Postmortem not needed for every case of death

The Wardha District Superintendent of Police issued directives to all police stations; while some say unnecessary autopsies are a waste of time, some doctors are sceptical

Some 630 km from Mumbai, a unique decision has been taken in Wardha district, regarding postmortems. To try and reform postmortem (PM) procedure, beginning from this month, the police have been asked not to send bodies for PM in each case of death which is reported to them.

The Wardha District Superintendent of Police, Ankit Goyal, issued directives on Feb 29 to all police stations in Wardha. As per legal provisions, there is no need to do a postmortem to know the cause of death in most cases.

Experts said if the new instruction is followed across the state, this will not only save invaluable time of police and doctors but also prevent mental trauma to the people whose dead relatives are subjected to postmortem. However, they said they have not heard of any other district in the state following such a procedure.

Police decision
In Wardha, the investigating officers have been asked to prepare a report of apparent cause of death as per a modified inquest form. The police have been asked to decide whether to send the dead body for postmortem or not, strictly as per the provisions of 174 Criminal Procedure Code, as enumerated in the modified form. The form has guidelines as to when police should not insist on getting autopsy done.

According to Dr Indrajit Khandekar, in-charge of the country’s first Clinical Forensic Medicine Unit (CFMU) at the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram - Wardha, presently police send dead bodies for PMs using the provision of 174 CrPC.

Dr Khandekar had brought to the notice of the chief minister, who also heads the home department that lakhs of unnecessary postmortems are carried out at the request of police for investigations.

“This overload of PMs is turning mortuaries into production-line abattoirs. As per legal provisions there is no need to do PM in most cases. Unnecessary PMs not only waste valuable time of police and doctors, but also cause tremendous trauma to relatives of the deceased,” Dr Khandekar told mid-day from Wardha. He said that the practice, if followed across the state, would improve quality of medico-legal investigation, help in increasing the conviction rate (Doctors who conduct postmortems will not be overburdened), and reduce the state’s expenditure.

A senior police officer recalled how relatives of students from Pune, who had drowned in Murud last month, were upset when all 14 bodies had postmortems when the cause of death was clear.

Shiv Sena MLA Ajay Choudhary from Sewri, had raised a question in the Legislative Assembly on Dr Khandekar’s report, and sought to know the action taken by the government. Following this, the home department had asked authorities to study this report.

Decision legal
Wardha SP Ankit Goyal said that the decision for the new procedure was within a legal framework. “The law specifies when we shouldn’t do the postmortem. We have also formed a district-level committee of experts and police officers to decide whether we should go in for an autopsy. There are guidelines in place for doing postmortem when required. We will follow our rule book while implementing the procedure,” he said.

The committee has the representative of the civil surgeon of Wardha, Dr Bandu Ramteke, and senior police officers, and Dr Khandekar as its principle coordinator.

 

Mumbai will benefit most: KEM
The head of the department of forensic medicine of the BMC-run KEM hospital, Dr Harish Pathak, welcomed the reform. He said that Mumbai wasn’t an exception when it came to unnecessary autopsies being carried out.

“I have given a proposal to the BMC that we should be allowed to (CT) scan the bodies of accident victims to ascertain the cause of death. In accidental deaths, bodies are already mutilated, and if we scan them wholly we will be able to see damage caused to various vital organs. This way we will have data of that particular body available for further medico-legal requirements,” Dr Pathak said, adding that countries like Switzerland, Malaysia and England were already practising this. Dr Pathak called for a provision for avoiding the need for cutting open the bodies in case external examination was sufficient. “We should emphasise on quality of postmortem and not the quantity of postmortems we do at various autopsy centres,” he said.

PM reform

>> When postmortem should be avoided
When the cause of death has been given by the attending/ treating medical practitioner in the Government Format of Medical Certification of Cause of death (MCCD Form 4/4A-). This will happen only when the police, panch, as well as relatives have no doubt in the cause of death given by the treating doctor.

>> When postmortem is mandatory
When there is a doubt about the cause of death. All unnatural, suspicious deaths of a female who has died within 7 years of marriage (Even though the treating doctor has given the cause of death in Form 4/4A)

Voices

Dr Shailesh Mohite, Professor and Head of the Dept, Forensic Medicine and Toxicology, Nair Medical College
This is absurd and clearly shows there is no application of mind by those who have suggested it. For instance, if someone has poisoned a senior citizen in the family, and managed to get a death certificate giving ‘myo cardiac infraction’ as the reason for death. Later when facts come to light, not only the body will have been cremated but crucial evidence will be lost.

Dr Rajesh Dhere, Professor of Forensic Medicine and Toxicology, LTMG Medical College
This can become a dangerous practice, as homicidal/suicidal cases can be declared as natural death and the body cremated. A city like Mumbai has witnessed many such incidents of certification of death as natural by GPs after the abolishment of Coroners Act of 1871 in the year 1999, and upon conducting postmortem, the death was found to be unnatural.

Dr S M Patil, Police Surgeon
As per provisions under the Maharashtra Medical Civil Code and Hospital Manual, in any death reported within 24 hours of admission, it is mandatory to do the postmortem. This is a foolproof method that is in practice since 1870 and the proposal mooted has lot of grey areas, which cannot be accepted in totality. Also medical negligence cases will go unchallenged, without an autopsy.

Case in point

>> Priya Rajvansh
On March 27, 2000, actress Priya Rajvansh was found dead at the Ruia Park bungalow of Chetan Anand. It was initially said that she died of a heart attack but the family doctor refused to certify the death as natural. The Juhu police had to send the body to the Cooper postmortem centre, where the forensic surgeons confirmed that death was due to strangulation, as they found ligature marks around her neck.

>> Versova siblings
On July 3, 2012, pest control was carried out at the Chougle residence in Panch Dhara Society, Versova. Both Rameez Chougle (25) and Rehab (27) were said to have died a natural death and their bodies were buried at the Versova Qabrastan. However it was later confirmed after exhuming both the bodies that it was a case of ingested poisoning, as traces of aluminum phosphide were found in their viscera.

>> Cursetji murder
The police retrieved the ravaged corpse of 72-year-old Adi Ardeshir Cursetji, from the Tower of Silence near Kemps Corner, South Mumbai, three days after his death on May 21, 2002. The reason for this unprecedented move was a complaint filed by Cursetji's family friend, Navroz Jilla, alleging that Cursetji was brutally murdered and did not die a natural death. The body was sent to Nair hospital postmortem center, where forensic surgeons confirmed that the death of Cursetji was murder. He was smothered using a pillow.

- Inputs by Vinod Kumar Menon

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