Funeral Home Accused of Routine Falsification of Death Certificates

A Westside funeral home routinely altered death certificates to avoid delays in funeral services or the expense of legally mandated coroner’s reviews, according to a mortuary supervisor whose charges were corroborated by 10 doctors.

Paul Sanders Jr., 25, of Panorama City, night supervisor for the Malinow & Silverman funeral home, told The Times that he collected evidence of more than 100 instances in which death certificates were altered, and the physician’s signature sometimes forged, by Malinow & Silverman employees before the certificates were filed with county health authorities.

The Times showed certificates to a sample of 13 physicians. Ten doctors said their names had been forged or the certificates had been altered after they were signed and turned over to Malinow & Silverman.

Subsidiary of Houston Firm

Malinow & Silverman is a subsidiary of Service Corp. International of Houston, a $386-million firm that is the largest funeral home and cemetery corporation in the United States. About 5% of all American and Canadian deaths are handled by some subsidiary of the corporation.

Executives of Malinow & Silverman at 1500 S. Sepulveda Blvd. did not respond to requests for comment. The Times made more than a dozen telephoned requests over four days.

Donald Campbell, executive vice president of Service Corp. International, said the parent corporation was conducting its own investigation of the mortuary “and if any of these allegations are true, it’s without the knowledge of the corporation.”

“We have a strong corporate commitment to comply with all existing laws, federal and state. Beyond that we are not in a position to comment,” he said.

The California Department of Health Services is also investigating Malinow & Silverman at the request of the Los Angeles County Medical Examiner-Coroner’s Department. State investigators served a search warrant on the funeral home Aug. 20, seizing funeral and employment records and questioning employees.

State health department representatives refused to discuss details of their investigation. But Senior Investigator Lisa Vernon stated in an application to a Municipal Court judge for a search warrant that two instances of falsification of doctors’ signatures had been discovered after a tip from “an anonymous informant” to the coroner’s office.

Sanders said he was the informant.

1,000 Certificates Reviewed

A spokeswoman for the state Department of Health Services said investigators were reviewing 1,900 death certificates handled by Malinow & Silverman from Jan. 1, 1985, to the present. To date, she said, investigators had found “no reason to believe that any of the workers, employees or current management is involved in any wrongdoing.”

Investigators indicated that suspicion was focused on disgruntled former employees who had not worked for the mortuary recently. The Times corroborated falsification of physicians’ signatures as late as June, 1987, however.

It is a misdemeanor to fraudulently fill out a death certificate and a felony to file a fraudulent certificate with the state, carrying a penalty of up to three years in prison and a $10,000 fine.

In California, funeral homes usually collect death certificates from physicians, complete them, and present them to the county Department of Health Services, which must issue a “permit for disposition of human remains” before a body can be buried or cremated.

Doctors normally fill out only about one third of the one-page death certificates. The mortuary fills in the remainder--including identification of the deceased, his or her parents and occupation.

But by state law, the coroner must review all “violent, sudden or unusual” deaths for evidence of crimes, malpractice, suicide, negligence, occupational hazards or accidents. If a physician lists any of the causes on a long list of possible indicators of “sudden or unusual” death, the health department withholds the disposition permit until the coroner’s office clears the case.

Often that involves only a telephone conversation with the doctor who certified the death or a visit to the mortuary by a coroner’s investigator, but sometimes it can mean the body must be turned over to the coroner for an autopsy. Of the 17,000 bodies the coroner’s office handles annually, about 10,000 are actually brought to the coroner’s office for examinations or autopsies, spokesman Bill Gold said.

The others are investigated through telephone inquiries or examinations at funeral homes or hospitals, he said.

Sanders alleged that one-quarter to one-third of all death certificates processed by Malinow & Silverman were altered. Often the purpose was to remove anything that would elicit a coroner’s review, he said, because the delay while the case is in the hands of the coroner costs the mortuary from $100 to $300 and can hurt business by offending the deceased’s family.

“A family walks in to arrange for burial, and the mortuary often makes a commitment,” Sanders said. “They say, ‘Sure, we’ll make arrangements for burial tomorrow at 11.’ They sign the contract. The family pays over $3,000 or $5,000. But most of the time the mortuary hasn’t seen the death certificate yet.”

If the physician’s analysis of the death triggers a coroner’s review, he said, “You have to call up the family and go through the embarrassment of saying, ‘I’m sorry. We can’t have the service tomorrow.’ The family’s going to be real upset, and they tend to blame the mortuary.

“The mortuary, since they work with these certificates every day, they know what’s accepted by the county and what’s not. So the mortuary turns around and rewrites the death certificate so none of that happens and they carry through on their commitment and they look good.”

Money was also a factor, he said.

“There’s another 10 man hours per case for anything to do with the coroner’s office--the drive down to the coroner’s office, a lot of paper work, background forms and reports you have to get from the hospital or wherever. Just to go down to the coroner’s office and back costs about $120. Then you have to wait till they investigate, then go back and wait an hour or so to get the body back and refile the death certificate.

“When the body comes back after an autopsy, it has to be embalmed and sewed back together. That’s about $150 right there.

“Most of the time it comes out of the mortuary’s share. When the mortuary already said, ‘Sure, we’ll have the service tomorrow at 11’ and then couldn’t come through on that, they don’t feel they can turn around and charge the family another $300 to boot.”

40 to 50 Bodies a Month

The funeral home, which handles between 40 and 50 bodies a month, has 15 to 20 employees, Sanders said.

Dr. Gary F. Krieger, president of the Los Angeles County Medical Assn., said it would be “deplorable” for funeral home personnel to alter death certificates.

“These are legal documents,” he pointed out, which can be cited as evidence in court and for insurance claims. In addition, they serve as the basis for occupational disease and other public health statistics, he said, and are supposed to be reliable information for family medical histories--the record of diseases that afflicted a patient’s ancestors.

The coroner’s office and the county health department also keep a “watch list” of certain nursing homes suspected of mistreating or neglecting elderly inhabitants and investigate any deaths in those homes in which evidence of neglect is mentioned, such as malnutrition or certain infections, a coroner’s spokesman said. The survey depends on obtaining the kind of information that the funeral home allegedly removed from the certificates.

Sanders said he secretly retrieved the original certificates from garbage cans where other Malinow & Silverman employees discarded them after they were copied. Sanders loaned the originals to The Times, which showed them to doctors along with a copy of the certificate filed with the county health department.

Many of the signatures on the documents Sanders said were the originals had been heavily and repeatedly traced over. Sanders said the true signature was traced heavily enough to leave an impression on a blank death certificate underneath the true one, which could then be filled in to duplicate the doctor’s signature.

Of the three doctors interviewed by The Times who did not confirm forgeries or alterations, one was unsure whether the signature on file was his. In the remaining two cases, physicians said they signed a second version of the certificate that had been written for them by Malinow & Silverman employees.

Unaware of Change

One said he did not realize the second certificate had changed his original description of the causes of death, because the rewritten version was equally correct medically. The other said he agreed to the funeral home’s request to remove a mention of a dead woman’s broken hip to spare the dead woman’s family the need for a coroner’s review.

By law, the coroner must review all deaths caused by broken bones, and a separate regulation specifically requires a review of any death in which a physician mentions a broken hip.

A state regulation requires that the coroner review any death in which the certifying physician had not seen the deceased within the last 20 days of life. Some certificates show evidence of date changes to meet that requirement.

In one instance, a physician’s original report said a patient died in part due to “inanition”--starvation--a possible cause for review. On the certificate filed with the state, the term became “irritation.”

“She was old and occasionally demented and she had lost the will to live,” her doctor said in an interview. “She had once expressed a desire not to be kept alive in such circumstances, and she simply stopped eating.”

In another, “malnutrition” was removed as a factor in the cause of death and reclassified as a contributing factor “not related” to the primary cause of death. “Arteriosclerosis and hypertension” was substituted for “malnutrition” as a factor in the primary cause of death. The presence of bedsores was stricken from one certificate. Anemia vanished from another.

The certificates Sanders provided The Times do not show evidence of concealing crimes or accidents. All the deceased were older men and women who died of predictable causes, usually in hospitals and of diseases of long duration. The changes appear to be concerned primarily with tidying up paper work requirements in the death certification process.

In many cases, certificates appear to have been rewritten for no apparent reason, or to meet regulations such as the requirement that doctors fill them out only in black ink.

While most physicians interviewed by The Times were unhappy to see the altered certificates--reactions ranged from mild annoyance to outrage--two expressed sympathy for funeral homes.

Employees Criticized

Health department and coroner’s officials “have driven them to this” through poor administration by ignorant employees, said Dr. James C. Meltzer, a Beverly Hills internist whose name was signed to one of the certificates checked by The Times.

“I fill out death certificates, and the next day some $3.25-an-hour clerk is calling me up from the coroner’s office, arguing with me about the cause of death because it doesn’t agree with some list or something they have down there.”

Authorities have created pressure to circumvent the system by a ridiculous insistence on perfectly clean paper work, said Dr. Jack Ditlove, a Beverly Hills nephrologist whose name appeared on two death certificates that he said he did not sign. Physicians as well as funeral homes “waste a great deal of time” trying to meet the standards, he said.

The problem is especially acute for a Jewish funeral home like Malinow & Silverman, he said, because of Jewish traditions calling for rapid burial.

Rabbi David Lieber of the University of Judaism in Bel-Air said that although it is a Jewish tradition to bury the dead as rapidly as possible, “no pressure could account for doing this sort of thing. The Jewish tradition provides a person should be buried when the details are taken care of.”

Most Jews would be guided by their rabbis on such matters, he said, “and most rabbis would advise them to cooperate with the system.”

Sanders said he was told by fellow workers and by an employee of another mortuary he met when taking the examination for his state funeral director’s license that altering death certificates was a common practice throughout the funeral industry.

“That is wholly inaccurate,” protested Bud Noakes, owner of Noakes Funeral Home in Glendora, a director and past president of the Los Angeles County Funeral Directors Assn.

‘Ethically and Legally Wrong’

“That would be a violation of the trust of the bereaved family and of the trust of the physician. It is morally, ethically and legally wrong. In 40 years in this business, I have heard of only a few isolated cases such as this--the last one was in San Francisco about seven or eight years ago--and I’ve never heard of this in the Los Angeles area.”

He said that in his mortuary “we send a photocopy of every completed death certificate back to the physician who signed it, so we could not make changes if we wanted to. That is becoming a common practice, especially since many hospitals are now asking for them to complete their records.”

County health and coroner’s officials, and state Registrar David Mitchell--whose agency is charged with keeping birth, marriage and death records--said they knew of no evidence that the practice was widespread.

“In the four years I’ve been in office, this is the first such case we’ve had,” Mitchell said. However, he added, for years he has been aware of “veiled hints” of death certificate alterations. The department acquired an investigator for such cases less than two years ago and this is the first case with a basis to look into, he said.

Sanders said he had never altered a death certificate himself and had protested the practice to his supervisors, but was told to “shut up if you want to keep your job.”

About two years ago, he consulted an attorney about the practice, but was advised that he did not have enough evidence to support his charge, he said, and so he began collecting the torn and discarded original certificates when he was alone in the mortuary at night.

Sanders supervises the night staff for Malinow & Silverman and three Gates-Kingsley-Gates mortuaries--in Culver City, Santa Monica and Canoga Park--also owned by Service Corp. International. The other three mortuaries handled their own death certificates, he said, and he is unfamiliar with their practices.

Sanders said that last week he was suspended without pay for one week as tension mounted in the mortuary’s management over the origin of the state investigation. He expected to be fired anyway when his accusations were made public, he said.

But although he is a state licensed funeral director, he was not planning on a mortuary career. He worked in the funeral home to support himself while he tries to get a start in acting and writing, he said. He has written two book-length manuscripts, neither of which has been sold, he said. One is a novel and the other a nonfiction work.

Both are about corruption in the funeral business.

A DOCUMENT UNDER SCRUTINY