In any kind of criminal investigation, forensic experts are required to examine the body (if dead) and collect evidence to investigate the matter such that the victim’s actual reason to die or experience an injury is understood. Death investigations are the most popular and have been performed for decades to establish the cause and manner of death. In cases of homicides or other suspicious and obscure cases, a medical practitioner is always expected to visit the crime scene before shreds of evidence are taken out.
The purpose of having a medical practitioner/ expert attend the crime scene is can be explained in many folds- A practitioner can view the surroundings that the shreds of evidence have been found in when he/ she reports to the crime scene. The observational findings along with autopsy create a huge difference to the investigation, as the experts often come out with accurate conclusions about may ‘may have happened’. The practitioner can also easily evaluate about the nature of the death of the victim, e.g., whether it can be confirmed as a homicide, and the circumstances with a natural death, or interpret the cause of blood loss of a deceased.
Medicine and Law have been completely intermingled in modern times and this has been beautifully explained in Sand, Knud.[i] The then professor of legal medicine and director of the Institute of Legal Medicine in the University Copenhagen tries to explain in it briefly 19th century when important developments of medicine led to rapid progress in judicial procedure and crime-solving.
Medical Practitioner at the Crime Scene
As soon as a crime is reported and the crime scene is sealed, a medical expert (forensic expert preferably) should be rushed to the spot to examine the body, shreds of evidence found as well as it’s surroundings. Such observations provide an opportunity to gain a better knowledge of important circumstantial evidence vital to decipher the case. Findings due to forensic practices like autopsy help gain answers to queries concerning time, cause, manner, time, method of death and nature of injuries, if any[ii] Presence of the practitioner as soon as a crime scene is found is important because his decisiveness depends on the timing. The first observational search is the most important time to carefully and judiciously select biological evidence put together for reports and analysed so those accurate conclusions are reached to. Retrospective observation leads to the hasty and irrational collection of evidence creating a lot of burden on police and the forensic lab. Observational findings to gain first-hand knowledge gives the best opportunity to the Investigating Officer, Forensic Expert, Fingerprint/Ballistic/Handwriting Expert/ etc. to come together to create a strong case. Often if observations are made retrospective in nature and not with time, fresh injuries might be added during the transit to the lab, Injuries may also be masked as the decomposition process on human body speeds up easily. Rigour Mortis may get damaged during transit. Clothing may get disturbed and disfigured, fresh tears may occur and damage the evidence. Fresh elements, like dirt, bloodstains etc may also be added.
Medical jurisprudence is a wide topic that covers the application of medical science to legal problems. This typically includes cases involving blood relationship between suspects and other case-related individuals, injuries, or death. The most extreme way to dive in the investigation using medicine is by way of ‘Autopsy’. Post-mortem examination involves studying of the dead body and it can lead to some constructive findings like an immediate agent of death (e.g. a gunshot or poison) and yield important information, like how long the person has been dead, what was its state when alive etc. Cases involving rape have been widely popular due to TV shows to make aware to the public at large how forensic experts help in finding the guilty.
Medical jurisprudence essentially covers the ambit of a doctor’s duties to legally obligate to certify persons for compensations, national insurance plans, to certify births, deaths, and also decisions to determine when a mentally disturbed individual should be detained for his safety as well as others. These routine jobs can be called as the most frequent works of medical jurisprudence. But more significant than these are the testimonies of the doctor as a witness in case trials. Medical experts giving any kind of legal evidence from a crime scene and beyond may appear before the courts of law as well as administrative tribunals, along with other investigative bodies.[iii]
[iv]A Medico-Legal Case is any general case of injury/illness where doctor, after examining the patient and understanding the circumstances thinks beliefs intervention of police investigation essential to establish proper criminal procedure according to the laws regulating the same and also to fix the responsibility if the injury or ailment is caused due to some other person. So what cases come under the purview of medico-legally?
The cases which cause the death of a person or any kind of injury/ infirmity etc. to the person due to-
- Injury due to any harmful object.
- If the person is found with Burns or dead due to drowning
- Immediate postoperative death.
- Death or injury to a woman within 7 years of marriage.
- If notifications of any such cases are essential as per the active laws.
- If the doctor examines the body and believes the suspicion of some foul play.
- Where the reason for death is not certain and cannot be understood.
Generally, medico-legal cases include only the cases whereby after establishing the cause of death the practitioner believes the existence of any foul play. Previously the belief that all deaths are to be considered as medico-legal cases is now no more a problem because there are better and faster diagnostic means in modern times and reports of investigations are recovered easily[v]. Although sadly, many criminal investigations due to such deaths never take place because they are not reported as medico-legal cases. The usual belief that such cases involve a lot of disputes, rough interrogation by police officials, unnecessary court hours, sometimes political pressure to restricts common public and they get rid of the matters or never report them.
Medico- legal Evidences
A medical practitioner has to often give different medical pieces of evidence to help build the case of innocence or guilt of the accused or to confirm the charges of assault, rape or even murder against any individual. Such experts opinions rely on evidence and the medical evidence in medico-legal cases are termed as medico-legal evidence- they constitute of the doctor’s analysis report of the examination, reports of the forensic examiner, even the doctor’s oral evidence[vi]. So, it can be said that medical evidence provided before a Court of Law can be in the documentary as well as oral forms.
The documentary forms of evidence presented by the doctor, are mostly in three categories – a medical certificate describing the physical and mental state of any individual, a medico-legal report or a dying declaration. A medical practitioner analyses samples and gives the reports. Samples include objects of circumstantial value from cases that may be of murder, rape, assault, violence etc. Few kinds of samples are- seminal fluids, head hair, pubic hair, blood, debris, cut marks, bullets gastric lavage/vomitus, urine samples, burnt pieces of nails, clothes, hairs, blood sample to determine carbon monoxide levels in cases of burns.
Provisions regulating evidence
The Indian Evidence Act 1872 legitimises the process of medical practitioners to document and provide evidence in the Courts of law. According to the Section 45 of the ‘Act’: Opinion of experts where it is important to form an opinion of science or art, or even handwriting [or finger impressions], are derived from experts, (especially skilled in such issues), their observations and conclusions are considered as relevant facts to the case. Further, Section 61 of the ‘Act’ legitimises the content of such documentary evidence (primary or secondary)
The Indian Penal Code, 1860 at the same time prevents people from fabricating false evidence, issuing or signing false certificates and makes it an illegal act, punishment for which is also provided by the ‘Code’. According to Section 291, The deposition of a surgeon(civil) or any other medical witness may be taken up to be given in as evidence.
Brief Guidelines for Medical Practitioners (Indian Army & NHSRC)
Guidelines accepted widely throughout India concerning medico-legal cases and related documents well as evidence are given in detail by indianarmy.nic.in and nhsrcindia.org. According to such guidelines, documents in medico-legal cases are to be considered as confidential records and should be protected under safe custody to avoid tampering. Medical records must be complete in form and should document all the significant events in the treatment of the patient. All the medical documents like X-rays and investigation reports are to be preserved meticulously in the medical record section and handed over to the concerned authorities (Police Investigating Officer) when required. The evidence should be identified and failure to do so, destruction or loss of exhibits would be punishable under Sec 201 of I.P.C. In situations where the patient wishes to make a dying declaration in the case, the magistrate is required to be intimated. If the Magistrate is unable to do so or reach within an appropriate time, the Medical Officer may record the dying declaration himself and in presence of two independent witnesses.
Since a very long time, the presence of a doctor at the scene of the crime has been treated as an out of the routine event. Doctors with their expertise in the medical field can contribute immensely to the quality of investigation( mostly in criminal cases). Visit of a doctor to a crime scene brings down a level of uncertainty in the case because conclusions are derived and observations are made that make findings related to cause, manner or mechanism of death. Although since the intervention of medical experts make the case very sensitive and often police interrogation become tedious, people are seen to be gone on the defensive. Concept of the visit of a doctor as soon as possible to the scene of crime needs to be emphasised as a routine & obligatory exercise to be undertaken only in few selected cases which need such an exercise.
- What is the meaning of medical jurisprudence?
- What are the benefits of a medical practitioner reporting a crime scene asap? What is his role?
- What cases come under the umbrella term of medico-legal cases?
- What is medico-legal evidence?
- What are the generally followed guidelines for Medical Practitioners in India?
[i] Sand, Knud: Origin, Development, and Status of. Legal Medicine in Modem Times, Status of Legal Medicine in Denmark, and Description of Institute of Legal Medicine, Copenhagen. Methods and Problems of Medical Education. Ninth Series. The Rockefeller Foundation, New York, N. Y., 1928. P. 349.
[ii] Mathiharan K, Patnaik AK. Modi’s Medical Jurisprudence & & Toxicology. 23rd Edition. New Delhi: LexisNexis. 2006; 24 and Karmakar RN. JB Mukherjee’s Forensic Medicine & Toxicology. 3rd Edition. Kolkata. Academic Publishers. 2007; 36-37
[iv] Meera T. Medicolegal cases: What every doctor should know. J Med Soc 2016;30:133-4
[v] 144 Interview by Dr P. Vijaykumar, Medical Officer, at Belgaum on 14th July 2013
[vi] Modi Jaisingh P., Modi’s Medical Jurisprudence and Toxicology, ed. by K.Mthiharan and Paranaik Amrit K., (2005) Lexis Nevis, Butterworths