From A Horrible Crime
You know that classy fanfare of trumpets that raises the curtain on the award-winning television series Masterpiece Theatre? For more than 20 years it introduced Sir Alistair Cooke, the show's celebrated host. He was knighted for his distinguished career and dignified life. But the indignities suffered after his death in March 2004 sent shock waves around the world.
In a secret back room of a New York City funeral home, the remains of the revered 95-year-old commentator were dissected and his bones illegally removed in what may be described as the ghoulish workings of a human chop shop. Cooke's body was then cremated, so no one was the wiser until his daughter received a disturbing phone call late last year -- from detectives in the New York City Police Department's Major Case Squad telling her what they had discovered.
"I was literally struck dumb," explains Susan Cooke Kittredge, a minister who lives in East Montpelier, Vermont. "I was stunned for days. I couldn't process the information."
Investigators found that Alistair Cooke's body was one of more than 1,000 used in a macabre, multimillion-dollar illegal human bone- and tissue-harvesting scandal that's reverberated throughout the medical, regulatory and donor industries worldwide.
Bone and tissue had been removed from Cooke's body without the family's consent, then were shipped to companies that clean and prepare the material for use in surgical transplants. Investigators also found that medical forms identifying the body parts documented his age as 85 and cause of death as heart attack. But actually, he was 95 when he died of lung cancer, which, Kittredge says, metastasized to his bones.
And there's the real danger: While legal donations help many patients regain full, active lives, tissue illegally obtained can create health risks for unknowing recipients if disease or infection is not screened or disclosed.
"The body needs to be treated in a respectful way," Kittredge says. "And it is outrageous and terrifying that people who are so ill and need a transplant should be given potentially diseased tissue. It's appalling."
Profits and Loss
The investigation generated front-page stories and sensational headlines such as "Body Snatchers of New York" and "Dead Reckoning." But the terrible crime also spotlights the growing need for body parts. It's big business.More than a million transplants are performed each year with tissue and related products that repair injured knees, relieve bad backs, and replace damaged heart valves or burned skin. Tissue banks are regulated to identify, retrieve and prepare medically suitable bone and tissue for future use. Most donations are made in hospitals, where federal law requires that a death be reported to an organ procurement organization (OPO) and tissue bank. Through tests and questionnaires, the OPO or bank determines if the donor is eligible. Tissue (bone, tendons, ligaments, skin, corneas, heart valves, blood vessels) can be recovered up to 24 hours after death. (This differs from organ donation, such as hearts, lungs or kidneys, which requires a more immediate retrieval process because of the need for oxygen and blood flow.)
"Tissue donation provides the last opportunity you have on earth to help someone," explains Bob Rigney, CEO of the American Association of Tissue Banks, in McLean, Virginia. "We've found more and more ways to recycle the human body." But these high-tech procedures don't come cheap. Screening, procuring, storing and cleansing the tissue is expensive. It's about a billion-dollar industry with a steady growth rate.
Scene of the Crime
The investigation began when the new owners of the Daniel George & Son funeral home in Brooklyn discovered that money from some prepaid funeral accounts was missing, and suspected mishandling of the deceased. When police searched the premises, they found a virtual chamber of horrors: a cold, clinical operating room atop the embalming chamber, accessed through a private elevator. It's where so-called cutters removed bones, ligaments, tendons and other valued tissue before cremation or burial; it became the gruesome pit stop for transporters of bodies destined for area funeral homes.
Michael Mastromarino, funeral director/body transporter Joseph Nicelli, and two others who were involved in the scheme were indicted on 122 counts in February. Mastromarino, a former oral surgeon and co-author of a book called Smile: How Dental Implants Can Transform Your Life, launched BioMedical Tissue Services, a bona fide tissue-retrieval company, after drug problems led to the surrender of his dental license. Authorities believe Mastromarino charged funeral home directors between $500 and $1,500 for each body as a handling fee, mainly for transporting to a funeral home or mortuary. But it turned out to be a way to procure a body and reap much more for the sum of its parts.
Mastromarino's retrieval practice had huge profit potential. The fee charged to distributors for a femur (thighbone) of someone under age 65 is $970. It drops to $550 over age 66. A tibia (lower leg bone) is listed at between $385 and $600, and veins, depending on their size, run between $350 and $1,000. All told, one body could generate as much as $250,000.
Unearthing Evidence
Vito Bruno was another one who learned about this crime the hard way. An award-winning recording industry producer, he had worked himself up from his dad's immigrant Italian roots. His 75-year-old father, Michael, proudly supported his family as a New York City cabdriver before succumbing to cancer at a veterans hospital in Brooklyn in May 2003. Bruno followed his father's wish for cremation and made arrangements with a local Brooklyn funeral home that authorities now say supplied bodies to Mastromarino's alleged scheme.Then late last year, police detectives knocked on Bruno's front door. They gently explained that his father was part of an ongoing bone-harvesting investigation, and they showed him the tissue transfer documents. "It was not my signature on the paper," Bruno says, "and they changed the cause of death from cancer to heart attack. Somebody was obviously pulling a scam, what could have been the perfect crime because the evidence was destroyed." Bruno described the disclosure as agonizing because "if my father had known that he could have made other people sick -- if he had a grave, he'd be rolling over in it."
Authorities continued to make the horrifying notifications, but they knew they needed physical evidence to make their case. On a chilly November day, law enforcement, medical and funeral industry officials gathered at a Queens, New York, cemetery as the coffin of Esfir Perelmuter was unearthed. It became the first in a series of exhumations, followed by autopsies, to determine whether tissue had been taken from the deceased. Authorities say the 82-year-old woman died of a brain tumor, but paperwork from BioMedical indicated she died at 69 of heart disease. Investigators also found an eerily similar pattern after more bodies were examined: tissue and bones from the waist down were gone.
"And what we discovered in their place was PVC pipe," says Michael Vecchione, chief of investigations for the Brooklyn DA. "An elbow-shaped pipe would be jammed into the hip and then a long pipe would be running down the leg and mimic the bone that was there. It would then be attached to the ankle or foot by a bolt that was driven through the pipe and screwed in on the outside of the leg."
"You don't go to Home Depot and get some PVC pipe," says Mastromarino's attorney Mario Gallucci, who explains that the pipe "has been acceptable" for this specific use. Gallucci says the funeral homes, not his client, handled consent forms. And he says the tissue banks accepting the body parts were responsible for testing tissue and blood samples sent by BioMedical.
Infected Tissues
At press time, the criminal investigation was reaching far and wide. Prosecutors believe Mastromarino expanded his services to Philadelphia, Newark, and Rochester, New York. And in Denver, Colorado, Dr. Michael Bauer reviewed up to 30 medical and consent donor documents that were signed and sent by Mastromarino to tissue processing company LifeCell Corporation. "When I finished," Dr. Bauer says, "they were all wrong; there was not one legitimate phone number in the charts I had."The breadth and scope of BioMedical's dispersal led the FDA to issue recalls in October 2005. Tissue banks quickly complied and pulled unused BioMedical inventory off the shelves. The agency shut down BioMedical's operations in January.
But what about the BioMedical tissue that had already been implanted in needy patients? The FDA and Centers for Disease Control and Prevention acknowledge that while the tissue is processed to reduce the likelihood of disease, "the actual infectious risk is unknown." The agencies urged doctors to test their patients for HIV, hepatitis and syphilis.
Notices went out, and worried patients called their doctors -- as well as lawyers. "We've been contacted by more than 350 people from across the country," says attorney Andrew D'Arcy of Galloway Township, New Jersey. He explains that so far a handful of callers have tested positive for hepatitis B and C and syphilis, but he believes it's too early to determine definitively a causal connection between the diseases and the implant. Yet worry and uncertainty have already set in.
Heather Augustin called D'Arcy after a meeting with her doctor. The 42-year-old FAA administrative assistant from Mays Landing, New Jersey, learned that the bone implants used in her neck surgery last March were part of the recall. So far, her blood tests proved negative, but she must repeat the tests later this year. The anxiety has her wondering, How do I know that in ten years, something's not going to show up? What do I do to protect myself and my family?
Sen. Charles E. Schumer (D-NY) has responded with legislation that would require the FDA to ban the retrieval of tissue from funeral homes and morgues unless they are types in short supply. And officials would have to conduct annual tissue bank inspections and periodic audits of documentation, and define the terms for "reasonable processing fees."
Yet Michael Meyer, a medical ethicist and professor at Santa Clara University in California, thinks more can be done. "National standards are the first step toward transparency. There can't be a patchwork quilt."
Vito Bruno favors more protection for transplant recipients. "An unbelievably horrible crime has taken place against families and other victims who are sitting there not knowing if they have ticking time bombs inside of them."
Alistair Cooke's daughter hopes that public awareness will be raised by the investigation and media coverage. Meanwhile, she prays that what happened to her father never happens to anyone else.