The Critical Role of the Embalmers Case Report

Now, I know that case reports can be just one more chore for an embalmer to do when they are already busy as heck. Quite frankly, I am used to talking about unpopular things (see all my discussions of postmortem chemistry and Safety Data Sheets), but I am not going to stop now. We have to remember that when a loved one passes, families reasonably expect that the decedent will be treated with dignity, that handling and preparation of the remains will comply with professional standards, and that documentation will reflect what was done (or not done). An embalming case report, whether the body is embalmed or not, serves as a vital piece of that documentation. It is part of our standard of care, and part of what we charge families for.  

Why an embalming (or non-embalming) report matters 

Even if the body is not embalmed, a report should still be generated. Why? Well, let me give you some perspective: 

• Verification and transparency: The report records what the funeral home or mortuary staff observed (condition of the body, time of arrival, refrigeration status, visible trauma, any treatments or preparations done). If no embalming is performed, that fact should be noted, along with the reason (e.g., immediate burial, religious objection, refrigeration available). It should also still contain any treatments that were done for viewing by the family such as bathing, feature setting, and medical device removal. Especially important if you plan on doing a viewing for the family, even if it’s just for ID purposes.  
• Standard of care: By documenting the status of the remains, the funeral provider shows they have observed and handled the remains in accord with acceptable mortality-care practices (e.g., appropriate refrigeration, prompt transport, no unauthorized modifications). 
• Baseline for later evaluation: If problems are discovered later (e.g., decomposition, leakage, odor, body damage, wrong body, or mix-up), the report becomes a baseline for what things looked like initially. Without that report, it’s much harder for families or legal counsel to assess negligence. 
• Evidentiary value and liability management: In litigation (or regulatory investigation) the embalming report may serve as key evidence. It supports or refutes claims of improper handling, omission of required steps, or breach of duty. 

Because the law does not always require embalming in every case (for example, immediate cremation, refrigeration, religious waiver, etc.), the decision not to embalm must be documented.  

Legal Responsibility?  

When a funeral home or mortuary fails to document properly or mishandles remains, families may have legal recourse. They may also be in violation of state law. Some states require documenting every case. For example, I am licensed in Texas and Texas Administrative Code (22 Tex. Admin. Code § 203.32(c)), states “all embalming case reports must … be completed for each embalming procedure …” and retained for two years. Arizona, Arkansas, New Mexico, and Florida also have similar laws on the books.  So, some states have seen the value in documentation so much they made it into law. Of course I don’t know the history of these laws, but keep in mind that funeral professionals in those states may have advocated for this as well.  

Why the embalming case report is central to a case 

Because the report documents the condition of the body, what was done (or not done), who performed it, when and how, and any complications, it becomes critical evidence. Without it, the funeral home has to rely on memory and other records (which are spotty at best. While the plaintiff has a harder burden but still may argue that the absence of documentation implies a lack of standard care. On the plaintiff side, a properly drafted independent review from an expert witness of the embalming report strengthens the ability to show breach and causation. If no such document exists, the ultimate outcome may settle whether the embalming was negligent or not.  

What an Expert Witness Will Look for in an Embalming Case Report 

When a plaintiff hires an expert to analyze an embalming report (or the absence thereof), the expert has several things to consider. Some major items would be:  

1. Was the person licensed?  

2. Timeline details 

3. 1. Time of death, time of body arrival at mortuary, refrigeration start time, time of embalming (if done) or time when decision was made not to embalm. 
   2. Was the body stored/refrigerated at appropriate temperature and within the allowable time window before embalming or viewing? 
   3. Were any delays documented and explained? 

4. Condition of the body on arrival 

5. 1. Was the body decomposed, bloated, discolored, purge present (fluids exiting orifices), insect/maggot presence or obvious pathology such as jaundice?  
   2. Was there trauma (e.g., due to an accident)? 
   3. Were there visible signs of prior interventions (autopsy, surgery, organ harvest, etc.) and are they documented? 

6. Embalming or preparation details (if embalming was done) 

7. 1. Chemicals used: type, quantity, concentration (arterial fluid, cavity fluid, additional treatments). This would also likely include a review of the Safety Data Sheets to evaluate the total content of fluids, not just formaldehyde content. An analysis of any trade descriptions from a manufacturer would also be pertinent to determine if the fluids were used appropriately.  
   2. Primary dilution calculation completed? I know you all hate math but determining the correct solution strength is a very easy way to say whether an embalming is potentially negligent 
   3. Technique: arterial injection, vessels raised, cavity aspiration, supplemental treatments such as hypodermic injections, surface packs, or other post-embalming treatments. 
   4. Whether there were anatomical anomalies, complications (e.g., extensive trauma, autopsy cavity) and how the embalmer treated them. 
   5. Distribution and diffusion of solution if pictures are available.  
   6. Was the body prepared for viewing (cosmetology, posing, closing eyelids/mouth) if promised or necessary? 
   7. Does the embalmer’s final assessment match the rest of the evidence?  

8. If no embalming done 

9. 1. The report should state clearly that embalming was not performed, and why (e.g., immediate cremation, family request, refrigeration adequate, religious waiver). 
   2. Documentation of refrigeration, time, and condition of body until disposition. 
   3. Record of any alternative preparation (e.g., refrigeration, minimal treatment). 
   4. Whether the decision not to embalm was consistent with standard of care under the circumstances (e.g., decomposition risk, transport delay, viewing planned). 
   5. Whether family instructions were followed regarding embalming or not. 

10. Causation and damages link (for the plaintiff) 

11. 1. The expert could opine whether the handling, preparation (or lack thereof) possibly caused or contributed to observable damage (e.g., odor, purge, decomposition, visible discoloration) that caused additional harm (emotional distress, denial of viewing, family upset). 
    2. The expert must connect the standard of care deviation to the injury/harm: e.g., “Had the body been embalmed or stored appropriately, the purge and odor would very likely not have occurred during the funeral service, thereby preventing additional emotional trauma to the family.” 
    3. The report may also address whether, in view of the body’s condition, the funeral home should have anticipated the need for embalming (or enhanced preparation) and would have done so under standard practice. 

So, while case reports might seemingly be another headache to deal with, they may very much come in handy. Funeral homes are meticulous recordkeepers in so many other ways; is the vault ordered, are the pre-needs in order, who has worked what hours? Further we live in a work environment where paperwork is king; transit permits, death certificates, FTC documents, so what’s one more that can save your bacon later?  

If you are feeling convinced about case reports, here are some links to free ones online that you should consider:  

Embalming Case Report (Texas). PDF 

The Dodge Company 

Embalming Case Report (New Mexico). PDF