Question: I am wondering who pays for autopsies on victims. A few years ago, our mother died suddenly and we were told autopsies are expensive and not covered by insurance (she had both Medicare and HMSA). I called HMSA and was told your medical coverage stops upon death. So we opted out, but we still wonder what was the real cause of death. So how expensive is it?

Answer: Deepest condolences on the loss of your mother.

Who pays for an autopsy depends on whether this thorough internal and external post-mortem examination is required under state law — as in the case of crime victims — or simply preferred by the next of kin to learn more detailed information about the cause of death than would be included on the state-issued death certificate.

If the autopsy is required by state law, it is conducted by the county medical examiner and paid for by taxpayers as a government function. Oahu’s medical examiner routinely performs autopsies to pinpoint the circumstances, cause and manner of death in all homicides, fatal accidents, workplace deaths and deaths that occur under suspicious circumstances, according to the department.

The medical examiner does not routinely perform autopsies when the person had “a significant medical history” and succumbed to natural causes. “Generally, we do not assert jurisdiction for natural deaths that do not pose a risk to the public health,” said John P. Burns, an administrative service officer in the County of Honolulu’s Department of the Medical Examiner.

Family members may seek a private autopsy by a pathologist at a hospital, which costs several thousand dollars. As you learned, this expense is not covered by HMSA or Medicare, nor by Medicaid or most private insurers. It is standard for a person’s medical coverage to cease upon death.

Cedric Yamanaka, a spokesman for The Queen’s Medical Center, Hawaii’s largest private hospital, said the cost of a routine autopsy conducted there can start at about $3,000 to $5,000. “At Queen’s, our priority and focus is on our patients. We do offer post-mortem examinations as a service to our patients and their families, but these procedures can be complex and take a significant amount of time to complete,” he said. “Thus, any non-Queen’s inpatient case is subject to approval by the attending pathologist. If there are suspicious circumstances surrounding any death, families are advised to contact the city medical examiner.”

An autopsy is not essential to determine the primary cause of death in most cases. The cause listed on the death certificate may be supplied by the deceased person’s physician or based on a post-mortem examination less invasive and less expensive than a full autopsy. Still, the procedure is the gold standard of death investigators, and the College of American Pathologists notes the important role an autopsy report plays in “easing the stress of the unknown for families and loved ones seeking reassurance or peace of mind after a death.”

We’re sorry that the cost was a barrier for your family.

Q: Are there any homeless people on the governor’s stakeholders group on homelessness?

A: No, but the Governor’s Leadership Team on Homelessness was not organized as a grass-roots stakeholders group as you describe. It’s billed as high-level decision makers committed to tackling Hawaii’s complex homelessness problems together, at the city, state and federal level. The leadership team includes Hawaii Gov. David Ige; Honolulu Mayor Kirk Caldwell; Honolulu City Council Chairman Ernie Martin; state Sen. Jill Tokuda and state Rep. Sylvia Luke (who lead the legislative money committees in their respective chambers); Rachael Wong, director of the state Department of Human Resources; and representatives from the offices of U.S. Sen. Mazie Hirono and U.S. Sen. Brian Schatz — Alan Yamamoto, Hirono’s state director; and longtime Democratic Party insider Chuck Freedman.

Mahalo

Mahalo to Rick who works at Chevron Kapolei. My daughters and I were having lunch at Pizza Hut Kapolei when the manager came over to us and said that Rick paid for our lunch. What a kind and generous person he is. I will certainly pay it forward. Thanks, Rick, for making our day! — A grateful patron

Write to “Kokua Line” at Honolulu Star-Advertiser, 7 Waterfront Plaza, Suite 210, 500 Ala Moana Blvd., Honolulu 96813; fax 529-4750; or email kokualine@staradvertiser.com.