The Best American Crime Reporting 2009

by Jeffrey Toobin

  The funeral directors apparently felt little obligation to their unsuspecting customers, even failing to make sure that the ashes returned to them were actually those of their loved ones. One family held its memorial the day before the relative was actually cremated. Another conducted a service in the family home at the precise time cutters were at work on the body.

  What then, exactly, is their crime? How to categorize it? Prosecutors have labeled it fraud. Theft. Fraud and theft committed upon the families who trusted the funeral directors to render the agreed-upon services. But also, implicitly, theft upon the dead, the very pilfering of their parts. Such thinking, though, not only places the dead, strangely, at the center of the victimization; it also ignores the underlying basis of what funeral directors do, which is, after all, to traffic in death.

  We have given them that. Until the Civil War—when sons died far from home and needed to be preserved for transport, and when hundreds of thousands of Americans were exposed for the first time to an embalmed body vis-à-vis Abraham Lincoln’s epic train journey from Washington to Philadelphia to New York to Illinois—there was no such thing as embalming here, or funeral directors. Americans took care of their dead. They stood by them when they died, washed them, built them wooden coffins, laid them out in front parlors (hence “funeral parlor”), and then buried them themselves, paying more than lip service to the axiom of “Ashes to ashes, dust to dust.” Now we hand off our loved ones’ bodies before they’ve even appreciably cooled to funeral directors charged with transforming corpses into what’s called, in funerary parlance, “a memory picture,” to drain them of blood, pump them full of dye and formaldehyde, glue their eyes and wire their mouths shut; to jab a metal instrument through their abdomens and pierce their vital organs, vacuuming up their discharge; to paint them with makeup and position them in coffins in mimicry of peaceful sleep. Or, in cases of cremation, to introduce their bodies into ovens heated to 1,600 degrees, and stoke their bones during an hours-long combustion. This is their job.

  Yes, the dead may have been victims of a sort, but beyond them, there was what the funeral directors and cutters did to the living, and not just to the families of the dead. For once their work was finished, the cutters packed the flesh and bones into picnic coolers and headed back north with them. BTS then forwarded the bones and tissue to its client processing companies, which cleaned, handled and supposedly sterilized the parts. Next they were repacked and shipped to doctors and hospitals around the world, including Thomas Jefferson University Hospital, where on the morning of May 12, 2005, 65-year-old Betty Pfaff lay unconscious in an operating room as her surgeon tore open a plastic package containing AlloDerm—a white freeze-dried substance, derived from cadaver skin, that dissolves into a wound and stimulates rapid tissue regeneration—which he lowered into the opening stretching across the woman’s abdomen.

  LYING IN THE RECOVERY ROOM, draped in covers and her mind foggy, Betty Pfaff was informed that her surgery—a somewhat complicated one, due to the fact that her abdomen had been opened so many times before—had been a success. Everything went well. You’re going to be fine, she was told. At this moment, these sentences were not only accurate as far as anyone knew, but provided Pfaff with great solace.

  Pfaff, a sweet, plump widow who lived alone in a tiny white house across the street from a picturesque cemetery in Jenkintown, had had surgery for abdominal hernias twice before. She’d become susceptible to them as a result of having undergone two cesarean sections within one year. (After her first child, a daughter, died at three months, in 1976, she’d quickly become pregnant with a son, Philip.) Another hernia had cropped up the previous winter; she scheduled the operation for the spring, when the weather would be better. She was unaware before her surgery that she’d be receiving human tissue—she didn’t recall her doctor explicitly telling her, and hadn’t read the consent forms carefully—and remained unaware after, which isn’t unusual, given how routinely it’s used.

  She was wheeled back to her room. Her wound, about eight inches long, was to remain open so that accumulating fluids could drain, and doctors came frequently over the next several days to check it, and to change the dressing. She was out of bed and sitting in a chair in one day, and walking down the hallway in three. After a week, she was doing well enough to be discharged. Instead of going home, she decided to recuperate at a nursing home, as she was worried about being alone. She intended to stay there for a month, but was so disgusted with the care she received that she left after six days, despite having developed a fever, which fluctuated seemingly without reason. Her doctor prescribed an oral antibiotic, which she supplemented with Tylenol. Overall, she felt unwell, weak.

  Surrounded by the comforts of home—her favorite navy blue recliner, her books and magazines, her favorite stuffed bunny with the long floppy ears and a country dress—Betty hoped she’d begin feeling better. She did not. Visiting nurses handled the wound and monitored her fever, which continued. In early June, she began feeling particularly bad, and her temperature spiked to 100.4°. She called a friend, who drove her back to Jefferson, where she was admitted.

  While examining Pfaff, her doctor discovered a tiny piece of gauze deep inside her wound. He performed a debridement—a deep cleaning of the wound. Afterward, he told her, once again, that all had gone well. He ordered a culture of the wound, and started her on a three-day course of high-potency amoxicillin. She remained in the hospital for four more days.

  Her son picked her up and returned her to her home, and the visiting nurses began coming again. She felt about the same, and her temperature persisted; she remained on antibiotics, and was instructed to return to the ER if her fever broke 100.5°. On July 1st, her visiting nurse came and took her temperature: It was 104°. “We have to get you to the hospital,” the nurse said, and left a message for Pfaff’s son. Betty called her sister Nancy, who came over to sit with her and wait for Philip.

  Betty’s condition worsened. She began staring; she had trouble focusing. She rocked oddly in her chair. Nancy feared her sister was suffering a stroke. Philip arrived, and Nancy went outside to confer with him. They dialed 911.

  By the time they reached Abington Hospital, Betty’s fever was burning at 106°. Her heart rate had increased rapidly, along with her respiration. Nurses threaded a catheter into her hand and pumped fluids into her. A doctor ordered several intravenous medications. She appeared to be getting better. At 9 p.m. she told Nancy and Philip to go home, that she would be fine. Then, at midnight, Philip received a call to return to the hospital. His mother had been moved to intensive care. Doctors told him there was just a 20 percent chance she would survive.

  Betty Pfaff was septic, meaning her entire body was ravaged by infection. When Philip saw her, a ventilator was breathing for her. She was horrifically swollen. She was hooked to a dialysis machine that was removing and purifying her blood. Philip was told to summon his family. They arrived at the hospital and surrounded Betty. A priest administered last rites.

  For nine days her family stood vigil, having been assured she would die. Incredibly, on the 10th day, she opened her eyes.

  All around the hospital, she became known as “the new Lazarus.”

  It would be, however, a long, difficult recovery. She couldn’t walk, wash, or take care of herself. She spent 26 days at Abington Hospital, then two months in rehabilitation, slowly building back her strength.

  Over and over, Betty Pfaff asked her doctors a single question: How could this happen? They replied with the only answer they knew: Infection is always a risk with surgery. But Betty was unsatisfied.

  It wasn’t until Valentine’s Day 2006, almost a year after her surgery, that she opened a letter that arrived from the Food and Drug Administration via her doctor. It advised her that she’d received human tissue, stolen from a cadaver, that was now the subject of an unprecedented and, for her, utterly impossible recall.

  AS OF PRESS TIME, after vehemently professing their innocence for two years, Michael Mas
tromarino, Lee Cruceta, several New York City funeral directors and several cutters were either in the process of accepting or already had accepted deals to plead guilty to the charges they faced in both New York City and Philadelphia. They are expected to testify against the remaining defendants, including the Garzone brothers and McCafferty, who have pleaded not guilty in Philadelphia court and are scheduled to stand trial later this year. The defense is expected to argue that these defendants did none of the actual harvesting and therefore cannot be held accountable, though the spate of plea agreements by their co-defendants obviously bodes poorly for them. In addition, Mastromarino, having just been sentenced to 18 to 54 years in prison, will likely cooperate in implicating the tissue companies that bought from him. Those companies—which generate multimillion-dollar profits annually and are publicly traded—have claimed they had no way of knowing the documents Mastromarino prepared were fabricated, and no way of knowing the true source of the materials they received.

  Then there are the civil lawsuits. Philadelphia attorney Larry Cohan has been named by the U.S. District Court in Newark, New Jersey, as lead counsel in a class-action lawsuit against all of the defendants in the criminal case as well as the tissue companies, representing so far 900 people nationwide, including Betty Pfaff, who received some of the 20,000 pieces of stolen tissue. In addition, along with his partner Melissa Hague, Cohan is representing 15 families of the unwitting donors in their suits in Philadelphia court, including the Oprea family.

  The cases are, however, by no means surefire. In the first place, there seems to be little money to be wrung from many of the defendants, including Mastromarino, who’s paid for legal representation in several jurisdictions, and the funeral home operators, whose insurers have maintained that their policies don’t cover subscribers’ criminal conduct. That leaves the tissue companies that distributed Mastromarino’s stolen goods, especially Regeneration Technologies Inc., recently renamed RTI Biologies, the first-stop processing company in Florida through which all of Mastromarino’s body parts flowed.

  Cohan and Hague argue that it’s impossible RTI didn’t know what Mastromarino was up to. Parroting the prosecutors’ argument, they say the paperwork—including the death certificates—forwarded to the company were almost transparently fraudulent. The numbers themselves coming out of Mastromarino’s company, they say, should have raised red flags. “Normally, one particular harvesting company might get just a minimal number of donors, say one a month or maybe two or three,” says Hague. “Mastromarino was getting 10 or 30 a month. He was RTI’s primary supplier for human tissue implants, and they never questioned him about it. There’s no way they couldn’t have known.”

  Still, RTI—which recently announced record revenues of $94.2 million for 2007—and the other tissue companies are preparing an aggressive defense, challenging the idea that those who’ve developed serious diseases contracted them from the transplanted materials, given the claimed sophistication of the companies’ sterilization processes.

  Bob Rigney, CEO of the American Association of Tissue Banks, puts great stock in RTI’s “BioCleanse” low-temperature chemical sterilization process; RTI claims to have distributed more than 500,000 BioCleansed implants “with zero incidence of infection.” Rigney says furthermore that the risk of spreading infection or disease from transplanted tissue, even in cases when the tissue has not been treated as such, is exceedingly low. “Quite frankly, the safety record in terms of tissue is remarkable,” he says. “In the last 20 years, we’ve seen only one confirmed death.”

  Rigney attributes that level of success in large part to the extraordinary safeguards his organization has helped build into the tissue-retrieval system, from the stringent donor criteria that disqualify 90 percent of would-be donors—not only the diseased but in some cases even those with tattoos—to the multi-layered testing of donors’ blood, to careful reviews of the deceased’s medical records, to elaborate interviews with loved ones to ascertain the donor’s lifestyle—the same safeguards, in short, that Mastromarino and his henchmen systematically ignored. And the one death that Rigney mentions is noteworthy. In 2001, a 23-year-old Minnesota man died following knee surgery to repair a torn ACL. An investigation later determined that the cadaver cartilage implanted during his surgery hadn’t been recovered until 19 hours after the donor’s death, during which time a deadly fungus grew in it, forming spores that withstood the sterilization process and blossomed inside the recipient into an overwhelming infection. The investigation specifically cited the 15-hour limit for safe retrieval, the same 15-hour limit authorities believe was exceeded in Philadelphia in almost every case.

  Cohan will also have the testimony of these witnesses to offer to a jury: A 41-year-old Ohio man who tested positive for HIV and hepatitis C after receiving BTS bone implants in surgery for degenerative disk disease. A 30-year-old Colorado woman who had to undergo a repeat ACL replacement after her first BTS tendon failed. A 74-year-old widow from Ohio who received BTS bone for a lower-back surgery and developed syphilis.

  THOUGH HE HAS THE MODEL SHIP READY, Dan Oprea hasn’t yet fulfilled his promise to his mother to deliver her ashes to the sea in a Viking funeral. “I intend to do this,” he says. “I’ve got the ship, I’ve got everything. I know it sounds ridiculous, but I have this feeling like…I’m throwing her in the trash. And I understand that’s not what’s happening, and I intend to do this eventually, but I’m just not ready yet.”

  Oprea says he’s struggled to get past the news of what happened to his mother’s body. His wife says she often catches him staring into space, and knows where his mind is. In many ways, Dan says, he wishes he never found out about it. “It’s just like something out of a horror movie,” he says. “You just can’t understand how anybody could do this.”

  And this poses the question, again, of what the greatest crime here may be. Irish journalist Mary Kenny, whose sister Ursula was among the unwitting donors, wrote that she doesn’t resent that her sister’s body was dissected, only that it was done without express permission. “What is a body after death anyway? Nothing but waxwork effigy,” she noted. “Her spirit remains strongly with me, hovering over so many moments in my life, and that is dearer to me than the fate of a mere anatomy.”

  Certainly the accused in this case may be guilty of much, of fraud, of larceny, of misleading loved ones, of taking advantage of their vulnerabilities, of falsifying records, of harvesting remains in grotesque, unsanitary settings, and of introducing potentially infectious parts into otherwise healthy bodies. Isn’t that last thing, without doubt, their most egregious offense? Yet it hasn’t resulted in a single criminal charge. Instead, it’s the charge of “abuser of corpses”—defined by the Commonwealth as “a person who treats a corpse in a way that he knows would outrage ordinary family sensibilities”—that has given the government the most traction. That may seem, in the scheme of things, almost quaint. Except that for Dan Oprea and millions of others, it goes to the very heart of how we still look at an uncertain line, between life and death.

  DAN P. LEE writes about crime, science, and politics for Philadelphia magazine. Another of his stories—about two dueling forensic pathologists—appeared in Best American Crime Reporting 2007. He lives in Philadelphia’s Old City neighborhood.

  Coda

  After pleading guilty to the thousands of charges against him, Michael Mastromarino was sentenced to twenty-five to fifty-eight years in Philadelphia and eighteen to fifty-four years in New York; the sentences are to be served concurrently, and he won’t be eligible for parole for at least eighteen years. Appearing in a Philadelphia courtroom, Mastromarino looked gaunt, his hair recently shaved. He apologized to his victims, saying, “I have many years to think about the wrongs I have committed, in prison.”

  Louis Garzone and his brother Gerald also pleaded guilty, on the day their criminal trial was to commence; each was sentenced to nine and a half to twenty years in state prison, of which they are expected to serve at least eight. Thei
r pleas were in large part the result of Mastromarino’s cooperation with Philadelphia authorities, as well as that of codefendant James McCafferty Jr. McCafferty, Jr. McCafferty, who claimed to have suffered from severe alcoholism, received a shorter sentence—three and a half to ten years in state prison—in exchange for agreeing to testify against the Garzone brothers and because he played a significantly smaller role in the criminal enterprise; he could be eligible for parole in as little as two years and eleven months.

  The scene was emotional as the Garzones offered their pleas. About fifty people—some furious, others sobbing—packed the courtroom. Among them was Elizabeth Sparagno, who’d hired Louis Garzone to cremate her eighty-four-year-old mother Marie Lindgren’s body; Lindgren had been savagely murdered by two teenage neighbors to whom she’d once fed homemade cookies. Sparagno told the Philadelphia Inquirer she remained tortured by the double indignity. “It’s just not right,” she said. “Those boys already cut her head off, her pinky finger. And then later I find out that Garzone took her to the funeral home for those cutters who came down from New York.”

  The civil trial against all the defendants is still pending.

  Mark Boal

  EVERYONE WILL REMEMBER ME AS SOME SORT OF MONSTER

  FROM Rolling Stone

  ON AN OVERCAST WEDNESDAY AFTERNOON last December, a skinny white teenager shuffled into the Westroads Mall in Omaha, Nebraska, with an assault rifle hidden under his black hoodie. A cheery holiday atmosphere filled the aisles. Christmas trees twinkled, holiday music played softly. Nobody paid attention to the slouching teen as he got on the elevator in the Von Maur department store and rode it to Level 3.