Madras HC Takes Serious Note Of Doctors Not Even Going Near Dead Bodies As Such Shabby Unscientific Reports Will Collapse Criminal Justice System In Country

While noting that in most of the medico-legal cases, the sentence in most of the medico-legal cases, the outcome of the criminal case depends upon the findings in the autopsy certificate and also the doctor's evidence, the Madras High Court in a latest, landmark and laudable judgment titled RM Arun Swaminathan Vs The Principal Secretary to the Government and 3 others in W.P.(MD) No. 78 of 2019 delivered on September 28, 2020 has clearly, cogently and convincingly held that if the autopsy reports are prepared in a shabby and unscientific manner and without actual performance of autopsies by doctors, it will lead to collapse of criminal justice delivery system in the country. The two Judge Bench of Madras High Court comprising of Justice N Kirubakaran and Justice SS Sundar explicitly, elegantly and effectively said in para 38 that, "The Doctors are the most respected citizens of this country and they are doing yeoman service and also aid in the justice delivery system in medico-legal cases. Therefore, corrective measures have to be taken as otherwise, criminals would escape from the clutches of law because of the negligence and deliberate failure on the part of the Doctors who are doing post-mortems." Very rightly so!

While outlining the prayer made by the petitioner, it is first and foremost pointed out that, "Petition under Article 226 of the Constitution of India praying for issue of a Writ of Mandamus directing the respondents to (a) strictly follow the Tamil Nadu Medical Code while conducting autopsies (b) to implement videography of all autopsies across the State in order to avoid issues and re-postmortems and the same videography shall be sent to the jurisdictional Magistrates (c) the postmortem certificates shall be sent to the Jurisdictional Magistrates on the same day of the post-mortem as stipulated in Article 621 of the Tamil Nadu Medical Code (d) to appoint the Scientific Officers in the Medical Colleges to enable to conduct fair and proper autopsies and (e) to adhere the directions given by the Hon'ble High Court in Criminal O.P. No. 12582 of 2007 dated 16.02.2008 in letter and spirit."

To start with, this notable judgment authored by Justice N Kirubakaran for himself and Justice SS Sundar after observing in para 1 that, "This Public Interest Litigation has been filed by a practicing Advocate before this Court seeking issue of directions with regard to conducting of autopsies" then sets the ball rolling in para 2 wherein it is put forth that, "The petitioner states that there is a huge shortfall of qualified Forensic Medical Experts. They are available only in Medical Colleges and not available in any of the Government Hospitals resulting in conducting of post-mortems without following the procedure as contemplated in Tamil Nadu Medical Code. The Medical College Hospitals are coming under the purview of Director of Medical Education and other Government Hospitals are coming under the Director of Medical Services. According to the petitioner, about a lakh of post-mortems are being done every year in the Government Hospitals. Due to shortfall of qualified staff, various shortfalls/lacunas are found in the procedure followed in conducting post-mortems. There is no transparency apart from lack of infrastructure for performing post-mortems. Dissection kits are not used for conducting autopsies and according to the petitioner, hammer and other tools are used."

Quite remarkably, the Bench then very rightly points out in para 38 that, "One more shocking revelation made in the report is that even though more Doctors are said to be attending duty, the reports give the details as to how only one Doctor conducts more than 10 autopsies in a single day which is impossible. The following tabular column given in the report would fortify the allegations made by the petitioner that the Doctors are not conducting autopsies themselves scientifically as it is impossible for a single Doctor to do autopsies ranging from 10 to 17 per day. Even in paragraph No. 8(a) of the counter affidavit, it is stated that duration of a post-mortem varies from 1 to 3 hours depending upon each case. However, very shockingly, one Doctor alone has done more than 10 autopsies in a single day. This fact would show that the Doctors are not doing it, which proves the allegation of the petitioner.

The aforesaid tabular column would prove the contention of the petitioner that almost, all the findings given in one post-mortem is being given in another case even without any post-mortem, which goes against the very purpose of post-mortem and it is as good as not doing post-mortem at all. In most of the medico-legal cases, the outcome of the criminal case depends upon the findings in autopsy certificate and also the Doctor's evidence. If in this shabby and unscientific manner and without actual performance of autopsies by Doctors, the autopsy reports are prepared, it will lead to collapse of criminal justice delivery system in this country. The Doctors are most respected citizens of this country and they are doing yeoman service and also aid in justice delivery system in medico-legal cases. Therefore, corrective measures have to be taken as otherwise, criminals would escape from the clutches of law because of the negligence and deliberate failure on the part of the Doctors who are doing post-mortems." There can be no denying it!

More significantly, the Bench then observes in para 49 that, "As already stated, this Court, in Crl.O.P. No. 12582 of 2007 in Muniammal V. The Superintendent of Police and others, by order dated 16.02.2008, gave a slew of directions to be followed while conducting autopsy. Paragraph 32 of the order contains the directions of the Court and they are usefully extracted hereunder:

"32. Medical Evidence is a scientific factor, which plays crucial role for determining many of the crimes perpetrated against the human body. Further the know-how in Forensic Medicine on the part of Medical Officers is of utmost significance for Justice Delivery System. At this juncture, this Court, after going through the materials available in this case and in the backdrop of the authorities on the subject, deems it appropriate and feels compelled to place some suggestions for consideration and implementation by the authorities concerned, in the following manner:

(1)(a) Directorate of Medical Sciences and Directorate of Medical Education with the concurrence of the State Government may contemplate imparting periodical training to the Medical Officers, who are in Government service, on Forensic Medicine, to make their efficiency updated in the field. A standardized format of noting down the injuries and their signs can be evolved so that a uniform procedure for issuing medical certificate be followed state wide. The said authorities may constitute a team of experts to prepare the format, so as to make the job of doctors, who perform medico-legal functions, easier.

(b) Every doctor posted in any Government hospital may undergo a week's training in Forensic Science Department in the nearby Government Medical College periodically and the State Government may evolve a scheme in this regard.

(c) The Government may provide sufficient infrastructural facilities to the mortuaries and places where autopsies are conducted.

(2)(a) In certain cases, the internal organs extracted from the corpse by the Doctor at the time of necropsy have not been properly preserved, resulting in the de-composition or dis-integration of the tissues by autolysis. When they are subjected to histopathological examination, desired result could not be secured leading to the loss of valuable evidence, which plays a crucial role in determination of the case by the Courts.

(b) The knowledge of the Medical and Para-medical staff should be updated by imparting periodical training to them. Adequate exposure to the preservation techniques is the need of the hour in order to secure accurate results. Hence, exhaustive examination of viscera can be obtained, only if the Medical and Para-medical personnel are possessing updated knowledge in preservation technique. The Government through Department of Health have been issuing circulars containing the procedures to be observed and followed by Medical and Para-medical Staff then and there. In some cases, errors occur on account of mis-application or improper handling of the procedures concerned, resulting in confusion in procedures, which screen the crimes from getting exposed to the eyes of Judiciary. So, it is desirable to issue the circulars whenever necessity arises, that is to say, if settled or codified procedures were violated or ignored, followed improperly and misapplied even for a single occasion.

(3) Medical Officers, who prepare the medical certificates, shall ensure that the findings written by them are legible. Inadequate, illegible and incomplete particulars in medical certificates are stumbling blocks in the administration of Criminal Justice System. The dimensions of the injuries and their colour age in certain cases and other features shall find place in the medical certificates. The format, presently maintained for the post-mortem certificate, may be modified so as to enable the doctor, who conducts autopsy, to furnish all his findings in detail, with reference to each organ and region as per procedure generally adopted.

(4) Expertise of Forensic Medicine Experts may be availed to train the Medical Officers as to the special features on the subject, to guard against the loss of valuable evidence.

(5)(a) It is high time, the Governments, the Medical Council of India and the Medical Universities, which control the quality of medical education in this country, took serious view of this aspect and brought about appropriate measures.

(b) Every student of medicine should get familiarised with the intricacies of Forensic Medicine apart from academic knowledge, right from his/her undergraduate level i.e., from the educational institution itself after passing through the curriculum prescribed for him/her.

(c) To facilitate a better understanding of nuances of Forensic Medicine, the teaching of the subject may be taken up in the later part of the clinical years. In case of their having this subject in the early years of their study, they know the importance of the principles applicable to the given circumstances. The students may read this subject for the purpose of getting through the examination, but the real involvement therein could not be expected.

(d) During the internship, all the House Surgeons (Compulsory Rotating Resident Internees) may be compulsorily posted in the Department of Forensic Medicine for a reasonable period, for a better comprehension of the subject. This suggestion is made, viewing that the medical students would sufficiently be equipped at the later part of their studies and the niceties of the features in the subject would be appropriately appreciated by them.

(6) It is the bounden duty of the Government to produce Medical Experts in the educational institutions with a strong academic background, who would be fit for becoming members in the Health Delivery System and also for rendering yeoman services, to assist the Justice Delivery System, for which their exposure in the field of Forensic Medicine is indispensable.

(7) The authorities concerned may initiate efforts to increase number of admissions to Post Graduate Course in Forensic Medicine and to get due recognition from Medical Council of India, and ensure output of such experts cater to the needs to a greater extent.

(8) The brass of police may issue directions to the Investigating Officers of the crimes, to get final opinion as regards the nature of wounds in injury cases and time and cause of death, in cases where unnatural death has occurred, before taking any decision either to proceed with the case or to drop further action. Instructions may also be issued, not to make any slipshod or improper investigation in the cases handled by the police, on the strength of wound certificates or post-mortem certificates, which lack material particulars. Necessary training may also be given to the police personnel, with regard to the appreciation of medical records, at the time of investigation in medico-legal cases.""

Having said this, the Bench then laments in para 50 that, "Though the said directions were given as early as in the year 2008, even after passing of one decade, all the directions have not been complied with even as per the counter affidavit filed by the respondents stating paucity of funds, which is found in paragraph No. 10 of the counter affidavit. Paucity of funds cannot be an excuse for non-implementation of the order passed by this Court about 12 years ago. Therefore, appropriate steps have to be taken by the authorities to implement the directions which are given in the interest of public and compliance should be reported to this Court."

As a corollary, it is then very aptly and appropriately summed up in para 51 that, "In view of the above, the following directions are given while disposing of the writ petition:

(i) There shall be a direction that the Doctors shall follow Article 621 of Tamil Nadu Medical Code by sending the post-mortem certificate as soon as it is over to the Judicial Magistrate and send a copy to the Head of the Department on the same day failing which departmental proceeding shall be initiated against them.

(ii) The Health Secretary shall issue a circular directing the Doctors to follow Article 621 of Tamil Nadu Medical Code in letter and spirit.

(iii) The post-mortem certificates should be issued based on the NHRC model and following the regulations governing the same.

(iv) The Government Servants shall mark their attendance only through biometric system while entering as well as at the time of leaving the office including hospitals.

(v) Based on the biometric attendance only, depending upon the number of days attended, the salary should be proportionately paid after deducting the days for which the employees had not attended subject to their leave entitlement.

(vi) There shall be a direction to the respondents to videograph post-mortems whenever a request is made by the relatives or friends of the deceased.

(vii) There shall be a notice in the hospitals especially in the mortuaries dissection halls informing that there will be videographing of post-mortem in case of request apart from advertising in the newspaper that at the request of relatives, videographing of post-mortem could be done.

(viii) All important points in the mortuaries as well as in the dissection halls, CCTV cameras shall be placed and shall be operational at all times.

(ix) The Government shall ensure that all the hospitals where the post mortem are done are provided with sufficient set of equipments, tools and other consumables within a period of six months.

(x) The Health Secretary has to nominate a higher official to conduct an enquiry with regard to the negligence in treating the patient Murugan in Karaikudi, Sivaganga, especially in Madurai on 09.04.2019, who died out of burn injuries.

(xi) The web based system namely, MedLeaPR developed by NIC, Haryana shall be followed by all the Doctors of the Hospitals in the State of Tamil Nadu, in Government Health Institutions, Private Nursing Homes and Hospitals and this direction shall be with effect from 1st January, 2021.

(xii) The Government should appoint Scientific Officers in all the Government Medical College Hospitals and in every District headquarters. The qualification, duties and responsibilities for the post of Scientific Officers shall be defined by the Government with the assistance of a Committee of Experts constituted by the Government consisting of experts in Forensic Science, Criminology and medical examination and in other fields as may be suggested by the Forensic Department. The State Government is directed to constitute a Committee of Experts within six months and the appointment of required number of Scientific Officers should be made within one year after the qualifications and duties and responsibilities of the Scientific Officers should be made within one year after the qualifications and duties and responsibilities of the Scientific Officer are defined by the Committee of Experts.

(xiii) Mr. K Loganathan, Scientific Officer, Stanley Medical College and Hospital, Chennai and Mr. J. Ramesh, Scientific Officer, Madurai Medical College, Madurai, who assisted the Court by giving the true facts shall not be victimized by the respondents or Government authorities.

(xiv) Directions given by this Court in Crl.O.P. No. 12582 of 2007 in Muniammal V. The Superintendent of Police and Others by order dated 16.02.2008 shall be complied with on or before 28.02.2021."

On a parting note, it must be said that the landmark directions which the Madras High Court has given so wonderfully in this leading, laudable and latest case while disposing of the writ petition in hand must be implemented in totality in letter and spirit as directed by it and must also be applauded and appreciated unequivocally. It merits no reiteration that no excuse of any kind should be given on this count. There can certainly be no denying or disputing it!