http://www.centredaily.com/mld/centredaily/news/opinion/12489175.htm
Posted on Sat, Aug. 27, 2005
Editorial | Pa. Court Rulings on Autopsies Narrow and confusing
Had Terri Schiavo died in her native Pennsylvania, rather than in Florida, it's unlikely that the public would know much more than her cause of death.
The critical findings - the condition of her brain, her blindness and the absence of abuse - could by law have been kept from the public.
Why? Because the case law in Pennsylvania at the time said that autopsy reports were not a public record and that a coroner or medical examiner need disclose only the cause and manner of death.
(In Schiavo's case, the cause was marked dehydration; the manner was undetermined.)
In Florida, where autopsy reports are public record, the autopsy findings quieted a raging national debate about the woman's cognitive functions and whether her husband had physically injured her.
Last week, Pennsylvania took a step toward more openness on autopsy reports, but in way so narrow that it will require further litigation or lawmaking to settle the question.
Yes, autopsy reports often include material, including photos, whose publication would serve mostly a prurient, not public purpose. Responsible media ought to exercise restraint. But autopsy reports can also shed invaluable light on legitimate public policy questions about drug abuse, domestic violence, gun lethality, suicide and other issues.
The state Supreme Court ruled Aug. 15 that a district attorney can seek a court order to seal an autopsy report if its disclosure could compromise an ongoing criminal investigation. The ruling, in a Blair County case, is based on the assumption that all autopsy reports, unless sealed, are public record in Pennsylvania.
Unfortunately, the Supreme Court made only passing reference to this point. So coroners who, for whatever reason, prefer to keep autopsies secret could harken back to a Commonwealth Court ruling earlier this year. In that March ruling, the lower court said, in unhelpfully contradictory fashion, that autopsy reports are not part of the official record that coroners must file with the county court clerk each January.
The General Assembly should take two corrective steps. First, it should amend the Coroner's Act so that it states unambiguously that autopsy reports are public record. Second, it should include autopsy reports among those things that are public records under the Right To Know Act, eliminating the embargo period that now freezes these records until January. No public purpose is served by withholding them for up to 12 months.
In an Internet world, there may be no surefire way to prevent the painful release of graphic autopsy photos. That's why Florida's legislature decided to ban the release of such photos.
The Pennsylvania Supreme Court ruling, however, suggests a better method. It allows for the trial judge and disputing parties to review - in the judge's chambers - whether specific information, if released, would hinder an ongoing investigation. A similar review could be made on photographs, with the judge weighing the public purpose versus the privacy rights of families.
Now's a good time for the legislature to clean up the confusion caused by court rulings - before some red-hot controversy such as the Schiavo case brings the issue to the fore.
Media mythology.
-- Terri's brain was functional. The autopsy showed only that the brain was severely atrophied (which we knew long before), not that it was non-functional. In fact, it tended to confirm the functionality observed by many medical professionals (not just the family) because the posterior area of the brain was relatively intact. As Dr. Hammesfahr noted, this would be enough to account for Terri's limited but real functionality as observed in his lengthy examination and others.
The media ignore a much more important finding that Terri's injury was specific to the front part of the brain. This rules out all general causes of injury (notably the ridiculous heart attack / bulimia theory) and focuses the search on a very specific cause for her anoxic injury: blockage of the carotid arteries that supply oxygen to the front of the brain.
In short, the autopsy supports the theory that Terri was strangled.
-- The "blindness" mentioned in the autopsy was a special kind called cortical blindness, inferred from the loss of cortex tissue used to process visual input (the eyes are not themselves damaged). But this inference in the autopsy -- which cannot be proven -- is at odds with clinical observation that Terri had some vision, though it was very poor. (She could see for a few inches in front of her, but not more than a foot and a half.) There are at least three reasonable ways to explain this discrepancy. 1) Dehydrating/starving Terri may have killed her remaining vision in her last horrible days. 2) The cortical atrophy may not have been enough to blind her completely. 3) The autopsy may have erred because Terri's brain "rewired" itself for that bit of vision she had. Damaged brains can and do open new channels to regain function.
-- It is not possible for an autopsy to conclude "no abuse." Bones heal. The severe traumatic abuse shown by Terri's 1991 bone scan would not have been detectable post-mortem. The abusive neglect by Michael in denying Terri all rehabilitation, therapy and even sensory stimulation were, of course, not the sort of thing that an autopsy can detect.