Amended in Assembly August 3, 2016

Amended in Assembly June 22, 2016

Amended in Senate April 26, 2016

Amended in Senate April 13, 2016

Amended in Senate March 28, 2016

Senate BillNo. 1189


Introduced by Senators Pan and Jackson

February 18, 2016


An act to amend Sections 27491.4, 27491.41, 27491.43, 27491.46, 27491.47, and 27520 of, and to add Section 27522 to, 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.begin insert Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of Health Care Services in any case where an infant has died suddenly and unexpectedly.end insert

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 bill would require that a forensic autopsy, as defined, be conducted by a licensed physician and surgeon. The bill would require that the results of a forensic autopsy be determined by a licensed physician and surgeon. The bill would require the manner of death to be determined by the coroner or medical examiner of a county. The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner to consult with the licensed physician and surgeon in the determination of the manner of death.begin insert The bill would require the coroner to conduct an evaluation pursuant to a standardized protocol developed by the State Department of Public Health in any case where an infant has died suddenly and unexpectedly.end insert

The bill would require, for health and safety purposes, that all persons in the autopsy suite be informed of the risks presented by bloodborne pathogens and be informed that they should wear personal protective equipment, as specified. The bill would require that only individuals who are directly involved in the investigation of the death of the decedent be allowed into the autopsy suite but would permit individuals to be in the autopsy suite for educational and research purposes at the discretion of the coroner, in consultation with any licensed physician and surgeon conducting an autopsy. The bill would prohibit law enforcement personnel directly involved in the death of an individual who died due to involvement of law enforcement activity from being involved with any portion of the postmortem examination or being inside the autopsy suite during the performance of the autopsy. 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.

The 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.

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

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.

The 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:

P3    1

SECTION 1.  

Section 27491.4 of the Government Code is
2amended to read:

3

27491.4.  

(a) For purposes of inquiry the coroner shall, within
424 hours or as soon as feasible thereafter, where the suspected
5cause of death is sudden infant death syndrome and, in all other
6cases, the coroner may, in his or her discretion, take possession of
7the body, which shall include the authority to exhume the body,
8order it removed to a convenient place, and make or cause to be
9made a postmortem examination, or cause to be made an autopsy
10thereon, and make or cause to be made an analysis of the stomach,
11stomach contents, blood, organs, fluids, or tissues of the body. The
12detailed medical findings resulting from an inspection of the body
13or autopsy by an examining licensed physician and surgeon shall
14be either reduced to writing or permanently preserved on recording
15discs or other similar recording media, shall include all positive
16and negative findings pertinent to establishing the cause of death
17in accordance with medicolegal practice and this, along with the
18written opinions and conclusions of the examining licensed
19physician and surgeon, shall be included in the coroner’s record
20of the death. The coroner shall have the right to retain only those
21tissues of the body removed at the time of the autopsy as may, in
22his or her opinion, be necessary or advisable to the inquiry into
23the case, or for the verification of his or her findings. Only
P4    1individuals who are directly involved in the investigation of the
2death of the decedent may be present during the performance of
3the autopsy.

4(b) In any case in which the coroner knows, or has reason to
5believe, that the deceased has made valid provision for the
6disposition of his or her body or a part or parts thereof for medical
7or scientific purposes in accordance with Chapter 3.5 (commencing
8with Section 7150) of Part 1 of Division 7 of the Health and Safety
9Code, the coroner shall neither perform nor authorize any other
10person to perform an autopsy on the body unless the coroner has
11contacted or attempted to contact the physician last in attendance
12to the deceased. If the physician cannot be contacted, the coroner
13shall then notify or attempt to notify one of the following of the
14need for an autopsy to determine the cause of death: (1) the
15surviving spouse; (2) a surviving child or parent; (3) a surviving
16brother or sister; (4) any other kin or person who has acquired the
17right to control the disposition of the remains. Following a period
18of 24 hours after attempting to contact the physician last in
19attendance and notifying or attempting to notify one of the
20responsible parties listed above, the coroner may authorize the
21performance of an autopsy, as otherwise authorized or required
22by law.

23(c) Nothing in this section shall be deemed to prohibit the
24discretion of the coroner to cause to be conducted an autopsy upon
25any victim of sudden, unexpected, or unexplained death or any
26death known or suspected of resulting from an accident, suicide,
27or apparent criminal means, or other death, as described in Section
2827491.

29

SEC. 2.  

Section 27491.41 of the Government Code is amended
30to read:

31

27491.41.  

(a) For purposes of this section, “sudden infant
32death syndrome” means the sudden death of any infant that is
33unexpected by the history of the infant and where a thorough
34postmortem examination fails to demonstrate an adequate cause
35of death.

36(b) The Legislature finds and declares that sudden infant death
37begin delete syndrome (SIDS)end deletebegin insert syndrome, also referred to as SIDS,end insert is the leading
38cause of death for children under age one, striking one out of every
39500 children. The Legislature finds and declares that sudden infant
40death syndrome is a serious problem within the State of California,
P5    1and thatbegin insert theend insert public interest is served by research and study of
2sudden infant deathbegin delete syndrome,end deletebegin insert syndromeend insert and its potential causes
3and indications.

4(c) (1) To facilitate these purposes, the coroner shall, within
524begin delete hours,end deletebegin insert hoursend insert or as soon thereafter as feasible, cause an autopsy
6to be performed in any case where an infant has died suddenly and
7unexpectedly.

8(2) However, if the attending licensed physician and surgeon
9desires to certify that the cause of death is sudden infant death
10syndrome, an autopsy may be performed at the discretion of the
11 coroner. If the coroner causes an autopsy to be performed pursuant
12to this section, he or she shall also certify the cause of death.

13(d) The autopsy shall be conducted pursuant to a standardized
14protocol developed by the State Department ofbegin delete Health Care
15Services.end delete
begin insert Public Health.end insert The protocol is exempt from the
16procedural requirements pertaining to the adoption of
17administrative rules and regulations pursuant to Article 5
18(commencing with Section 11346) of Chapter 3.5 of Part 1 of
19Division 3 of Title 2 of the Government Code.begin delete The protocol shall
20be developed and approved by July 1, 1990.end delete

21(e) The protocol shall be followed by all coroners throughout
22the state when conductingbegin delete the autopsiesend deletebegin insert an evaluation as part of
23an autopsyend insert
required by this section. The coroner shall state on the
24certificate of death that sudden infant death syndrome was the
25cause of death when the coroner’s findings are consistent with the
26definition of sudden infant death syndrome specified in the
27standardized autopsy protocol. The protocol may include
28requirements and standards for scene investigations, requirements
29for specific data, criteria for ascertaining cause of death based on
30the autopsy, and criteria for any specific tissue sampling, and any
31other requirements. The protocol may also require that specific
32tissue samplesbegin delete mustend deletebegin insert shallend insert be provided to a central tissue repository
33designated by the State Department ofbegin delete Health Care Services.end deletebegin insert Public
34Health.end insert

35(f) The State Department ofbegin delete Health Care Servicesend deletebegin insert Public Healthend insert
36 shall establish procedures and protocols for access by researchers
37to any tissues, or other materials or data authorized by this section.
38Research may be conducted by any individual with a valid
39scientific interest and prior approval from the State Committee for
40the Protection of Human Subjects. The tissue samples, the
P6    1materials, and all data shall be subject to the confidentiality
2requirements of Section 103850 of the Health and Safety Code.

3(g) The coroner may take tissue samples for research purposes
4 from infants who have died suddenly and unexpectedly without
5consent of the responsible adult if the tissue removal is not likely
6to result in any visible disfigurement.

7(h) A coroner or licensed physician and surgeon shall not be
8liable for damages in a civil action for any act or omission done
9in compliance with this section.

10(i) begin deleteNo consent end deletebegin insert Consent end insertof any person isbegin insert notend insert requiredbegin delete prior toend delete
11begin insert beforeend insert undertaking the autopsy required by this section.

12

SEC. 3.  

Section 27491.43 of the Government Code is amended
13to read:

14

27491.43.  

(a) (1) Notwithstanding any other law, except as
15otherwise provided in this section, in any case in which the coroner,
16before the beginning of an autopsy, dissection, or removal of
17corneal tissue, pituitary glands, or any other organ, tissue, or fluid,
18has received a certificate of religious belief, executed by the
19decedent as provided in subdivision (b), that the procedure would
20be contrary to his or her religious belief, the coroner shall neither
21perform, nor order the performance of, that procedure on the body
22of the decedent.

23(2) If, before beginning the procedure, the coroner is informed
24by a relative or a friend of the decedent that the decedent had
25executed a certificate of religious belief, the coroner shall not order
26an autopsy to be performed, except as otherwise provided in this
27section, for 48 hours. If the certificate is produced within 48 hours,
28the case shall be governed by this section. If the certificate is not
29produced within that time, the case shall be governed by the other
30provisions of this article.

31(b) Any person, 18 years of age or older, may execute a
32certificate of religious belief which shall state in clear and
33unambiguous language that any postmortem anatomical dissection
34or that specified procedures would violate the religious convictions
35of the person. The certificate shall be signed and dated by the
36person in the presence of at least two witnesses. Each witness shall
37also sign the certificate and shall print on the certificate his or her
38name and residence address.

39(c) Notwithstanding the existence of a certificate, the coroner
40may at any time cause an autopsy to be performed or any other
P7    1procedure if he or she has a reasonable suspicion that the death
2was caused by the criminal act of another or by a contagious
3disease constituting a public health hazard.

4(d) (1) If a certificate is produced, and if subdivision (c) does
5not apply, the coroner may petition the superior court, without fee,
6for an order authorizing an autopsy or other procedure or for an
7order setting aside the certificate as invalid. Notice of the
8proceeding shall be given to the person who produced the
9certificate. The proceeding shall have preference over all other
10cases.

11(2) The court shall set aside the certificate if it finds that the
12certificate was not properly executed or that it does not clearly
13state the decedent’s religious objection to the proposed procedure.

14(3) The court may order an autopsy or other procedure despite
15a valid certificate if it finds that the cause of death is not evident,
16and that the interest of the public in determining the cause of death
17outweighs its interest in permitting the decedent and like persons
18fully to exercise their religious convictions.

19(4) Any procedure performed pursuant to paragraph (3) shall
20be the least intrusive procedure consistent with the order of the
21court.

22(5) If the petition is denied, and no stay is granted, the body of
23the deceased shall immediately be released to the person authorized
24to control its disposition.

25(e) In any case in which the circumstances, manner, or cause
26of death is not determined because of the provisions of this section,
27the coroner may state on the certificate of death that an autopsy
28was not conducted because of the provisions of this section.

29(f) A coroner shall not be liable for damages in a civil action
30for any act or omission taken in compliance with the provisions
31of this section.

32

SEC. 4.  

Section 27491.46 of the Government Code is amended
33to read:

34

27491.46.  

(a) The coroner shall have the right to retain
35pituitary glands solely for transmission to a university, for use in
36research or the advancement of medical science, in those cases in
37which the coroner has required an autopsy to be performed pursuant
38to this chapter, and during a 48-hour period following such autopsy
39the body has not been claimed and the coroner has not been
40informed of any relatives of the decedent.

P8    1(b) In the course of any autopsy, the coroner may cause to be
2removed the pituitary gland from the body for transmittal to any
3public agency for use in manufacturing a hormone necessary for
4the physical growth of persons who are, or may become,
5hypopituitary dwarfs, if the coroner has no knowledge of objection
6to the removal and release of the pituitary gland having been made
7by the decedent or any other person specified in Section 7151.5
8of the Health and Safety Code. Neither the coroner nor the medical
9examiner authorizing the removal of the pituitary gland, nor any
10hospital, medical center, tissue bank, storage facility, or person
11acting upon the request, order, or direction of the coroner or
12medical examiner in the removal of the pituitary gland pursuant
13to this section, shall incur civil liability for the removal of the
14pituitary gland in an action brought by any person who did not
15object prior to the removal of the pituitary gland, nor be subject
16to criminal prosecution for removal of the pituitary gland pursuant
17to the authority of this section.

18Nothing in this subdivision shall supersede the terms of any gift
19made pursuant to Chapter 3.5 (commencing with Section 7150)
20of Part 1 of Division 7 of the Health and Safety Code.

21

SEC. 5.  

Section 27491.47 of the Government Code is amended
22to read:

23

27491.47.  

(a) Notwithstanding any other law, the coroner may,
24in the course of an autopsy, authorize the removal and release of
25corneal eye tissue from a body within the coroner’s custody, if all
26of the following conditions are met:

27(1) The autopsy has otherwise been authorized.

28(2) The coroner has no knowledge of objection to the removal
29and release of corneal tissue having been made by the decedent or
30any other person specified in Section 7151 of the Health and Safety
31Code and has obtained any one of the following:

32(A) A dated and signed written consent by the donor or any
33other person specified in Section 7151 of the Health and Safety
34Code on a form that clearly indicates the general intended use of
35the tissue and contains the signature of at least one witness.

36(B) Proof of the existence of a recorded telephonic consent by
37the donor or any other person specified in Section 7151 of the
38Health and Safety Code in the form of an audio recording of the
39conversation or a transcript of the recorded conversation, which
40indicates the general intended use of the tissue.

P9    1(C) A document recording a verbal telephonic consent by the
2donor or any other person specified in Section 7151 of the Health
3and Safety Code, witnessed and signed by no fewer than two
4members of the requesting entity, hospital, eye bank, or
5procurement organization, memorializing the consenting person’s
6knowledge of and consent to the general intended use of the gift.

7The form of consent obtained under subparagraph (A), (B), or
8(C) shall be kept on file by the requesting entity and the official
9agency for a minimum of three years.

10(3) The removal of the tissue will not unnecessarily mutilate
11the body, be accomplished by enucleation, nor interfere with the
12autopsy.

13(4) The tissue will be removed by a licensed physician and
14surgeon or a trained transplant technician.

15(5) The tissue will be released to a public or nonprofit facility
16for transplant, therapeutic, or scientific purposes.

17(b) Neither the coroner nor medical examiner authorizing the
18removal of the corneal tissue, nor any hospital, medical center,
19tissue bank, storage facility, or person acting upon the request,
20order, or direction of the coroner or medical examiner in the
21removal of corneal tissue pursuant to this section, shall incur civil
22liability for the removal in an action brought by any person who
23did not object prior to the removal of the corneal tissue, nor be
24subject to criminal prosecution for the removal of the corneal tissue
25pursuant to this section.

26(c) This section shall not be construed to interfere with the
27ability of a person to make an anatomical gift pursuant to the
28Uniform Anatomical Gift Act (Chapter 3.5 (commencing with
29Section 7150) of Part 1 of Division 7 of the Health and Safety
30Code).

31

SEC. 6.  

Section 27520 of the Government Code is amended
32to read:

33

27520.  

(a) The coroner shall cause to be performed an autopsy
34on a decedent, for which an autopsy has not already been
35performed, if the surviving spouse requests him or her to do so in
36writing. If there is no surviving spouse, the coroner shall cause an
37autopsy to be performed if requested to do so in writing by a
38surviving child or parent, or if there is no surviving child or parent,
39by the next of kin of the deceased.

P10   1(b) The coroner may cause to be performed an autopsy on a
2decedent, for which an autopsy has already been performed, if the
3surviving spouse requests him or her to do so in writing. If there
4is no surviving spouse, the coroner may cause an autopsy to be
5performed if requested to do so in writing by a surviving child or
6parent, or if there is no surviving child or parent, by the next of
7kin of the deceased.

8(c) The cost of an autopsy requested pursuant to either
9subdivision (a) or (b) shall be borne by the person requesting that
10it be performed.

11

SEC. 7.  

Section 27522 is added to the Government Code, to
12read:

13

27522.  

(a) A forensic autopsy shall only be conducted by a
14licensed physician and surgeon. The results of a forensic autopsy
15shall only be determined by a licensed physician and surgeon.

16(b) A forensic autopsy shall be defined as an examination of a
17body of a decedent to generate medical evidence for which the
18cause of death is determined.

19(c) For purposes of this section, a postmortem examination shall
20be defined as the external examination of the body where no
21manner or cause of death is determined.

22(d) For purposes of this section, the manner of death shall be
23determined by the coroner or medical examiner of a county. If a
24forensic autopsy is conducted by a licensed physician and surgeon,
25the coroner shall consult with the licensed physician and surgeon
26in the determination of the manner of death.

27(e) For health and safety purposes, all persons in the autopsy
28suite shall be informed of the risks presented by bloodborne
29pathogens and that they should wear personal protective equipment
30in accordance with the requirements described in Section 5193 of
31Title 8 of the California Code of Regulations or its successor.

32(f) (1) Only individuals who are directly involved in the
33investigation of the death of the decedent shall be allowed into the
34autopsy suite.

35(2) If an individual dies due to the involvement of law
36enforcement activity, law enforcement personnel directly involved
37in the death of that individual shall not be involved with any portion
38of the postmortem examination, nor allowed inside the autopsy
39suite during the performance of the autopsy.

P11   1(3) Notwithstanding paragraph (1), individuals may be permitted
2in the autopsy suite for educational and research purposes at the
3discretion of the coroner and in consultation with any licensed
4physician and surgeon conducting an autopsy.

5(g) Any police reports, crime scene or other information, videos,
6or laboratory tests that are in the possession of law enforcement
7and are related to a death that is incident to law enforcement
8activity shall be made available to the forensic pathologist prior
9to the completion of the investigation of the death.

10(h) This section shall not be construed to limit the practice of
11an autopsy for educational or research purposes.

12

SEC. 8.  

If the Commission on State Mandates determines that
13this act contains costs mandated by the state, reimbursement to
14local agencies and school districts for those costs shall be made
15pursuant to Part 7 (commencing with Section 17500) of Division
164 of Title 2 of the Government Code.



O

    94