Monday, January 23, 2012

IMPORTANCE OF MEDICAL REPORTS/FORENSIC MEDICINE

IMPORTANCE OF MEDICAL REPORTS /FORENSIC MEDICINE 

OVERVIEW : 


The bondage of law and medicine is ancient one ,as old as Egyptian civilization,The code of Hammurabi [Babylon-2200 BC]is oldest code on medical -legal cases.The Forensic medicine or legal medicine  &Toxicology and medical jurisprudence gained lot of importance in the modern world due to newer technology like Finger Printing and DNA.

It is prudent for young police officers ,prosecuting officers,defence counsels and general public to gain fundamental knowledge of medical jurisprudence , forensic medicine  and toxicology.The forensic medicine deals with the medical aspects of law viz .death,injuries,sexual offences ,infant deaths, poisoning ,accidents, homicide.The Medical jurisprudence deals with the legal aspects of practice of medicine viz.medical negligence ,rights &duties of doctor ,professional misconduct.Both Forensic medicine and Medical Jurisprudence are very important subjects in the criminal Justice system.    
  
The medical students will be familiar with 'Medical Jurisprudence' , 'Forensic Medicine and Toxicology'.The 'Forensic medicine&Toxicology' is a branch of 'Medical Sciences',which plays crucial role in deciding medico-legal court cases.

The highly experienced forensic medicine professional act as expert witness and their evidence[as per Indian Evidence Act under section 45 e.g doctor,firearms expert,finger prints experts,handwriting experts etc are called expert witnesses]will be considered  crucial[or even clinching evidence] corroborative evidence in all court cases viz.cause of the death[medico-legal death investigation],time of death,sexual offences,paternity,fertility,determination of age etc.

INQUEST: 

An inquest is an detailed inquiry or investigation into the cause of death or sudden death,it is conducted , in case of suspicious or sudden death,murder ,mass killings ,killing by animals and accidents.

  1. The Police inquest.
  2. The Coroner inquest.
  3. The magistrate inquest.

1.The Police Inquest : The police  conducts inquest  under section 174 of Criminal Procedure code ,1929 ,inform the local magistrate about the crime.

2.The Coroner Inquest : The corner inquest is conducted in Bombay /Calcutta under Coroner Act ,1871.No need to inform the crime to magistrate.The law commission in its report  206 ,in the year 2008 ,recommended enactment of central act  called Coroner Act 2008.

3.The Magistrate Inquest:The District Magistrate or Sub Divisional  Magistrate [District Collector or  Dy.Collector or Tahsildar ] is empowered to conduct inquest in cases of custodial death, prison death,police firing ,dowry deaths and exhumation under section 174 &Section 176 of Cr.PC   

In some countries like USA ,the coroner system is prevalent ,a coroner is a government official,who Investigates human deaths, determines cause of death for the issuing the death certificates,In India,in Bombay ,the corner system is prevalent as per  corner act ,1871.


AUTOPSY

The ancient Egyptians used to perform autopsy on corpses  ,the removal and examination of internal organs for religious practice of mummification.
The term Autopsy is a Greek term autopsia,  which mean "to see for oneself"In 44 BC, Julius Caesar was the subject of an official autopsy after, he was  murdered by rival senators.

The Autopsy on corpses will be performed for medical examination of human and animal body parts by the medical students and it is also done to ascertain the cause of the death in medico -legal cases or sudden or suspicious death.  


The Post-Morten examination and Post Morten certificate are other terms used in the modern world,they are medico legal reports on the request of the investigating officer for corroboration of criminal case in cases of assault,murder,rape,homicide and poisoning.The medical conduct autopsy after receiving request form from I.O,magistrate or coroner.

The reports consists of facts drawn from detailed observation of the body and the opinion formed basing on said  facts,the same will be attached to the case file to be produced in the court during criminal trial,this will become evidence,once doctor attends the court and testify the facts under the oath.



FUNDAMENTALS OF  MEDICAL REPORT. 


 
The medical report should be two parts consists of examination of body and the opinion ,The Examination of body consists both external and internal. No doctor should sign the medical report with out examining the body & observing due formalities ,including visiting scene of crime to form suitable  expert opinion on the cause of the death.If doctor does not visit the scene of crime ,he may not know all details of the crime. 

CASE PARTICULARS:
 

1.Name of deceased or victim and as entered in the Jail or Police record

2.Address,Age (Approx)  yrs; Sex : Male/Female
 

3.Body brought by (Name and rank of Police officials)
of Police Station 


4.Identified by Names & addresses of relatives/persons acquainted


PART-I 

SCHEDULE OF OBSERVATIONS

 GENERAL

(l)Height__ cms.(2)Weight__ Kgs.


(3)Physique -(a)lean/medium/obese-(b)Well built/average built/poor built/emaciated


(4)Identification features (if body is unidentified), Finger prints be taken on seperate sheet and attached by the doctor.


(5)Description of clothes worn-important features:


(6)Post-mortem Changes:(a)As seen during inquest,Whether rigor mortis present Temperature (Rectal) others, (b) As seen at Autopsy.


(7)(a)External general appearance-(b)State of eyes(c) Natural orifices


  


EXTERNAL EXAMINATION OF BODY PARTS:

EXTERNAL INJURIES:Mention Type,Shape,Length x Breadth&Depth of each injury and its relation to important body landmark.Indicate,which injuries are fresh and which are old and their duration.(i) Injuries be given serial number and mark similarly on the diagrams attached.(ii) In stab injuries, mention angles,margins and direction inside body.(iii) In fire arm injuries,mention about effects of fire also.



EXAMINATION OF BODY PARTS:

 1.EXAMINATION OF HEAD
  • Scalp findings
  • Skull(Describe fractures here & show them on body diagram enclosed)
  • Meninges,meningeal spaces&Cerebral vessels(Hemorrhage&its locations,abnormal smell etc.be noted)
  • Brain findings & Wt.(Wt._gms.)
  • Orbital,nasal&aural cavities-findings
 2. EXAMINATION OF NECK
  • Mouth, Tongue & Pharynx
  • Larynx & Vocal cords
  • Condition of neck tissues
  • Thyroid & other cartilage conditions 

  • Trachea
 3. EXAMINATION OF CHEST
  • Ribs and Chest wall
  • Oesophagus
  • Trachea & Bronchial Tree
  • Pleural Cavities 
  • Pleural Cavities-R-L

  • Lungs findings & Wt.- Rt.__ gms.&Lt._ gms.
  • Pericardial Sac 
  • Heart findings & Wt__
  • Large blood vessels
 4. EXAMINATION OF ABDOMEN
  • Condition of abdominal wall
  • Peritoneum & Peritoneal cavity 
  • Stomach(wall condition,contents&smell)(Weight__ gms.)
  • Small intestines including appendix
  • Large intestines & Mesentric vessels
  • Liver including
  • Gall bladder (wt _gms) 
  • Spleen (wt._gms.)
  • Pancreas 
  • Kidneys finding & Wt. - Rt._ gms & Lt._ gms.
  • Bladder & urethra 
  • Pelvic cavity tissues
  • Pelvic Bones 
  • Examination of Genital organs(Note the condition of the vagina, scrotum, presence of foreign body,presence of foetus,semen or any other fluid,and contusion,abrasion in and around genital organs)[helpful in determining the sexual assault]


5.EXAMINATION OF SPINAL COLUMN&SPINAL CORD(To be opened where indicated)


PART-II

OPINION: 
 
i)Probable time since death(keep all factors including observations at inquest)

ii)Cause &manner of death-The cause of death to the best of my knowledge and belief is :-

(a)Immediate cause -
(b)Due to -

(c)Which of the injuries are ante-mortem/post-mortem& duration if antemortem ?

(d)Manner of causation of injuries

(e)Whether injuries (individually or collectively) are sufficient to cause death in ordinary course of nature or not ?

iii)Any other


SPECIMENS COLLECTED & HANDED OVER [
Enclosures ] 


a)Viscera(Stomach with contents,small intestine with contents, sample of liver,kidney(one half of each),spleen, sample of blood on gauze piece (dried),any other viscera, preservative used)

b)Clothes

c)Photographs(Video cassettes in case of custody deaths, finger prints etc)

d)Foreign body(like bullet, ligature etc.)

e)Sample of preservative in cases of posioning &Sample of seal

g)lnquest papers (mention total number & initial them)

h)Slides from vagina, semen or any other material.


MEDICAL EXAMINATION OF RAPE VICTIM&PROCEDURES/ FORMALITIES:  


No doctor can examine women without prior request form from I.O or magistrate and no women can be forced to undergo medical examination,her prior consent is required,if victim is under 12 yrs or unsound mind ,the consent of parents or guardians must be taken in writing.

The victim should be examined in the presence of female nurse or attendant.The I.O should also ensure that victim should be taken to hospital immediately[not take bath or change cloths prior to medical examination]. 

The moot questions  for the doctor is
[1]whether there is recent evidence of sexual intercourse with presence of semen or other discharges.

[2]physical signs  to confirm use of the force viz. pain or oozing of blood  from vagina or bruises ,wounds,scratches,teeth bites  on the body parts e.g face,chest[breast],hands,thighs and genital organs. 

[3]Whether medical evidence confirm the allegations of sexual assault. 


  
OTHER PROCEDURAL FORMALITIES :

PM report in original,inquest papers,dead body,clothings and other articles (mention there) duly sealed (Nos.) handed over to police official No.of PS-whose signatures are herewith.Signature,Name of Medical Officer:(in block letters),Designation,Seal.


The medical report prepared by doctor should based on his own observation,the doctor should be able to defend the same in the court of law personally testifying ,he should not hesitate to give details of observation in the court and answer all questions diligently posed by the court and patiently face the cross examination of defence counsel by answering questions in an unbiased manner. He should confine himself to medical knowlegde,his role is furnishing the expert opinion of  the crime.The presumptions,conjectures and assumptions are not expert evidence or proof.There should be no scope for vagueness or inaccuracy in preparing the medical report.

THE MEDICAL CERTIFICATION OF DEATH :

India follows the International Statistical classification of diseases,injuries, and causes of the death as per classification ,the reports are prepared in India.No doctor should sign death certificate without examination of body.



The medical reports play crucial role in courts cases,it is corroborative peice of evidence in determining  the crime.It has become indispensable part of   criminal justice administration.



References :

  1. http://en.wikipedia.org/wiki/Autopsy
  2. http://en.wikipedia.org/wiki/Inquest
  3. http://uppolice.up.nic.in/All%20Rules/Dr%20Training%20material%20for%20CD/Annex%202%20custodial%20rape%20death.pdf -NHRC guidelines in custodial deaths.
  4. UN model format of Post-Mortem /autopsy report 
  5. Dr.K.S Narayana Reddy:The Essentials of Forensic Medicine and toxicology.






Disclaimer :This is only informative peice of article not reference material or expertise work.



Next : Importance of Medical reports in Paternity,Impotence ,Sterility&Sexual offences cases.


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