Mortuary backlogs result in ‘horror’ viewings

Families have had to identify their loved ones in a state of decomposition because of a backlog in post-mortems caused by an apparent shortage of pathologists at state mortuaries.

Lakewood Funeral Services owner Kevin Bougaard, who assisted two families with burials recently, described the experiences they had to endure to identify their family members.

“The one case was a 40-year-old woman who died of unnatural causes. When the family did the viewing, she was already decomposed and the brother-in-law could not identify her. The only way he could identify her was by looking at her hands, because he could recognise her nails,” Bougaard said.

He said this was as a result of backlogs in the release of bodies from the state-controlled Hillbrow mortuary because of delays in performing post-mortems. 

“In the same week, there was another case where a 37-year-old man had been shot, so he was murdered, and we had to go to the mortuary with the family to do the identification of the loved one,” he said.

Bougard said he arrived at the mortuary on Friday 21 July to fetch the body of the man who had died on 16 July, but he was told that it was not ready for collection. He said bodies were usually ready for collection two to three days after the day of death.

“When we inquired, the mortuary said there is a backlog but they would work the weekend to do the autopsy to get the body released. We were supposed to have his funeral on Saturday, but we had to postpone it,” he said.

“On Monday, when we went to the mortuary, his name was on the list to be the first for the autopsy [that day]. We waited about 30 minutes or so and one of the staff then said ‘there are no doctors’; no one had pitched for work, they are all off sick,” he said.

“On Tuesday we went into the mortuary again and still no doctors had pitched up to work. and that’s when we started reaching out to the media, we were desperate. They never mentioned the word ‘strike’ but the conditions they work under are not good. We eventually got the body on Wednesday and moved the funeral to Sunday. The body was not in a good condition,” he said.

According to Bourgard, pathologists at Hillbrow mortuary do on average 4 000 autopsies a year, but apparently only five pathologists are employed at the facility.

A source who works in the funeral parlour industry, who asked not to be identified because he is not the business owner, said “the situation” at the mortuary was “not up to standard”.  

“The place has a stench that is unhealthy to the human body. We go on a Thursday to collect a body and they say come back on Friday, and then when we go back we are told to ‘go, come back next week’, because they are short staffed. The system is not working because they are doing favours for some people [who jump the post-mortem queue],” said the source. 

He claimed that pathologists usually left the mortuary by noon every day, and just one would stay on duty to deal with emergencies.

The Democratic Alliance spokesperson for health, Jack Bloom, said he had alerted Gauteng’s health and wellness MEC, Nomantu Nkomo-Ralehoko, to the “unacceptable situation” where bodies were not released for burial by the Hillbrow mortuary because of delayed post-mortems.                  

“Families are anguished as the bodies of their loved ones are not released. This issue needs to be resolved urgently. All cases of unnatural death are supposed to be sent to the state mortuaries for a post-mortem, which should be done within two days. But the backlog at Hillbrow mortuary has grown to about 100 bodies, and families are waiting for more than a week before the body is released,” Bloom said.

He said funeral parlours had also complained that bodies were sometimes released in a decomposed state.

“There is a general problem of poor management and staff shortages at the nine mortuaries run by the Gauteng health department, but the Hillbrow mortuary seems to be worst affected,” he said.

Funeral Industry Reform Association chairperson Johan Roussow, who has been lobbying the government to amend regulations related to the funeral sector and mortuaries, said the problem of backlogs was countrywide in cities and towns.

“It is all over the country, because, in the first instance, the government doesn’t have the capacity for sufficient storage space in all of the provinces,” he said.

He said a large part of the problem was pauper burials, where poor families did not claim bodies because they could not afford a funeral.

Moonlighting pathologists 

Roussow alleged that there were also pathologists who worked full-time for the state who were moonlighting, doing post-mortems for clients in the private sector for fees of R4 000 to R7000 per autopsy.  

He said doctors who did not know the person who died tended not to specify the cause of death and instead wrote “natural causes”. 

When families want a cremation, the law requires that a post-mortem be conducted. He said pathologists could do about four or five autopsies a day and earn up to R35 000 in this market.

“It’s all about money. The funeral parlour has a doctor in his network and says ‘please sign the death certificate’, so whether doctor says natural causes and does not stipulate the cause of death, they don’t care because it enables them to register the death, but when they find out the customer wants a cremation then then need the exact cause of death,” Roussow said.

He believes there legal reform is required to clean up the industry, which is also beset by fly-by-night funeral parlours that lie in wait “like tow truck drivers” outside mortuaries to prey on traumatised families, and then charge “exorbitant fees” to release the bodies to their undertaker of choice for the funeral.

“There is no national law incorporating everything, there is no regulator in place, no ombudsman, and we unfortunately have to say there is a lack of management and skills even in the government mortuaries,” he said.

Avbob’s general manager for funerals, Pieter van der Westhuizen, said his funeral directors had said there was a “serious problem” at the Hillbrow mortuary, which was struggling with backlogs, while Cape Town mortuaries took four to five days for the release of bodies. 

He said no problems had been reported in Durban at this stage.

Van der Westhuisen said he was not sure of the cause of delays, but he was aware that in many cases private pathologists were contracted to the state to do post-mortems at a fee of R3 500 to R5 000.

The Gauteng health department announced on 24 July that it has established a provincial task team to address the backlog at mortuaries. 

Departmental spokesperson Motalatale Modiba said it had also introduced a digital fingerprint system that will help ensure people can be identified and that unknown individuals can be referred for paupers’ burials.

“The issue of insufficient pathology services has got to do with the shortage of specialists in this area across the country. As Gauteng we recently opened a training room which will assist with training of more specialists in this area,” he said.

Speaking at a media briefing last week, Nkomo-Ralehoko said the team would ensure bodies were examined and released without delays.    

“At this particular Hillbrow mortuary alone, this move has resulted in 139 bodies being examined between 24 and 31 July 2023. Out of the 139 bodies examined, 96 of them have been claimed or collected by their families while 43 are still awaiting collection,” she said. 

“The task team is providing this support on a 24-hour basis and seven days for the next 30 days while we finalise other processes,” Nkomo-Ralehoko said.

Modiba added that full-time pathologists may only conduct private work with special permission, but some worked for the state on a part-time basis.

Health department spokesperson Foster Mohale said ageing infrastructure was affecting mortuary services, especially where storage facilities are still at police stations.

He said the department was facing problems with unclaimed bodies and also in cases where they could not be disposed of because of ongoing police investigations.

“The Department is working with SAPS [South African Police Service] and Cogta [department of cooperative governance and traditional affairs] to resolve the issue of unclaimed bodies,” Mohale said. 

Western Cape department of health spokesperson Megan Davids said regulations pertaining to the Rendering of a Forensic Pathology Service (FPS) promulgated under the National Health Act, state that an unidentified person should be buried within 30 days for health and safety reasons.

“But we have opted to follow every available process to try identify the person and to have a DNA profile on record for future inquiries, which greatly exceeds the 30 days.”

“The Western Cape government has invested extensively in increasing storage capacity and infrastructure and thus we are able to safely manage our cases with no storage concerns. What is of concern, however, is the minimal inquiries received at our facilities by families looking for their loved ones, and the amount of deceased that are not registered on our National Population Register,” she said.Davids said she was not aware of any pathologists moonlighting in the Western Cape.