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EDITORIAL COMMENTARY
Year : 2023 | Volume
: 69
| Issue : 3 | Page : 134-135
Private medical autopsies - The road ahead!
A Aggrawal
Correspondence Address:
Dr. A Aggrawal
Ex Director Professor, Maulana Azad Medical College, New Delhi
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jpgm.jpgm_194_23
How to cite this article:During my long career as a forensic pathologist, I spent one year at the University of Edinburgh [1989–1990], under an academic exchange program. I was an Associate Professor of Forensic Medicine at that time [in India] and was still learning the finer nuances of this vast specialty. One fine day, a faculty member came to me and asked if I was interested in accompanying him to Glasgow for a defense autopsy. I was excited at the prospect of having a complimentary visit to a new city, but I was more intrigued about defense autopsy—a completely new term to me at that time. As I asked him what a defense autopsy was, he sensed that he would have to take a great time explaining everything to me. So, he asked me to get on in his car, and we could talk about it during the one-hour drive.
What I learnt during the next hour was completely mesmerizing. In Scotland, apparently there is a legal provision, whereby after the first autopsy—which is necessarily conducted by a state pathologist—the defense has the option to get a second postmortem done from any pathologist of his own choice [for which the party pays. My friend had been offered £800 for that autopsy!]. At the second autopsy, certain requisites are necessary though. For example, the first pathologist, who conducted the autopsy, must be present to explain the internal and external cuts/fractures/other damages to organs, etc., that were produced during the first autopsy [either intentionally, such as to test the integrity of the hyoid, or as an unintended consequence of autopsy, e.g., muscle cuts and tears]. His presence also ensures that the second pathologist, who is working for a fee, does not “cook up” any findings to help his client. Conversely, the possibility of a second autopsy possibly keeps the first pathologist too from “cooking up” any findings. Thus, the system is quite foolproof. I watched the entire second autopsy—which went on for about 4 hours—with intense curiosity and listened to a rather friendly and cooperative talk between the two pathologists. There was absolutely no tinge of enmity between the two.
I have wondered since that day, why such a practice cannot be started in India. Undoubtedly, there is no law in India, authorizing private autopsies, but Indian Law is definitely not against privatization of medicolegal services. Take, for example, section 53A of Criminal Procedure Code [CrPC]. It does allow the examination of an accused of rape by a private medical practitioner if no government doctor is available within 16 km. Section 164A of CrPC is even more explicit. Under this section, the examination of a victim of rape is possible by a private medical practitioner, even without the restricting 16 km clause. The idea is not to let evidence of rape disappear from the body, which does so very fast, if the examination is not done immediately. Is this a first step towards privatization of medical services in India in the interest of justice? I would think so, although this issue needs a lot of discussion and debate before this can be implemented on a universal basis.
Medicolegal work including autopsies can equally well be done in private medical colleges, as the viewpoint article by James et al.[1] being published in this issue suggests. The paper discusses relevant data from Tamil Nadu, Kerala, Maharashtra, and Uttar Pradesh states of India, but let us see the scenario in the entire country. Currently, there are 657 medical colleges teaching MBBS in India, of which 421 are recognized by the National Medical Commission (NMC). Of the recognized medical colleges, 211 are managed by the government and 210 are run by private/trust managements.[2] Imagine the lessening of work of government doctors, if all medicolegal work and autopsies were shared by their colleagues working in private medical colleges, a strong workforce, which is currently engaged only in theoretical teaching!
Private medical autopsies are not a new phenomenon. They were being done in private hospitals in the West from as early as 1947.[3] Autopsies have even been done even as part of private practice.[4] Private forensic toxicology is equally common.[5] In the USA, the National Association of Medical Examiners (NAME) even gives the names/address/e-mails of all forensic pathologists, who conduct private postmortems for a fee.[6] Even in India, Truth Labs are already providing private medicolegal services [not autopsies though] for a fee,[7] and their reports are being accepted by the judiciary.
The ground is ripe for not only private medical colleges to conduct autopsies, but for an overall privatization of medicolegal work/autopsies. The viewpoint article by James et al.[1] is a welcome beginning in this direction. It definitely will start a heated discussion among medicolegal personnel, which is the need of the hour. The ensuing discussion, which I am eagerly looking forward to, will show us the road ahead.
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