Amended in Senate April 26, 2016

Amended in Senate April 13, 2016

Amended in Senate March 28, 2016

Senate Bill No. 1189

Introduced by Senators Pan and Jackson

February 18, 2016

An act begin insert to amend Sections 27491.4, 27491.41, 27491.43, 27491.46, 27491.47, and 27520 of, and end insert to add Section 27522 begin delete to end delete begin insert to, end insert the Government Code, relating to autopsies.

LEGISLATIVE COUNSEL’S DIGEST

SB 1189, as amended, Pan. Postmortem examinations or autopsies: forensic pathologists.

Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law imposes certain requirements on a postmortem examination or autopsy conducted at the discretion of a coroner, medical examiner, or other agency upon an unidentified body or human remains.

Existing law authorizes the board of supervisors of a county to consolidate the duties of certain county offices in one or more of specified combinations, including, but not limited to, sheriff and coroner, district attorney and coroner, and public administrator and coroner. Existing law authorizes the board of supervisors of a county to abolish the office of coroner and provide instead for the office of medical examiner, as specified, and requires the medical examiner to be a licensed physician and surgeon duly qualified as a specialist in pathology.

This begin insert bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The end insert bill would require that the results of a begin delete postmortem examination or autopsy, as specified, end delete begin insert forensic autopsy end insert and the cause and manner of death be determined by a licensed physician and begin delete surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology. end delete begin insert surgeon. end insert

begin delete

This bill would also require blood and urine specimens collected from a patient at the time of admission to a hospital, if the patient is admitted under specified circumstances, to be retained until the patient is discharged from the hospital. The bill would require the specimens to be released to the coroner if the patient dies prior to discharge.

end delete begin delete

This

end delete

begin insert The end insert bill would require, for health and safety purposes, that all persons in the autopsy suite have current bloodborne pathogen training and personal protective equipment, as specified. The bill would provide that police and other law enforcement personnel who have completed the specified training may be allowed into the autopsy suite at the discretion of the forensic pathologist, but would prohibit law enforcement personnel directly involved with the care and custody of an individual who died begin delete incident to end delete begin insert due to involvement of end insert law enforcement activity from being begin insert involved with any portion of the postmortem examination or being end insert inside the autopsy suite during the performance of the autopsy. begin insert The bill would define a postmortem examination for this purpose to be the external examination of the body where no manner or cause of death is determined. end insert

begin delete

This

end delete

begin insert The end insert bill would require specified materials that are in the possession of law enforcement and are related to a death that is incident to law enforcement activity to be made available to the forensic pathologist prior to the completion of the investigation of the death.

begin insert

The bill would specify that these provisions shall not be construed to limit the practice of an autopsy for educational or research purposes.

end insert

By imposing additional duties upon local officials and law enforcement agencies, this bill would create a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

begin delete

This

end delete

begin insert The end insert bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 27491.4 of the end insert begin insert Government Code end insert begin insert is
amended to read: end insert

27491.4.  

(a) For purposes of inquiry the coroner shall, within
24 hours or as soon as feasible thereafter, where the suspected
cause of death is sudden infant death syndrome and, in all other
cases, the coroner may, in his or her discretion, take possession of
the body, which shall include the authority to exhume the body,
order it removed to a convenient place, and make or cause to be
made a postmortem begin delete examination end delete begin insert examination, end insert or begin insert cause to be made
an end insert autopsy thereon, and make or cause to be made an analysis of
the stomach, stomach contents, blood, organs, fluids, or tissues of
the body. The detailed medical findings resulting from an
inspection of the body or autopsy by an examining begin insert licensed end insert
physician begin insert and surgeon end insert shall be either reduced to writing or
permanently preserved on recording discs or other similar recording
media, shall include all positive and negative findings pertinent to
establishing the cause of death in accordance with medicolegal
practice and this, along with the written opinions and conclusions
of the examining begin delete physician, end delete begin insert licensed physician and surgeon, end insert shall
be included in the coroner’s record of the death. The coroner shall
have the right to retain only those tissues of the body removed at
the time of the autopsy as may, in his or her opinion, be necessary
or advisable to the inquiry into the case, or for the verification of
his or her findings. No person may be present during the
performance of begin delete a coroner’s end delete begin insert an end insert autopsy without the express consent
of the begin delete coroner. end delete begin insert licensed physician and surgeon who is conducting
the autopsy. end insert

(b) In any case in which the coroner knows, or has reason to
believe, that the deceased has made valid provision for the
disposition of his or her body or a part or parts thereof for medical
or scientific purposes in accordance with Chapter 3.5 (commencing
with Section 7150) of Part 1 of Division 7 of the Health and Safety
Code, the coroner shall neither perform nor authorize any other
person to perform an autopsy on the body unless the coroner has
contacted or attempted to contact the physician last in attendance
to the deceased. If the physician cannot be contacted, the coroner
shall then notify or attempt to notify one of the following of the
need for an autopsy to determine the cause of death: (1) the
surviving spouse; (2) a surviving child or parent; (3) a surviving
brother or sister; (4) any other kin or person who has acquired the
right to control the disposition of the remains. Following a period
of 24 hours after attempting to contact the physician last in
attendance and notifying or attempting to notify one of the
responsible parties listed above, the coroner may begin delete perform or end delete
authorize the performance of an autopsy, as otherwise authorized
or required by law.

(c) Nothing in this section shall be deemed to prohibit the
discretion of the coroner to begin delete conduct autopsies end delete begin insert cause to be
conducted an autopsy end insert upon any victim of sudden, unexpected, or
unexplained death or any death known or suspected of resulting
from an accident, suicide, or apparent criminal means, or other
death, as described in Section 27491.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 27491.41 of the end insert begin insert Government Code end insert begin insert is amended
to read: end insert

27491.41.  

(a) For purposes of this section, “sudden infant
death syndrome” means the sudden death of any infant that is
unexpected by the history of the infant and where a thorough
postmortem examination fails to demonstrate an adequate cause
of death.

(b) The Legislature finds and declares that sudden infant death
syndrome (SIDS) is the leading cause of death for children under
age one, striking one out of every 500 children. The Legislature
finds and declares that sudden infant death syndrome is a serious
problem within the State of California, and that public interest is
served by research and study of sudden infant death syndrome,
and its potential causes and indications.

(c) (1) To facilitate these purposes, the coroner shall, within
24 hours, or as soon thereafter as feasible, begin delete perform end delete begin insert cause end insert an
autopsy begin insert to be performed end insert in any case where an infant has died
suddenly and unexpectedly.

(2) However, if the attending begin insert licensed end insert physician begin insert and surgeon end insert
desires to certify that the cause of death is sudden infant death
syndrome, an autopsy may be performed at the discretion of the
coroner. If the coroner begin delete performs end delete begin insert causes end insert an autopsy begin insert to be performed end insert
pursuant to this section, he or she shall also certify the cause of
death.

(d) The autopsy shall be conducted pursuant to a standardized
protocol developed by the State Department of Health Services.
The protocol is exempt from the procedural requirements pertaining
to the adoption of administrative rules and regulations pursuant to
Article 5 (commencing with Section 11346) of Chapter 3.5 of Part
1 of Division 3 of Title 2 of the Government Code. The protocol
shall be developed and approved by July 1, 1990.

(e) The protocol shall be followed by all begin delete coroners end delete begin insert licensed
physicians and surgeons end insert throughout the state when conducting the
autopsies required by this section. The coroner shall state on the
certificate of death that sudden infant death syndrome was the
cause of death when the begin delete coroner’s end delete begin insert licensed physician and surgeon’s end insert
findings are consistent with the definition of sudden infant death
syndrome specified in the standardized autopsy protocol. The
protocol may include requirements and standards for scene
investigations, requirements for specific data, criteria for
ascertaining cause of death based on the autopsy, and criteria for
any specific tissue sampling, and any other requirements. The
protocol may also require that specific tissue samples must be
provided to a central tissue repository designated by the State
Department of Health Services.

(f) The State Department of Health Services shall establish
procedures and protocols for access by researchers to any tissues,
or other materials or data authorized by this section. Research may
be conducted by any individual with a valid scientific interest and
prior approval from the State Committee for the Protection of
Human Subjects. The tissue samples, the materials, and all data
shall be subject to the confidentiality requirements of Section
103850 of the Health and Safety Code.

(g) The coroner may take tissue samples for research purposes
from infants who have died suddenly and unexpectedly without
consent of the responsible adult if the tissue removal is not likely
to result in any visible disfigurement.

(h) A coroner begin insert or licensed physician and surgeon end insert shall not be
liable for damages in a civil action for any act or omission done
in compliance with this section.

(i) No consent of any person is required prior to undertaking
the autopsy required by this section.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 27491.43 of the end insert begin insert Government Code end insert begin insert is amended
to read: end insert

27491.43.  

(a) (1) Notwithstanding any other begin delete provision of end delete law,
except as otherwise provided in this section in any case in which
the begin delete coroner, end delete begin insert licensed physician and surgeon, end insert before beginning an
autopsy, dissection, or removal of corneal tissue, pituitary glands,
or any other organ, tissue, or fluid, has received a certificate of
religious belief, executed by the decedent as provided in
subdivision (b), that the procedure would be contrary to his or her
religious belief, the coroner shall not perform that procedure on
the body of the decedent.

(2) If, before beginning the procedure, the coroner begin insert or licensed
physician and surgeon end insert is informed by a relative or a friend of the
decedent that the decedent had executed a certificate of religious
belief, the begin delete coroner end delete begin insert licensed physician and surgeon end insert shall not perform
the procedure, except as otherwise provided in this section, for 48
hours. If the certificate is produced within 48 hours, the case shall
be governed by this section. If the certificate is not produced within
that time, the case shall be governed by the other provisions of
this article.

(b) Any person, 18 years of age or older, may execute a
certificate of religious belief which shall state in clear and
unambiguous language that any postmortem anatomical dissection
or that specified procedures would violate the religious convictions
of the person. The certificate shall be signed and dated by the
person in the presence of at least two witnesses. Each witness shall
also sign the certificate and shall print on the certificate his or her
name and residence address.

(c) Notwithstanding the existence of a certificate, the coroner
may at any time begin delete perform end delete begin insert cause end insert an autopsy begin insert to be performed end insert or any
other procedure if he or she has a reasonable suspicion that the
death was caused by the criminal act of another or by a contagious
disease constituting a public health hazard.

(d) (1) If a certificate is produced, and if subdivision (c) does
not apply, the coroner may petition the superior court, without fee,
for an order authorizing an autopsy or other procedure or for an
order setting aside the certificate as invalid. Notice of the
proceeding shall be given to the person who produced the
certificate. The proceeding shall have preference over all other
cases.

(2) The court shall set aside the certificate if it finds that the
certificate was not properly executed or that it does not clearly
state the decedent’s religious objection to the proposed procedure.

(3) The court may order an autopsy or other procedure despite
a valid certificate if it finds that the cause of death is not evident,
and that the interest of the public in determining the cause of death
outweighs its interest in permitting the decedent and like persons
fully to exercise their religious convictions.

(4) Any procedure performed pursuant to paragraph (3) shall
be the least intrusive procedure consistent with the order of the
court.

(5) If the petition is denied, and no stay is granted, the body of
the deceased shall immediately be released to the person authorized
to control its disposition.

(e) In any case in which the circumstances, manner, or cause
of death is not determined because of the provisions of this section,
the coroner may state on the certificate of death that an autopsy
was not conducted because of the provisions of this section.

(f) A coroner shall not be liable for damages in a civil action
for any act or omission taken in compliance with the provisions
of this section.

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 27491.46 of the end insert begin insert Government Code end insert begin insert is amended
to read: end insert

27491.46.  

(a) The coroner shall have the right to retain
pituitary glands solely for transmission to a university, for use in
research or the advancement of medical science, in those cases in
which the coroner has begin insert required an autopsy to be end insert performed begin delete an
autopsy end delete pursuant to this chapter, and during a 48-hour period
following such autopsy the body has not been claimed and the
coroner has not been informed of any relatives of the decedent.

(b) In the course of any begin delete autopsy performed by the coroner, end delete
begin insert autopsy, end insert the coroner may begin delete remove end delete begin insert cause to be removed end insert the pituitary
gland from the body for transmittal to any public agency for use
in manufacturing a hormone necessary for the physical growth of
persons who are, or may become, hypopituitary dwarfs, if the
coroner has no knowledge of objection to the removal and release
of the pituitary gland having been made by the decedent or any
other person specified in Section 7151.5 of the Health and Safety
Code. Neither the coroner nor the medical examiner authorizing
the removal of the pituitary gland, nor any hospital, medical center,
tissue bank, storage facility, or person acting upon the request,
order, or direction of the coroner or medical examiner in the
removal of the pituitary gland pursuant to this section, shall incur
civil liability for the removal of the pituitary gland in an action
brought by any person who did not object prior to the removal of
the pituitary gland, nor be subject to criminal prosecution for
removal of the pituitary gland pursuant to the authority of this
section.

Nothing in this subdivision shall supersede the terms of any gift
made pursuant to Chapter 3.5 (commencing with Section 7150)
of Part 1 of Division 7 of the Health and Safety Code.

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 27491.47 of the end insert begin insert Government Code end insert begin insert is amended
to read: end insert

27491.47.  

(a) Notwithstanding any other begin delete provision of end delete law, the
coroner may, in the course of an autopsy, begin delete remove and release or end delete
authorize the removal and release of corneal eye tissue from a
body within the coroner’s custody, if all of the following conditions
are met:

(1) The autopsy has otherwise been authorized.

(2) The coroner has no knowledge of objection to the removal
and release of corneal tissue having been made by the decedent or
any other person specified in Section 7151 of the Health and Safety
Code and has obtained any one of the following:

(A) A dated and signed written consent by the donor or any
other person specified in Section 7151 of the Health and Safety
Code on a form that clearly indicates the general intended use of
the tissue and contains the signature of at least one witness.

(B) Proof of the existence of a recorded telephonic consent by
the donor or any other person specified in Section 7151 of the
Health and Safety Code in the form of an audio recording of the
conversation or a transcript of the recorded conversation, which
indicates the general intended use of the tissue.

(C) A document recording a verbal telephonic consent by the
donor or any other person specified in Section 7151 of the Health
and Safety Code, witnessed and signed by no fewer than two
members of the requesting entity, hospital, eye bank, or
procurement organization, memorializing the consenting person’s
knowledge of and consent to the general intended use of the gift.

The form of consent obtained under subparagraph (A), (B), or
(C) shall be kept on file by the requesting entity and the official
agency for a minimum of three years.

(3) The removal of the tissue will not unnecessarily mutilate
the body, be accomplished by enucleation, nor interfere with the
autopsy.

(4) The tissue will be removed by a begin delete coroner, end delete licensed physician
and begin delete surgeon, end delete begin insert surgeon end insert or a trained transplant technician.

(5) The tissue will be released to a public or nonprofit facility
for transplant, therapeutic, or scientific purposes.

(b) Neither the coroner nor medical examiner authorizing the
removal of the corneal tissue, nor any hospital, medical center,
tissue bank, storage facility, or person acting upon the request,
order, or direction of the coroner or medical examiner in the
removal of corneal tissue pursuant to this section, shall incur civil
liability for the removal in an action brought by any person who
did not object prior to the removal of the corneal tissue, nor be
subject to criminal prosecution for the removal of the corneal tissue
pursuant to this section.

(c) This section shall not be construed to interfere with the
ability of a person to make an anatomical gift pursuant to the
Uniform Anatomical Gift Act (Chapter 3.5 (commencing with
Section 7150) of Part 1 of Division 7 of the Health and Safety
Code).

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 27520 of the end insert begin insert Government Code end insert begin insert is amended to
read: end insert

27520.  

(a) The coroner shall begin delete perform or end delete cause to be performed
an autopsy on a decedent, for which an autopsy has not already
been performed, if the surviving spouse requests him begin insert or her end insert to do
so in writing. If there is no surviving spouse, the coroner shall
begin delete perform the end delete begin insert cause an end insert autopsy begin insert to be performed end insert if requested to do
so in writing by a surviving child or parent, or if there is no
surviving child or parent, by the next of kin of the deceased.

(b) The coroner may begin delete perform or end delete cause to be performed an
autopsy on a decedent, for which an autopsy has already been
performed, if the surviving spouse requests him begin insert or her end insert to do so in
writing. If there is no surviving spouse, the coroner may begin delete perform
the end delete begin insert cause an end insert autopsy begin insert to be performed end insert if requested to do so in
writing by a surviving child or parent, or if there is no surviving
child or parent, by the next of kin of the deceased.

(c) The cost of an autopsy requested pursuant to either
subdivision (a) or (b) shall be borne by the person requesting that
it be performed.

begin delete SECTION 1. end delete

begin insert SEC. 7. end insert   

Section 27522 is added to the Government Code, to
read:

27522.  

(a)  begin insert A forensic autopsy shall only be conducted by a
licensed physician and surgeon. end insert The results of a begin delete postmortem
examination or end delete begin insert forensic end insert autopsy begin delete and the cause and manner of death end delete
shall begin insert only end insert be determined by a licensed physician and begin delete surgeon who
is a forensic pathologist, preferably a diplomat of the American
Board of Pathology. end delete begin insert surgeon. end insert

begin delete

(b) For purposes of this section, a postmortem examination or
autopsy includes, but is not limited to, the following items, if
physically feasible:

(1) Procedures described in subdivision (b) of Section 27521.

(2) An analysis of the blood, vitreous fluid, urine, bile, stomach
contents, other tissues or bodily fluids, or organs of the body.

(3) The examination or removal, or both, of the internal organs
of the body.

(4) The retention of any organs or tissues of the body as part of
the investigation of the death.

(5) Any laboratory analysis, chemical testing, or imaging
performed as part of the investigation of the death.

(c) If a patient is admitted to a hospital with a life-threatening
injury, or is under the influence of an intoxicating substance, as
determined by the attending physician at the hospital, or was in
the custody of a law enforcement agency within 24 hours of
admission to the hospital, blood and urine specimens collected
from the patient at the time of admission shall be retained until the
patient is discharged from the hospital. If the patient dies prior to
discharge, the specimens shall be released to the coroner.

end delete begin insert

(b) A forensic autopsy shall be defined as an examination of a
body of a decedent to generate medical evidence for which the
cause and manner of death is determined.

end insert begin insert

(c) For purposes of this section, a postmortem examination shall
be defined as the external examination of the body where no
manner or cause of death is determined.

end insert

(d) For health and safety purposes, all persons in the autopsy
suite shall have current bloodborne pathogen training and personal
protective equipment in accordance with the requirements described
in Section 5193 of Title 8 of the California Code of Regulations
or its successor.

(e) (1) Police and other law enforcement personnel who have
completed training as described in subdivision (d) may be allowed
into the autopsy suite at the discretion of the forensic pathologist.

(2) Notwithstanding paragraph (1), if an individual dies begin delete incident
to end delete begin insert due to the involvement of end insert law enforcement activity, law
enforcement personnel directly involved with the care and custody
of that individual shall not be begin insert involved with any portion of the
postmortem examination, nor allowed end insert inside the autopsy suite
during the performance of the autopsy.

(f) Any police reports, crime scene or other information, videos,
or laboratory tests that are in the possession of law enforcement
and are related to a death that is incident to law enforcement
activity shall be made available to the forensic pathologist prior
to the completion of the investigation of the death.

begin insert

(g) This section shall not be construed to limit the practice of
an autopsy for educational or research purposes.

end insert

begin delete SEC. 2. end delete

begin insert SEC. 8. end insert   

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.