CASE #1 A defendant was convicted in a criminal court of murder but the decision was appealed. The defendant, now the appellant, alleged that the trial court erred in admitting as evidence the autopsy report prepared by the medical examiner because the proper predicate for its admission as a business or official record was not laid.

He also alleged that the admission of the report denied him his constitutional right of confrontation. The only evidence in the record as to the cause of death of the deceased was the autopsy report prepared by the medical examiner.

Mary Pare, for 10 years, the executive secretary for the examiner, testified that her main duty was to transcribe the reports dictated by the examiner during autopsies and to present them to the doctor for his signature. She also said that these transcriptions were generally prepared on the same day the autopsy was performed and that the reports were filed in the regular course of business in the examiner's office.

Ms. Pare stated that she had the care, custody, and control of autopsy reports and identified the file number of the deceased's autopsy report. The report was dated and signed by the examiner.

The trial (lower) court admitted the autopsy report as evidence and allowed the prosecutor to read it to the jury.

Discussion Questions

1. Should the executive secretary be allowed to prepare and file the reports in the regular course of business? Is this duty similar to what ambulatory health care employees do? Explain your answer.

2. When the executive secretary appeared with the record in the lower court, what type of subpoena did she receive?

3. Who owns this medical record? Who has access to it?

4. Should the trial court have allowed the autopsy report as evidence without the medical examiner present? Justify your answer.

5. Was the appellant denied his constitutional right of confrontation?

6. If the appellant had wanted the medical examiner present, what procedures could he have followed?

Case 2 A woman (Mrs. X) had been tissue typed at the University of Iowa hospital as a potential donor for her 3-year-old son. Unfortunately her son had died of leukemia before she could become a doner.

A 27-year-old leukemia client, Mr. Head, from Louisiana asked an Iowa district court to intervene on his behalf with the Iowa Institutional Review Board (IRB). He wanted the board to make a third appeal to contact Mrs. X. Mr. Head needed a bone marrow donor. He had called several medical centers within the United States attempting to find a suitable unrelated donor.

He had received information about a potential donor when a technician informed him, without authorization, that a possible matching donor, Mrs. X, did exist.

Mrs. X's name was obtained from the computer files of the University of Iowa, IRB. Mr. Head asked the IRB to send a letter to the prospective donor. After much deliberation, the IRB decided to send a letter to Mrs. X stating the problem and describing its program.

Two letters were in fact sent; Mrs. X answered neither of them. When the IRB made a telephone call to Mrs. X, she responded that she had received the letters but that she was unwilling to be a donor unless it was for a relative.

When Mr. Head was informed of this decision, he retained a lawyer and went to court. He wanted the court to try one more time to get Mrs. X to agree to be a donor.

Discussion Questions

1. Does Mrs. X's original informed consent for tissue typing as a possible bone marrow donor for her 3-year-old son protect her from future requests?

2. Has Mrs. X's privacy been invaded? Defend your response.

3. What obligations does the IRB have to Mr. Head? To Mrs. X?

4. Will a subsequent court verdict affect anyone but these two people? Support your answer.