Off a gritty Los Angeles street, near the Flamingo Banquet Hall and the Two Grumpy Old Men used-car dealership, you can learn how someone died.
That's where Autopsy/Post Services, better known as 1-800-AUTOPSY, has set up shop. Although it's a nondescript storefront painted battleship gray, the Grateful Dead sticker on the front door and the fake skull in the window are sort of a giveaway.
There's no joke in the fact that 1-800-AUTOPSY is one of the most successful providers in the burgeoning field of private autopsies. The company claims to perform more than 1,000 autopsies a year on corpses from all over the world, usually for the families of the deceased. They want to know how their loved ones died and are curious as to their options if the death is deemed preventable.
Business is so good the company's founder recently turned down a $21 million buyout offer from a group of New York investors. And plans to franchise the company are in the works.
"Many, many times the cause of death (as ascertained through an autopsy) is contrary to what's on the death certificate," says Vidal Herrera, 1-800-AUTOPSY's garrulous, barrel-chested founder.
Such curiosity, coupled with a dramatic decrease over the past three decades in autopsies performed by hospitals, is fueling a surge in private autopsy firms. Though no statistics are kept on their growth, industry observers agree that they're filling the gaps in services that private hospitals or county coroners once routinely provided.
In recent years new firms have sprouted up in such disparate places as the Rust Belt, the Southwest and the Pacific Northwest. They're usually run by coroner investigators or pathology assistants-called dieners-looking to strike out on their own. The firms contract with pathologists in private practice and usually do most procedures in funeral homes. Such firms charge clients from $1,000 to $3,500, depending on the extent of the autopsy and what ancillary services-such as organ harvesting-are performed.
Like 1-800-AUTOPSY, Oklahoma City-based Private Autopsy Services of Oklahoma has built a permanent home. At a cost of about $300,000, the company has constructed a 3,200-square-foot autopsy facility near the state Capitol. It's complete with morgue, autopsy suite and office space for physicians. Plans are in the works by the company's owners to build similar facilities in Tulsa, Okla., Dallas and San Antonio.
"We could handle all the population the state of Oklahoma could give us," says Terry Felts, a managing member of Private Autopsy Services, which opened for business about a year ago. Felts, a veteran investigator for the state of Oklahoma medical examiner, designed the structure himself.
Felts said his Private Autopsy Service of Oklahoma performed about 75 autopsies during the past year, a number he expects will grow steadily.
"There were 33,000 deaths in Oklahoma last year, and (government) medical examiners performed only about 1,400 autopsies," he says.
The same low rate prevails at private hospitals throughout the country.
"A couple of decades ago, hospitals used to do autopsies in about 50% of all patient deaths. Now they're performing them perhaps 10% of the time," says Michael Graham, M.D., chief medical examiner for the city of St. Louis and secretary-treasurer for the Minneapolis-based National Association of Medical Examiners. Graham says the reason is simple: As hospitals' bottom line wanes, so do autopsies.
"They cost around $3,000 to perform, and when money's tight, hospitals will whittle back on doing them," he says. However, most hospitals are willing to perform a voluntary autopsy when a deceased patient's family is willing to pay for their cost, according to officials with the American Hospital Association and other industry observers.
Graham's anecdotal evidence is supported by interviews with both hospital officials and data compiled by the Northfield, Ill.-based College of American Pathologists. In testimony to Congress last year, CAP President Thomas Wood, M.D., said there were hospitals "where an autopsy is an extremely rare occurrence, or is not provided at all." Wood cited rising confidence in new diagnostic devices, such as magnetic resonance imaging machines, which make determining ailments-and therefore, the cause of death-more conclusive. He also cited elimination by the Joint Commission on Accreditation of Healthcare Organizations in 1970 of a mandate that hospitals perform autopsies on up to 25% of deceased patients.
Richard Wade, the AHA's senior vice president for communications, agreed that hospitals do fewer autopsies because there's simply less of a need to do so. "There have been improvements in technology, a more complete medical record and a lot more medical knowledge and quality assurance" than in the past, he says.
At Cedars-Sinai Medical Center in Los Angeles, the autopsy rate has shrunk from about 30% in the early 1970s to about 10% now, according to Stephen Geller, M.D., chairman of Cedars' department of pathology and laboratory medicine. Geller believes two likely factors have conspired to drive autopsies down: the medical staff's rising confidence in their diagnostic abilities, and fear of a malpractice suit if an autopsy contradicts their medical reports.
Autopsy rates are slightly higher at academic medical centers, about 15% to 20%, pathologists and industry observers say, in part to further their roles as teaching institutions.
Those trends are confirmed by at least one private autopsy firm, Autopsy Associates in Dearborn, Mich. Autopsy Associates, which was formed in 1998, focuses more on providing diener support to six Detroit-area hospitals than performing autopsies. It projected it would conduct about 20 diener procedures this year.
"The hospitals love having us around because hospitals are doing so few autopsies it doesn't make sense for them to have a support staff on the payroll," says Tom Bigelow, one of Autopsy Associates' co-founders.
The sharp fall in hospital-based autopsies-combined with last year's explosive Institute of Medicine report claiming that medical errors kill from 44,000 to 98,000 patients per year-provide a built-in business base, observers say.
"People who do request (autopsies) are not trusting of the hospital where the patient died," Geller says. "We live in a litigious society; we get calls occasionally asking for autopsies from the outside, which is implying a sort of broad level of conspiracy exists."
Ironically, the AHA's Wade notes that technological improvements that have reduced the in-hospital autopsy rate may actually spur familial suspicions when a patient does die. The presumption is that the wealth of available information should negate all surprises-which it doesn't, Wade says.
And although Wade acknowledges that there could be an evolving niche for private autopsy firms, the AHA is still concerned that those firms lack official oversight. "There's concern that poor information (from a private autopsy) could set off a chain of events that could lead to a legal action and further distrust between patients, doctors and families," he says.
The 48-year-old Herrera appears undeterred. Directly or indirectly, his company plays up the legal angle. "The primary purpose of an autopsy is to put to rest any questions the family may have regarding the cause of death, nature of an illness and reassurance that the appropriate healthcare was provided," reads some of 1-800-AUTOPSY's promotional literature. Herrera estimates that as much as 30% of the autopsies performed by his firm lead to a lawsuit. Vaunted attorney Johnnie Cochran regularly refers business to Herrera.
It could be said that Herrera, trained as a pathologist's assistant, works as hard as any star attorney, despite the fact he was housebound for years because of a severe back injury from lifting an obese corpse. Herrera struck out on his own in 1988, doing subcontracting work for the Veterans Affairs Medical Center in Los Angeles when he realized hospitals would pay him far more than if he worked as an employee.
Herrera isn't just hawking autopsies. His company also sells macabre gifts from a link on its Web site titled "Casket of Goodies." They include pens and keychains made from fake bones, a miniature guillotine, gelatin molds in the shape of a brain and hand, and T-shirts and bumper stickers. Herrera says competition from the L.A. County Coroner's Office, which also sells such souvenirs, is the reason for such a merchandising scheme.
Meanwhile, he also rents his autopsy suite to film and television crews for $200 an hour. He installed two fake morgue refrigerator doors in the suite to attract the crews (because Herrera doesn't operate a hospital or funeral home, he's prohibited by law from storing bodies).
Hollywood glitz and props aside, the authenticity and quality of Herrera's work is unquestioned by his would-be competitors, all of whom mentioned his name without prompting.
"I really enjoy the work," he says. "It allows me to find out the truth, and help families get on with their lives."