Dr. West advises that even if a lab does only an occasional autopsy for a coroner service, “you should not only view what is now in the general autopsy section of the checklist and make sure you are meeting those requirements, but also pay close attention to these new requirements in the forensic autopsy pathology section. It highlights important issues that need to be addressed if you are even considering doing forensic work.”
Members of the CAP Forensic Pathology Committee voiced concern, Dr. Hooper says, that “because CAP was inspecting a facility’s general autopsy services, there might be an assumption that CAP was endorsing those services as also being qualified for forensic autopsies.”
“This was a problem,” she adds, “because we weren’t even inspecting things pertaining to forensics. It was a component of practice that was falling through the cracks.”
The new forensic requirements could build the confidence of laboratories that have few calls for forensic autopsies and of those requesting their forensic autopsy services. “Labs will gain additional guidance and credibility through the checklist,” Dr. Reichard says. “When someone asks, ‘What did your lab do on this forensic case?’ a pathologist can say, ‘We followed these checklist requirements, vetted through CAP’s Forensic Pathology Committee. We are accredited by CAP.’ That is a pretty robust defense of your process.”
The forensic autopsy checklist requirements will appear in the anatomic pathology checklist only when a laboratory indicates (on its activity menu) it performs forensic autopsies. “If labs indicate they perform forensic cases, both the general autopsy requirements and the new forensic section requirements will appear in their ANP checklist,” Dr. West says. “If they perform only general autopsies, only the general autopsy requirements will appear.”
Dr. Hooper characterizes the forensic requirements in two broad ways: expertise and services. “Facilities providing forensic autopsy services must have the ability to access appropriate consultation and provide appropriate expertise for a particular specialty area,” she explains. “They also must offer necessary services—be able to do toxicology, have the appropriate kind of imaging, be able to collect trace evidence and keep it secure, etc.”
One of the requirements in the forensic autopsy section, ANP.35000 “Forensic Pathologist and Expert Consultants,” requires that the laboratory have access to a forensic pathologist and expert consultants in forensic neuropathology, forensic dentistry/odontology, forensic anthropology, and radiology. “We have basically asked labs to think about who they can turn to for consultations ahead of time,” Dr. West says. “You don’t have to retain experts on site, but you do need to be able to contact them, send a slide, and so on.”
Another requirement, ANP.35025 “Analysis of Post-Mortem Specimens,” says forensic toxicology and clinical laboratory services must be available as needed for analysis of postmortem specimens. Testing services must be available on site or at a referral lab for ethanol, volatiles, carbon monoxide, major drugs of abuse, major acidic drugs, and major basic drugs. It also calls for compliance with toxicology guidelines.
ANP.36000 “Trace Evidence Collection” requires collection of such evidence, including hair samples, swabs, and nail clippings and scrapings. “This requirement reminds participants that in some situations, such as in sexual assault or a case of a pedestrian struck by a motor vehicle, you need to collect trace evidence, which is important in the subsequent handling of the case and in making medical legal determinations,” Dr. West says.
ANP.36025 “Specimen Collection” says specimens must be routinely collected and retained for toxicology, potential DNA analysis, and histological examination. Inspectors must examine chain-of-custody procedures pertaining to specimens and evidence. “This is a high-level addition that stands out to me,” Dr. Reichard says. “The need to apply a rigorous process of chain-of-custody to specimens and evidence is overarching. It requires more detailed documentation from the point when it is first collected, how it was collected, the time and date, right up to the moment it is stored.” Dr. West urges labs to spend time thinking about how to collect specimens for toxicology, for possible DNA analysis, and for histology. “Consider the possibilities before the time comes when you face them.”
Additional forensic autopsy requirements are as follows:
- ANP.36050 “Unidentified Bodies” requires a written policy defining actions to be taken before the disposition of unidentified bodies, such as fingerprinting and DNA sample storage.
- ANP.36075 “Photographs” details the types of photographs that should be taken during a forensic autopsy. “This requirement is intended to remind people of the items to be addressed when taking photographs in a medical legal case in order to have as complete a photographic record as possible,” Dr. West says.
- ANP.36100 “Autopsy Notes and Photographs” requires written notes and photographs that would make it possible to reconstruct the autopsy report in the event dictations are lost or damaged.