Objective

To determine if the Department of Health is effectively overseeing the practice of funeral directing in accordance with relevant law and regulation and if the New York City Department of Health and Mental Hygiene is effectively overseeing selected aspects of the practice of funeral directing. The audit covered the period from April 2019 through November 2023.

About the Program

Under provisions of the Public Health Law (Law), the Department of Health (DOH) is responsible for governing and regulating the business and practice of funeral directing, undertaking, and embalming in New York State. The Law defines funeral directing as the care and disposal of the body of a deceased person and/or the preserving, disinfecting, and preparing, by embalming or otherwise, the body of a deceased person for funeral services, transportation, and burial or cremation. In New York State, only a licensed and registered funeral director may make funeral arrangements for the care, moving, preparation, and burial or cremation of a deceased person, and these services may only be provided by firms that are also registered with DOH. At the least, the funeral director will file the death certificate, transfer the body, coordinate with cemetery or crematory representatives, make the necessary preparations, and move the body to the cemetery or crematory.

DOH’s Bureau of Funeral Directing (BFD) and Bureau of Vital Records (BVR) are responsible for oversight of most of these activities. BFD handles the licensure and registration of funeral directors, registration of funeral firms, investigation of consumer complaints related to the practice of funeral directing, and continuing education and training of practitioners. BVR is responsible for administering the Electronic Death Registration System—EDRS—which health care providers, medical certifiers, medical examiners/coroners, funeral directors, and local registrars use to electronically register vital events, such as deaths, that occur in New York State but outside of New York City. For deaths that occur within New York City, the New York City Department of Health and Mental Hygiene (DOHMH) administers eVital, its electronic system for registering deaths. According to aggregated data from both EDRS and eVital, a total of 801,421 deaths occurred between April 1, 2019 and November 4, 2023 in the State. Most of these deaths (508,775, or 63%) occurred outside of New York City and 292,646 (37%) occurred within New York City.

Funeral directors must comply with various requirements set forth in the Law and corresponding New York Codes, Rules and Regulations (Regulations). For example, they must use prescribed tests to determine that life is extinct before removing a body from the place of death, preparing it for burial (such as through embalming), or proceeding to bury or cremate the body. While there are no requirements that explicitly require funeral directors to identify or label bodies in their care, it’s reasonable to view minimizing this risk as inherent in the practice of funeral directing. Regulations also require firm preparation rooms to meet standards, and DOH requires firms to submit photos of the preparation room at the time of firm registration. In addition, disposition of a body may not occur until a permit is issued following registration of the death.

The Law also requires that firms register each of their locations. While more than one firm may be registered at a single location, DOH officials said it’s been a long-standing protocol to document the legitimacy of secondary registration, and they require documentation that secondary firms have permission to operate at the location where they’re attempting to register. Under the Law, death certificates must also include the Social Security number (SSN) for the deceased person. Provisions in the Law and Regulations state that DOH must be notified at least 30 days prior to the termination, cessation of operation, or discontinuation of the business of a funeral firm and within 10 days of changes to a firm’s name, address, ownership, or other legal status.

Key Findings

We identified several areas in which DOH needs to improve its oversight of the practice of funeral directing in New York State. In addition, DOH and DOHMH should improve their interagency data sharing and other communication to better identify and address risks of unauthorized funeral directing activity and to improve the quality of SSN information that’s captured in their respective systems. Our audit report includes 12 recommendations—nine to DOH and three to both DOH and DOHMH—to help make this oversight more effective. Specifically:

• Some funeral directors we interviewed said they aren’t using the tests prescribed by the Regulations to verify death. In addition, some said they don’t always label or otherwise identify the bodies in their care, increasing the risk that bodies may be misidentified. While the likelihood of an error in either of these areas is low, recent occurrences demonstrate the potential for significant distress for the deceased’s loved ones, and also for damage to the reputation of the funeral firm and the profession, underscoring the critical need for DOH’s attention.
• DOH has reduced or no assurance that some firms initially met or continue to meet standards for their preparation rooms.
• There were more than 2,500 cases in which deaths were registered after the disposition of bodies, according to information in EDRS and eVital, the DOH and DOHMH vital records systems.
• We identified concerns with DOH’s oversight of funeral firm and director registration. We found two instances in which a firm may have been practicing funeral directing at an unknown or unregistered location. We also found over 23,000 death certificates that were issued in both DOH and DOHMH’s systems by unregistered or unknown funeral directors and/or firms.
• We identified 7,484 death certificates (2,785 EDRS, 4,699 eVital) with duplicated or no SSNs that affect the certificates’ accuracy and reliability, as well as their ease of use in post-death arrangements.
• DOH’s practices for learning about and following up on firm closures provide little assurance that it has the information it needs to investigate any risks identified.

Key Recommendations

To DOH:

• Take steps to enhance assurance that funeral directors and firms are:
  • Aware of and complying with required death tests; and
  • Minimizing the risk of misidentifying human remains.
• Take appropriate action to provide greater assurance that firms meet requirements related to their preparation rooms.
• Work with DOHMH to develop an approach to identify and follow up, as appropriate, on risks that disposition of bodies occurs prior to registering the death.
• Strengthen methods to identify and address risks of unauthorized funeral directing activity by unregistered directors or firms or at unregistered firm locations. This might include improving internal communication and information sharing between BFD and BVR.
• Evaluate the benefit of conducting inspections of funeral firms, based on risks identified, and document the results.
• Take steps to improve assurance that closing and/or closed firms have ceased to operate.

To DOH and DOHMH:

• Improve interagency communication, which could include analysis of registration data and sharing results, to better identify and address risks of unauthorized funeral directing activity, whether by unregistered people or by unregistered firms or firm locations.
• Improve the completeness and accuracy of death certificate SSN information that’s captured in EDRS and eVital, respectively.