A British government-ordered investigation said Tuesday that it found serious deficiencies in hospitals, where an electrician later convicted of murder was able to have sex with a hundred corpses over 15 years without being detected.

David Fuller’s necrophilia came to light in 2020 when police used DNA analysis to link him to the murder of two women and found millions of images of sexual abuse in his home. The images included videos of him having sex with the corpses of women and girls in the morgues of two hospitals in the south-east of England where he worked.

“The crimes committed by David Fuller were truly scandalous,” the 308-page report says. “However, deficiencies in management, governance, regulation and processes and a persistent lack of curiosity contributed to creating the environment in which he was able to commit them.

“This is not just the story of an electrical maintenance supervisor who is a crook. David Fuller’s victims and their relatives were repeatedly let down by the people at all levels charged with protecting and caring for them.”

Fuller, 69, is serving life in prison without the possibility of parole for two homicides.

At the same time, he is serving a 12-year sentence for dozens of cases of necrophilia on a scale unprecedented in a British court, according to the prosecutor.

The point of the investigation was to find out how Fuller was able to get away with it for so long and prevent it from happening again.