NEW YORK >> One died in her multimillion-dollar apartment. Another left $1.3 million to charity. A third was an opera costume designer who took regular trips to Europe with his devoted partner. All three donated their bodies to medical science, and eventually served as cadavers for first-year medical students at the New York University School of Medicine. All three had signed forms that promised cremation and the disposal of their ashes by the medical school “in an appropriate and dignified manner.”

So how did their dissected corpses end up instead in mass graves on Hart Island, where New York City buries the dead it considers unclaimed and indigent?

Those cases, discovered during an investigation by The New York Times into Hart Island burials, shocked surviving family members and friends. But they also raised larger questions about body donations at a time when medical schools throughout the country increasingly rely on such gifts, rather than on unclaimed bodies, to teach future doctors.

Now, after searching through anatomical records at The Times’ request, NYU is apologizing, and acknowledging that the cases were part of a practice that went on for years. Until 2013, the school was sending a subset of privately donated cadavers to a city morgue for burial at public expense.

“As an institution, we weren’t aware that this was happening,” Lisa Greiner, a spokeswoman for NYU Langone Medical Center, said. “I promise you it’s not happening now.”

But the revelation reinforces long-standing concerns by some anatomists about the lack of regulation and oversight in a national patchwork of body donation operations. And it could have repercussions at the 16 medical schools in New York state, which use more than 800 donated bodies a year.

How many bodies donated to NYU ended up on Hart Island is unknown, Greiner said, partly because some records were lost in Hurricane Sandy, and also because the longtime director of the program, Dr. Bruce Bogart, who withdrew from most university responsibilities in 2011 and officially retired in 2013, now has dementia.

Medical schools often share an excess supply of cadavers with other schools that have run short, and some bodies donated elsewhere were passed to NYU. Indeed, among the privately donated cadavers that NYU dispatched to Hart Island was the body of Leo Van Witsen, the author of an influential book on costume design for opera, who had donated his corpse to Columbia University’s College of Physicians and Surgeons.

According to NYU’s records, Columbia’s program did not need Van Witsen’s body when he died at 96 in 2009. So with permission from the executor of his will, Columbia transferred his body to NYU, Greiner said. Three years later, apparently because his executor had checked off a box on an NYU form stating that the family did not want the remains returned, the school sent Van Witsen’s corpse to a city morgue as unclaimed instead of cremating it.

“He deserved something much better than that, even if it was scattering his ashes in Central Park,” said Sharon Stein, a former neighbor who described Van Witsen as “thorny, interesting and dapper,” and recalled that he had escaped the Holocaust as a refugee from the Netherlands in 1938.

Unexplained practice

Without public records on body donations, there is no systematic way to identify how many donors have wound up on Hart Island. The Times stumbled on the cases it linked to NYU while combing through a database of 62,000 Hart Island burials since 1980, originally compiled by volunteers for the Hart Island Project, a nonprofit organization. A gap of one to three years between death and burial typically was a sign that the deceased had served as a medical cadaver. But among hundreds of such cases, sometimes only an unusual name or another exceptional piece of information in the records made further investigation possible.

One of the most striking involved Marie Muscarnera, who was buried in a pauper’s grave in 2008, three years after her death at 91. Her brother Joseph, who died a few months before her, lies in another Hart Island trench. Yet an estate bearing Marie Muscarnera’s name is on a 2009 list of donors of money to NYU’s medical school, in the $550,000-to-$999,000 category.

Muscarnera, it turns out, grew up in Brooklyn in dire poverty, the oldest of 10 children in an Italian immigrant family that depended on her teenage labor to survive. But by the time she died, in 2005, her fierce drive, dressmaking talent and shrewd investments had earned her a nest egg of more than $1.3 million. She left it all to charity, including $691,700 to NYU’s medical school. Separately, like Joseph, who was disabled and lived for years under her care until he died at NYU Langone, she gave the medical school her body for use as a cadaver.

The NYU form she signed stated, “I wish my remains to be cremated and the New York University School of Medicine to be responsible for burying or spreading the cremains in a dignified manner.”

Instead, after using her body as a cadaver for three years, the anatomy program paid a funeral home $225 to transport it to a city morgue in the Bronx, to be boxed in pine and ferried to Hart Island, where the city pays inmates 50 cents an hour to do the burying. Cremation costs the school $155 more per body.

Greiner said money had nothing to do with it. “It really does not appear that any of these individuals were buried on Hart Island for any savings,” she said.

She said she was unable to explain the reasoning behind NYU’s practice, but she linked it to confusing notification letters sent out to survivors, sometimes months after a donor’s body had been accepted as a cadaver. Notwithstanding the written wishes of the donor, unless a surviving relative or executor responded to that notification within 90 days by checking the right box, the body was not cremated but dispatched to the city morgue for a Hart Island burial.

The wording of the notification changed a few times, but no version disclosed the plan for a mass grave on Hart Island, and one form in use for several years falsely stated that after cremation, cremains that went uncollected would be buried by the city of New York. In fact, New York does not bury ashes, and unlike many other major cities in the United States, it is barred by state law from cremating bodies considered unclaimed.

Greiner said all donated bodies are now cremated at Rosehill Crematory in Linden, New Jersey, and if families do not wish the return of the ashes, they are scattered in a memorial garden there.

Lack of transparency

NYU was one of the first medical schools in the country to publicize annual memorial ceremonies held by grateful medical students to honor body donors. Each year, on average, it receives 46 cadavers and signs up 65 donors. Officials at the Associated Medical Schools of New York, of which NYU is a member, said it knew of no other school that had ever sent privately donated bodies to a potter’s field, and that it had been unaware that NYU was doing so.

Todd Olson, a professor of anatomy at the Albert Einstein College of Medicine who formerly directed its anatomical donation program and has been a leader in the profession’s state and national organizations, said he was sickened to learn of NYU’s method of disposing of some privately donated bodies.

“This is so out of line with common practice,” he said. “The idea of it is so disrespectful.” But, he added, “Every time you turn around you’re going to find some people who are taking advantage of their access to the dead, because they know the dead are not going to talk.”

To Brandi Schmitt, an officer of the American Association of Clinical Anatomists and the director of the anatomical donation program at the University of California, the existence of such a long-undetected policy at a major institution underscores the lack of transparency and oversight in donation operations. Nationally, such operations include large for-profit companies supplying a booming demand for human tissue in science and industry, as well as academic programs teaching anatomy to medical students.

“There continues to be a need for comprehensive laws and policies to allow a layperson to understand the choice they’re making,” Schmitt said of body donation. “It is absolutely essential to have an institution’s leadership involved and to have strong policies and procedures in place that are not a secret.”

In recent years, body donation operations of various kinds have been enmeshed in scandals. Federal raids on anatomical donation companies in several states led to criminal indictments this year after more than a thousand decaying body parts were discovered in a shabby Detroit warehouse. They had been supplied and sold for profit, without the donors’ consent. In another case, George Washington University’s medical school announced that it had lost track of the identities of about 50 donated cadavers used to train future doctors, and families were suddenly left to wonder whether they had been sent the wrong ashes.

Schmitt said news of NYU’s missteps would inevitably affect the public perception of other body donation programs, which rely on their reputations to attract donors. “Doing what you say you will do has to be the cornerstone of your policies,” she said. “The families, the loved ones, the living donor, in fact, deserve to have a tracking process and an oversight process that equals respect.”

In the Muscarnera case, a surviving brother, Vincent, had checked a box saying, “The family no longer wishes to have the remains of Ms. Marie Muscarnera returned.” In an interview last year, Muscarnera, a retired teacher in his 90s who calls himself “a loner,” said he had no idea NYU would send the bodies to a potter’s field, and no one told him so when he was being pressed to make decisions at his sister’s hospital bedside.

“Now, I think they had so much money we could have had a normal burial,” he said.

Donors’ intentions

In the family of another NYU donor, a son who checked the same box as Muscarnera was angry.

“It’s a travesty based on a falsehood,” said Anthony R. Smith, the son of Ruth Proskauer Smith, a celebrated feminist and reproductive rights advocate who had arranged to donate her body to NYU years before her death at 102.

“Ruth Proskauer Smith would be outraged by what your reporter learned,” he wrote in a letter to The Times, “NOT because she would have cared where she was ‘disposed of’ but because this hugely wealthy institution used this device to cheat the city by having taxpayers pay for burial.”

In a statement sent to The Times by Greiner, Mel Rosenfeld, senior associate dean for medical education at NYU, was apologetic. “We sincerely regret any actions on our part that did not reflect the wishes of those altruistic donors and their families who willingly donated their remains for medical education,” he wrote. “In 2013, we instituted major changes to our disposition practices for donor remains that will ensure that we honor the donors’ wishes with regard to their remains.”

© 2016 The New York Times Company