The autopsy service performs about 550 autopsies and postmortem examinations per year. About 86% of these are medicolegal cases, and the remainder are based on signed permits on hospital deaths within the Wake Forest Baptist Medical Center. This department serves as a regional forensic pathology center for 30 counties in western North Carolina. Residents perform hospital autopsies and forensic cases under the supervision of a forensic pathologist.
These number assume the Forensic Pathology Fellow will perform 250 medicolegal autopsies, the remainder divided among the general pathology residents, with about 50 performed by the faculty without resident contribution. (We actually perform ~850 autopsies annually.) The numbers are for general-pathology resident-aided autopsies only and will give a better idea of the proportion of medicolegal cases we handle.
The department also offers a forensic pathology fellowship.
The forensic cases provide knowledge of untreated natural diseases and traumatic processes to which many pathology residents are unaccustomed. Their responsibilities include receiving information from the outside medical examiner, legal authorities, clinicians, or family before beginning an autopsy.
After collecting the appropriate microbiologic and toxicologic specimens, they perform the dissection and present their findings to the staff pathologist before contacting the clinicians and medical examiner with the autopsy results. Residents are encouraged to use readily available technologies to facilitate autopsy diagnoses, including frozen sections, fine-needle aspirates and postmortem specimen radiography.
The pathology house officers are responsible for performing hospital and medical examiner autopsies during the week and on Saturday. Sunday autopsies are done on an on-call basis by the house officer on duty. The dissection and special procedures are done with an autopsy assistant and appropriate faculty members.
All cases are signed out grossly and microscopically with the faculty pathologist on service for that day. House officers are to report their findings directly to the clinicians on completion of a case and invite them for a daily conference of autopsy cases.
"Selected Images in Autopsy" for the entire department is held Thursdays from 3:30 to 4:30 pm. Brain cutting is on Thursday from 1:00-2:00 pm.
Goals and Objectives
The major objectives of the Autopsy rotation are to acquire the necessary skills to complete the following tasks:
- Perform a thorough and complete hospital or medicolegal autopsy with attention to the external examination, internal examination, microscopic examination and toxicologic analysis
- Select special procedures on cases including virology, microbiology, chemistry and postmortem radiography
- Promptly dictate and write autopsy data, including logical anatomic diagnoses, clinical summaries, microscopic descriptions, and final opinions and comments
- Present autopsy cases at mortality conferences and to medical students
- Differentiate normal and pathologic anatomy and histopathology
- Discuss the management of an autopsy service; including the legal setting of autopsies, financing, relations with regulatory and governmental agencies, interactions with hospital committees, and public relations
- Anticipate medical and legal questions posed by individual autopsies
- Assist in the supervision of more junior residents
Patrick E. Lantz, MD
Director of Autopsy Service
Donald R. Jason, MD, JD
Jerri L McLemore, MD