California Senate Bill SB1189 Amended / Bill

 BILL NUMBER: SB 1189AMENDED BILL TEXT AMENDED IN SENATE APRIL 26, 2016 AMENDED IN SENATE APRIL 13, 2016 AMENDED IN SENATE MARCH 28, 2016 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   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 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  postmortem examination or autopsy, as specified,   forensic autopsy  and the cause and manner of death be determined by a licensed physician and  surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology.   surgeon.   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.   This   The  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  incident to   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.   This  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.  This   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   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  physician,   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. No person may be present during the performance of  a coroner's   an  autopsy without the express consent of the  coroner.   licensed physician and surgeon who is conducting 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  perform or  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  conduct autopsies   c   ause 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 (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,  perform   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  performs   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 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  coroners   licensed physicians and surgeons  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  coroner's   licensed physician and surgeon'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 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  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) No consent of any person is required prior to 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  provision of  law, except as otherwise provided in this section in any case in which the  coroner,   licensed physician and surgeon,  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  or licensed physician and surgeon  is informed by a relative or a friend of the decedent that the decedent had executed a certificate of religious belief, the  coroner   licensed physician and surgeon  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  perform   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  an autopsy  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 performed by the coroner,   autopsy,  the coroner may  remove   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  provision of  law, the coroner may, in the course of an autopsy,  remove and release or  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  coroner,  licensed physician and  surgeon,   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  perform or  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  perform the   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  perform or  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  perform the   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.  SECTION 1.   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  postmortem examination or   forensic  autopsy  and the cause and manner of death  shall  only  be determined by a licensed physician and  surgeon who is a forensic pathologist, preferably a diplomat of the American Board of Pathology.   surgeon.   (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.   (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.   (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 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  incident to   due to the involvement of  law enforcement activity, law enforcement personnel directly involved with the care and custody 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. (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.  (g) This section shall not be construed to limit the practice of an autopsy for educational or research purposes.   SEC. 2.   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.