Stories Waiting to be Found at Your County's "Office of the Unclaimed Dead"

What happens when someone dies who has no assets – or friends or relatives – to pay for his burial?

As our society becomes more and more fragmented, and the economic crisis worsens for more and more people, your jurisdiction may be struggling to pay for the disposition of bodies of indigents. Or, perhaps you've had a recent experience yourself with a neighbor or a friend, or even a local homeless person, who died unable to afford a burial. What happens then?

Procedures for pauper's burials vary widely by jurisdiction. It is one of those little-discussed arenas of public health, a topic that often intersects with the deaths of the homeless.

In Florida, counties bear the cost of burying indigents.  But, in Leon County, for instance, friends and relatives may not attend the burial at the Pauper's Cemetery, due to "liability issues," and cremation is not allowed. In Bexar County, Texas,  paupers are entitled to a simple casket, a viewing for up to two hours, burial three to a plot (one to a plot for children), a brief gravesite service, and a granite headstone. Cremation is allowed.

When I was a medical resident here in San Francisco, an Office of  the Unclaimed Dead (literally) handled paupers' burials. Now, the San Francisco Medical Examiner's office handles them.

San Francisco has roughly 250 indigent deaths a year to manage - approximately one a weekday. Richard Vetterli, adminstrator of the Office of the  Chief Medical Examiner, is the person charged with dealing with these cases.

Establishing identity is a crucial first step, Vetterli says. As in most major urban areas, San Francisco's medical examiner investigators use DNA databases and publicity. Most people are conclusively identified fairly quickly. But there are still, even after prolonged and intense efforts, John and Jane Does who remain unidentified, sometimes for years.

Once identity is established, the next step is locating next of kin. Here in San Francisco, the medical examiner's office has an impressive track record for finding next of kin. Vetterli told me they manage to find, and notify, next-of-kin within 24 hours 95 percent of the time. Finding next of kin is a crucial step -- both for humane and economic reasons, Vetterli says, "It's amazing how often a family will step up, and assume the cost of burial, even when they've been estranged for years and years and had no idea where the person was living. Most families take jurisdiction. There's a lot of basic decency out there. And it is often very healing for the family to know."

But what if there is no one? Or no one willing to pay?

First, the medical examiner's office contacts the Willed Body Program at UC San Francisco. However, as Vetterli points out, the criteria for being accepted by the program is quite strict, and many bodies do not qualify.

Next, the ME's office determines if the dead person was a qualified veteran. If so, the person will be buried in the San Joaquin Valley National Veteran's Cemetery, with burial costs covered as a veteran's benefit. 

If these options are not available, and the Public Administrator's office determines that there are no assets to contribute toward burial costs, the city's indigent death program takes over.

In San Francisco, all indigents who die are cremated, with  the cremains  stored for one year. If no family comes forward during that year, the cremains are scattered at sea. There is no ceremony, and the task is performed under contract with a funeral home in Oakland.

Each disposition costs San Francisco $700. With 250 deaths of indigents a year, that's  $175,000.

Studies show that homeless people die at high rates, and at early ages, frequently from treatable illnesses. Death is a looming, ever-present backdrop to life on the streets. Surveys show that homeless people have unique fears around death and dying -- specifically that they will die alone, and anonymously.

You might think that a busy, urban, crime- and forensics-oriented staff would find the experience of dealing with indigent deaths, well, tedious. Annoying at best, or distasteful at worst. But after my questions about the logistics of the city's program ended, here's what Vetterli spontaneously offered as his impression of the value of this type of work and investment: "We deal with the families, and the deceased. When families do come forward, we can bring them some closure. The compassion I've seen on this end by all our staff, well, it continues to amaze me."

Is there a story about indigent deaths in your area? Should donors be able to sponsor a burial? Does your county have a pauper's burial ground? Have you tracked an indigent death lately? Or been present for a pauper's ceremony? Consider giving a voice to the unclaimed dead in your area.

Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

Photo Credit:  Potters Field image from Bcostin via flickr

Photo Credit:  Tagged body image from Calvin Cropley via flickr