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Forensic pathology might be hot TV, but in real life, autopsies are growing less common locally.

They probably are less common nationally, too, but the government has stopped keeping track. Between 1972 and 1995, the last year for which statistics are available, the rate fell from 19.1 percent of all deaths to 9.4 percent.

Some health care professionals fear they are missing learning opportunities as a result.

Autopsy is the medical examination of a person's body to determine the cause of death. It can be valuable in determining accuracy of diagnosis. In one well-publicized case, an autopsy performed on the actor John Ritter found that he had died from a tear in his aorta, not a heart attack as previously thought.

Autopsies also are valuable in tracking the spread of disease, gauging the effectiveness of treatment, and educating physicians and medical students. And they can determine whether an illness has a genetic component that the deceased's family needs to know about.

In North Carolina, the state medical examiner's office still routinely performs autopsies in such cases as homicide, suicide, traffic accidents and unexplained deaths.

But at Greensboro's Moses Cone Hospital, the number of autopsies has fallen from 179 in 1978 to a projected 57 to 60 this year.

When a patient is terminally ill from an obvious cause, often neither the patient's doctor nor the patient's family sees much point in an autopsy.

"(When) all the people involved in the care of that individual realize that they've come to the end of their life and there's nothing to be learned, (an autopsy is) sort of just a waste of time and resources," said Cone pathologist Dr. Robert Gay.

However, Cone will perform an autopsy free if the deceased's family requests it. Nationwide, many hospitals have begun charging for autopsies — $2,500 and up, a fee that most insurers will not cover.

Another reason for the decline of autopsies is that imaging technologies such as CT scanning and ultrasound have enabled doctors to "see" such obvious internal causes of death as tumors before the patient dies, said Dr. Patrick Lantz, associate professor of pathology at Wake Forest University Baptist Medical Center.

Also, because most insurance won't cover an autopsy, hospitals have no way of getting back those costs, Lantz said. Baptist performs autopsies on request at no charge.

Gay and Lantz point out that a few decades ago, the Joint Commission, the organization that accredits hospitals, dropped a requirement that hospitals perform autopsies on a certain percentage of their patients who died.

The decline in autopsies carries some risk. The U.S. Agency for Healthcare Research and Quality has reviewed studies of autopsies dating back four decades. It reported in 2002 that autopsies revealed misdiagnoses that may have affected outcome in roughly 11 percent of all U.S. cases in which an autopsy was performed.

It found that in roughly 24 percent of U.S. cases, an autopsy revealed a major diagnostic error, whether or not it would have affected the outcome. Although it used the term "error," the report emphasized that incorrect diagnoses might be the best a doctor can do with the information and technology available.

The report also found that some autopsies revealed unsuspected complications.

Doctors "have compelling reasons to request autopsies far more often than currently occurs," the report concluded.

Lantz agrees, likening the current situation to investigating a plane crash only by examining the aircraft's "black box" flight-data recorder.

"(If) you don't look at the airplane itself, and all you do is look at the black box, you say it must be pilot error," he said. "But if you look at the jet engine, you find a flock of seagulls got sucked into the engine and that's what caused the plane to go down."

Lantz doesn't think the situation will change until hospitals begin getting reimbursed for autopsies. And a good system for that reimbursement "would provide good information back to the hospital, back to the clinicians, back to the insurance companies and back to society."

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com