Amended in Assembly August 19, 2016

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 Bill No. 1189

Introduced by Senators Pan and Jackson

begin insert

(Coauthor: Assembly Member Irwin)

end insert

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. Existing law requires the coroner to perform an autopsy pursuant to a standardized protocol developed by the State Department of begin insert Public end insert Health begin delete Care Services end delete in any case where an infant has died suddenly and unexpectedly.

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. begin insert The bill would authorize trained county personnel who are necessary to the performance of an autopsy to take body measurements or retrieve blood, urine, or vitreous samples from the body of a decedent at the direction and supervision of a coroner, a medical examiner, or a licensed physician and surgeon. end insert The bill would require, if a licensed physician and surgeon conducts a forensic autopsy, the coroner begin insert or medical examiner end insert to consult with the licensed physician and surgeon in the determination of the manner of death. 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.

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 begin delete forensic pathologist end delete begin insert physician and surgeon who conducts the autopsy end insert 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:

SECTION 1.  

Section 27491.4 of the Government Code is
amended to read:

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 examination, or cause to be made an 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 licensed physician and surgeon 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 licensed
physician and surgeon, 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. Only
individuals who are directly involved in the investigation of the
death of the decedent may be present during the performance of
the autopsy.

(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 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 cause to be conducted an autopsy 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.

SEC. 2.  

Section 27491.41 of the Government Code is amended
to read:

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, also referred to as 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 the 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, cause an autopsy to be
performed in any case where an infant has died suddenly and
unexpectedly.

(2) However, if the attending licensed physician and surgeon
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 causes an autopsy to be performed 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 Public Health. 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.

(e) The protocol shall be followed by all coroners throughout
the state when conducting an evaluation as part of an autopsy
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 coroner’s 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 shall be
provided to a central tissue repository designated by the State
Department of Public Health.

(f) The State Department of Public Health 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 or licensed physician and surgeon shall not be
liable for damages in a civil action for any act or omission done
in compliance with this section.

(i)  Consent of any person is not required before undertaking
the autopsy required by this section.

SEC. 3.  

Section 27491.43 of the Government Code is amended
to read:

27491.43.  

(a) (1) Notwithstanding any other law, except as
otherwise provided in this section, in any case in which the coroner,
before the beginning of 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 neither
perform, nor order the performance of, that procedure on the body
of the decedent.

(2) If, before beginning the procedure, the coroner is informed
by a relative or a friend of the decedent that the decedent had
executed a certificate of religious belief, the coroner shall not order
an autopsy to be performed, 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 cause an autopsy to be performed 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.

SEC. 4.  

Section 27491.46 of the Government Code is amended
to read:

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 required an autopsy to be performed 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 autopsy, the coroner may cause to be
removed 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.

SEC. 5.  

Section 27491.47 of the Government Code is amended
to read:

27491.47.  

(a) Notwithstanding any other law, the coroner may,
in the course of an autopsy, 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 licensed physician and
surgeon 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).

SEC. 6.  

Section 27520 of the Government Code is amended
to read:

27520.  

(a) The coroner shall cause to be performed an autopsy
on a decedent, for which an autopsy has not already been
performed, if the surviving spouse requests him or her to do so in
writing. If there is no surviving spouse, the coroner shall cause an
autopsy to be performed 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 cause to be performed an autopsy on a
decedent, for which an autopsy has already been performed, if the
surviving spouse requests him or her to do so in writing. If there
is no surviving spouse, the coroner may cause an autopsy to be
performed 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.

SEC. 7.  

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

27522.  

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

(b) A forensic autopsy shall be defined as an examination of a
body of a decedent to generate medical evidence for which the
cause of death is determined. begin insert At the direction and supervision of
a coroner, a medical examiner, or a licensed physician and
surgeon, trained county personnel who are necessary to the
performance of an autopsy may take body measurements or retrieve
blood, urine, or vitreous samples from the body of a decedent. end 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.

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

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

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

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

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

(g) 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 begin delete forensic pathologist end delete
begin insert physician and surgeon who conducts the autopsy end insert prior to the
completion of the investigation of the death.

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

SEC. 8.  

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.