policy committee analysis for a full discussion of this bill.
Analysis Prepared by: Gregory Pagan / PUB. S. / (916) 319-3744 FN: 0004631
SENATE THIRD READING
STR Bill Id:SB 1189
Author:(Pan and Jackson)
As Amended Ver:August 3, 2016
Majority vote
SENATE VOTE: 24-14
Committee | Votes | Ayes | Noes |
Public Safety | 7-0 | Jones-Sawyer, Melendez, Lackey, Lopez, Low, Quirk, Santiago | |
Appropriations | 19-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Daly, Eggman, Gallagher, Eduardo Garcia, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood, Chu |
SUMMARY: Requires that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. Specifically, this bill:
- Provides that a forensic autopsy shall only be conducted by a licensed physician and surgeon, and the results of a forensic autopsy only be determined by a licensed physician and surgeon.
- Defines a "forensic autopsy" to mean an examination of a body of a decedent to generate medical evidence for which the cause and manner of death is determined.
- Defines "postmortem examination" to mean the external examination of the body where no manner of death is determined.
- States that the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the physician in determining the cause of death.
- Provides that for health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by blood borne pathogens and that they should wear personal protective equipment, as specified.
- States that only persons directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
- Provides that if an individual dies due to the involvement of law enforcement activity, law enforcement directly involved with the death of that individual shall not be involved with any portion of the post mortem examination, nor allowed into the autopsy suite during the performance of the autopsy.
- States that at the discretion of the coroner and in consultation with the licensed physician and surgeon conducting the autopsy, individuals may be permitted in the autopsy suite for educational and research purposes.
- Requires that any police reports, crime scene or other information, videos, or laboratory test that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity be made available to the forensic pathologist prior to the completion of the investigation of the death.
- States that the above autopsy protocol shall not be construed to limit the practice of an autopsy for educational or research purposes.
- Makes conforming changes to other provisions of law relating to the conduct of an autopsy.
EXISTING LAW:
- Requires coroners to determine the manner, circumstances and cause of death in the following circumstances:
- Violent, sudden or unusual deaths;
- Unattended deaths;
- When the deceased was not attended by a physician, or registered nurse who is part of a hospice care interdisciplinary team, in the 20 days before death;
- When the death is related to known or suspected self-induced or criminal abortion;
- Known or suspected homicide, suicide or accidental poisoning;
- Deaths suspected as a result of an accident or injury either old or recent;
- Drowning, fire, hanging, gunshot, stabbing, cutting, exposure, starvation, acute alcoholism, drug addiction, strangulation, aspiration, or sudden infant death syndrome;
- Deaths in whole or in part occasioned by criminal means;
- Deaths associated with a known or alleged rape or crime against nature;
- Deaths in prison or while under sentence;
- Deaths known or suspected as due to contagious disease and constituting a public hazard;
- Deaths from occupational diseases or occupational hazards;
- Deaths of patients in state mental hospitals operated by the State Department of State Hospitals;
- Deaths of patients in state hospitals serving the developmentally disabled operated by the State Department of Development Services;
- Deaths where a reasonable ground exists to suspect the death was caused by the criminal act of another; and
- Deaths reported for inquiry by physicians and other persons having knowledge of the death.
- Requires the coroner or medical examiner to sign the certificate of death when they perform a mandatory inquiry.
- Allows the coroner or medical examiner discretion when determining the extent of the inquiry required to determine the manner, circumstances and cause of death.
- Requires the coroner or medical examiner to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has not already been performed.
- Allows the coroner or medical examiner discretion to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has already been performed.
- Specifies that the cost of autopsies requested by the surviving spouse or other specified persons are borne by the requestor.
- Requires that discretionary autopsies include the following:
- All available finger and palm prints;
- Dental examination;
- Collection of tissue including hair sample and (deoxyribonucleic acid) DNA sample, if necessary;
- Notation and photographs of significant marks, scars, tattoos and personal effects;
- Notation of observations pertinent to the time of death; and
- Documentation of the location of the remains.
- Provides that a coroner shall within 24 hours, or a soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome, take possession of the body, and make or cause to be made a postmortem examination or autopsy thereon, and the detailed medical findings resulting from an examination of the body or autopsy by an examining physician must either be reduced to writing, or permanently preserved, as specified.
- Defines "sudden infant death syndrome" to mean the sudden death of an infant that is unexpected by the history of the infant and where a thorough postmortem fails to demonstrate an adequate cause of death.
- Requires that an autopsy conducted where it is suspected that the cause of death is sudden infant death syndrome be conducted pursuant to a standardized protocol developed by the State Department of Public Health (SDPH). The protocol shall be developed and approved by July 1, 1990.
- Requires that all coroners, throughout the state, follow the established protocol when conducting autopsies where the suspected cause of death is sudden infant death syndrome, and requires a coroner to state on the certificate of death that sudden infant death syndrome was the cause of death when the findings are consistent with the definition of sudden infant death syndrome.
FISCAL EFFECT: According to the Assembly Appropriations Committee, "The Department of Consumer Affairs reports that this bill would have no fiscal impact.
"Potential minor reimbursable mandated costs, but so minor that it is doubtful a mandate claim will be submitted."
COMMENTS: According to author, "Autopsy reports are valuable documents that should be accurate and unbiased. Current law presents grey areas which could undermine public confidence in autopsy findings by allowing non-medically trained individuals, who are often elected or appointed, to conduct the autopsies. Current law also allows law enforcement involved with the death of the individual inside the autopsy suite during the procedure which could create the appearance of influence on the findings and create public distrust in our criminal justice system. Not only do families deserve to know what happened to their loved ones, but the public and juries need to trust that they received accurate objective information to make the correct verdict on a criminal case. SB 1189 is important to clarify and codify the best practices taking place in an autopsy room to guarantee an objective and trustworthy autopsy system."
Please see the policy committee analysis for a full discussion of this bill.
Analysis Prepared by: Gregory Pagan / PUB. S. / (916) 319-3744 FN: 0003947
Date of Hearing: August 10, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SBPCA Bill Id:SB 1189
Author:(Pan) – As Amended Ver: August 3, 2016
Policy Committee: | Public Safety | Vote: | 7 - 0 |
Urgency: No State Mandated Local Program: Yes Reimbursable: Yes
SUMMARY:
This bill:
- Provides that a forensic autopsy may only be conducted by a licensed physician and surgeon, and the results of a forensic autopsy may only be determined by a licensed physician and surgeon;
- States that the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the physician in determining the cause of death;
- Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes; and
- Provides that if an individual dies due to the involvement of law enforcement activity, law enforcement directly involved with the death of that individual may not be involved with any portion of the post mortem examination, nor allowed into the autopsy suite during the performance of the autopsy.
FISCAL EFFECT:
The Department of Consumer Affairs reports that this bill would have no fiscal impact.
Potential minor reimbursable mandated costs, but so minor that it is doubtful a mandate claim will be submitted.
COMMENTS:
- Background. Under current law, a coroner is required to determine the cause and manner of death under certain circumstances. In a minority of deaths, coroners’ offices conduct a forensic autopsy to determine the cause of death. Under current practice, most coroners’ offices employ or contract with forensic pathologists to conduct autopsies. When there is an autopsy, the pathologist determines the cause of death. Nothing in statute requires a coroner’s autopsy to be performed by a physician, but most (if not all) counties follow National Association of Medical Examiners protocals. The manner of death is determined by the coroner from the autopsy report (if there is one) and from information developed by investigators in the coroner’s office. Most counties in California have sheriff-coroner offices; some counties, like Ventura County, have a coroner or a Medical Examiner.
In May 2015, Ventura County relieved their medical examiner of three years of his duties after it had come to light that in some cases, he was not actually performing postmortem exams, but his signature still appeared on death certificates. According to a special report published in December 2015 by the Ventura County Star, records show 17 postmortem exams were performed during the ME’s two-week vacation in May. A part-time contract pathologist was listed as the pathologist on 13 of the death certificates and the ME’s name was on four. Those four died, received postmortem exams, and their bodies were released for burial or cremation before the ME returned from his vacation, but their death certificates show that he certified the cause of death for three of the men.
- Purpose. This bill requires a licensed physician to perform the autopsy and to determine both the cause and manner of death. According to the author, “autopsy reports are valuable documents that should be accurate and unbiased. A medically trained physician or surgeon, particularly one trained in forensic pathology, is best equipped to determine the cause of death and provide an accurate report. Clarifying that a medically-trained professional should be the one who conducts the autopsy also leaves out ambiguities in current law. Equally important is the safety of the coroners and others in the autopsy room. By requiring all personnel to wear protective gear and to get proper training in blood borne pathogens, health risks and contamination of the results are significantly reduced. SB 1189 ensures that coroners are protected and able to conduct precise autopsy reports.”
- Support. The Union of American Physicians and Dentists writes, "Elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases.
- Opposition. The California State Sheriffs' Association (CSSA) writes that “limiting law enforcement access to an autopsy suite causes significant issues especially because many autopsies are conducted because the death is potentially the result of a criminal act. CSSA states that in such a case, the body being examined is, and/or contains evidence, and the presence of law enforcement is crucial to maintain care and custody of that evidence. CSSA contends that while a physician generally determines the cause of death, the manner of death is a determination often made by the coroner in concert with other individuals, including the pathologist, and the coroner’s role in making this determination should not be removed.”
Analysis Prepared by: Pedro Reyes / APPR. / (916) 319-2081
Date of Hearing: June 28, 2016
Chief Counsel: Gregory Pagan
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Reginald Byron Jones-Sawyer, Sr., Chair
SBPCA Bill Id:SB 1189
Author:(Pan) – As Amended Ver:June 22, 2016
SUMMARY: Requires that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. Specifically, this bill:
- Provides that a forensic autopsy shall only be conducted by a licensed physician and surgeon, and the results of a forensic autopsy only be determined by a licensed physician and surgeon.
- Defines a "forensic autopsy" to mean an examination of a body of a decedent to generate medical evidence for which the cause and manner of death is determined.
- Defines "postmortem examination" to mean the external examination of the body where no manner of death is determined.
- States that the manner of death shall be determined by the coroner or medical examiner of a county. If a forensic autopsy is conducted by a licensed physician and surgeon, the coroner shall consult with the physician in determining the cause of death.
- Provides that for health and safety purposes, all persons in the autopsy suite shall be informed of the risks presented by blood borne pathogens and that they should wear personal protective equipment, as specified.
- States that only persons directly involved in the investigation of the death of the decedent shall be allowed into the autopsy suite.
- Provides that if an individual dies due to the involvement of law enforcement activity, law enforcement directly involved with the death of that individual shall not be involved with any portion of the post mortem examination, nor allowed into the autopsy suite during the performance of the autopsy.
- States that at the discretion of the coroner and in consultation with the licensed physician and surgeon conducting the autopsy, individuals may be permitted in the autopsy suite for educational and research purposes.
- Requires that any police reports, crime scene or other information, videos, or laboratory test that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity be made available to the forensic pathologist prior to the completion of the investigation of the death.
- States that the above autopsy protocol shall not be construed to limit the practice of an autopsy for educational or research purposes.
- Makes conforming changes to other provisions of law relating to the conduct of an autopsy.
EXISTING LAW:
- Requires coroners to determine the manner, circumstances and cause of death in the following circumstances:
- Violent, sudden or unusual deaths;
- Unattended deaths;
- When the deceased was not attended by a physician, or registered nurse who is part of a hospice care interdisciplinary team, in the 20 days before death;
- When the death is related to known or suspected self-induced or criminal abortion;
- Known or suspected homicide, suicide or accidental poisoning;
- Deaths suspected as a result of an accident or injury either old or recent;
- Drowning, fire, hanging, gunshot, stabbing, cutting, exposure, starvation, acute alcoholism, drug addiction, strangulation, aspiration, or sudden infant death syndrome;
- Deaths in whole or in part occasioned by criminal means;
- Deaths associated with a known or alleged rape or crime against nature;
- Deaths in prison or while under sentence;
- Deaths known or suspected as due to contagious disease and constituting a public hazard;
- Deaths from occupational diseases or occupational hazards;
- Deaths of patients in state mental hospitals operated by the State Department of State Hospitals;
- Deaths of patients in state hospitals serving the developmentally disabled operated by the State Department of Development Services;
- Deaths where a reasonable ground exists to suspect the death was caused by the criminal act of another; and
- Deaths reported for inquiry by physicians and other persons having knowledge of the death. (Gov. Code, § 27491.)
- Violent, sudden or unusual deaths;
- Requires the coroner or medical examiner to sign the certificate of death when they perform a mandatory inquiry. (Gov. Code, § 27491, subd. (a).)
- Allows the coroner or medical examiner discretion when determining the extent of the inquiry required to determine the manner, circumstances and cause of death. (Gov. Code, § 27491, subd. (b).)
- Requires the coroner or medical examiner to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has not already been performed. (Gov. Code, § 27520, subd. (a).)
- Allows the coroner or medical examiner discretion to conduct an autopsy at the request of the surviving spouse or other specified persons when an autopsy has already been performed. (Gov. Code, § 27520, subd. (b).)
- Specifies that the cost of autopsies requested by the surviving spouse or other specified persons are borne by the requestor. (Gov. Code, § 27520, subd. (c).)
- Requires that discretionary autopsies include the following:
- All available finger and palm prints;
- Dental examination;
- Collection of tissue including hair sample and DNA sample, if necessary;
- Notation and photographs of significant marks, scars, tattoos and personal effects;
- Notation of observations pertinent to the time of death; and
- Documentation of the location of the remains. (Gov. Code, § 27521, subds. (a) and (b).)
- All available finger and palm prints;
- Provides that a coroner shall within 24 hours, or a soon as feasible thereafter, where the suspected cause of death is sudden infant death syndrome, take possession of the body, and make or cause to be made a postmortem examination or autopsy thereon, and the detailed medical findings resulting from an examination of the body or autopsy by an examining physician must either be reduced to writing, or permanently preserved, as specified. (Gov. Code, § 27491.4, subd. (a).)
- Defines "sudden infant death syndrome" to mean the sudden death of an infant that is unexpected by the history of the infant and where a thorough postmortem fails to demonstrate an adequate cause of death. (Gov. Code, § 27491.49, subd. (a).)
- Requires that an autopsy conducted where it is suspected that the cause of death is sudden infant death syndrome be conducted pursuant to a standardized protocol developed by
the SDPH. The protocol shall be developed and approved by July 1, 1990. (Gov. Code, § 27491.41 (d.).) - Requires that all coroners, throughout the state, follow the established protocol when conducting autopsies where the suspected cause of death is sudden infant death syndrome, and requires a coroner to state on the certificate of death that sudden infant death syndrome was the cause of death when the findings are consistent with the definition of sudden infant death syndrome. (Gov. Code, § 27491.41 (e).)
FISCAL EFFECT: Unknown
COMMENTS:
- Author's Statement: According to author, "Autopsy reports are valuable documents that should be accurate and unbiased. Current law presents grey areas which could undermine public confidence in autopsy findings by allowing non-medically trained individuals, who are often elected or appointed, to conduct the autopsies. Current law also allows law enforcement involved with the death of the individual inside the autopsy suite during the procedure which could create the appearance of influence on the findings and create public distrust in our criminal justice system. Not only do families deserve to know what happened to their loved ones, but the public and juries need to trust that they received accurate objective information to make the correct verdict on a criminal case. SB 1189 is important to clarify and codify the best practices taking place in an autopsy room to guarantee an objective and trustworthy autopsy system."
- Argument in Support: The Union of American Physicians and Dentists writes, "Elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases. NAME writes that determining the cause and manner of death should be performed by a medical professional with the expertise to make those medical diagnoses. NAME furthers states that MEs and forensic pathologists and deaths in custody or associated with law enforcement personnel are some of the most highly contentious deaths and can generate a tremendous amount of public interest, and all affected parties must be able to trust that the professionals investigating these deaths are free of undue influence from the law enforcement personnel who may have been involved in that individual’s death. Consumer Attorneys of California writes that it is a conflict of interest to allow the law enforcement personnel, a potential defendant in a civil or criminal action, to be allowed inside the autopsy room during the performance of an autopsy."
- Argument in Opposition: The California State Sheriffs' Association (CSSA) writes, "Limiting law enforcement access to an autopsy suite causes significant issues especially because many autopsies are conducted because the death is potentially the result of a criminal act. CSSA states that in such a case, the body being examined is, and/or contains, evidence and the presence of law enforcement is crucial to maintain care and custody of that evidence. CSSA contends that while a physician generally determines the cause of death, the manner of death is a determination often made by the coroner in concert with other individuals, including the pathologist, and the coroner’s role in making this determination should not be removed."
REGISTERED SUPPORT / OPPOSITION:
Support
California District Attorneys Association
California Society of Pathologists
College of American Pathologists
Consumer Attorneys of California
Medical Board of California
National Association of Medical Examiners
Union of American Physicians and Dentists
Ventura County District Attorney's Office
Opposition
California State Coroners Association
California State Sheriffs' Association
Analysis Prepared by: Gregory Pagan / PUB. S. / (916) 319-3744
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 1189
:
SENATE HEALTH COMMITTEE: 6-2, 4/20/16
AYES: Hernandez, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SOURCE: Union of American Physicians and Dentists
DIGEST: This bill requires a forensic autopsy to only be conducted by a licensed physician. Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes. Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
Existing law:
- Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Requires a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent.
- Imposes certain requirements on a coroner conducting a postmortem examination or autopsy on conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
- Permits a county Board of Supervisors to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner (ME), as specified, and requires the ME to be a licensed physician and surgeon duly qualified as a specialist in pathology.
- Makes it a crime for any person to practice or attempt to practice, or to advertise or hold himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or to diagnose, treat, operate for, or prescribe for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended license as a physician or without being authorized to perform the act pursuant to a certificate, punishable by a fine up to $10,000, by imprisonment, or by both the fine and either imprisonment.
This bill:
- Requires a forensic autopsy to only be conducted by a licensed physician and surgeon.
- Defines a forensic autopsy as a medical examination of a body of a decedent to generate medical evidence for which the cause of death is determined.
- Defines a postmortem examination as the external examination of the body where no cause of death is determined.
- Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes.
- Permits police and other law enforcement personnel who have completed training described in 4) above to be allowed into the autopsy suite at the discretion of the forensic pathologist.
- Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
- Requires police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
- Makes conforming changes to other portions of the Government Code that references autopsies.
- Prohibits this bill from being construed to limit the practice of an autopsy for educational or research purposes.
Comments
- Author’s statement. According to the author, autopsy reports are valuable documents that should be accurate and unbiased. A medically trained physician or surgeon, particularly one trained in forensic pathology, is best equipped to determine the cause of death and provide an accurate report. Clarifying that a medically trained professional should be the one who conducts the autopsy also leaves out ambiguities in current law. Equally important is the safety of the coroners and others in the autopsy room. By requiring all personnel to wear protective gear and to get proper training in blood borne pathogens, health risks and contamination of the results are significantly reduced. SB 1189 ensures that coroners are protected and able to conduct precise autopsy reports.
- Sheriff-coroner vs. coroner/ME. Fifty of California’s 58 counties have sheriff-coroner offices, which means that the two offices are consolidated and the sheriff also serves as the coroner. The other eight counties (Calaveras, Inyo, Los Angeles, Sacramento, San Diego, San Francisco, San Mateo, and Ventura) have a coroner or ME that is separate from the sheriff. Counties that do not have a separate ME or coroner either contract with another local agency for sheriff-related cases (for example, Marin has an interagency agreement with Napa to perform that county’s autopsies), contract with a private independent pathologist, or employ a physician that is not a fulltime pathologist, but does this work on a case-by-case basis. Nothing in statute requires a coroner’s autopsy to be performed by a physician, but most (if not all) counties follow National Association of Medical Examiners (NAME) standards, which call for physicians to conduct autopsies. In those counties that have abolished the coroner’s office and instead provide for a ME (San Francisco, San Diego, Ventura, and Los Angeles), the ME has the same powers and duties of a coroner, but the ME is required to be a physician.
- Ventura County ME investigation. In May 2015, Ventura County relieved their medical examiner of three years of his duties after it had come to light that in some cases, he was not actually performing postmortem exams, but his signature still appeared on death certificates. According to a special report published in December 2015 by the Ventura County Star, records show 17 postmortem exams were performed during the ME’s two-week vacation in May. A part-time contract pathologist was listed as the pathologist on 13 of the death certificates and the ME’s name was on four. Those four died, received postmortem exams, and their bodies were released for burial or cremation before the ME returned from his vacation, but their death certificates show that he certified cause of death for three of the men. Emails exchanged between the ME and his staff show that he directed an assistant without a medical license to perform procedures on the men's bodies. For two men, he instructed staff by email to cut open their abdomens to take samples from internal organs. A whistleblower initiated a complaint to the District Attorney’s (DA’s) office, which commenced an investigation. The DA’s investigation revealed that non-physician staff at the ME’s office had performed these functions at least one other time as far back as 2013. The investigation also revealed that the ME had been contracting out his services while working for Ventura County to a private company that provides pathology and autopsy services, as well as Santa Barbara and Monterey counties. The conclusion of the DA’s report states that the investigation “…exposed the need for legislation to clarify whether the performance of an autopsy is included in the “practice of medicine.” Clarification is also necessary to define the terms “autopsy” and “partial autopsy” and to clearly define the qualifications and training required for forensic examiners who conduct such procedures. The legislature must reconcile existing law that allows non-physicians to serve as coroners.”
- Performance of autopsies. California statute does not define the term “autopsy,” but a 1970 opinion of the California Attorney General states that an autopsy is “a form of postmortem examination in which a dead body is examined and at least partially dissected for the purpose of ascertaining the cause of death, the nature and extent of lesions of disease, or any other abnormalities present.” This meaning seems to align with other definitions of the term, however there is dispute in the field regarding what specific actions constitute an autopsy and regarding the dividing line between collecting samples and performing an autopsy. The Ventura County report consulted with San Bernardino’s Chief Medical Examiner (Frank Sheridan, MD) to provide an expert opinion as to the practice of pathology, the definition of “autopsy” and the “practice of medicine.” Dr. Sheridan opined that the following actions do not constitute the practice of medicine and need not be performed by a licensed physician: extracting vitreous fluid from the decedent’s eye, extracting blood from vessels, extracting urine from the bladder with a needle, and making an incision in the quadriceps muscle to collect a sample of tissue. Dr. Sheridan also stated there was no consensus within the field of pathology that the aforementioned procedures, which could be accomplished without opening any internal cavities, would constitute performance of an autopsy. He indicated these types of procedures could be performed by a pathologists’ assistant without a physician present.
Dr. Sheridan opined that an autopsy occurs when an internal cavity is opened and organs are examined and/or samples taken for the purpose of determining the cause or manner of death. He considers such actions to be the practice of medicine. He feels there is consensus within the field of pathology on these points. However, he is not aware of any law that specifically requires such actions be performed by a licensed physician, nor is he aware of any law that specifically prohibits a pathologists’ assistant from cutting into the body and obtaining samples without a physician present. Dr. Sheridan based his opinions in large part on the NAME standards. However, he acknowledged that there is debate within the field of forensic pathology as to whether these standards should be considered best practices guidelines or requirements that must be followed. He stated that pathologists in smaller counties, with smaller budgets, do not believe they can comply with NAME standards because of the costs involved in doing so.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Potentially significant state reimbursement costs, due to the requirement in the bill that a licensed physician determine the cause and manner of death (General Fund).
- By requiring a physician to determine the manner of death in cases where there is a forensic autopsy, the bill may impose additional costs on coroner’s offices to have physicians review information developed by investigators and make the final determination of the manner of death. Whether the Commission on state mandates would rule that this requirement imposes a higher level of service (and is therefore reimbursable by the state) is unknown. If the Commission did rule that the bill imposes a reimbursable mandate, the costs to the state could be considerable. The hourly rate to employ or contract with pathologists is significantly higher than the costs for investigators. The statewide costs to require pathologists to make the determination of the manner of death could be in the millions per year.
Union of American Physicians and Dentists (source)
Consumer Attorneys of California
Medical Board of California
National Association of Medical Examiners
Three individuals
OPPOSITION: (Verified 5/27/16)
California Hospital Association
California State Coroner’s Association
California State Sheriffs' Association
ARGUMENTS IN SUPPORT: The Union of American Physicians and Dentists write that elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases. NAME writes that determining the cause and manner of death should be performed by a medical professional with the expertise to make those medical diagnoses. NAME furthers states that MEs and forensic pathologists and deaths in custody or associated with law enforcement personnel are some of the most highly contentious deaths and can generate a tremendous amount of public interest, and all affected parties must be able to trust that the professionals investigating these deaths are free of undue influence from the law enforcement personnel who may have been involved in that individual’s death. Consumer Attorneys of California writes that it is a conflict of interest to allow the law enforcement personnel, a potential defendant in a civil or criminal action, to be allowed inside the autopsy room during the performance of an autopsy.
ARGUMENTS IN OPPOSITION: The California State Sheriffs' Association (CSSA) writes that limiting law enforcement access to an autopsy suite causes significant issues especially because many autopsies are conducted because the death is potentially the result of a criminal act. CSSA states that in such a case, the body being examined is, and/or contains, evidence and the presence of law enforcement is crucial to maintain care and custody of that evidence. CSSA contends that while a physician generally determines the cause of death, the manner of death is a determination often made by the coroner in concert with other individuals, including the pathologist, and the coroner’s role in making this determination should not be removed.
5/31/16 9:46:51
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 1189
:
SENATE HEALTH COMMITTEE: 6-2, 4/20/16
AYES: Hernandez, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
NO VOTE RECORDED: Hall
SENATE APPROPRIATIONS COMMITTEE: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SOURCE: Union of American Physicians and Dentists
DIGEST: This bill requires a forensic autopsy to only be conducted by a licensed physician. Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes. Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
Existing law:
- Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Requires a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent.
- Imposes certain requirements on a coroner conducting a postmortem examination or autopsy on conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
- Permits a county Board of Supervisors to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner (ME), as specified, and requires the ME to be a licensed physician and surgeon duly qualified as a specialist in pathology.
- Makes it a crime for any person to practice or attempt to practice, or to advertise or hold himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or to diagnose, treat, operate for, or prescribe for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended license as a physician or without being authorized to perform the act pursuant to a certificate, punishable by a fine up to $10,000, by imprisonment, or by both the fine and either imprisonment.
This bill:
- Requires a forensic autopsy to only be conducted by a licensed physician and surgeon.
- Defines a forensic autopsy as a medical examination of a body of a decedent to generate medical evidence for which the cause of death is determined.
- Defines a postmortem examination as the external examination of the body where no cause of death is determined.
- Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes.
- Permits police and other law enforcement personnel who have completed training described in 4) above to be allowed into the autopsy suite at the discretion of the forensic pathologist.
- Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
- Requires police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
- Makes conforming changes to other portions of the Government Code that references autopsies.
- Prohibits this bill from being construed to limit the practice of an autopsy for educational or research purposes.
Comments
- Author’s statement. According to the author, autopsy reports are valuable documents that should be accurate and unbiased. A medically trained physician or surgeon, particularly one trained in forensic pathology, is best equipped to determine the cause of death and provide an accurate report. Clarifying that a medically trained professional should be the one who conducts the autopsy also leaves out ambiguities in current law. Equally important is the safety of the coroners and others in the autopsy room. By requiring all personnel to wear protective gear and to get proper training in blood borne pathogens, health risks and contamination of the results are significantly reduced. SB 1189 ensures that coroners are protected and able to conduct precise autopsy reports.
- Sheriff-coroner vs. coroner/ME. Fifty of California’s 58 counties have sheriff-coroner offices, which means that the two offices are consolidated and the sheriff also serves as the coroner. The other eight counties (Calaveras, Inyo, Los Angeles, Sacramento, San Diego, San Francisco, San Mateo, and Ventura) have a coroner or ME that is separate from the sheriff. Counties that do not have a separate ME or coroner either contract with another local agency for sheriff-related cases (for example, Marin has an interagency agreement with Napa to perform that county’s autopsies), contract with a private independent pathologist, or employ a physician that is not a fulltime pathologist, but does this work on a case-by-case basis. Nothing in statute requires a coroner’s autopsy to be performed by a physician, but most (if not all) counties follow National Association of Medical Examiners (NAME) standards, which call for physicians to conduct autopsies. In those counties that have abolished the coroner’s office and instead provide for a ME (San Francisco, San Diego, Ventura, and Los Angeles), the ME has the same powers and duties of a coroner, but the ME is required to be a physician.
- Ventura County ME investigation. In May 2015, Ventura County relieved their medical examiner of three years of his duties after it had come to light that in some cases, he was not actually performing postmortem exams, but his signature still appeared on death certificates. According to a special report published in December 2015 by the Ventura County Star, records show 17 postmortem exams were performed during the ME’s two-week vacation in May. A part-time contract pathologist was listed as the pathologist on 13 of the death certificates and the ME’s name was on four. Those four died, received postmortem exams, and their bodies were released for burial or cremation before the ME returned from his vacation, but their death certificates show that he certified cause of death for three of the men. Emails exchanged between the ME and his staff show that he directed an assistant without a medical license to perform procedures on the men's bodies. For two men, he instructed staff by email to cut open their abdomens to take samples from internal organs. A whistleblower initiated a complaint to the District Attorney’s (DA’s) office, which commenced an investigation. The DA’s investigation revealed that non-physician staff at the ME’s office had performed these functions at least one other time as far back as 2013. The investigation also revealed that the ME had been contracting out his services while working for Ventura County to a private company that provides pathology and autopsy services, as well as Santa Barbara and Monterey counties. The conclusion of the DA’s report states that the investigation “…exposed the need for legislation to clarify whether the performance of an autopsy is included in the “practice of medicine.” Clarification is also necessary to define the terms “autopsy” and “partial autopsy” and to clearly define the qualifications and training required for forensic examiners who conduct such procedures. The legislature must reconcile existing law that allows non-physicians to serve as coroners.”
- Performance of autopsies. California statute does not define the term “autopsy,” but a 1970 opinion of the California Attorney General states that an autopsy is “a form of postmortem examination in which a dead body is examined and at least partially dissected for the purpose of ascertaining the cause of death, the nature and extent of lesions of disease, or any other abnormalities present.” This meaning seems to align with other definitions of the term, however there is dispute in the field regarding what specific actions constitute an autopsy and regarding the dividing line between collecting samples and performing an autopsy. The Ventura County report consulted with San Bernardino’s Chief Medical Examiner (Frank Sheridan, MD) to provide an expert opinion as to the practice of pathology, the definition of “autopsy” and the “practice of medicine.” Dr. Sheridan opined that the following actions do not constitute the practice of medicine and need not be performed by a licensed physician: extracting vitreous fluid from the decedent’s eye, extracting blood from vessels, extracting urine from the bladder with a needle, and making an incision in the quadriceps muscle to collect a sample of tissue. Dr. Sheridan also stated there was no consensus within the field of pathology that the aforementioned procedures, which could be accomplished without opening any internal cavities, would constitute performance of an autopsy. He indicated these types of procedures could be performed by a pathologists’ assistant without a physician present.
Dr. Sheridan opined that an autopsy occurs when an internal cavity is opened and organs are examined and/or samples taken for the purpose of determining the cause or manner of death. He considers such actions to be the practice of medicine. He feels there is consensus within the field of pathology on these points. However, he is not aware of any law that specifically requires such actions be performed by a licensed physician, nor is he aware of any law that specifically prohibits a pathologists’ assistant from cutting into the body and obtaining samples without a physician present. Dr. Sheridan based his opinions in large part on the NAME standards. However, he acknowledged that there is debate within the field of forensic pathology as to whether these standards should be considered best practices guidelines or requirements that must be followed. He stated that pathologists in smaller counties, with smaller budgets, do not believe they can comply with NAME standards because of the costs involved in doing so.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Potentially significant state reimbursement costs, due to the requirement in the bill that a licensed physician determine the cause and manner of death (General Fund).
- By requiring a physician to determine the manner of death in cases where there is a forensic autopsy, the bill may impose additional costs on coroner’s offices to have physicians review information developed by investigators and make the final determination of the manner of death. Whether the Commission on state mandates would rule that this requirement imposes a higher level of service (and is therefore reimbursable by the state) is unknown. If the Commission did rule that the bill imposes a reimbursable mandate, the costs to the state could be considerable. The hourly rate to employ or contract with pathologists is significantly higher than the costs for investigators. The statewide costs to require pathologists to make the determination of the manner of death could be in the millions per year.
Union of American Physicians and Dentists (source)
Consumer Attorneys of California
National Association of Medical Examiners
Three individuals
OPPOSITION: (Verified 5/27/16)
California Hospital Association
California State Sheriffs' Association
ARGUMENTS IN SUPPORT: The Union of American Physicians and Dentists write that elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases. NAME writes that determining the cause and manner of death should be performed by a medical professional with the expertise to make those medical diagnoses. NAME furthers states that MEs and forensic pathologists and deaths in custody or associated with law enforcement personnel are some of the most highly contentious deaths and can generate a tremendous amount of public interest, and all affected parties must be able to trust that the professionals investigating these deaths are free of undue influence from the law enforcement personnel who may have been involved in that individual’s death. Consumer Attorneys of California writes that it is a conflict of interest to allow the law enforcement personnel, a potential defendant in a civil or criminal action, to be allowed inside the autopsy room during the performance of an autopsy.
ARGUMENTS IN OPPOSITION: The California State Sheriffs' Association (CSSA) writes that limiting law enforcement access to an autopsy suite causes significant issues especially because many autopsies are conducted because the death is potentially the result of a criminal act. CSSA states that in such a case, the body being examined is, and/or contains, evidence and the presence of law enforcement is crucial to maintain care and custody of that evidence. CSSA contends that while a physician generally determines the cause of death, the manner of death is a determination often made by the coroner in concert with other individuals, including the pathologist, and the coroner’s role in making this determination should not be removed.
5/28/16 17:15:04
**** END ****
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1189 (Pan) - Postmortem examinations or autopsies: forensic pathologists
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
SB 1189 would require a forensic autopsy to be conducted by a licensed physician and require the results of the forensic autopsy and the cause and manner of death to be determined by a licensed physician. The bill would place restrictions on who could be present for an autopsy.
Fiscal Impact:
Potentially significant state reimbursement costs, due to the requirement in the bill that a licensed physician determine the cause and manner of death (General Fund).
By requiring a physician to determine the manner of death in cases where there is a forensic autopsy, the bill may impose additional costs on coroner’s offices to have physicians review information developed by investigators and make the final determination of the manner of death. Whether the Commission on state mandates would rule that this requirement imposes a higher level of service (and is therefore reimbursable by the state) is unknown. If the Commission did rule that the bill imposes a reimbursable mandate, the costs to the state could be considerable. The hourly rate to employ or contract with pathologists is significantly higher than the costs for investigators. The statewide costs to require pathologists to make the determination of the manner of death could be in the millions per year.
Background:
Under current law, a coroner is required to determine the cause and manner of death under certain circumstances. In a minority of deaths, coroners offices conduct a forensic autopsy to determine the cause of death. Under current practice, most coroner’s offices employ or contract with forensic pathologists to conduct autopsies. When there is an autopsy, the pathologist determines the cause of death. The manner of death is determined by the coroner from the autopsy report (if there is one) and from information developed by investigators in the coroner’s office. The bill would require a licensed physician to perform the autopsy and to determine both the cause and manner of death.
Proposed Law:
SB 1189 would require a forensic autopsy to be conducted by a licensed physician and require the results of the forensic autopsy and the cause and manner of death to be determined by a licensed physician.
The bill would require that all persons in the autopsy suite have specified training and authorize certain law enforcement personnel to be in the autopsy suite, at the discretion of the pathologist. The bill would prohibit law enforcement personnel directly involved with a death related to law enforcement activity from being involved in a postmortem exam or autopsy.
Staff Comments:
The bill requires forensic autopsies to be conducted by a physician, whereas current law makes autopsies the responsibility of coroners. In theory, this change in law imposes a new mandate on coroners offices. Under current practice, coroners offices currently use physicians to conduct forensic autopsies, either by employing physicians directly of contracting for their services. Given that the use of physicians is standard practice, it is unlikely that the Commission on State Mandates would rule that the requirement to use a physician requires a new or higher level of service by coroners offices. Therefore, it is not likely that the state would be required to reimburse local governments for those costs.
The requirements in the bill regarding who is allowed to be present for an autopsy are not likely to be ruled reimbursable state mandates.The bill generally prohibits people who have not had certain training from being present for an autopsy, rather than requiring all law enforcement personnel to have such training. The Commission is not likely to rule that these requirements require a new or higher level of service from law enforcement agencies or coroners offices. Therefore, it is not likely that the state would be required to reimburse local governments for those costs.
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SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1189
AUTHOR: | Pan and Jackson | ||
VERSION: | As Proposed to be Amended | ||
HEARING DATE: | April 20, 2016 | ||
CONSULTANT: | Melanie Moreno | ||
SUBJECT: Postmortem examinations or autopsies: forensic pathologists
SUMMARY:
- Requires a forensic autopsy to be considered the practice of medicine and to only be conducted by a licensed physician who has expertise in forensic pathology or has been trained as a forensic pathologist. Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes. Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
Existing law:
- Requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Requires a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent.
- Imposes certain requirements on a coroner conducting a postmortem examination or autopsy on conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.
- Permits a county Board of Supervisors to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Permits a county Board of Supervisors to abolish the office of coroner and provide instead for the office of medical examiner (ME), as specified, and requires the ME to be a licensed physician and surgeon duly qualified as a specialist in pathology.
- Makes it a crime for any person to practice or attempt to practice, or to advertise or hold himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or to diagnose, treat, operate for, or prescribe for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person, without having at the time of so doing a valid, unrevoked, or unsuspended license as a physician or without being authorized to perform the act pursuant to a certificate, punishable by a fine up to $10,000, by imprisonment, or by both the fine and either imprisonment.
This bill:
- Requires a forensic autopsy to be considered the practice of medicine and to only be conducted by a licensed physician who has expertise in forensic pathology or has been trained as a forensic pathologist.
- Defines a forensic autopsy as a medical examination of a body of a decedent to generate medical evidence for which the cause of death is determined.
- Defines a postmortem examination as the external examination of the body where no cause of death is determined.
- Requires all persons in the autopsy suite to have current bloodborne pathogen training and personal protective equipment in accordance with existing law for health and safety purposes.
- Permits police and other law enforcement personnel who have completed training described in 4) above to be allowed into the autopsy suite at the discretion of the forensic pathologist.
- Prohibits, if an individual dies due to the involvement of law enforcement activity, law enforcement personnel directly involved with the care and custody of that individual from being involved with any portion of the postmortem examination nor allowed inside the autopsy suite during the performance of the autopsy.
- Requires police reports, crime scene or other information, videos, or laboratory tests that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.
- Makes conforming changes to other portions of the Government Code that references autopsies.
- Prohibits this bill from being construed to limit the practice of an autopsy for educational or research purposes.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, autopsy reports are valuable documents that should be accurate and unbiased. A medically trained physician or surgeon, particularly one trained in forensic pathology, is best equipped to determine the cause of death and provide an accurate report. Clarifying that a medically trained professional should be the one who conducts the autopsy also leaves out ambiguities in current law. Equally important is the safety of the coroners and others in the autopsy room. By requiring all personnel to wear protective gear and to get proper training in blood borne pathogens, health risks and contamination of the results are significantly reduced. SB 1189 ensures that coroners are protected and able to conduct precise autopsy reports.
- Sheriff-coroner vs. coroner/ME. Fifty of California’s 58 counties have sheriff-coroner offices, which means that the two offices are consolidated and the sheriff also serves as the coroner. The other eight counties (Calaveras, Inyo, Los Angeles, Sacramento, San Diego, San Francisco, San Mateo, and Ventura) have a coroner or ME that is separate from the sheriff. Counties that do not have a separate ME or coroner either contract with another local agency for sheriff-related cases (for example, Marin has an interagency agreement with Napa to perform that county’s autopsies), contract with a private independent pathologist, or employ a physician that is not a fulltime pathologist, but does this work on a case-by-case basis. Nothing in statute requires a coroner’s autopsy to be performed by a physician, but most (if not all) counties follow National Association of Medical Examiners (NAME) standards, which call for physicians to conduct autopsies. In those counties that have abolished the coroner’s office and instead provide for a ME (San Francisco, San Diego, Ventura, and Los Angeles), the ME has the same powers and duties of a coroner, but the ME is required to be a physician.
- Ventura County ME investigation. In May 2015, Ventura County relieved their medical examiner of three years of his duties after it had come to light that in some cases, he was not actually performing postmortem exams, but his signature still appeared on death certificates. According to a special report published in December 2015 by the Ventura County Star, records show 17 postmortem exams were performed during the ME’s two-week vacation in May. A part-time contract pathologist was listed as the pathologist on 13 of the death certificates and the ME’s name was on four. Those four died, received postmortem exams, and their bodies were released for burial or cremation before the ME returned from his vacation, but their death certificates show that he certified cause of death for three of the men. Emails exchanged between the ME and his staff show that he directed an assistant without a medical license to perform procedures on the men's bodies. For two men, he instructed staff by email to cut open their abdomens to take samples from internal organs. A whistleblower initiated a complaint to the DA’s office, which commenced an investigation. The DA’s investigation revealed that non-physician staff at the ME’s office had performed these functions at least one other time as far back as 2013. The investigation also revealed that the ME had been contracting out his services while working for Ventura County to a private company that provides pathology and autopsy services, as well as Santa Barbara and Monterey counties. The conclusion of the DA’s report states that the investigation “…exposed the need for legislation to clarify whether the performance of an autopsy is included in the “practice of medicine.” Clarification is also necessary to define the terms “autopsy” and “partial autopsy” and to clearly define the qualifications and training required for forensic examiners who conduct such procedures. The legislature must reconcile existing law that allows non-physicians to serve as coroners.”
- Performance of autopsies. California statute does not define the term “autopsy,” but a 1970 opinion of the California Attorney General states that an autopsy is “a form of postmortem examination in which a dead body is examined and at least partially dissected for the purpose of ascertaining the cause of death, the nature and extent of lesions of disease, or any other abnormalities present.” This meaning seems to align with other definitions of the term, however there is dispute in the field regarding what specific actions constitute an autopsy and regarding the dividing line between collecting samples and performing an autopsy. The Ventura County report consulted with San Bernardino’s Chief Medical Examiner (Frank Sheridan, MD) to provide an expert opinion as to the practice of pathology, the definition of “autopsy” and the “practice of medicine.” Dr. Sheridan opined that the following actions do not constitute the practice of medicine and need not be performed by a licensed physician: extracting vitreous fluid from the decedent’s eye, extracting blood from vessels, extracting urine from the bladder with a needle, and making an incision in the quadriceps muscle to collect a sample of tissue. Dr. Sheridan also stated there was no consensus within the field of pathology that the aforementioned procedures, which could be accomplished without opening any internal cavities, would constitute performance of an autopsy. He indicated these types of procedures could be performed by a pathologists’ assistant without a physician present.
Dr. Sheridan opined that an autopsy occurs when an internal cavity is opened and organs are examined and/or samples taken for the purpose of determining the cause or manner of death. He considers such actions to be the practice of medicine. He feels there is consensus within the field of pathology on these points. However, he is not aware of any law that specifically requires such actions be performed by a licensed physician, nor is he aware of any law that specifically prohibits a pathologists’ assistant from cutting into the body and obtaining samples without a physician present. Dr. Sheridan based his opinions in large part on the NAME standards. However, he acknowledged that there is debate within the field of forensic pathology as to whether these standards should be considered best practices guidelines or requirements that must be followed. He stated that pathologists in smaller counties, with smaller budgets, do not believe they can comply with NAME standards because of the costs involved in doing so.
- Practice of medicine. The practice of medicine is defined differently by states in their respective practice acts, but all the definitions are quite broad. They give physicians great latitude in the therapies they provide, but they also leave some uncertainty as to what actually constitutes practicing medicine. California law is more broad than most states, stating “…any person who practices or attempts to practice, or who advertises or holds himself or herself out as practicing, any system or mode of treating the sick or afflicted in this state, or who diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person…”
With regard to autopsies, although forensic technicians, laboratory assistants and other personnel may assist with minor procedures, according NAME standards, only a forensic pathologist or physician can determine the cause of death. NAME standards require that a forensic autopsy must be conducted by a licensed physician who is a forensic pathologist, or by a physician who is a forensic pathologist-in-training. Some procedures may be accomplished by a trained technician, they can only be done in the physical presence of a licensed pathologist. According to NAME standards, the performance of an autopsy is the practice of medicine. While physician organizations may argue that it’s the practice of medicine, California law is explicitly contradictory in this sense, as it allows a sheriff-coroner to conduct autopsies.
- Support. The Union of American Physicians and Dentists write that elected officials lack the medical expertise necessary to perform a postmortem examination to the same degree as a forensic pathologist, and this bill seeks to add further legitimacy and authority to death investigations in coroner cases. NAME writes that determining the cause and manner of death should be performed by a medical professional with the expertise to make those medical diagnoses. NAME furthers states that MEs and forensic pathologists and deaths in custody or associated with law enforcement personnel are some of the most highly contentious deaths and can generate a tremendous amount of public interest, and all affected parties must be able to trust that the professionals investigating these deaths are free of undue influence from the law enforcement personnel who may have been involved in that individual’s death. Consumer Attorneys of California writes that it is a conflict of interest to allow the law enforcement personnel, a potential defendant in a civil or criminal action, to be allowed inside the autopsy room during the performance of an autopsy.
- Opposition. The California State Sheriffs' Association (CSSA) writes that limiting law enforcement access to an autopsy suite causes significant issues especially because many autopsies are conducted because the death is potentially the result of a criminal act. CSSA states that in such a case, the body being examined is, and/or contains, evidence and the presence of law enforcement is crucial to maintain care and custody of that evidence. CSSA contends that while a physician generally determines the cause of death, the manner of death is a determination often made by the coroner in concert with other individuals, including the pathologist, and the coroner’s role in making this determination should not be removed.
SUPPORT AND OPPOSITION:
Support: Union of American Physicians and Dentists (sponsor)
Consumer Attorneys of California
National Association of Medical Examiners
Three individuals
Oppose: California Hospital Association (oppose unless amended)
California State Sheriffs' Association
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Discussed in Hearing
3MIN
Senate Floor
1MIN
Assembly Floor
3MIN
Assembly Standing Committee on Appropriations
9MIN
Assembly Standing Committee on Public Safety
7MIN
Senate Floor
6MIN
Senate Standing Committee on Appropriations
3H
Senate Standing Committee on Health
Bill Co-Author(s):
