Dead but Not Gone: Some Bodies Linger at Medical Examiner's Office 

click to enlarge

• Matthew Thorsen
• Dr. Steven Shapiro

The door to Cooler B opened, releasing a strong, rotting smell.

Roughly 15 bodies lay on tiered steel racks in the refrigerated vault at the Vermont Chief Medical Examiner's Office in Burlington. A decomposing foot protruded from the sheet covering one body, suggesting the corpse had been there for a while.

Every year, a small number of people who die in Vermont linger at the medical examiner's office because no one comes forward to claim them. Typically, relatives identify and take charge of their loved ones in a matter of hours or days following death. But longer-term "guests," as Dr. Steven Shapiro, Vermont's chief medical examiner, refers to them, stick around. These abandoned Vermonters pose a logistical problem — and numerous ethical dilemmas.

In some cases, the dead people have no immediate family to collect them, and the medical examiner's office functions as a funeral home of last resort. "An indigent ends up in an emergency room," said Shapiro. After he or she dies, the hospital winds up with an unwanted corpse. "What are they going to do with it? So they turf it to us."

More often, though, they have relatives who decline to take the body after the medical examiner's office calls. "It's, 'Screw you; he's always been a prick; you deal with him,'" said Shapiro, exhibiting some of the gallows humor for which he is known.

Next of kin may also decline because they don't want to pay for a burial. "They don't want to make any decisions. They don't want to sign any papers," Shapiro said. "They don't want any bills."

Typically, Shapiro is in possession of no more than 10 unclaimed bodies. But there are more — those who have been cremated — in boxes in a file cabinet. At least seven sets of cremains from the past two years are being stored in the bowels of the University of Vermont Medical Center.

You need a guide to find this not-so-final resting place. Dressed in freshly laundered blue scrubs, the trim, animated Shapiro greeted visitors who'd walked from the emergency room through a maze of halls to his office. A door — usually locked — off a small reception area opens to another hall with rooms on either side.

In one, several UVM undergraduates celebrated the end of their internship at the medical examiner's office over pizza and a game of Forensic Jeopardy.

Beyond another set of doors, in a room with soft lighting, a dead man, presumably a former patient, lay on a gurney with the sheet pulled back to reveal his pallid face. Next door, a social worker had gathered the family to say their goodbyes. After they'd had a chance to view the deceased, an undertaker would transport him to a funeral home for burial or cremation.

That's how it's supposed to go, anyway — but it doesn't always. Further along on the tour, a bright, spotless examining room with steel counters, scalpels and scales stood ready for autopsies.

Shapiro's office reviews the paperwork on all of the roughly 5,000 deaths that occur annually in Vermont and conducts several hundred autopsies a year. The results help solve crimes, provide evidence in malpractice lawsuits and answer public health questions.

"I monitor the health of Vermont by what's killing people," Shapiro explained.

That task is vitally important, and figuring out what to do with uncollected bodies saps time and funding, Shapiro said. A white board next to Cooler B listed names of the deceased and dates marking their arrival, with at least one dating back 10 months.

Although he won't disclose the exact number of unclaimed bodies he deals with annually, Shapiro said it's growing. With the addition of Cooler B, installed a few years ago because unclaimed bodies were taking up too much space in Cooler A, he can accommodate 50.

Also easing the storage problem: The Vermont Department of Health successfully lobbied for a change in state law 18 months ago to give the medical examiner the authority to order cremation of unclaimed bodies, clarifying what had been uncertain before. "I hate having to cremate a body and authorize that," Shapiro said, explaining that it's a personal decision that no stranger should be making.

Shapiro puts off state-funded cremation as long as he can, but even refrigerated bodies decompose, and the office can't store them forever. "It becomes a space issue, and, you know, these bodies, they are not embalmed; they start to go," Shapiro said.

After cremation, the medical examiner is required to keep the ashes for at least three years. If no one claims them, the law says the medical examiner shall "arrange for the final disposition of the cremated remains consistent with any applicable law and standard funeral practices."

There are some exceptions: A duo picking wildflowers in East Middlebury found three bodies in 1935. The mother and two children had been shot in the head — possibly, police theorized, in another state. Never identified, the skeletonized remains were kept in boxes in the medical examiner's office for decades. In the fall of 2014, the medical examiner's office assisted in their burial at Prospect Cemetery in East Middlebury.

Shapiro can only speculate why more bodies are being abandoned today than they were 80 years ago. It could be that families are more fractured, he said, or that small towns that once embraced their eccentric citizens are no longer doing so.

Taking care of the dead is expensive. A traditional burial — embalming, coffin, cemetery plot and gravestone — can easily run $8,000.

Far less expensive is direct cremation, in which a funeral director transports the body to be cremated and returns the ashes to the family. There's no coffin, no embalming, and the whole process costs between $1,200 and $3,200.

Low-income families who do claim their dead can apply for state assistance, but funds are limited, and there is an income-based application process. The Vermont subsidy for indigent burial runs about $1,100. The state paid to bury or cremate 482 people through this program in fiscal year 2015, for a total expenditure of about half a million dollars.

For the self-reliant, there is a cheaper, DIY option: Transporting a body to a crematorium is allowed under Vermont law, and, with the appropriate paperwork, can lower the costs of cremation to as little as $300. Few people, however, are keen to transport Mom or Dad themselves, in the back seat of the family car.

Shapiro works closely with funeral directors, and sometimes they pay for cremation of unclaimed bodies, or split the cost with the state. "I just feel that it's so sad to leave someone," said Sumner Cohen, funeral director at Boucher & Pritchard in Burlington, which has paid for the cremation of five or six unclaimed bodies in the past five years. "We did one, and the guy had been up there two years."

The man, a central Vermont resident in his fifties, died in his apartment, and none of his relatives could be found, Cohen said. The funeral home returned the man's ashes to the medical examiner's office, and, as far as Cohen knows, they are still in a filing cabinet there.

That shouldn't be happening, said Joshua Slocum, executive director of the Funeral Consumers Alliance, a national organization with headquarters in South Burlington. Many states have special mausoleums or cemeteries for unclaimed bodies and "cremains," and three years in a filing cabinet is too long, he said. Vermont can and should resolve the problem by legally designating a place for the unclaimed deceased, Slocum suggested, and freeing the medical examiner to focus on death investigations.

"Their job should not be to be custodians of cremated remains," Slocum said. "They have better things to do." The problem is an indicator that funeral customs need to change, Slocum added. He advocates that people should be comfortable tending their own dead, as was common a century ago.

Current law gives a surviving spouse authority over a deceased person. Next in line are children, then siblings or other family. If no relations step forward, friends, neighbors or other "interested parties" can claim the body. The law was amended a few years ago to make it easier for people who aren't relatives to take charge — another attempt to get unclaimed bodies out of limbo.

Some families say they want the remains, but only after the state pays for the cremation. This creates a dilemma for Shapiro.

On one hand, he doesn't have the budget or the legal authority to turn his office into a funeral service, so when people ask: "Would you get her cremated before Christmas, so I can put her under the tree?" Shapiro said, he has an answer: "No."

On the other hand, after Shapiro has exhausted all possible leads in an effort to get next of kin to take responsibility for a body and goes ahead with a state-funded cremation, he doesn't like to see people's ashes residing indefinitely in the filing cabinet. If someone approached Shapiro and said, "Oh, he's my neighbor. I'll sprinkle him in the backyard if you want," Shapiro noted, "Chances are, I'd give him to you."

Shapiro predicts that, as Slocum suggested, at some point Vermont will have to designate a place for the cremated remains now resting in his filing cabinet. Many municipal cemeteries in Vermont have sections that were historically reserved for "paupers."

At Burlington's Lakeview Cemetery, more than 300 indigent people are buried in a section known as the "free ground." Most of the graves have stone markers bearing numbers but no names, making them anonymous in death. If, after the free burial, family members wanted to erect a stone with a loved one's name on it, they'd also have to pay for the plot.

Lakeview still buries some indigents without state assistance, but these days, it's rare, according to Anne D'Alton, an office assistant at the cemetery. It has no arrangement with the medical examiner's office.

"Eventually, the state's going to have to buy a plot, and we're going to have to get rid of these folks," Shapiro said. "It's just one of those things."