The different levels like police, public, court, and lawyer.

The
Medico-Legal Autopsy in India

Dr.
Sunita Arya , Guest Faculty, Govt. New Law College, Indore M.P.

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Abstract

Most of the time deaths are unnatural
reasons and deaths which are believed to cause by natural reasons but where the
medical cause of death is not certain or known are subjected to an inquest. The
purpose of an inquest is to ascertain facts concerning to the death. From this accomplishment
of inquiry and at the conclusion of the inquest or a result is facilitate to
appear as to whether the death was caused by either natural, accidental,
suicidal or a homicidal cause. An inquest is not a trial. There is no
complainant or defendant and at the conclusion of the inquest no judgment is
passed. The inquest system exists in all parts of the world. A postmortem
examination may become necessary in certain deaths that come up for inquests.
In these situations the authority which conducts the inquest will order a
doctor to perform a postmortem examination (medico-legal autopsy). To perform a
medico-legal autopsy, consent from the relatives of the deceased is not
required. In an unexpected sudden death, only a doctor after a postmortem
examination may be able to determine the cause of death. However, it is often
wrongly assumed that the objective of a postmortem examination is only to
ascertain the cause of death. This article deals with the purpose of the
inquest and roles of the medico-legal autopsy.1

Keywords: Autopsy, Inquest, Panchnama, Artefacts, medico-legal
significance

Introduction:

Post-mortem examination
is a very important part of the duties of Medical Officers working in different
Government Hospitals and other Institutions such as dispensaries, primary
health centers etc. Since this work is a vital link in the dispensation of
justice, it goes without saying that careful attention and promptness is quite
essential in dealing with it2. The post mortem report is required by
people of different levels like police, public, court, and lawyer.

———-

1( Department
of Pathology, University of Malaya, Kuala Lumpur, Malaysia)

2.(Post Mortem And Medico-Legal Work Ref: Hospital
Administration Manual Vol. I (revised) CHAPTER XII)

All have different level of understanding. It should
be concise, simple and relevant to points raised during interrogation of the
particular case. The main unavoidable reason for ordering PM remains cause of
death. Postmortem is a serious exercise and has serious medical, social and
legal consequences. The result of autopsy has potential of affecting life, limb
and liberty of people so utmost care should be taken to avoid injustice to
anyone. One should be cautious in medico-legal practice that very genesis of
this work is doubt, litigation, review and re-examination at various stages
till conclusion by court. Waiving off Postmortem Medico-Legal Postmortem is
done on request of Police/Magistrate/ Court. Medical Officer has no power to
waive off postmortem examination. He can play a role of an advisor in such
cases but final decision lies with Investigative Agency3.

Postmortem
Examination4:

The performance of
postmortem examination requires attention to a number of details some important
points need emphasis: 

a) No dead body brought
for postmortem examination at any time of day or night should be refused. It is
found that Medical Officers ask police Officers to bring the body on the
“next morning” when it is received during evening or night. In this
connection it is clarified that at present Government of Maharashtra have
allowed Postmortem examination to be made during night time if lighting
arrangements are satisfactory. The important point to decide whether the
examination can be done at night or in the morning is whether points of
medico-legal significance are likely to be missed. 

b) Post Mortem
examination should be always considered as an urgent piece of work. It ought to
be done as soon as possible leaving aside all other work barring that which is
necessary to immediately save a patient’s life. In a hospital or dispensary
where the examination cannot be done at night, it should be done the very first
thing on the next morning without attending to routine O.P.D., indoor patient’s
work etc.

——-

3.
Uniform Guidelines for Postmortem Work
in India:Article January 2013: Om P Murty, All India Institute of Medical
Science

 

4. (Post Mortem And
Medico-Legal Work Ref: Hospital Administration Manual Vol. I (Revised) Chapter
Xii)

Medical Officers should appreciate the psychological
background of relatives who are waiting for the body to be handed over.
Secondly, in our country decomposition process advances rapidly due to weather
conditions. This will affect the findings on postmortem examination. No delay
is therefore permissible.

c) Some Medical
Officers refuse to accept the dead body on the ground that it is from an area
outside their jurisdiction. This is however, not correct. The Medical Officer
should perform the postmortem examination in the first instance and make any
representation in the matter if necessary later on.

d) Every Medical
Officer allotted the work should carry it out without any argument or
discussion. He may represent the matter to the Medical Officer In charge of the
Hospitals later on if necessary.

e) No outsiders are
allowed during autopsy except medical students undergoing training. Even if the
cause of death is obvious from examination of a part of the body, all the part
must be systematically examined as required by the standard postmortem
examination form.

f) Before starting a
postmortem examination the Medical Officer should read panchnama and the Police
report carefully. If either of them is illegible the fact should be brought to
the notice of the police. If the Medical Officer finds any major discrepancy
between the injuries as described in the documents and as found out by him, he
should cause a fresh Panchnama to be made by a Magistrate.

g) The postmortem
report is written on a printed form and the various columns automatically
invite the required answers. There should, therefore be no omissions. The
important points to be kept in mind are as follows.

 

i)                  
 Column NO.5.- The Medical Officers should not
write the words “as per  Inquest
Report”. They should write a summary of the important facts and mention
the injuries as mentioned in the Panchnama and confirmed by them.

ii)               
Column No. 9.- The remark against this
column should not be ;nil; and a thorough search must be made. It is improbable
not to find any identification marks.

iii)             
Column No. 9.- The state of teeth should
not be described by a “dash'” It should be stated how many teeth are
present in the upper as well as the lower row and their condition, i.e. shaky
etc . 

iv)             
Column No. 10.- Rigor mortis should
always be described in detail i.e., whether present in the whole body or in
parts.

v)               
Column No. 12. – Details of signs of
decomposition should be mentioned.

vi)             
No. 17.- A detailed description of
injuries should be given as regards their exact site as from fixed bony points,
length, breadth, depth and character; it is advisable to attach a diagram of
the injuries. All injuries should be carefully measured and noted individually
though numerous in number. Conclusion about the cause and age of injuries
should always be mentioned Medical Officers cannot answer this point in a court
of law without any record.

vii)          
Column No. 18.- It should always be
mentioned whether the injuries are ante or postmortem.

viii)        
Weights of all organs as required
according to the postmortem form should be taken and noted.

ix)             
If blood is present in any part of the
body cavities its approximate quantity should always be mentioned.

x)               
There are often tears and injuries on
internal organs. Medical Officers should always mention the dimensions namely,
the length, breadth and depth. In case of hollow viscera, it should always be
mentioned whether the injury is through and through or not.

xi)             
 Column NO.2l.- Remarks should be always passed
about the state of digestion of the stomach contents, if any.

xii)          
Condition of the hair, clothes, nails,
mouth, tongue, genital Organs and general appearance of the body is at times
not mentioned. Attention should be paid to this.

xiii)        
Medical Officers should not avoid
postmortem examination because the bodies are decomposed .The examination
should be done with the same care and precision as in a fresh body. They also
cannot refuse to do the postmortem examination at the site whenever called upon
to do so. If they have any complaints in this respect they can make them after
doing the postmortem examination.

Medico-Legal Postmortem
Autopsy is being requested by Investigative Agencies -Police under Section 174
Cr PC and /or Magistrate under section 176 Cr. P. C. with following objectives:

i)                  
To find out cause of death.

ii)               
 To find factual, objective, medical
information for law enforcing agencies and court.

iii)             
To allow proper recovery and
preservation evidence.

iv)             
To document injuries and disease.

v)               
To determine manner of death

vi)             
To know time of death

vii)          
To reconstruct Crime Scene

viii)        
To provide correlation of facts and
circumstances related to the death

ix)             
To help in identification of victim,
etc.

Complete or Incomplete
Postmortem Procedure As on today in India, full postmortem is carried out in
medico-legal cases i.e.

i)                  
Examination of clothing /items over the
body.

ii)               
External examination of body from head
to toe front, back and sides.

iii)             
Internal examination with opening of all
the three cavities i. e Head, chest and abdomen.

There is no practice or
provision of incomplete or partial or limited postmortem in medico-legal cases.
Partial postmortem is practiced in clinical autopsies (Non-MLC cases). Exchange
of dead bodies in large number of public mortuaries in India, possibility of
exchange of bodies is always there. This is mainly due to disinterest of
relatives to touch the bodies due to their personal beliefs and practices;
bodies of similar appearance, height, sex, and look, illiteracy among handlers
and relatives. More possibilities do exist in circumstances:

a)    
Visual identification can be wrong in
mutilated, burnt and decomposed bodies.

b)   
There is strong repulsion in public in
viewing decomposed and distorted faces.

c)    
Circumstances are shocking and
disturbing to next of kin so they avoid seeing it.

Steps to be taken when body
exchange has taken

i)                  
 Set up teams to handle specific tasks as body
recovery, public handling, media handling, counseling and legal handling of
case.

ii)               
Try to recover the right bodies and
handover to relatives with sympathy and apology.

iii)             
 If body has been taken to different state then
help of local police is must to recover body or ashes.

iv)             
Enquiry should be carried out to fix
responsibility.

v)               
Steps should be taken to prevent future
happening.

Document
Policies

The common form of
documentation in postmortem services remains written reports, diagrams,
sketches, photographs and videography. Postmortem reports are usually
handwritten but due to court requirement, electronic advancement and for
clarity, nowadays computer typed reports are required. All doctors must get
orientated to this development and should type their own reports. General
points about these reports are given below.

i)                  
Report completion time – Immediate to 3
days in normal cases; 3 weeks when histopathology is carried out; 3 months when
viscera analysis or special examination is required.

ii)               
Handwritten or Typed reports – Typed
reports should be given now within reasonable time- 2 weeks if handwritten
report of death certificate has been issued immediately.

iii)             
 Printed Forms / typed reports for different
type of death as mentioned in next page should be made available for clear and
fast work.

iv)             
Photocopy and scanning facilities so
that soft copies of document can be retained.

v)               
Internal Audit policies /cross-checking
– daily/weekly/ monthly.

vi)             
 External Audit Policies – periodical 5 years
(Currently not practiced in India).

vii)          
Maintenance of files, documents,
photographs, etc should be clearly documented.

viii)        
Custody of documents, procedure for keeping
and releasing documents.

ix)             
Accreditation of centre. Postmortem
reports are maintained for indefinite period. Local guidelines and policies
should be drafted in consistency with recommendation of government. If storage
space is a problem then these can be maintained electronic form (pdf) after a
cutoff point like 30 years. Postmortem center must develop common formats; some
of these are mentioned in next page.

Inquest
Papers Required For Conducting PM

i)                  
Request for Postmortem – Must

ii)               
Medico Legal Certificate if any- desirable

iii)             
Police Form 25/35A , B or C as per need
of case- Must

iv)             
Seizure memo( items seized at scene )-
Desirable

v)               
Crime Scene assessment by CSI team /
Photographs – Desirable  ( overall scene
can be provided in CD/ Pen drive). Overall scenario information is very helpful
otherwise precious time of medical man and investigator is lost in speculations
and confabulations.

vi)             
 Statements of 
public/panch/ relatives – desirable

vii)          
Death Summary in hospital death
/treatment summary – most desirable if hospitalization was there. In fact,
above mentioned documents are essentially desired but in cases when it is a
holiday, document is not ready, interstate-transfer of patient, it may not be
feasible to bring these in reasonable period. Autopsy should not be delayed
unnecessarily. With scanning facilities a copy of inquest papers can be
retained in Pdf form with the department5.

Conclusion:

In the field of
forensic medicine, often medico-legal problems arise due to postmortem
Artefacts. Relatives of the deceased and general public often witness

————-

5.
Uniform Guidelines for Postmortem Work in India:Article January 2013: Om P
Murty, All India Institute of Medical Science

and wrongly interpret the external findings
(Artefacts) which lead to serious suspicion about cause and manner of death and
compel the police to book the case under Sec. 174 (C) Cr.P.C. or Sec. 302 IPC.
Relatives of deceased put pressure or harass the doctors alleging the case is
of murder etc., as doctors are always soft target of public. Medical officers
fail to interpret these Artefacts and unwanted suspicion arises. Often such
cases are referred to forensic experts for autopsy. Herewith cases that created
medico legal problems due to external Artefacts are reported and the importance
of interpretation of these findings and convincing relatives, police, lawyers
and the judiciary has been stressed. Post mortem artefacts are common phenomena
in forensic practice. Medico legal problems arising from  case along with ancillary investigations and
photography. Ultimately being a forensic expert one should develop the public
relations skills as most of these misunderstandings can be dealt effectively by
taking the relatives of the deceased into confidence by explaining the case to
them objectively6.

———————–

6.Artefacts And Its
Medico-Legal Problems: Dr. HT Thejaswi, Dr. AP Rayamane, Dr. R Puneeta, Dr. S
Kalai, Dr. Jagadeesh H, Dr. Chandrashekaraiah C.

References:

1. Department of Pathology, University of Malaya, Kuala
Lumpur, Malaysia

2.(Post Mortem And
Medico-Legal Work Ref: Hospital Administration Manual Vol. I (revised) CHAPTER
XII)

3. Uniform Guidelines for
Postmortem Work in India:Article January 2013: Om P Murty, All India Institute
of Medical Science.

4. (Post Mortem And
Medico-Legal Work Ref: Hospital Administration Manual Vol. I (Revised) Chapter
Xii)

5.Uniform Guidelines
for Postmortem Work in India:Article January 2013: Om P Murty, All India
Institute of Medical Science.

6.Artefacts And Its
Medico-Legal Problems: Dr. HT Thejaswi, Dr. AP Rayamane, Dr. R Puneeta, Dr. S
Kalai, Dr. Jagadeesh H, Dr. Chandrashekaraiah C.

 

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