The man believed to be the worst necrophiliac killer in British history was able to abuse the bodies of more than 100 women and girls over a 15-year period because of “serious failings” at the hospitals where he worked, an inquiry has found.
David Fuller, who admitted murdering two women and sexually abusing the bodies of many more he found in the mortuaries, was told he would spend the rest of his life behind bars in 2021. The case prompted the launch of a two-part independent inquiry.
“Over the years, there were missed opportunities to question Fuller’s working practices,” the inquiry’s chair, Sir Jonathan Michael, said, as he announced the first round of findings on Tuesday.
“He routinely worked beyond his contracted hours, undertaking tasks in the mortuary that were not necessary or which should not have been carried out by someone with his chronic back problems. This was never properly questioned.”
During his trial in 2021, Fuller admitted to having murdered 25-year-old Wendy Knell and 20-year-old Caroline Pierce in separate attacks in Tunbridge Wells, Kent, in 1987. He subsequently admitted to sexually abusing the bodies of dead women and girls aged between nine and 100 years while working for Maidstone and Tunbridge Wells NHS trust between 2005 and 2020.
The later crimes were uncovered after police raided his home and found more than 800,000 images and 500 videos of his abuse – as well as evidence of his “persistent interest” in rape, abuse and murder of women.
On Tuesday, Michael said: “The offences that Fuller committed were truly shocking and he will never be released from prison.
“Failures of management, of governance, of regulation, failure to follow standard policies and procedures, together with a persistent lack of curiosity, all contributed to the creation of the environment in which he was able to offend, and to do so for 15 years without ever being suspected or caught.”
There was “little regard” given to who was accessing the mortuary, with Fuller visiting 444 times in a year – something that went “unnoticed and unchecked”, reporters were told. And senior bosses were said to be “aware of problems in the running of the mortuary from as early as 2008”.
Michael added: “In identifying such serious failings, it’s clear to me there is the question of who should be held responsible.
The inquiry’s chair, a former NHS hospital consultant and chief executive, outlined 17 recommendations designed to help prevent similar atrocities. Among those was the call for CCTV cameras to be installed in the mortuary and post-mortem room and for maintenance staff to carry out tasks in those areas in pairs.
Michael also said the “practice of leaving deceased people out of mortuary fridges overnight” or while maintenance is carried out should end. And his report called for a review of governance policies by the trust’s board.
The government launched the inquiry in 2021, with its first phase looking at his employer. Its second was launched in July to review how people who have died are cared for around the country, focusing on safeguarding in private mortuaries, private ambulances and funeral directors. Those findings are expected in 2024.
The trust’s chief executive, Miles Scott, who took on the role in 2018, said he was “deeply sorry for the pain and anguish” suffered by the families of Fuller’s victims, adding that the report “contains important lessons for us”.
While many of the recommendations were acted on after Fuller’s arrest, Scott said the trust would implement the remainder “as quickly as possible”.
The health minister Maria Caulfield apologised on behalf of the UK government and the NHS, saying the report made for “harrowing reading” and vowed that “lessons will be learnt” so “no family has to go through this experience again”.