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Selected Investigations Completed April - September 1997 > Part II, Case no. E.0271/96-97

Part II - Full Texts of Selected Investigations

Case No. E.0271/96-97 - Destruction of deceased person's clothing

Matters considered: Destruction of deceased person's clothing without next of kin's permission - handling of complaint

Complaint against: Redbridge Health Care NHS Trust, Essex

Complaint as put by complainant

1. The account of the complaint as put by the complainant was that on 5 November 1995 his father-in-law was taken to King George Hospital, Goodmayes, where he was found to be dead on arrival. The complainant's father-in-law's family believed that he would have had money with him at the time of his death, but there was none among the personal belongings returned to them and his clothing was destroyed without their permission. On 7 December solicitors acting for the family wrote to Redbridge Health Care NHS Trust (the Trust), which manage the hospital, about the complainant's father-in-law's belongings. The Trust's patient services manager replied on 11 January 1996. Despite further correspondence, including a letter dated 8 May from the chairman of the Trust, the complainant remained dissatisfied.

2. The complaints investigated were that:

(2.1) the Trust did not seek the permission of the complainant's father-in-law's next of kin before destroying his clothing; and

(2.2) the handling of the complaint was dilatory and unsatisfactory.

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Investigation

3. My predecessor obtained the comments of the Trust and examined relevant documents. Evidence was taken from Trust staff involved and from the Trust's chairman. I have not put into this report every detail investigated but I am satisfied that no matter of significance has been overlooked.

Complaint (a)
Trust did not seek permission before destroying clothing. Complainant's evidence

4. On 29 May 1996 the complainant wrote to my predecessor complaining that the Trust had destroyed his father-in-law's clothing without first obtaining the permission of his next of kin. He told one of my investigators that his father-in-law was found in his front garden at 10.00 am on 5 November 1995, where it was believed he had been since midnight, and that he was then taken to King George Hospital. In a letter to the Trust, dated 7 December 1995, the complainant's solicitors listed the items which the Trust returned to the family as wrist-watch, glasses, house-keys and cap.

Local and national guidance

5. When the complainant complained to the Trust about his father-in-law's clothing being destroyed, the Trust had no written policy about the handling and disposal of property of the dead. A consultant histopathologist (the histopathologist) and another consultant pathologist, who jointly managed the mortuary and its staff, later produced a 'Protocol for Preparation of Bodies for Post Mortem Examination', which reflected established practice within the Trust. It includes:

'.... if the body is very stiff because rigor mortis has set in, [the clothes] are cut away. ....

'If .... clothes are soiled .... or if they have been cut and damaged .... they are placed in yellow plastic bags for incineration. The clothes and shoes are not differentiated for this purpose. However, as underclothes are frequently soiled, they may often be discarded while the remaining clothing is retained. Soiled clothing is destroyed for reasons of hygiene. (It is not normal procedure to ask for consent .... from relatives.)'

'- keep accurate records of the dead and their property in the mortuary register, ensure the safe keeping of clothing, property and valuables of the dead and maintain appropriate and complete records as required.'

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Evidence of Trust staff

6. The histopathologist told my investigator that she had worked at seven other hospitals and, as far as she was aware, their procedures for the handling and disposal of property of the dead had been broadly similar. Within the Trust, if there was any visible soiling of clothing it was normal practice to destroy all the clothing even though some might be clean; that was because of the difficulty of making sure that there was no cross-contamination between soiled and clean items when clothing was removed from the body. She said it was good practice to regard all body fluids as potentially infective (i.e. they might contain infectious organisms) and pointed out that protective clothing worn by mortuary personnel was routinely incinerated after use. From what she knew of the circumstances of the complainant's father-in-law's death it was likely that his body would have been rigid. It might therefore have been necessary to cut his clothing away, in which case it would have been discarded as it would, effectively, have been destroyed in the process. Following the complaint she had spoken to colleagues at two other London hospitals and, at her request, one of the anatomical pathology technicians (the first technician) had made enquiries of staff at two local mortuaries. The practice at those other units proved to be similar to that of the Trust, the only significant difference being that in the other units a record was kept of any items destroyed whereas the Trust's practice was to record only those items returned to relatives.

7. The first technician said that, when bodies were brought into the mortuary, clothing was frequently found to be soiled. When there was soiling to outer garments all clothing would be destroyed even though some items might be clean. When, as was often the case, only the undergarments were soiled, only those items would be destroyed. He was unable to remember the complainant's father-in-law, but said that clothing would always be thoroughly searched before disposal, and a colleague (the second technician) would usually do that. Details of items found would be recorded in the mortuary register; and if nothing was found that would also be recorded. (Note: I have seen extracts from that register; beside the name of the deceased there was space to record 'jewellery or valuables' handed to the undertaker, under which signatures were required of the mortuary attendant and the undertaker collecting the body. The only items listed in respect of the complainant's father-in-law, whose entry was signed by the first technician, were a watch and a pair of glasses.) The first technician had seen the Trust procedure referred to in paragraph 5 and said that it accurately represented working practice in the mortuary. The second technician did not remember the complainant's father-in-law. He gave evidence similar to that of the first technician about the disposal of clothing and other procedures in the mortuary.

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Findings (a)

8. The Trust do not dispute that the complainant's father-in-law's clothing was destroyed without permission from his next of kin, but it was not their normal practice to obtain such consent. The complainant believes that the Trust had no authority to dispose of the clothing. I am advised that his view of the law is correct: a hospital has no more right to destroy clothing which was the property of someone who is dead without the consent of the personal representative or representatives than they have to destroy clothing which is the property of someone who is alive. I note, too, the Royal Institute's requirement that mortuary technicians should ensure the safe keeping of the clothing, property and valuables of the dead. However, it seems to me right to set on the other side of the balance a hospital's obligation under the Public Health (Control of Diseases) Act 1984 and otherwise to minimise the risk of infection represented by clothing soiled by body fluids. Whether soiling, in any particular case, is likely to present a danger such as to override the Royal Institute's requirement is, in my view, a matter for the professional judgment of the staff concerned. However, the histopathologist has said that where any garment was soiled, it was normal practice for all items to be destroyed. While I recognise the need for effective measures to control infection I consider that approach to be unnecessarily inflexible, in that it does not seem reasonable, for example, that a pair of shoes should be destroyed simply because a jacket is soiled. I believe that those having ownership of such items, should normally be consulted about their disposal unless the risk of infection is considered to be such that immediate destruction is necessary in which case accurate recording of the circumstances would be of paramount importance. There is conflict between the complainant's evidence about items returned to the family and what was recorded in the mortuary register, with fewer items listed than were actually returned. I am concerned that it was not the practice of mortuary staff to keep a record of items destroyed or retained other than jewellery and valuables handed to the undertaker, or of the reasons for the destruction of clothing. I recommend that the Trust revise their procedures to take account of all these matters.

9. I have been unable to establish exactly why the complainant's father-in-law's clothing was destroyed, though I note the view of the histopathologist that it was likely to have been damaged during removal. I note also the evidence of the first technician, that clothing was often found to be soiled. Given that uncertainty, I cannot comment on the Trust's actions in this case. However, as the Trust's practice made no provision for consent, or for consideration of individual circumstances, I uphold the complaint.

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Complaint (b)
Dilatory and unsatisfactory handling of the complaint

10. I first set out details of the relevant correspondence:

7 December 1995

Solicitors acting for the complainant wrote to the Trust that his father-in-law's relatives believed that he was in possession of a sum of money when he died but that none had been returned to them. The solicitors asked for enquiries to be made to establish whether any items had been overlooked, and also expressed concern that permission was not obtained from his family before his clothing was destroyed.

15 December

The Trust's facilities manager replied that the complaint was already under investigation and that a full reply would be sent at the earliest opportunity.

11 January 1996

The patient services manager sent a substantive reply which included: '.... I would wish to assure you that a thorough search of clothing would have been made ....'. The letter made no mention of the destruction of the complainant's father-in-law's clothing.

18 January

The complainant's solicitors wrote to the Trust:

'.... Our clients are not particularly happy with your response ....

'.... on a number of occasions, you refer to what 'would have' happened. It would appear to us that you are quoting standard procedure, but have not investigated the exact circumstances of this particular case .... We should be grateful, therefore, if you would clarify exactly what investigations have been carried out.

'.... you appear to have completely ignored the position as regards the disposal of .... clothing. We do not consider there was any authority to dispose of these items without obtaining our clients' consent ....'

The letter also asked for confirmation of the procedure for the safe-keeping of money found on deceased persons and for a copy of the Trust's complaints procedure.

26 February

The solicitors wrote to the Trust expressing disappointment at not having received a reply to their letter of 18 January and repeating the request for a copy of the complaints procedure. (Note: the complainant told my investigator in November 1996 that he had still not received that guidance.)

13 March

The complainant's solicitors wrote to the Trust's chairman, making a formal complaint about the way in which the matter had been dealt with.

18 March

The chairman sent a holding letter to the complainant's solicitors.

11 April

The solicitors wrote again to the chairman, asking when a substantive reply could be expected.

12 April

The chairman sent a letter, signed in his absence by his personal assistant, apologising for the delay, and saying that he expected to be able to provide the information requested within ten days.

3 May

The chairman's personal assistant wrote again to explain that he had been away but was to return on 8 May, when he would reply without further delay.

8 May

The chairman wrote to the complainant's solicitors:

'I have now had the opportunity to check the facts with everybody involved and apologise for the time it has taken.

'This specific case was investigated .... but some of the words used in the reply may have given the impression that [staff] were simply quoting the system ....

'To answer the original questions put in your letter of 7 December 1995: a. No cash or articles other than those returned were found; b. The clothing was destroyed as it was soiled and this is the normal procedure; it is not usual procedure to ask for consent.'

The letter ended with an apology that the matter had not been dealt with 'more clearly and quickly'.

10 July

The chief executive wrote to my office at the start of my investigation:

'.... I acknowledge that the length of time taken to deal with this complaint is clearly unacceptable, particularly in view of the undertaking given following the Commissioner's investigation into the complaint made by .... (Reference E.260/94-95).'

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Trust's complaints procedure

11. The Trust's complaints procedure which was in operation at the time of the complaint to the Trust included:

'.... All complaints, including any internal review .... should be completed within 3 MONTHS.

'.... where the complainant remains dissatisfied [the complaint] will be dealt with by the Chief Executive.

'The Chief Executive, Care Group Manager or Facilities Manager are responsible for ensuring a complaint is properly investigated. .... All correspondence with the complainant is .... the responsibility of the Care Group Manager/Facilities Manager or Chief Executive.

'The Chief Executive, Care Group Manager or Facilities Manager are responsible for sending final responses to complaints.

'Records of all complaint correspondence .... should be kept centrally by each .... Care Group Manager/Facilities Manager.

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Evidence of Trust staff

12. The patient services manager said that when she received the letter of complaint from the complainant's solicitors, she consulted the bereavement officer, who she knew had spoken to the complainant's wife and the first technician. She also examined the mortuary register. The first technician had been unable to remember the complainant's father-in-law, but explained the mortuary procedure with regard to clothing and property. That was why, in her letter to the complainant, she had said that a search 'would have been made'. When she learned that the complainant was not satisfied with the reply she told the chief executive's office that she was making further enquiries. She spoke to the histopathologist and, again, to the first technician, but obtained no new information. She said that although she could not be certain she had probably made notes of those conversations, but would have discarded them when she produced the substantive reply of 11 January. She had then overlooked her responsibilities to reply to the solicitors' letters of 18 January and 26 February and to send them a copy of the complaints procedure. She added that responsibility for complaints was, at the time of the complaint, shared between three or four members of staff. Since then, one person had been made responsible and a revised 'bring forward' system had been introduced. In her view those changes had resulted in an improvement in service.

13. The facilities manager, who was the patient services manager's line manager, said that on receiving a complaint she would complete a form which would be used to log the progress of the investigation. In the complainant's case no such form had been found. She could offer no explanation of why one appeared not to have been completed. She had passed the complaint to the patient services manager, who had responsibility for the bereavement office. Sometimes the facilities manager carried out complaints investigations herself; and when she did so she kept a record of discussions with staff and asked for their comments in writing. She doubted that the patient services manager had done that; and she would not have required her to do so.

14. The facilities manager did not think she had seen the patient services manager's letter of 11 January to the complainant's solicitors (paragraph 10) before it was sent; but she had seen it since and considered it satisfactory. Although under the Trust's complaints procedure in operation at the time the facilities manager was responsible for correspondence with complainants, such matters were commonly dealt with at a lower level, as had happened in this case. She also thought it unlikely she had seen the solicitors' letters of 18 January and 26 February, but said that they should have been acknowledged immediately and the matter passed to the chief executive. Her understanding of the complaints procedure was that the complaint would then have been investigated by someone who had had no previous involvement in the case. The patient services manager kept all the papers relating to complaints that she dealt with. While that did not fully comply with the Trust's written procedure, those papers were readily available to the facilities manager, as the patient services manager's office was close to her own.

15. The chairman accepted that the Trust's handling of the complaint had been dilatory. He was unable to explain why it had taken two months to acknowledge the solicitors' letter of 18 January, and said that his own reply had taken longer than he would have liked as the histopathologist had taken three weeks to provide her written comments. He had been away from the Trust during April, but wrote to the complainant immediately on his return on 8 May. The chairman felt that the patient services manager's letter of 11 January (paragraph 10) was less than clear, particularly with regard to the explanation of what 'would have' been done. The chairman knew that mortuary staff were unable to recall the complainant's father-in-law, but believed that his letter answered fully the questions raised in the solicitors' letter of 18 January. His intention was to remove any doubt resulting from the letter of 11 January. He did not consider it appropriate to explain again the procedures referred to in that earlier letter. He also did not consider it appropriate to enter into a legal argument about the disposal of clothes removed from bodies brought to the hospital as the practice adopted by the Trust was well established throughout the NHS. When he wrote the letter he believed that the complainant had already been provided with the Trust's guidance on how to make a complaint.

16. The chairman said that as the complaint contained, in his opinion, a veiled accusation of theft, it might have been preferable to involve the chief executive, or even the police, from the beginning. He felt that suspicion had been cast over the staff concerned by the solicitors' letters and that that had inhibited the patient services manager when she wrote the first substantive reply.

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Previous investigations

17. In other investigations my predecessor has had cause to criticise this Trust's handling of complaints. As the chief executive has acknowledged (paragraph 10), my predecessor conducted an investigation in September 1995, as a result of which the Trust undertook to make sure that all staff were aware of the complaints procedure and that it was correctly followed. In October 1996 (after the period during which the complaint was handled), in response to another investigation (E.803/94-95), the Trust wrote:

'We are currently in the process of employing a patient liaison officer .... Duties will include ensuring that complaints are handled effectively ....

'The new complaints procedure is currently being communicated throughout the Acute Division .... The patient liaison officer will monitor staff response on an ongoing basis.'

In a letter to my investigator of 25 November 1996, the Trust's complaints and risk administration officer said that the patient liaison officer had been appointed.

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Findings (b)

18. Solicitors acting for the complainant made a complaint to the Trust on 7 December 1995, and on 18 January 1996 wrote to express dissatisfaction with the Trust's reply of 11 January. They received no acknowledgement of that letter or of a further letter until two months later; and a substantive reply was not sent until 8 May, almost four months after the letter of 18 January. The chairman (paragraph 15) and the chief executive (paragraph 10) have acknowledged that the Trust's handling of the complaint was dilatory. I agree with them, and uphold this aspect of the complaint.

19. The Trust's first reply to the complainant was vague, contained little information, and gave no assurances that mortuary procedures had been followed. It is not difficult to see how he came to the view that the matter had not been fully investigated. When the complainant's solicitors wrote to the Trust on 18 January expressing dissatisfaction with that reply, the matter should have been passed to the chief executive according to the complaints procedure in place at the time, but that was not done. The chairman eventually responded; but I consider that his reply, too, was unsatisfactory. It gave no details of the investigation that had been carried out, despite a specific request in the letter of 18 January for that information, added little to the patient services manager's earlier reply and brushed aside the legal issue. I criticise also the Trust's failure to respond to the request for guidance about how to make a complaint. I uphold the complaint that the handling of the complaint was unsatisfactory.

20. I note that the Trust have introduced a new complaints procedure since the complaint. However, the principal failing in this case was not the procedure that was in place at the time, but the failure to comply with it. Correspondence was dealt with at too low a level within the Trust, mistakes were made, and progress was not monitored as it should have been. This is not the first time the Trust's complaint handling has been the subject of investigation by this office. Following a previous case an undertaking was given to my predecessor about staff awareness and correct implementation. I am concerned that action taken as a result of that undertaking had little effect when it came to handling the complaint. I recommend that the Trust should take action to make sure that the measures referred to in paragraph 17 improve the way in which complaints are dealt with, and that the Trust should monitor both the speed and quality of complaint handling.

Conclusion

21. I have set out my findings in paragraphs 8, 9, 18, 19 and 20. The Trust have accepted my recommendations in paragraphs 8 and 20 and have asked me to convey to the complainant - as I do - their apologies for the shortcomings I have identified.

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Last updated: 7 February 2006