Experts agree that it is acceptable and often necessary to revise autopsy reports, but some say accepted practice when a new cause of death is made is to amend the original autopsy report, providing an explanation.

A doctor who lost a medical malpractice case has criticized former Allegheny County Coroner Dr. Cyril H. Wecht for writing an autopsy report that described one cause of death, then revising it more than two years later without explanation or changing the date.

"If that opinion is to be changed, it has to follow a pretty rigid protocol," said Jeff Segal, the founder and chief executive officer of Medical Justice, an organization based in Greensboro, N.C., that protects physicians from frivolous lawsuits.

Doctors are taught not to change records without thorough explanation.

"It's the type of thing that should be explained away pretty quickly and not left to fester," Dr. Segal said. "It certainly doesn't smell right."

But Dr. John Meyer, a forensic pathologist in Boulder, Colo., disagreed. Though an amendment can be attached to an old report, a forensic pathologist can choose to simply write a new one, he said.

"I don't think that necessarily implies anything sinister. I don't think there is any law or rule that says how it should be done per se."

Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners, said he is not aware of any official, written policy dictating how reports should be changed. He said, though, that backdating is not a good idea and any changes should be accompanied by explanation.

"We typically don't care which side is right or wrong. For most of our membership, almost without exception, we're unbiased observers of fact," Dr. Jentzen said, noting that Dr. Wecht is a member. "When we have an opinion, we advocate for that. We don't necessarily shop the opinion."

Though they may not be written, Dr. Eric L. Vey, a forensic pathologist in Erie County, said there are well-established standards of practice.

New findings in a cause of death are to be typed in bold, including an explanation indicating it is an amended or corrected report, he said. Then, the forensic pathologist should sign it with the current date that the report was amended, Dr. Vey said.

Dr. Phillip Reilly, the Fayette County coroner who requested Dr. Wecht perform the autopsy in question on Stephanie Santello, said he had no problem with how Dr. Wecht made the change.

"He goes by the date of the autopsy," he said. "Other coroners may not do that. Different coroners have different practices. It's an approach thing. It isn't right or wrong."

Jerry McDevitt, Dr. Wecht's attorney in his pending federal case, said nothing was unusual with how his client handled that particular case.

"The protocol followed in the Santello case is typical when clinical information is later provided that has a bearing on cause or manner of death determinations," he said.

Often, Dr. Vey said, a thorough autopsy report can't be written until toxicology and microscopy results come back, which can take weeks.

But Dr. Reilly said that he tries to issue the death certificate within 48 hours of a death because families often need it to take care of personal matters.

In terms of expert witnesses, legal ethicists say that they are supposed to advocate for the truth and not any one side.

"I would hope people wouldn't change allegiance because of money," said Haskell Pitluck, the ethics chair for the American Academy of Forensic Sciences.

Stephen Gillers, who teaches evidence and legal ethics at New York University's law school, said experts are hired based on their expertise.

"If that opinion turns out to be harmful to the side that's hired him -- tough," Mr. Gillers said.

--