Disposing of bodies without cause-of-death certificate 'dangerous'

Updated: Jun 27, 2020, 07:18 IST | Vinod Kumar Menon | Mumbai

As BMC asks kin of non-COVID victims to follow old circular that does not require 'cause of death certificate', experts say it could be detrimental

The Gavanpada cremation ground at Mulund East. In some deaths, the relatives are not in a position to produce it since the last illness of the person was not attended to by the doctors. File pic
The Gavanpada cremation ground at Mulund East. In some deaths, the relatives are not in a position to produce it since the last illness of the person was not attended to by the doctors. File pic

Owing to the issues faced by families of people dying of non-COVID causes in disposing of the bodies, the civic body's health department has directed that a 2010 notice be referred to in handing over these bodies. Relatives have been having a tough time procuring a 'cause of death medical certificate' during the pandemic, leading to trouble in disposing of the body. The civic body has, therefore, issued the circular that relaxes the norms for disposal of dead bodies. Forensic surgeons have, however, expressed reservations about this.

The executive health officer, in his circular dated January 13, 2010, had stated, "Dead bodies brought without Cause of Death Medical Certificates to the cemeteries are disposed under the Registration of Birth and Death Act, 1969. For disposal of any dead body, Cause of Death Medical Certificate is compulsory. In some cases, the relatives are not in a position to produce it since the last illness of the person was not attended to by the doctors.

"In such cases, medical officers of wards are directed to follow the procedure as below: a) If the age of the deceased is 65 years or above, the body may be allowed to be disposed off on submission of panchnama by five citizens/relatives residing in nearby area and would know the deceased. (b) If a young adult's body is brought without a certificate of cause of death, it will be allowed for disposal only after receiving permission (NOC) from the local police station.

Forensic surgeons have raised concerns about such a practice as numerous instances have taken place in the past where death was certified as 'natural' and it later turned out to be otherwise. In cases of burial, they could be exhumed after months/years to prove the claims, but in case of cremation, crucial evidence is lost forever.

This BMC notification is to be followed for non-COVID deaths where the body can be easily referred to the nearest post-mortem centre and an autopsy can be performed to ascertain the cause of death and rule out foul play.

"Every death needs to be tabulated for statistical medical references and ascertain if death was due to heart attack, cardiac ailment, any other disease, suicidal, homicidal, poisoning, accidents etc. No dead body can be disposed of without ascertaining the 'cause of death'. Otherwise, who is responsible for issuing the death certificate and what is the cause of death for elders? Why can't an autopsy be conducted? Who will be held accountable if something goes wrong?" a forensic surgeon questioned.

The BMC health department officials allegedly issued the notification without consulting the police surgeon or forensic medicine and toxicology experts.

PPE kits to autopsy staff

Police surgeon Dr S M Patil, who is in charge of five post-mortem centres in the city, said that the old practice of conducting an autopsy on any dead body brought by the police for ascertaining cause of death under section 174 of Criminal Procedure Code is being followed. "I have already directed my centres to conduct a post-mortem analysis and hand over the body to relatives after conducting the autopsy procedure within a short span of time so that relatives do not have to face any inconvenience. Also, we have provided PPE kits to postmortem centre staff and forensic surgeons. The BMC order is not applicable to my centres and it might be limited to three BMC-run medical colleges — Nair, KEM and Sion," Dr Patil said.

A senior forensic surgeon added that getting a death certificate from any general practitioner is not easy during the pandemic. "Those who do issue them are charging exorbitant rates. Moreover, police are also reluctant to come close to bodies without being sure of the COVID status. Getting five independent witnesses is also difficult," he said.

'Dangerous directives'

Dr Indrajit Khandekar, professor of forensic medicine and toxicology, Mahatma Gandhi Institute of Medical Sciences (MIMS), Sewagram, raised questions over the powers of the executive officer to "issue instructions contrary to the provisions enshrined in Law/Act."

He said, "Permitting disposal without cause of death certificate is dangerous and may lead to escaping of suspicious unnatural deaths. It will leave senior citizens vulnerable to neglect, abuse and even murder."

The government should, instead, consult forensic and medical experts to develop a proper protocol regarding procedures to be followed. The BMC directive is confusing, he said, just like the ICMR guidelines of May 10 which asked hospitals to record "clinically diagnosed" or "probable" or "suspected" COVID as the underlying cause of death even when the tests were negative or awaited.

He said that doctors have never in the past been asked to follow such practices and are instead asked to focus on "precision and specificity," while writing the cause of death. The new guidelines "will only end up inflating the number of COVID deaths and could mislead the public about the actual number of these deaths," he concluded.

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