medical laws and ethics
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This article is written by Mourisha Karnan, a student from The Central Law College, Salem, Tamil Nadu. In this article, the author explains the importance and the duties of a medical practitioner in a crime investigation.

Introduction 

For any criminal case to be proved beyond a reasonable doubt to the satisfaction of the courts of law, a thorough and methodical criminal investigation is the foremost requirement. Majority of such cases involve an element of assault or injury to a victim & one or more scene of occurrences/crimes. A fair investigation must include (besides interrogation of concerned persons & others) identification & collection of various physical evidences including biological ones and interconnecting them before presentation in the courts of law. Evidently, therefore, the gathering of evidences must begin from the scene of crime itself & that too at the earliest. It is furthermore easy to appreciate that the investigation into offences against human body will warrant a fair knowledge of structure, function & its anomalies of human body at some or other point to corroborate & relate chain of events.

Medical Experts at Scene of Crime

Criminal investigation in India is mostly conducted by police investigators. The existing criteria of their selection & on the job training do not lay emphasis on requisite medical jurisprudence. The investigators are one of the first persons to visit scene of crimes & to plan & decide upon further course of action. Due to growing need & demand for objective, methodical and scientific methods of investigation however, investigating officers have started asking & arranging for scene of crime visit by Forensic Scientists & others. 

Presently, scene of crime investigation teams in India do not have a medical man (Medico-legal expert/Forensic Pathologist/General Medical Practitioner) as a member barring few exceptions. Not surprisingly, therefore investigations usually lack quality in terms of interpretation of complex medico-legal complexities.

Similarly, photographs of scene of crime, howsoever well intentions maybe, at the best serve as good alternative but cannot substitute for a medical man’s observation, having visited scene of crime. The dictum of “Eyes cannot see what mind does not know” explains the above statement very well. Selection of areas focused or angles of photography make a lot of difference to the perspective in which a photograph may be interpreted by different men. A medical man can be of great help in guiding even an expert photographer in medico-legal aspects to extract what really is intended to be.

Original Evidence if Altered/Disrespected?

Though most of the biological evidences in the form of blood, seminal fluid, vaginal smears, hair, viscera, tissues, pieces of skin, nails etc. are collected & preserved by doctors, but almost always away from scene of crime, when the body has been shifted & transported to mortuaries, usually many hours or even couple of days after the first visit by investigating officers to scene of crime. 

For example in cases of poisoning, vomitus found at scene of crime is known to have maximum concentration of poison. Whereas viscera collected much after consumption of poison (usually after most of the gastric contents have either been vomited out or evacuated by gastric lavage) obviously contains far too less concentration. It is not surprising therefore, that in many of these cases viscera test negative for the poison in question. 

It is ironical but an unfortunate fact that police insists to preserve viscera at autopsy, whereas no sincere effort is made to preserve vomitus from scene of incidence or over clothing or even first gastric lavage sample. 

Background Information with Doctors   

This is all the more noteworthy in the light of the above mentioned fact, that the doctors recording & documenting medico-legal reports (autopsy reports included) have practically nil background information on circumstances of the case in many parts of the country including Madhya Pradesh. 

Various recommendations regarding mandatory furnishing of relevant history of the case, panchnama, copy of FIR, scene of crime report, photographs as & when feasible along with requisition for medico-legal examination are seldom respected & complied. It is not a rare sight to find mere mention of “reported to be a case of assault” or “cause of death is unknown” in the columns of history of the medico-legal reporting proforma. 

Relevant History & Facts of the Case do help in Proper Interpretation by a Doctor 

Medical science (like any other biological science) is an inexact science. In a living case, the physical clinical signs & symptoms may be interpreted differently forming multiple differential diagnoses, which may be narrowed down to a few after thorough laboratory & radiological investigations and proper history taking. 

In postmortem cases though, in absence of a detailed & reliable background information (history by attendants, if any present, may be one-sided, biased & unreliable) and with very limited access to diagnostic & analytical aids (combined with inordinate delays in dispatching collected materials, long pendency of cases at Forensic Science Laboratories, poor infrastructural facilities, lack of properly trained staff at FSLs), the misinterpretation of findings may at times be unavoidable. 

Lack of Interaction, Communication & Liasoning between Investigating Officer & Medical Expert 

The introduction of various artefacts like those due to transportation, storage, decomposition etc. with passage of time make it very difficult to interpret the findings correctly particularly in the current scenario where very few investigating officers talk to doctors directly regarding all such cases. 

Lack of Motivation & Proper Training of Doctors in Medico-Legal Work 

Majority of doctors performing medico-legal work are poorly trained & non-specialists in
Forensic Medicine. The undergraduate curriculum & thereafter internship program of MBBS students, is unable to lay adequate emphasis on this obligatory duty towards state. Moreover, the doctors are least inclined & motivated to perform such duty with conviction & sincerity that it demands. Rather, they are usually found trying to avoid & sometimes resist on being asked to do medico-legal work.

Lack of Professionalism in Medico-Legal Duties by Doctors

Medical evidence, like medical profession in general, has traditionally been enjoying respect & reliance it deserved in the courts of law. However, various court judgments have started casting serious aspersions on medical reports in more & more number of cases and passing strictures on medical practitioners, as poor & non-corroborative medical evidences lead to poor rates of conviction in criminal cases. 

Analysis Report of Biological Evidence Collected Not Made Available to the Doctor For Interpretation & Final Opinion

In many states including Madhya Pradesh, the medical officers collecting biological evidences, do not get reports of analysis afterwards to enable him to form/modify/substantiate his opinion, if any expressed immediately after medical examination, in the light of facts or observations as noted in his medico-legal report. Neither police nor prosecutors pay any attention to this missing link. It is clearly evident, that no uniform or standard operative procedure/protocol is in place regarding medico-legal reporting services. It is in the above mentioned background, therefore that the concept of visit to scene of crime by medical expert deserves sincere discussions & deliberations in our country.

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What is intended to be achieved by a Visit of a Doctor to Scene of Crime?

  1. Provides an opportunity to gain first hand knowledge of vital circumstantial evidences needed to decipher postmortem findings to answers to queries regarding time, cause & (more importantly) manner of death, time, mechanism & nature of injuries.
  2. Minimizes misinterpretation of facts due to introduction of artifacts due to passage of time.
  3. Most important time to judiciously select biological evidences to be collected in order to achieve maximum utility of their analytical reports. Irrational collection of evidence overburdening police & FSL staff can be avoided. 
  4. Best opportunity for interaction & liaison between various experts involved in the case i.e. Investigating Officer, Forensic Scientist, Fingerprint/Ballistic/Handwriting Expert/ Photographer.
  5. Always a learning experience to a medical man may help in driving away sense of “not quite belonging to the task” & misconceptions regarding working of criminal investigation system. Strength & limitations of all the parties involved in the team are made known to each other. Reinforces medical man’s confidence in himself by acknowledging his contribution to the joint exercise. 
  6. An opportunity to explain importance of early analysis of an evidence in a particular case, objectives of analysis, precautions in handling or transportation and place where the analysis may be undertaken (it is not very rare to note at a very late stage during investigation that a bone preserved for DNA test was sent to another laboratory or tissue for histopathology being sent to FSL only to be returned back after a while as the concerned laboratory did not entertain such samples). 

Limitations & Roadblocks

  1. Lack of motivation, incentives & proper training of doctors in dealing medico-legal cases. 
  2. Poor interdepartmental liasoning & cooperation (between police & health as the later may have a feeling that this is not their job).
  3. Absence of uniform medico-legal work guideline or protocol.
  4. Inertia on the part of the investigating officers. 
  5. Visit may come out to be journey to one of very difficult to reach, unhygienic/dirty places on earth. 

Crime Scene Investigation Kit for Medical Personnel

A standard kit may comprise of:

  • Surgical gloves,
  • Measuring tape & steel tape roll, 
  • Hand lens,
  • Digital camera,
  • Clean containers ( glass & plastic ),
  • Polythene & paper envelopes, 
  • Cotton swabs, 
  • Glass slides, 
  • Glass marking pencils, 
  • Suitable thermometer, 
  • Notebook, pen, markers, pencils, 
  • Disposable syringes, glass vials (EDTA & oxalate), 
  • Stethoscope, 
  • Flashlight, 
  • Surgical knives with spare blades, forceps, scissors, blunt probes.

Prerequisites: 

  • On receipt of a request for a visit to scene of crime, a doctor should depart/accompany the team punctually.
  • Formal written requisition may not be made available before visit, however the same may be made available afterwards on return.
  • It is always better if team members including members of scene of crime units, investigating officer & doctor assemble at a common place before departing for the scene preferably at control room or police station, where the IO briefs the team of the preliminaries. 
  • On reaching the spot, the doctor must first of all identify himself to all concerned. 
  • Must carry scene of crime kit with him. 
  • An assistant preferably a medical man (may be postgraduate student, an intern or even a colleague) is always an asset to have at scene for helping taking down notes or help in dissection, if needed. 
  • An enquiry should be made as to whether an experienced class IV employee has been arranged or not to assist in collection & labelling of evidences and small dissections/ cleaning of body, if needed. If not it is great to have one of the seasoned morgue attendants, provided he can be separated.
  • Services of an expert/ trained crime scene photographer or fingerprint expert should be requested, if feasible.

Do’s & Don’ts at Scene of Crime: 

  • A doctor is not supposed to touch or alter anything until the same has been identified, documented & photographed. He has to ask/inform the IO before moving anything. He should not lead but follow the police around the scene. 
  • The most detrimental effect of a medical man’s visit can be encountered when he jumps the gun shortly after reaching & inspecting the scene by pronouncing about cause, manner, time of death or the weapon causing certain injuries. A guarded opinion can however be given, if other possibilities can reasonably be ruled out. 
  • One of the very first things that a doctor is supposed to do on reaching is to check for any clinical sign of life, howsoever the onlookers may think it to be a futile exercise & thereby be certain about death. If otherwise, immediately he must arrange a call for an ambulance, simultaneously doing whatever he can at the spot to resuscitate the person. 
  • If the person’s death is so imminent as to be certain of him/her not reaching nearest hospital before death & the person happens to be able to communicate, dying
    declaration must be recorded.
  • He must enquire about Brief history about incidence if available, Prior manipulations/handlings (before his arrival), Original position/posture of the body, condition of clothing & surroundings. 
  • Go through the photographs taken prior to his arrival if any & ensure snapping relevant parts/areas from medico-legal point of view. 
  • Make a sketch of position & condition of body in relation to surroundings and depict relevant details for example injuries in assault cases, ligature material, knot, suspension point in hanging/strangulation cases etc. in body diagrams.
  • Take notes of points of identification in unidentified bodies. 
  • Description of clothing & signs of struggle/assault, stains, fibers/hairs or foreign objects found therein. 
  • General observations about the scene, any evidence of struggle. 
  • Description of rigor mortis, hypostasis, signs of decomposition etc. for estimation of time since death. 
  • Presence or absence of defence wounds in hands/forearms in assault cases. 
  • Markings of weapons, bullets, cartridges or cartridge cases must be done for identification after exercising due care to preserve hair, fibers, stains or fingerprints. 
  • Pattern, approximate quantum & position of blood over body parts, at the scene or weapons must be described. 
  • Any materials or evidences which are likely to be distorted or lost during shifting/transporting body to mortuary should be collected e.g. loose fibers or hair with adhesive tape, combing of loose hair from pubic region and perianal or vaginal swabbing in sexual assault cases, nail scrapping if indicated, swabbing of hands in firearm cases, ligature material. 
  • All the materials like clothing etc. may be left in situ to be preserved during detailed autopsy. 
  • Presence of drag marks or shifting of body from some other place must be noted. 
  • Autopsy at scene of crime itself should always be strongly resisted. Body should rather be transported to mortuary wrapped in a plastic sheet. 

It is best if the pathologist who attends the scene is the one who conducts the autopsy, particularly in the more complex cases. This is not always feasible, particularly in a busy or understaffed department. However, the information gleaned at the scene should be passed on to the other pathologist prior to autopsy. 

Disadvantages from Not Visiting the Scene of Crime

  • Fresh injuries may be added during transit to mortuary. 
  • Injuries may be masked due to onset of decomposition. 
  • Rigor mortis may get broken down during transit.
  • Clothing may get disarranged, fresh tears & blood stains may be introduced. 
  • Addition of fresh trace elements, dirt, stains etc. 

Retrospective Visit to the Scene: 

In a situation where a medical person’s visit to scene could not be arranged before dead body had been shifted, the same exercise done afterwards is still likely to yield positive results. Visit enables to gain better understanding of nature of surroundings, which is mostly different from the account of other people’s description. The same knowledge goes on to help immensely during cross examination in courts of law as well. 

Measures to Increase Practical Feasibility of Doctor’s Visit to Scene of Crime: 

  • The rationale & protocol of a doctor’s visit to scene of crime need to be incorporated in a uniform medico-legal manual, which is the need of the hour. 
  • The general awareness regarding utility/contribution of a doctor at scene of crime needs to be augmented amongst police investigators, judiciary & Forensic Scientists. Induction & on the job training programs of these functionaries needs to incorporate medico-legal aspects involved in different crimes for their sensitization. 
  • The curriculum of undergraduate medical courses needs to lay more emphasis on doctor’s contribution to scene of crime visits in particular & devising better alternative teaching & training methodologies to empower medical graduates to handle medico-legal problems in the field in general. 
  • A separate cadre for medico-legal services is needed at state/central level to meet the requirements of criminal investigation or law enforcement system in the country 
  • A clear & strong message is needed to be handed over to doctors entrusted with medico-legal responsibilities that this is an obligatory duty towards state & society and any laxity, indifference or negligence simply cannot be tolerated 
  • Better & more frequent interaction is needed between law enforcement agencies &
    medical professionals 
  • Doctor’s visit to scene of crime should not be designed to become a perfunctory, routine or casual exercise. Rather it should be carried out only in cases where there is a likelihood of a worthy outcome or a doctor demands it. For example: this exercise can be done away with in cases of recovery of a dead body from water or death from poisoning (unless the case is suspicious as in case of CO poisoning). 

Conclusion and Summary

Conventionally, presence of a doctor at scene of crime had been an exception rather than a routine event. Doctors with their background of medical/medico-legal knowledge (with proper motivation & sensitization) can contribute immensely to the quality of investigation in vast spectrum of criminal cases. Police apparently is too busy, not sure about rationale behind doctor’s presence at scene. Doctors, on the other hand, are reluctant and consider this job to be “alien to their profession” quite often than not visit of a doctor to a scene of crime certainly brings down level of uncertainty/ indetermination of medical opinion regarding cause, manner or mechanism of death.

Investigators usually doctors about their shaky, hesitant or over defensive approach in medico-legal matters. The same approach leads to a battery of usually irrational, over defensive evidence collection during autopsy causing undue delay in investigation and a waste of already constrained manpower & resources. Concept of visit of a doctor to scene of crime needs to be introduced not as a routine & obligatory exercise but to be undertaken only in selected cases which warrant such an exercise.

References

  1. Horswell J. The practice of Crime Scene Investigation. Florida. CRC Press. 2004; 195-238
  2. Polson CJ, Gee DJ, Knight B. The essentials of Forensic Medicine. London. Pergamon Press. 1985; 574-589 
  3. Rao N. K. G. Text book Forensic Medicine & Toxicology. 1st Edition. New Delhi. Jaypee Publishers. 2010; 21-22 
  4. Fateh A. Medico-legal investigation of gunshot wounds. Lippincott Company. 1976; 44-60
  5. Nandy A. Principles of Forensic Medicine including Toxicology. 3rd Edition. Kolkata: New Central Book Agency (P) Limited. 2010; 303-312 
  6. Reddy KSN. The essentials of Forensic Medicine & Toxicology. 30th Edition. Hyderabad: K Suguna Devi. 2011; 16-18 
  7. Mathiharan K, Patnaik AK. Modi’s Medical Jurisprudence & & Toxicology. 23rd Edition. New Delhi: LexisNexis. 2006; 24 
  8. Karmakar RN. JB Mukherjee’s Forensic Medicine & Toxicology. 3rd Edition. Kolkata. Academic Publishers. 2007; 36-37

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