Medicolegal autopsies in private medical colleges in India: An urgent needRI James1, M Delighta2, D Manoj1, LR Johnson1
1 Department of Forensic Medicine and Toxicology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Forensic Medicine and Toxicology, St. John's Medical College, Bengaluru, Karnataka, India
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpgm.jpgm_466_22
Source of Support: None, Conflict of Interest: None
In Greek mythology, Alexander the Great faced a complex knot tied by Gordius, king of Phrygia; that could only be untied by bold action. The Forensic Medicine fraternity in India is facing its own Gordian knot. One should remember that medicolegal autopsies are often indispensable towards getting justice in the criminal justice system. But unfortunately, reporting the final opinion after medicolegal autopsies is often plagued by undue delays. And in such scenarios, the legal maxim “Justice delayed is justice denied” is woefully evident. These inordinate delays often stem from overburdening of facilities in Government Medical Colleges and the perceived lack of Forensic Medicine experts in the country. But that is simply not the case. There is untapped manpower which, if utilized, will reduce the burden on the overworked Forensic Medicine experts in Government Medical colleges. We are talking about Forensic Medicine experts in private medical colleges.
Allowing Forensic experts from private medical colleges to perform autopsies is not a new or radical thought. In 2014, the Madras High Court had suggested to the State Government to explore the feasibility of permitting private medical colleges to perform autopsies. They made this suggestion with the aim of relieving the congestion and workload in the mortuaries of Government hospitals.
Currently, there are 32 private medical colleges in the State of Tamil Nadu alone. In the year 2018, there were 55,761 autopsies conducted in Tamil Nadu, of which 99% were done in Government centres. On an average, 6 to 10 autopsies are done per day in a Government Medical college in Tamil Nadu. Considering the faculty strength in these centres, this causes an unreasonable burden to be placed on these already overworked Forensic Medicine experts. Now, if the Government were to permit private medical colleges to conduct autopsies, the burden would be shared by an equal number of private medical colleges with qualified experts literally halving the burden on the Government experts. The same policy could easily be extrapolated to all the States of the country as well. Similarly, in the State of Kerala, there are 10 medical colleges in the Government sector, and 21 in the private sector. One can imagine that distributing the burden of autopsies among 31 colleges rather than 10, would tremendously decrease the bottleneck experienced in obtaining autopsy reports.
Permission being granted to private medical colleges to conduct autopsies would also be extremely beneficial to the undergraduate medical students as well. As per the Graduate Medical Education Regulations (GMER) 2019 curriculum, each medical student is expected to observe at least 15 medicolegal autopsies as part of their training. Furthermore, the National Medical Commission (Compulsory Rotating Medical Internship) Regulations recommend that an intern should observe or preferably assist in a medicolegal autopsy. These measures are required since any registered medical practitioner (RMP), especially in rural India, may be called upon to perform a medicolegal autopsy and furnish a detailed report. This is only possible if all undergraduate medical students, especially those in private medical colleges are also given sufficient opportunities to witness autopsies.
Since in many states, medicolegal autopsies are conducted exclusively in Government medical colleges, the undergraduate medical students in private medical colleges are robbed of this opportunity to observe and learn. Considering the number of doctors graduating from private medical colleges which do not conduct autopsies, it is obvious that a fairly large number of RMPs would not have any knowledge regarding conducting autopsies. This is not an ideal situation.
Another unfortunate result of this disparity between Government and private medical colleges with respect to conducting autopsies is that very few medical graduates show an inclination to specialize in Forensic Medicine. This trend is very evident in states like Maharashtra where since only Government centres are conducting autopsies, undergraduate students perceive that there is less scope of employment after training in Forensic Medicine. With progressively fewer postgraduate students specializing in Forensic Medicine, the burden on existing Forensic experts is constantly increasing overworked Forensic Medicine experts performing autopsies with the assistance of unskilled workers creates a situation that is rife with the potential errors, which can lead to miscarriage of justice. The Forensic Medicine experts in the 29 Government medical colleges in Maharashtra are overworked, despite there being 33 medical colleges in the private sector to assist them. In the state of Uttar Pradesh, most autopsies are performed in the district mortuaries/hospitals; and it is only since 2015, that a few of the state's 67 medical colleges have been permitted to conduct autopsies.
While insisting on performing autopsies in Government centres alone, the humanitarian aspect is often overlooked. Even when a private medical college with all the facilities and trained faculty for conducting the autopsy is present closer to the location of the deceased, the relatives are often forced to transport the body of their loved one to a government centre. The Government centre may be quite far away and/or understaffed. This leads to the added burden of expense to the family and delay in releasing the body to the family for funeral rites. The private medical colleges would be able to cater to these needs of the community around them, keeping in mind their social and religious customs.
Under the cadaver donor program in Tamil Nadu, if a private hospital has a brain-dead donor reported as a medico-legal case, they are authorized to perform the autopsy after retrieval of organs. This autopsy can be performed by any Forensic Medicine expert, or by a pathologist posted in Forensic Medicine department, or by any Government medical officer experienced in conducting post-mortem examinations.
Since such a practice is permitted by the state on humanitarian grounds, private medical colleges and hospitals with the requisite infrastructure and expertise should also be allowed to perform all autopsies and assist the state in administering justice. These are areas which need to be explored further in order to strengthen medico-legal work in India.
A bench of the Madras high court comprising Justices S. Rajeswaran and P.N. Prakash, cited an order of the Karnataka Government relating to conducting of post-mortem, and suggested that, “Due to paucity of post-mortem doctors in Government hospitals, post-mortem on unidentified bodies is not done immediately and preference is given only to murder cases, accident cases and in cases where the body is identified. In our opinion, a solution to this problem can be found, if private medical college hospitals in the state are given permission to conduct post-mortem as done in the state of Karnataka.”
Those opposed to allowing Forensic experts in private medical colleges to conduct autopsies claim that this will open Pandora's box as a doctor in a private institution may become amenable to influence and issue fraudulent post-mortem certificates. However, the bench pointed out that doctors in Government hospitals were not immune to these influences either., There have been many reports supporting the observations of the bench, like the recent allegation, where a Forensic Medicine expert in a government hospital was extorting money from the police; maliciously refusing to issue many autopsy reports unless he was paid exorbitant sums.
The bench further suggested that by video recording all post-mortem examinations, such practices may get curtailed. The bench acknowledged that an apprehension was raised regarding the ability of the state to take any action against a doctor of a private medical college in the event of a felonious act. However, the bench also cited various sections (176, 177, 198, 199, 201 and 203) under the Indian Penal Code (IPC) dealing with furnishing false information and causing disappearance of evidence, etc., apart from invoking conspiracy provisions, could be used to prosecute the doctor if needed.
The Government could also bring a legislature to amend the definition of “public servant” found in Section 21 of IPC and in Section 2 (c) of the Prevention of Corruption Act 1988, by including “The doctors who perform autopsy at the request of a police officer” so that the doctor can be prosecuted even under the Prevention of Corruption Act 1988, the bench added. India has a low conviction rate which is indirectly linked with Forensic medicine reports. In several cases, because the post-mortem reports are erroneous or conducted by inexperienced MBBS doctors, which negatively affects the chances of conviction of the accused.
Though the High Court has recommended video recording of all post-mortem examinations, similar to the initial mandatory guidelines laid down by the National Human Rights Commission (NHRC) for autopsy in custodial deaths, the authors feel it may not be feasible. Moreover, the NHRC guidelines do not address a number of aspects. This raises many questions like who is responsible for bringing the videographer to the mortuary, what should be the qualification of the videographer, i.e., should they have basic medical knowledge or are any studio videographer is sufficient? The guidelines also don't provide any technical specifications, like where to position the camera, the distance of the camera from the autopsy table, and methods to prevent editing of the video, storage and preservation of the video, etc. In addition, the guidelines does not define the requisite qualifications of the doctor who should perform such autopsies. The intention of the guidelines is to provide the recording and reports to an independent third party who should be able to interpret and give an expert opinion to aid the investigation. Though some of these queries have already been addressed later by the NHRC via their letter and revised guidelines,, we believe that there is still scope for improvement in the guidelines, and to create a Standard Operating Procedure (SOP) for videography, the technical specifications and training requirements, etc.
With the pool of Forensic experts depleting, the State Government, police, and judiciary are increasingly relying on MBBS graduates and unqualified mortuary workers to conduct medico-legal autopsies. However, granting permission to private medical colleges to conduct medico-legal autopsies will not only reduce the burden on the government centres, but also enable starting of postgraduate programmes in many centres leading to more trained Forensic Medicine experts. In order to allay the apprehensions regarding available infrastructure and expertise for starting autopsies in private medical colleges, the state authorities can subject the colleges to inspections and audits to ensure efficient functioning. In a suitable environment, Indian Forensic Medicine experts can perform and deliver reports as good as their counterparts in any part of the world. The Gordian knot faced by the Forensic Medicine fraternity in Government centres is the unfounded fear of sharing the burden with private medical colleges. Like Alexander the Great, the Government and Forensic faculty together must take a bold step and cut this knot, so that the discipline of Forensic Medicine can flourish in India and the quality of reporting improves.
The authors would like to thank Dr. Mukesh Yadav and Dr. Indrajit Khandekar for their valuable insights.
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