Why do autopsies take so long?

The sudden and unexpected death of Prince at the young age of 57 naturally arouses curiousity as to the cause. Although he was a Jehovah’s Witness and reportedly abstained entirely from recreational drugs and alcohol, the fact that he was part of the popular music world immediately fueled speculation that drugs were involved. He supposedly had prescription painkillers, needed because he refused to have double hip replacement surgery due to the fact that it would require blood transfusions that are prohibited by his religion, and an overdose of these might be a possible cause.

News reports say that the full autopsy reports will take three to four weeks to be completed. I am a big fan of murder mystery stories, and at least on TV and in films about crime, the pathologists’ reports seem to come back within a day or even hours, enabling the sleuths to crack the case within days. In these days of high technology, this seemed plausible and I was curious as to why things took so much longer in real life.

It turns out that while a preliminary autopsy report may be available within a few hours and usually by the next day, the complete autopsy report may take several weeks and in complex cases up to three months.

Preparing a comprehensive toxicology report is also a pretty complicated process and takes time because it is a multi-step process that has to be done sequentially.

In post-mortem toxicology screenings, blood is drawn from various areas of the deceased person’s body. This initial test indicates what type of drugs, such as opiates or amphetamines, might be present.

The secondary part is where it becomes complicated.

If the screening test indicates the person may have had opiates in his or her body, further tests are required to figure out what kind of opiates and in what amount.

“You confirm the preliminary test,” said Douglas Rohde, supervisor of chemistry and toxicology at the Lake County Crime Lab in Ohio. “You confirm that drug is actually there. There’s not one test as seen in ‘CSI.’ There’s no quick test that gives you a positive identification and confirmation. The confirmatory tests can take days or weeks, if they have to be repeated.”

To confirm that a person had a type of drug in his or her body, the drug has to be separated from the blood or tissue.

This process could take several days depending on the types of drugs found in the body. And drugs could be present in very minute levels, in measurements like parts per million or parts per billion. Rohde likens it to searching for five black marbles in a pile of 1 million white marbles.

In the final step, the toxicologist reviews the evidence and determines whether drugs found in the body were enough to kill an individual. That report is submitted to the coroner or medical examiner, at least in the United States.

Cases involving Michael Jackson, Heath Ledger and Anna Nicole Smith were complicated because they had several different drugs in their bodies – some of the substances “weren’t in the regular menu in the toxicology lab,” Rohde said.

If foul play is suspected, the time of death becomes an important feature and in the absence of direct evidence, it is usually arrived at by examining the body. Here too, many factors come into play and the process can be quite laborious and getting a precise estimate quite difficult.

Both the time of death and the postmortem interval cannot be determined with 100% accuracy, particularly when a body is found in advanced state of decomposition or is recovered from fire, water, or ice. Therefore, time of death and PMI are given as estimates, and can vary from hours to days, or from months to years, depending on each particular case.

Evidence for estimating time of death includes physical evidence present in the corpse (postmortem changes, presence of insects, etc.), environmental evidence such as location where the body was found (indoors, outdoors, buried, burned, in water, etc.), and other evidence found at the crime scene (a stopped wrist watch due to a blow or impact, an answering machine record, a 911 call, phone calls received or made around the time of the assault, etc.), and finally, the historical evidence (habits and daily routine of the victim, relationships, existence of enemies, etc). The knowledge of the internal sequential changes a dead body undergoes in relation to the variations on the rate of their occurrence due to ambient temperature, humidity, and the presence of insects or other predators are all considered when estimating the time of death.

This is awkward for crime fiction writers who like to have tight time limits for greater dramatic effect

In her somewhat macabre yet humorous book Stiff: The Curious Lives of Human Cadavers, Mary Roach describes how forensic crime investigators use an open field where dead bodies are strewn all over the place under all kinds of conditions to see how they decompose. The rate of decay can vary widely depending on a whole host of factors. She describes walking gingerly among the stench of corpses in various stages of decay and paints a pretty gruesome scene.

So there you are. Real life is more complicated than what we see on TV. What a surprise.


  1. johnson catman says

    The stench of decomposition of bodies is something that doesn’t easily leave your memories. I would be in a constant state of retching if I had to wander among a bunch of decaying bodies. The popular forensic shows on television would lose a lot of their audience if we instead had smellivision.

  2. says

    Real life is also often a lot less complicated than it seems on TV. A star dies. People are interviewed. A few friends say “yeah he was fucked up on percocet a lot.” The dead person has a bottle of pills in their travel bag. Their doctor writes them prescriptions. There’s an empty bottle of bourbon.

    I’ve been listening to this song a lot lately:

  3. moarscienceplz says

    The Poisoner’s Handbook is a fascinating look at the history of forensic medicine. It really amazed me to learn how recently we started testing bodies for the presence of poisons and how easy it was to get away with murder before that.

  4. says

    That’s why a new poison was a big deal. The effects of the known ones were pretty detectable. If your king suddenly started babbling and drooling and their pupils were hugely dilated, everyone in the path of their food preparation was about to have a really bad couple of days. (That’d be datura or aconite) Screaming and vomiting and clutching the stomach would most likely be a bolete. Pallor and panting with a blue tinge, why that’s cyanosis…

    When there are new poisons used, or creative uses are found for old ones, the poisoner can get away with it -- or nearly. There was that lady in new jersey who was feeding her husband antifreeze… And of course the ancients would have killed (literally) to be able to have a few doses of polonium-209 — imagine how easily radiation sickness could be fobbed as the affliction of the gods!
    Soothsayer: “The gods will strike you dead! Your hair will fall out! You will erupt in sores! In 13 days you will cough blood!”
    Grand Vizier’s chief investigator: “Uh. You’re being awfully specific about that…”
    And then there was the time a friend asked me if I could spare some cadmium bromide from my chemical cabinet. Uh, no. Just … No. In the small community of nuts that do alternative process photography we occasionally get emo kids trying to obtain cyanide 🙁 Uh. No. No. No.

  5. says

    Final random thought Re: poisons:
    And then there were all the wonderful ways people took poisons to try to cure syphillis. Gargling with mercury, anyone? Christfuck, that’s a bad idea.

  6. johnson catman says

    Marcus @6:
    When I worked in a gasoline station 30 years ago, one of the neighborhood regulars stopped for some conversation during a slow time of the day. He swore by a sure-fire way to eliminate STDs: he would drip gasoline over the head of his penis. Not so sure about eliminating the STDs, but I am sure he replaced one kind of burning with a different kind!

  7. says

    He swore by a sure-fire way to eliminate STDs: he would drip gasoline over the head of his penis.

    Might even work if he was suffering from scabies or maybe even gonorrhea. But using the word “sure fire” in that context … ow. It gives me visuals I don’t want in my head. (Fetch me some relish and buns, stat!)

  8. lorn says

    Considering th sheer amount of detailed laboratory work necessary to do a complete autopsy, and the often underpaid and overworked personnel, and frequently obsolete equipment, the wonder should not be why they take so long, but rather why they are both so fast and generally well done.

    Perhaps the greatest disservice ever done to coroners was the CSI series of TV shows. On TV a fingerprint search takes all of ten seconds. Toxicology screens are available in an hour and really, really involved stuff might take a day with cutting edge stuff taking two. According to a local tech, a relative died and we got talking, complete toxicology using good equipment at the state certified lab takes about two weeks if they rush it. Rushing it costs money and screws with the orderly system.

    Surprise, surprise, reality is much slower and far more complicated than a TV show depicts. I’m shocked, shocked I tell you.

  9. says

    Well, scabies are mites that live under the skin, occasionally surfacing to lay eggs. If you washed with gasoline you’d stand a chance of interfering with their reproductive cycle. But, ugh. That’s very much “destroy village to save it”

    Same thing with gonorrhea, I believe it’s a bacterial infection and persists because of infection reservoirs in the urethra and on/around the other foldy bits of the genitals. So I suppose dousing in gasoline might knock down the population enough for the immune system to whack it (might also stimulate the immune system with tissue damage, too?)

    I dunno, which is why I waffled a bit. How antibacterial is gasoline? It was used as a field ‘cure’ for lice in WWII and it’s pretty lethal; I doubt ticks or mites like it much.

  10. Who Cares says

    About that guy using gas for treatment. There are/were petroleum products out there to treat various skin (and sometimes more) ailments. Most of them quite likely snake oil but that is probably where that treatment was from.

  11. lorn says

    Gasoline as disinfectant seems harsh, back in the day gas had tetra-ethyl lead that, I was told, could be absorbed into the skin. Mites can be smothered with anything viscus and clinging enough to block their breathing ports and cause them to smother. Olive oil has been recommended. Vaseline might be another go-to.

    Back in the day, when we rode dinosaurs, turpentine was sometimes used as a disinfectant for cuts and a cure-all. I knew someone who kept dogs and when his dogs would get torn up running trough the brambles and fighting with raccoons he would wash the wounds with soap and water and follow with a liberal coat of turpentine before stitching and bandaging them up. It seemed to work. He had very few infections.


    Of course, none of this is going to do a damn thing about gonorrhea. For that you want calomel:



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