Manohar Shelake^1*, S D Nanandkar²

¹Assistant Professor, Forensic Medicine, Government of Medical College and Hospital, Aurangabad, Maharashtra, INDIA.

²Dean, RCSGMC and CPR Hospital, Kolhapur, Maharashtra, INDIA.

Email: drmanu0389@gmail.com

DISCUSSION

In study time total 211 cases were referred for autopsy from various peripheral postmortem centers. Majority of cases belongs to middle age group i.e. from 31 to 60 yrs age group as this age group is having more responsibilities and strive to fulfill increasing demands of personal, professional and family life. In the age group 20 to 30 years 74 (35.07%) cases noted intense competition in every field of life and unemployment due to recession is making young group vulnerable to mental disturbances. In 19 (9%) cases were from age group of less than 1 year including foetus, newborns and infants. Many of these cases found to be of non-viable fetuses which were unnecessarily referred. Time, money and manpower of police force is wasted in carrying these unknown dead born non-viable fetuses to tertiary center for autopsy which could have been possible at primary center. The deceased with age group more than 61 were 7 (3.32%) cases noted. In older age group associated co-morbid conditions are present. This age group is having limited mobility and interaction to outside environment. Hence deaths were less suspicious and referrals were least in this age group. Male corpses referred for autopsy were outnumbered than female corpses. This is because of paternalistic nature of our society which leads to male dominance on mobility and movement in outside environment, male to male interaction and involvement in crime. In case of females, death of young females under suspicious circumstances gives rise to various predictions and allegations. Death of woman associated with pregnancy is of great concern for government. In majority of cases there was no prior information about referring the deceased body for autopsy to tertiary referral center was given and dead body brought all of a sudden for autopsy. Prior intimation telephonically might have reduced the number of referrals due to trivial problems which could have been solved by discussion with qualified person at referral center. In such cases if autopsy could have been carried out at primary center, it might have been put relatives and police at ease. In this study we found that many cases were referred by Medical officers on their own and various reasons were given by medical officers while referring dead body with referring letter. These reasons include need of forensic expert to carry out autopsy. Even in simple and clear cases of death, medical officers found them incompetent and referred the case to referral center labeling it as complicated one. Few case referred on request of relatives to Medical Officer for referring dead body to higher center. Varied reasons and illogical unscientific thinking of relatives can addressed and autopsy may be done. (J Indian Acad Forensic Med. October-December 2014, Vol. 36, No. 4; Perceptions of Relatives’ towards Medico-Legal Investigation and Forensic Autopsy: A Survey from Rural Haryana Shelesh Goel, Pankaj Chikkara,Virender K Chhoker, Abhishek Singh, Anu Bhardwaj, Rajesh DR, Nand Kishore Singh ; page 371-373) For that, the medical officer must explain the relatives the procedure and its importance along with time bound early autopsy, referral might had been avoided. 61 cases were directly referred to tertiary center by police without taking to primary postmortem center. These cases were referred to referral center directly from spot of recovery of dead boy or from private hospitals after death of admitted patient or brought dead cases to the private hospital. In these cases, in 7 (11.47%) cases request for referral was done by relatives to police. Police referred such cases giving due attention to allegations and requests made by relatives. Relatives having knowledge of law and administration were requested for referral for autopsy at higher center in such casesIn 54 (88.52%) cases police brought dead body directly to tertiary center for autopsy. The law and order problem and tense situation compelled them to refer such cases directly to higher referral center without taking to designated postmortem center of their jurisdiction. In maximum number of cases i.e. 94 (44.55%) authorization was given by Senior Police Inspector (SrPI) or Police inspector (PI) of concerned Police station where death was registered and was under investigation. Assistant Police Inspector (API) or Police Sub-Inspector (PSI) gave the requisition in73 (34.6%) cases Newly recruited officers in probationary period faced problems regarding requisition and authorization due to little orientation regarding technical things. Magistrate ordered autopsy in 37 (17.54%) cases. These cases comprised of jail deaths and custodial deaths. Custodial death is not only the death of a person in possession of police but also death of person or child under legal care and protection in any institution as ordered by the court of law or child welfare committee. Consultation of Medico-legal expert and administrative authorities was not taken in majority of cases. Consultation from person having sound knowledge of death and changes after death can judge the cost and benefit of referral in particular case. In the study it may be hours to days after actual death in many cases when body was reached to referral center. As the time increases, time bound putrefaction is going to occur in dead body. In addition to it, extra time taken for travel and shifting body from one spot to other will spoil the case. Due to it not only there is loss of evidences but also artefacts may develop causing difficulty in interpretation of actual findings. This may lead to grave consequences as seen in bhandara district girls’ death cases and similar other ones. Apart from delay at administrative and procedural level, getting transport facilities like ambulance or hearse van and arranging manpower to accompany dead body to referral center is also a challenging job. It is on record that no attempt is done for cold preservation of body at first center. However we cannot ignore the fact that at many Primary Health Centers, functioning cold storages are not available. In majority cases autopsy was started within 6 hours after receiving body and in few cases the time goes up to the 18-24 hrs. This situation adversely affects the important parameters like postmortem lividity, rigor mortis and cooling of the body resulting in great difficulty in calculating time of death. These postmortem changes also create difficulties in observation and interpretation of matters related to wounds and other vital phenomenon. Reddy K. S. N., The essentials of Forensic Medicine and Toxicology, Published by K Suguna Devi, 2011, 30th edition, p ^{3,4, 149, 291, 358,432} Before referring the body, medical officer is expected to carry out external examination. External examination was done in 72 (47.95%) cases and not done in 78 (52.05%) cases. Partial autopsy was done in 4 (4.11%) cases which is also a contradictory and objectionable situation. Rigor mortis, postmortem lividity, injuries and its details get affected to a great extent due to time required for transport. If such findings were noted initially when dead body first arrived at primary referral center it would be helpful for forensic experts and police also to interpret findings observed at autopsy. It would have been helpful for calculating and opining upon time since death and age of injuries etc. In spite of availability of technical and procedural guidelines in the civil medical code Civil Medical Code, Government of Maharashtra, 1951, Chapter 13, Chapter 20, 20.3, 20.11, 20.19, 20.20, 20.22, 20.29, and many available standard textbooks, the overall mindset and attitude of medical officers is preventing them from applying simple logic and technically required common sense in performing majority of cases which need no referral. The medicolegal work and postmortem examinations in particular has an integral role in the process of crime investigation and administration of justice.

CONCLUSION

To conclude from the aforesaid discussion, it is pretty clear that the very objective of providing prompt, passionate, positive and qualitatively perfect medicolegal postmortem examination service is defeated because of unjustified and indiscriminate referrals to the higher / tertiary centers. Necessary infrastructure and timely up gradation and continuous update of autopsy services at government hospitals is key factor for providing satisfactory services without need of referral. Directorate of Health Services, Government of India, Circular No. Z-2615/40/2012-MH-I, 20/12/12.- Reforms in the procedure for conducting postmortems. Lack of medicolegal awareness, reluctance in performing medicolegal work, inability to consult higher authorities, failure in making sincere attempts in preserving evidence and subjecting the body for a distant travel for referral, all these things geometrically contribute to their vicious cycle of making a simple case complex one. Maximum care should be taken to conduct the autopsy examination at primary center and unjustifiable referrals should be avoided. However unavoidable referrals should be done in certain cases due care must be taken before the referral.

REFERENCES

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10. Civil Medical Code, Government of Maharashtra, 1951, Chapter 13, Chapter 20, 20.3, 20.11, 20.19, 20.20, 20.22, 20.29, 
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