New York Law Review

Tag: Autopsy

  • Gross v. New York, 73 N.Y.2d 860 (1989): Autopsies as the Practice of Medicine

    73 N.Y.2d 860 (1989)

    The performance of an autopsy constitutes the practice of medicine under New York Education Law § 6521, thereby subjecting medical examiners to the jurisdiction of the State Board for Professional Medical Conduct.

    Summary

    Gross, New York City’s Chief Medical Examiner, faced professional misconduct charges related to autopsy performance. An Administrative Officer (AO) initially dismissed the charges, deeming autopsies outside the scope of “practice of medicine” as defined in Education Law § 6521, thus asserting a lack of jurisdiction by the State Board for Professional Medical Conduct. The Board of Regents reversed the AO’s decision. Gross then initiated an Article 78 proceeding, arguing the Board lacked subject matter jurisdiction. The Court of Appeals affirmed the Appellate Division’s dismissal of Gross’s petition, holding that autopsies do constitute the practice of medicine, and the AO’s decision was subject to administrative review.

    Facts

    Petitioner Gross, as New York City’s Chief Medical Examiner, was accused of professional misconduct in conducting autopsies. These charges were brought under Education Law § 6509 (2). An Administrative Officer (AO), designated within the disciplinary hearing committee, ruled that performing an autopsy did not constitute the “practice of medicine” as defined by Education Law § 6521. The AO consequently dismissed the charges based on a lack of subject matter jurisdiction by the State Board for Professional Medical Conduct.

    Procedural History

    1. The AO dismissed the charges against Gross.
    2. The Commissioner of Health and the Regents Review Committee reviewed and reversed the AO’s decision, remanding the case for further proceedings.
    3. Gross initiated an Article 78 proceeding under Education Law § 6510-a (4), seeking relief in the nature of prohibition.
    4. The Appellate Division dismissed Gross’s petition.
    5. The Court of Appeals affirmed the Appellate Division’s dismissal.

    Issue(s)

    1. Whether the performance of autopsies constitutes the “practice of medicine” as defined in Education Law § 6521, thus granting the State Board for Professional Medical Conduct jurisdiction over such activities.
    2. Whether the decision of the Administrative Officer (AO) to dismiss the charges against Gross was subject to review by the Commissioner of Health and the Board of Regents.

    Holding

    1. Yes, because Education Law § 6521 defines the practice of medicine as “diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition,” and an autopsy is the ultimate diagnostic procedure to determine the cause and means of death.
    2. Yes, because neither Public Health Law § 230 nor Education Law § 6510-a precludes the reversal of an AO’s rulings through administrative review, and absent a specific legislative mandate, an AO’s order erroneously dismissing charges is not final.

    Court’s Reasoning

    The Court reasoned that Education Law § 6521, defining the practice of medicine, lacks any limitation suggesting it applies only to living patients. It emphasized that an autopsy is fundamentally a diagnostic procedure used to determine the cause and manner of death. Therefore, it falls squarely within the definition of “diagnosing… any human disease, pain, injury, deformity or physical condition.” The court stated, “Clearly, an autopsy is the ultimate diagnostic procedure through which are determined the cause and means of death. Accordingly, since the practice of medicine includes the performance of autopsies, subject matter jurisdiction obtains.”

    Regarding the reviewability of the AO’s decision, the Court found no statutory basis to prevent the Commissioner of Health and the Board of Regents from reviewing and reversing the AO’s ruling. While Public Health Law § 230 (10) (e) defines the AO’s authority to make legal rulings, it does not grant those rulings finality. The court noted, “Absent a specific legislative mandate to the contrary, we perceive no basis for attributing finality to an order made by an Administrative Officer which erroneously dismisses charges of professional medical misconduct.” This ensures that errors in initial legal rulings can be corrected through established administrative processes.

  • Cremonese v. City of New York, 17 N.Y.2d 22 (1966): Medical Examiner’s Authority to Perform Autopsy

    Cremonese v. City of New York, 17 N.Y.2d 22 (1966)

    A medical examiner has the statutory authority to perform an autopsy when a death occurs in an unusual manner, such as when a hospital is unable to definitively diagnose the cause of death after extensive medical tests.

    Summary

    This case addresses the scope of a medical examiner’s authority to order an autopsy when a patient dies in a hospital, and the cause of death remains undetermined despite medical intervention. The New York Court of Appeals held that the medical examiner acted within his statutory authority to perform an autopsy because the hospital could not provide a definitive diagnosis for the patient’s death, rendering the death “unusual.” This decision emphasizes the importance of the medical examiner’s role in protecting public health and ensuring accountability in hospital care when the cause of death is uncertain.

    Facts

    The plaintiff’s wife was admitted to Coney Island Hospital with acute abdominal pain and died nine days later. Despite x-ray studies and medical procedures, the hospital staff could not determine the exact cause of her death. The hospital initially signed out the case as “peritonitis due to perforation of viscus,” but this diagnosis was considered too general and unacceptable to the Board of Health. The plaintiff refused to consent to an autopsy. Due to the obscure cause of death, the medical examiner’s office was notified, and the medical examiner decided to perform an autopsy.

    Procedural History

    The plaintiff sued the City of New York, alleging that the hospital performed the autopsy without his consent. The trial court found in favor of the plaintiff. The Appellate Division reduced the damage award from $12,500 to $3,500. The City appealed to the New York Court of Appeals, arguing that the medical examiner acted within his statutory authority.

    Issue(s)

    Whether the medical examiner acted within the scope of his statutory authority in deciding to perform an autopsy on the deceased when the hospital could not provide a definitive cause of death, and the Board of Health found the hospital’s explanation unacceptable?

    Holding

    Yes, because the hospital’s inability to provide a definitive diagnosis for the patient’s death, despite extensive medical intervention, constituted an “unusual” manner of death, thereby triggering the medical examiner’s authority to perform an autopsy under the New York City Charter and Administrative Code.

    Court’s Reasoning

    The Court of Appeals emphasized that the medical examiner’s authority, as defined by the New York City Charter § 878 and the Administrative Code § 878-3.0, permits autopsies in cases of “unusual” deaths. The court reasoned that because the hospital could not definitively determine the cause of death after extensive tests and procedures, the death was considered “unusual.” The court relied on the medical examiner’s testimony that the hospital physicians “had no definitive diagnosis” and that he himself “was unable to determine any exact cause of death.” The court stated, “The inability of physicians to diagnose the nature of her illness or to determine the cause of her death after following procedures customary in a modern hospital was an ‘unusual’ termination of life.” The court distinguished this case from cases like Darcy v. Presbyterian Hosp., where the allegations did not indicate an unusual manner of death. The court concluded that allowing the medical examiner to investigate such deaths protects public health and provides additional safeguards in hospital care, especially when a hospital leaves the cause of a patient’s death uncertain. The court emphasized that it is the medical examiner’s duty in the public interest to investigate when a hospital fails to provide a clear explanation of a patient’s death.