Medico Legal Autopsies of Custodial Deaths in Mumbai Region - A two Years Prospective Study

Sachin S. Sonawane1, S.D.Nanandkar2 Assistant Professor, Dept. of Forensic Medicine, T.N. Medical College & B. Y. L. Nair Ch. Hospital, Mumbai 2 Professor and Head, Dept. of Forensic Medicine, Grant Medical College & Sir J.J. Hospital, Mumbai ABSTRACT The study comprises of total 108 autopsies of custodial deaths which are referred for post mortem examination by magistrate from various police custodies and prisons in Mumbai region. The study is carried out over period of two year from July 2005 to July 2007. Autopsies were conducted as per NHRC guidelines. The study was mainly aimed to evaluate various factors in relation to custodial deaths like to assess mean age at death, drug addictions in deceased, type of custody and the evidence of injuries, relation of age (in year) with type of offence committed, the common manner and cause of deaths in police and judicial custody. It was observed that of total 108 deaths 16 (14.81%) were in police custody and 92 (85.19%) were in judicial custody. 74% deaths were in age group ranging from 18 years to 45 years; with mean age at death was 34 yrs.75% of deceased were addicted. Alcoholism and smoking was common addiction observed. Maximum number of deceased (59%) was from age group of 26 to 45. Offences more frequently was homicide (31.5%) followed by NDPS related (15.75%). 70.4% of deaths were occurred either before or within 24 hr of admission in hospital. Evidence of injuries is seen in 56% cases in police custody. 93.5% of deaths in judicial custody were from natural causes and tuberculosis is common cause of death (50.5%). 81.2% of deaths in police custody were unnatural and common cause was suicide by hanging. Key words: Custodial Deaths, Judicial Custody, Police Custody, NHRC, Natural Deaths, Unnatural Death, Drug Addiction, and Offences Committed.

INTRODUCTION Custodial deaths are sensitive issue and autopsy surgeon plays important role in these cases as there is hardly any outside independent evidence in these cases, the fate of the cases would depend entirely on the observations recorded and the opinion given by the doctor in the post-mortem report. Though autopsy performed previously of custodial death is same as routine autopsy but from inception of Protection of Human Rights Act 1993 some additional procedures are included in routine autopsy like postmortem examinations done in respect of deaths in police custody and in jails should be video-filmed. The
Correspondence Address Sachin S. Sonawane Assistant Professor Dept. of Forensic Medicine Room no. 511, college building ,T.N. Medical College & B. Y. L. Nair Ch. Hospital, Mumbai Central, Mumbai Maharashtra State (India) Phone No. 08976224403, Email: dr.sacs@rediffmail.com

cassettes are sent to the Commission along with the post-mortem report. In order to make transparency in custodial deaths and to plugs the loop holes in such deaths. MATERIAL AND METHODS The present study is conducted at Department of Forensic Medicine and Toxicology, Grant Medical College Mumbai. The study comprises of total 108 autopsies of custodial deaths which are referred for post mortem examination by magistrate from various police custodies and prisons in Mumbai region. The study is carried out over period of two year from July 2005 to July 2007. Before starting autopsy detailed history of deceased was obtained regarding: Date of admission in custody, type of offence committed, drug addiction, type of custody. The hospital record papers are carefully reviewed for clinical history, investigations like X-rays, CT scan, bio-chemical& blood investigations, treatment given,

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and probable clinical diagnosis. Inquest papers are carefully viewed particularly about external injuries which are mentioned. In all cases magistrate inquest is conducted and all inquests are videographed. The post-mortem examination is performed by at least two doctors or a panel of doctors with one senior qualified staff member. A detailed and meticulous autopsy with video recording of whole procedure is performed as per guidelines given by National Human Rights Commission1. Criterion for selection of cases of custodial deaths is as following: i) Deaths which occurred in prison custody. ii) Deaths of which occurred in rout of medical care. iii) Deaths which occurred in hospital. iv) Deaths which occurred in police custody Exclusive criteria: i) Deaths which occurred from police encounters ii) Age of custodian less than 18years. Incisive criteria: Autopsy is conducted with addition following procedures are done: i. The post-mortem examination is performed by at least two doctors or a panel of doctors with one senior qualified staff member. A detailed and meticulous autopsy with video recording of whole procedure is performed as per guidelines given by National Human Rights Commission. ii. No unauthorized persons are to be allowed during autopsy. The time during autopsy when each person is present is included using sign-in sheet. iii. Videorecording is done in all case. Name and address of person videorecording the autopsy is noted. iv. Identification of body of deceased is done by relative. If relatives are not presents identification is done by concerned Jailer and videographed. v. Careful examination is done for the physical findings which indicate evidence of detention or torture . vi. Multiple parallel Incisions is taken over palms and soles to rule out any blunt injuries.2 vii. In dark skinned person long incision is taken on front and back of each limb, buttocks and on back both side to exclude any deep seated contusion. viii. Weight of each organ is recorded. Each organ is videographed before and after sectioning.

OBSERVATIONS AND RESULTS 1. Age wise distribution: The age wise distribution of deceased is calculated which shows that maximum 37.96% of cases are in age group 26-35 years and mean age at death was found 34 years. The incidence of death is more in age group of 26-55 years (59%).
Age(years) Percentage 18-25 14.81% 26-35 41 37.96% 36-45 23 46-55 15 Above 55 Total 13 108 100% No. of deaths 16

21.29% 13.88% 12.08%

2. Distribution of type of drug addiction among deceased Study shows various type of drug addiction among deceased. Smoking and alcoholism is seen together in 52 cases. Out of total 108 cases 81 had various type of addiction. Intravenous drug users are HIV positive. Those of charas smokers had found lung abscesses.
Drug addiction No. of cases Percentage Alcoholism Only Charas Heroin Cocaine and Alcoholism and smoking ganga 52 64 09 11.11 11 13.58 05 6 04 4.9 Total

81 75

3. Literacy status distribution of deceased

Education No. deceased Percentage Illiterate Primary Secondary Higher Graduation Post smoking ganga secondary Graduation 18 16.66% 48 44.44% 21 19.44% 15 13.88% 04 03.70% 02 01.85%

Above table shows the literacy status of 108 deceased, Illiterates comprise 16%, while most of deceased 44% had completed their primary education. 19% secondary.13% higher secondary, 3% graduation, 1.8%posts graduate. 4. Relation of age (in year) with type of offence committed The deceased under which type of offence they are arrested, under trail or convicted is as shown below:
Type of offence Homicide and related Hurt and related Robbery Theft Cheating Forgery Rape NDPS related Rioting Extortion Other Total 18-25 4 2 7 3 3 1 1 21 26-35 36-45 46-55y > 55 Total 7 3 5 5 1 2 1 10 1 2 2 39 7 1 4 4 2 1 2 4 2 1 28 8 1 1 1 11 8 1 9 34 8 16 12 3 3 4 18 2 5 3 108

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One deceased can be charged with more than one offence at time but out that major offence is mentioned in table no.9.from table it is observed that maximum number of deceased are from age group of 26 to 45 offences more frequently was homicide followed by NDPS related, robbery, theft and hurt related. 5. Evidence of injuries and that suggestive of its nature The evidence of injuries fresh as well as old which was observed at the time of autopsy and its nature is shown in table below. More than one type of injuries was present in one deceased
Physical finding General beating Linear contusions on back Linear contusions on buttocks Linear contusions on thighs Contusions on soles Contusions on palms Mal united fracture at ankle Mal united fracture at wrist Multiple stab injuries Head injury Scars on chest & forearms Abrasions on fore arm/ wrist Abrasions on knee and leg Total 02 01 03 02 05 04 02 01 02 01 05 01 02 Self Torture Homicidal inflicted -

7. Age wise distribution of unnatural deaths

Age (years) 18-25 26-35 36-45 46-55 Above55 Total suicides 6 4 2 1 13 Homicides 1 2 1 1 5 Accidental 1 1 Total 8 6 3 1 1 19

It was observed that out of total 19 unnatural deaths. Most of them were suicides. DISCUSSION Comparative table showing mean age at deaths and sex distribution of deceased The present study is comprises of total 108 of custodial deceased with mean age at death was 34 years and out of 108 inmates died only two were of female
Studies Wendy L. wobeser3 Derrick J. pounder4 Bardale rajesh et. al5 Marrissa McCcall6 Okoye M. et. al.7 Petschel et. al.8 Salive M.E.et.al.9 Smialek J. E. et. al.10 Ghazala sattar11 Present study No. of deaths 291 31 70 68 51 96 206 25 236 108 Period No. of of study males 10 yrs 11yrs 5yr 1yrs 6yrs 6yrs 9yrs 1yr 2yrs 2yrs 283 31 70 63 51 90 195 22 228 106 No. of Mean age females at death 8 5 6 11 3 8 2 41yrs 44yrs 45yrs 39yrs 42 yrs 41yrs 39 yrs 27yrs 41yrs 34yrs

In total 20 cases injuries were seen out of which 11were in judicial custody Cases. Three of them are fresh injuries and homicidal in nature. They were due to scuffle between the prisoners in prison. Two presented with multiple stab injuries over chest and abdomen one with head injury. Multiple linear scars on forearms and chest seen in 5 cases those were drug addict. Mal united fracture at ankle seen in two cases and mal united fracture at wrist seen in one case. 9 deceased in police custody shows evidence of injuries and all injuries were fresh and suggest non self inflicted in custody. It is observed that the common method of torture is beating on soles palms, buttocks and thigh. 6. Causes of deaths in judicial and police custody
Custody Police Judicial Total Percentage Natural 03 86 89 82.40 Unnatural 13 06 19 17.60 Total 16 92 108 100

Study of Smialek J. E. et. al.10 shows that mean age was 27 yr at death. However Bardale rajesh et. al57 shows that mean age at death is 45 years .in all study very few female inmates are involved. Alcohol and smoking is predominant in present study followed by charas/ganja smoking Lung abscesses were found in cases of charas smoker's predominance of alcohol and smoking in study is due to easy availability in country. Gore S.M., Bird A.G. et. al.23 Studied 871 cases of random urine sample of inmate of England and Wales. 32% of them were positive for cannabis and 4% were positive for heroin Literacy status of prisoners in India12 as BPRD record shows that 72% of prisoners were completed their primary education in present study 80% of total deceased had completed their primary education and finding were consistent with all India prisoners statistics. Criminal activity is more common in younger than older most offence committed was homicide (n=34)

It was observed that unnatural deaths are more common in police custody. However natural deaths are more common in judicial custody

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and related followed by NDPS related (n=18) and robbery (n=16). maximum numbers of offender were fall in age group 18-35yrs its shows that criminal activity is common in youth population. The present study finding was consistent with Taylor P.J. et.al13. Study most vulnerable age group is 18-45, the reason being presence of aggressive trait in this age group. While frequency of crime decreased in old age. Petschel et. al.8 Study shows that out of 96 deaths 52 deaths were occurred in police custody and police related operation 46 deaths were occurred in judicial custody and most of deaths in police custody were unnatural and that in judicial custody were natural. Bardale rajesh et. al5. Study shows that 10 deaths were occurred in police custody all were unnatural. Present study findings were consistent with above study that unnatural deaths are far much exceeds natural deaths in police custody. However natural deaths were common in prison custody. Wendy L. wobeser et. al3 Study shows that there were 56 deaths were accidental which were seen in drug addicts due to excess of drug doses. Which is common in prisoner of Ontario custody? Bardale rajesh et. al 5 Study shows that there were three homicidal deaths of which two were occurred in police custody while one occurred in prison. CONCLUSION 1. 74% deaths were in age group ranging from 18 years to 45 years; with mean age at death was 34 yrs. 2. Majority of the deceased were male with only 1.86% as females. 3. The literacy status of the deceased showed the prison population to be literate, only 16.66% Of the deceased were illiterate.

4. Evidence of injuries suggestive of torture is seen in 56% cases in police custody. 5. Natural deaths were common in judicial custody. However unnatural deaths were common in police custody. 6. Suicide is common in unnatural deaths; most of suicides were by hanging. Identification of suicidal risk individuals with exploring factor for suicide and initiation of psychological counseling for such cases is recommended. REFERENCES 1. Souvenir of Medico-Legal Association of Maharashtra 10th Annual Conference 2000 "NHRC guidelines for custodial deaths" (52-58). Dr. Amrit K. Patnaik and k. mathiharan ." Model protocol for Autopsies in Custodial Death" Indian Journal of Medical Ethics June1999, (2) 59-63. Wendy L.Wobeser, Jason Datema, Benoit Bechard, Peter Ford "causes of death among people in custody in Ontario 1990-99 ",Canadian medical Association Journal Nov 2002,167(10): 1109-1113. Derrick J. Ponder "Death behind bars an 11year survey in south Australia " Medicine, science and Law 1986, 26(3) Bardale Rajesh, Shrigiriwar Manish, Vyawahare M S , Dixit P.G., Tayade S. N. "Death behind bars: A five year study of custodial death". Journal of Medico- Legal Update Dec.2005, 5(4)105-109 Marissa McCall "Deaths in custody in Australia :2003 National Death in Custody Program " Australia Institute of Criminology ,2004 (Technical &background paper series no.12 ). Okeye M, Kimmera E H , Reinhard K, "An analysis and report of custodial deaths in Nebraska, USA" J Clin Forensic Med.1999 , Jun;6(2) 77-84. Petschel K,Gall J A. " A profile of deaths in custody in Victoria, 1991-96" J Clin Forensic Med. 2000 Jun; 7(2): 82-87

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