Issues Surrounding a Reduction in the Use of Internal Autopsy in the Coronial System

In 2003 in Queensland it was estimated that 2700 full internal Coronial autopsies were performed at a cost of approximately $5.3 million. This large number of internal Coronial autopsies (almost 95% of all matters referred to the Coroner) is of concern not only due to the economic cost, but also because of the public heath risks, availability of specialist staff and significant religious and cultural sensitivities surrounding internal autopsies. In 2005 we began research funded by the Australian Research Council (ARC) to determine if unnecessary internal autopsies are being performed in Queensland. The grant was made with the view to establishing guidelines for when an internal autopsy is required. This paper will highlight areas of potential concern when the issue of autopsy is reviewed within the coronial system through an examination of International literature on the issue of autopsy diagnosis and error rates more generally, and through preliminary discussion of our data. In order to achieve this, this paper will consider four issues: the role and purpose of the autopsy generally as well as within the coronial system specifically; the comparability of the literature on diagnostic error rates in hospital autopsies with that within the coronial system; the current situation Internationally with regard to internal autopsies; and finally the specific circumstances operating in Queensland