In 1997, 158 autopsies were performed at Charleston Area Medical Center, a community-based, teaching tertiary care center. The autopsies revealed 29 (18.4%) clinically undiagnosed principal causes of death, of which 79% were considered treatable. The five leading undiagnosed causes were: infarctions, 27.6%; malignant neoplasms, 17.2%; pulmonary emboli, 13.8%; dissecting or ruptured aortic aneurysms, 13.8%; and genetic or congenital disorders 10.2%. These results were significantly different from those reported from some other major tertiary care centers. Reports were completed in 5-302 days (average 59, median 32 days). For more than 40 (25%) of these autopsies, the purpose was only to confirm specific disorders such as occupational injury, which can be accomplished by a highly selective, cost-effective posthumous analysis. In summary, an autopsy in today's high-technology era is still useful, however, the high cost, long length of reporting time, and number of clinically non-enlightening cases are a reasons to reform both the format and procedure in which these procedures are conducted.