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Scalia cause of death undetermined

Larry H. Bernstein, MD, FCAP, Curator

LPBI

George D. Lundberg, MD

Hello and welcome. I am Dr George Lundberg, and this is At Large at Medscape.

Back in the “good old days,” I was proud to be part of the profession of American medicine—a culture of self- and peer criticism where truth was sought and told, and recognition of error led to individual and group improvement. If a patient was seen by a physician who took a history, conducted a physical examination and ordered tests, diagnosed a nonlethal condition, and provided treatment, and 2 days later that patient was found dead, the physician wanted to know what happened and how he could have done better. An autopsy often provided the answers. Doctors learned. Autopsy rates on hospital deaths in those days were in the 50% range.

In February 2016, a 79-year-old man who had just returned from a vigorous trip to Hong Kong saw his physician with complaints of a head cold and shoulder pain. Examinations and tests were done and treatment provided. Two days later that patient was found dead. If you were that physician, would you not want to know what happened? But no autopsy was performed. (Autopsy rates on nonviolent deaths in the United States in 2014 were down to 3.5%.)

I know nothing about Supreme Court Associate Justice Antonin Scalia’s life or death except what I have read in news reports. It is not my intent here to go into historical detail. However, I do know a lot about the value of an autopsy.

What was the cause of death of Antonin Scalia on February 13 or 14, 2016? I do not know and neither do you. Nor does Presidio County, Texas Judge Cinderella Guevara, who said, from many miles away and without seeing the body, that he died of “natural causes” (which, of course, is not a cause of death at all), and then said that he had a “myocardial infarction.” Nor does his putative physician, Rear Admiral Brian T. Monahan in Washington, DC, with whom Judge Guevara spoke by telephone.

I seize this event as a Teachable Moment about the autopsy, which has, sad to say, become almost nonexistent for most current American physicians and hospitals