presentation related to autopsy in Cases of Death in Custody, Torture and Violation of Human Rights

1. Autopsy in Cases of Death in
Custody, Torture and
Violation of Human Rights
Presenter: Supervisor:
Dr. Sandeep Kumar Giri Dr. Vijay Pal
Resident Professor

2. NATIONAL HUMAN RIGHTS COMMISSION
[NHRC]
The Protection of Human Rights Act, 1993.
• National Human Rights Commission.
• State Human Rights Commissions in States.
• Human Rights Courts.
 For better protection of human rights and for matters connected therewith or
incidental thereto.
 R. V. Pillai, Secretary General 14 December, 1993
• On the reporting of custodial deaths within 24 hours.

3. Justice Ranganath Misra, Chairperson August 10,1995
• The Commission very often shows that the post-mortem in many cases has
not been done properly. Usually the reports are drawn up casually and do
not at all help in the forming of an opinion as to the cause of death.
• The Commission has formed an impression that a systematic attempt is
being made to suppress the truth and the report is merely the police version
of the incident.
• The Commission would like that all post-mortem examinations done in
respect of deaths in police custody and in jails should be video-filmed and
cassettes be sent to the Commission along with the post-mortem report.

4. Justice M.N. Venkatachaliah, Chairperson March 27, 1997
• In some cases it was found that the post-mortem examination was not
carried out properly and in others, inordinate delays in their writing or
collecting.
• As there is hardly any outside independent evidence in cases of custodial
violence, the fate of the cases would depend entirely on the observations
recorded and the opinion given by the doctor in the post-mortem report.
• Model Autopsy Form based on U. N. Model Autopsy Protocol.

5. MODEL POST-MORTEM REPORT FORM
• Name of Institution ____________________________________________
• Post Mortem Report No. _________________ Date ___________________
• Conducted by Dr._______________________________________________
• Date & Time of receipt of the body and Inquest papers for Autopsy ____
• Date & Time of commencement of Autopsy____________________
• Time of completion of autopsy___________________________________
• Date & Time of examination of the dead body at Inquest (as per
Inquest Report) ____________________
• Name & Address of the person video recording the Autopsy ________

6. CASE PARTICULARS
1. a) Name of deceased and as entered in the Jail or Police record_______
b) S/O, D/O, W/O__________________________________________
c) Address :________________________________________________
2. Age (Approx) :___________ yrs; Sex : Male/Female________________
3. Body brought by (Name and rank of Police officials)
i. _________________________________________________________
ii. _________________________________________________________
of Police Station ______________________________________________
4. Identified by (Names & addresses of relatives/persons acquainted )
i. _________________________________________________________
ii. _________________________________________________________

7. IF HOSPITAL DEAD BODIES - (particulars as per hospital records)
a) Date & Time of Admission in Hospital____________________________
b) Date & Time of Death in Hospital _______________________________
c) Central Registration No. of Hospital _____________________________
SCHEDULE OF OBSERVATIONS
(A) GENERAL
1. Height _______ cm.
2. Weight _______ Kg.
3. Physique - (a) lean/ medium / obese
(b) Well built/average built/poor built/emaciated
4. Identification features (if body is unidentified)
i. __________________________________________
ii. ___________________________________________
iii. Finger prints be taken on separate sheet and attached by the doctor.

8. 5. Description of clothes worn - important features:
6. Post-mortem Changes :
a) As seen during inquest
- Whether rigor mortis present____________________________________
- Temperature (Rectal)__________________________________________
b) As seen at Autopsy -
7. (a) External general appearance -
(b) State of eyes
(c) Natural orifices
(B) 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.)

9. 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.
C) INTERNAL EXAMINATION
1. HEAD
a) Scalp findings
b) Skull (Describe fractures here & show them on body diagram enclosed)
c) Meninges, meningeal spaces & Cerebral vessels (Haemorrhage & its
locations, abnormal smell etc. be noted)
d) Brain findings & Wt. (Wt. _________________ gm.)
e) Orbital, nasal & aural cavities - findings.

10. 2. NECK
⁃ Mouth, Tongue & Pharynx
⁃ Larynx & Vocal cords
⁃ Condition of neck tissues
⁃ Thyroid & other cartilage conditions
⁃ Trachea
3. CHEST
⁃ Ribs and Chest wall
⁃ Oesophagus
⁃ Trachea & Bronchial Tree
⁃ Pleural Cavities - R - - L -
⁃ Lungs findings & Wt. - Rt. _________gm. & Lt. ___________ gm.

11. ⁃ Pericardial Sac
⁃ Heart findings & Wt. ________ .
⁃ Large blood vessels
4. Abdomen
- Condition of abdominal wall
- Peritoneum & Peritoneal cavity
- Stomach (wall condition, contents & smell) (Weight ______________ gm.)
- Small intestines including appendix
- Large intestines & Mesentric vessels
- Liver including gall bladder (wt. _________________ gm)
- Spleen (wt. ___________ gm.)
- Pancreas

12. ⁃ Kidneys finding & Wt. - Rt. ______ gm. & Lt. _________ gm.
⁃ Bladder & urethra
⁃ Pelvic cavity tissues
⁃ Pelvic Bones
⁃ Genital organs (Note the condition of vagina, scrotum, presence of foreign
⁃ body, presence of foetus, semen or any other fluid, and contusion, abrasion
in and around genital organs).
5. SPINAL COLUMN & SPINAL CORD (To be opened where indicated)

13. 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 and 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 ?

14. SPECIMENS COLLECTED & HANDED OVER (Please tick)
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 poisoning.
f) Sample of seal
g) Inquest papers (mention total number & initial them)
h) Slides from vagina, semen or any other material
Signature : ___________________________
Name of Medical Officer _______________
(in block letters) ______________________
Designation __________________________
SEAL

15. EXTRA / DIFFERENT POINTS OF MODEL PMR
• Date & Time of examination of the dead body at Inquest (as per Inquest
Report).
• Name & Address of the person video recording the Autopsy.
• Finger prints be taken on separate sheet and attached by the doctor.
• Post-mortem changes:
1. As seen during inquest
2. As seen during autopsy
• Injuries be given serial number and mark similarly on the diagrams
attached.

16. OPINION
1. Probable time since death (keep all factors including observations at
inquest)
2. 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 and 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 ?

17. • For proper assessment of “Time since death” or ‘the time of death’, determination
of temperature changes and development of Rigor Mortis at the time of first
examination at the scene is essential. This can conveniently be done by following
some easily understandable and implementable procedure.
• Done by Medical Officer or Police Officer who trained properly at the Police
Training institution.

18. N. Gopalaswami, IAS, Secretary General January 3, 2001
The following instructions are issued:
1. The post-mortem report along with the videograph and the Magisterial
Enquiry report must be sent within 2 months of the incident.
2. In every case of custodial death, Magisterial Enquiry has also to be done
as directed by the Commission. It should be ensured that the Magisterial
Enquiry is completed as soon as possible but in such a way that within 2
months.

19. • In some cases of custodial death, after post-mortem the viscera is
sent for examination and viscera report is called for. However, the
viscera report takes some time in coming and therefore, this is to clarify
that the post mortem report and other documents should be sent to the
Commission without waiting for the viscera report. The viscera report
should be sent subsequently as soon as it is received.

20. Justice J.S. Verma, Chairperson, 21st December, 2001
• The requirement of videography of post-mortem examinations in respect of
deaths in jail will be applicable only in the following cases:-
I. Where the preliminary inquest by the Magistrate has raised suspicion of
some foul play.
II. Where any complaint alleging foul play has been made to the concerned
authorities or there is any suspicion of foul play.

21. CUSTODIAL DEATH
• Death occurring in some form of custodial detention is commonly
known as death in custody, such as police cell or prison.
• It also include death resulting from police or prison officers attempting
to detain a criminal or a person escaping or attempting to escape from
police custody or prison.

22. 1. During arrest:
i. Traumatic asphyxia
ii. HOG Tying (Total appendage restrain procedure)

23. iii. Choke or Carotids Holds
a) Choke (Bar Arm) Holds
b) Carotid Sleeper Hold

24. 2. During Lockup:
i. Intoxicated person : Death may be due to Acute alcoholic poisoning,
Aspiration of vomit, Head injury due to fall.
ii. Injuries that sustained before or during arrest and die in the custody.
iii. Torture by kicking and stomping, or a backward blow from the
point of an elbow on the face, neck, or abdomen, etc. inflicted with
sufficient force can cause severe damage and death.

25. Procedure of autopsy in Custodial Deaths/
Torture
• Forensic Medicine experts at the teaching hospitals of Govt. Medical
Colleges should do all Custodial victims.
• On no condition should such autopsies be conducted in the absence of
natural light.
• If autopsy is conducted in district or taluk govt. hospitals, efforts should be
made to include a Forensic Medicine expert.

26. Phases of Videography
Phase I: The bearings of the body like clothes, etc. should be individually
videographed with focus on striking features like stains, cuts or holes on the
relevant materials.
Phase II: Front view of the body on the autopsy table before wiping and after
wiping the body.
• The same process should be repeated with the back of the body.
• Conjunctiva and lips should be videographed for the presence of any
haemorrhagic spots.

27. Phase III: External Injuries :
1. These injuries should be recorded a/c to one’s own practice, i.e. beginning
with head and neck, trunk, upper and lower (right and left) extremities,
front, back and sides of the body is the commonest way of recording.
2. Each injury should be serially numbered by number tags (adherent
labels).
3. The videograph should be taken in parts or as a whole as the videographer
feels fit to produce their images with clarity.
4. Any suspected areas of fractured bones of the limbs should be exposed
and videographed.

28. • Phase IV: The actual dissection for exposing the body cavities need not be
videographed in order to avoid the lengthiness of the video and to keep the
viewers live to the bare facts of the trauma.
• It is a good practice to begin the autopsy with the exposure and removal of
the brain.
• Phase V: The scalp should be dissected up to the eyebrows on the front and
below the mastoids on the back.
• The inner surface of the anterior and posterior flaps should be videographed
separately, followed by the videography of the exposed cranial surface.

29. • The removed vault of the skull should be videographed by stretching it in
the sagittal plane and in the coronal plane. This procedure will expose all
types of fractures, if they are there.
• The extradural space should be videographed in situ followed by subdural
space. If there is subdural haemorrhage (SDH), it should be removed and
videographed again to confirm SDH and for the presence of subarachnoid
haemorrhagic (SAH).
• The brain is removed and placed on its vault to expose the basal surface.
This exposed surface should be videographed. The Circle of Willis dissected
out in situ. This should be videographed again. Then it is turned to rest on
its base and videographed again.

30. • Each stage of the brain dissection should be exposed and videographed to
its conclusion according to one’s methodology of brain dissection.
• The base of the skull along with the meninges should be videographed
before and after wiping its surface. The basal meninges should be stripped
out.
• The stretch force is applied to the base of skull in the sagittal and coronal
planes and videographed in each plane to exposed any type of fracture.

31. • Phase VI: Chin to pubic symphysis dissection is continued to expose
the chest and abdominal cavities. The neck and the chest wall are
dissected to their extreme sides to expose the front as wide as possible.
This widely exposed neck and the chest wall should be videographed.
• The cupped palm should dipped gently into the pelvic cavity and
raised to check the injury to the visceral organs. This entire manoeuvre
of dipping and raising the hand should be consecutively videographed.

32. • Bent the removed sternum in both the planes to expose any fracture. This
process should be videographed.
• The hand manoeuvre done in the pelvic cavity should be done to rule out
any bleeding injury for right and left pleural cavity with consecutive
videography of the procedure.
• The pericardium with the heart in situ should be videographed.
• The heart is exposed in situ and videographed before and after wiping the
pericardial sac.

33. Neck:
• Exposed the superficial muscles of the neck and videographed.
• Expose the hyoid bone and examined it in situ by slight adduction and
abduction of the greater horns of the hyoid bone.
• This manoeuvre should be videographed as it explicitly conveys that the
hyoid bone was properly examined for any fractures in the greater horn.
This manoeuvre will show inward or outward compression fractures, if
present.
• The deep muscles are removed to expose the larynx, submandibular glands
and thyroid glands. This exposed surface should be videographed.

34. Evisceration process: Tongue down to the rectum. The body cavities should
be cleaned and later videographed.
• The anterior chest wall should be pressed backwards on each side
separately. If there is yielding, it indicates fracture of the ribs and that area
should be videographed.
• The aorta should be opened before the viscera are separated. The intima of
the aorta should be videographed.
• The posterior surface of the pharynx and the oesophagus should be
videographed for the presence of blood.

35. • The esophagus is opened upto its cardiac end and videographed.
• The larynx and trachea should be opened and videographed.
Heart: The heart should be dissected. Inflow – outflow method,
videographed the chambers and pulmonary and aortic valves.
• Coronary arteries should be dissected as far as possible.
• Videography is done before sectioning and after serial sections to explore
any block in them. The area of block should be isolated and videographed
again.

36. • Visceral organs: Separate each organ and videographed.
• After sectioning, each organ should again be videographed.
• The process of sectioning by the dissector need not be videographed.
• In the case of kidneys, the process of stripping the capsule should be
videographed.
• Scrotum: Through the midline incision the testes are exposed and
videographed.

37. To expose deep contusions of the limbs:
• In fair skinned people, abnormal discolorations of the skin alone should be
cut and exposed and videographed.
• In dark people through one long incision on the front and back on each limb
to exclude any extravasation of blood in the muscular tissue.
• Multiple parallel incisions can be put in the sole and palm. These should be
videographed.

38. Guidelines for Video-Filming and
Photography of Post-Mortem Examination
1. The aim of video-filming and photography of post-mortem examination
should be:-
a) To record the detailed findings of the post-mortem examination,
especially pertaining to marks of injury and violence which may suggest
custodial torture.
b) To supplement the findings of post-mortem examination (recorded in the
post-mortem report) by video graphic evidence so as to rule out any
undue influence or suppression of material information.
c) To facilitate an independent review of the post-mortem examination
report at a later stage if required.

39. 2. The following precautions should be taken before conducting post-
mortem examination:
a) Both hands of the deceased need to be wrapped in white paper bags
before transportation. The dead body afterwards should be covered in
special Body Bags having zip pouches for proper transportation.
b) Clothing on the body of the deceased should not be removed by the police
or any other person. It should be collected, examined as well as preserved
and sealed by the doctor conducting the autopsy, and should be sent for
further examination at the concerned forensic science laboratory.
c) A detailed note regarding examination of the clothing should be
incorporated in the post-mortem examination report by the doctor
conducting the autopsy.
d) In case of alleged firearms deaths, the dead body should be subjected to
radiological examination (X-rays/ CT Scan) prior to autopsy.

40. 3. Video-filming and photography of post-mortem examination should be
done in the following manner:
I. The voice of the doctor conducting the post-mortem should be recorded.
The doctor should narrate his prima-facie observations while conducting
the post-mortem examination.
II. A total of 20-25 coloured photographs covering the whole body should
be taken. Some photographs of the body should be taken without
removing the clothes. The photographs should include the following:
a) Profile photo-face (front, right lateral and left lateral views), back of
head.
b) Front of body (up to torso-chest and abdomen) – and back
c) Upper extremity - front and back

41. d) Lower extremity – front and back
e) Focusing on each injury/ lesion-zoomed in after properly numbering
the injuries*
f) Internal examination findings (2 photos of soles and palms each, after
making incision to show absence/ evidence of any old/ deep seated
injury).
* In firearm injuries while describing, the distance from heel as well as
midline must be taken in respect of each injury which will help later in
reconstruction of events.

42. iv. Photographs should be taken after incorporating post-mortem number,
date of examination and a scale for dimensions in the frame of
photographs itself.
v. While taking photographs the camera should be held at right - angle to
the object being photographed.
vi. Video-filming and photography of the post-mortem examination should
be done by a person trained in forensic photography and videography. A
good quality digital camera with 10X optical zoom and minimum 10
mega pixels should be used.

43. Custody of the Videocassette
• Immediately after the videography of the autopsy is completed, the essential
details relating to the case such as name of the deceased, general particulars
of the deceased, particulars of requisition of autopsy should be recorded on
the video.
• Thereafter, the Forensic Medicine expert conducting the autopsy should
ensure immediate sealing of the videocassette and its immediate dispatch
with all required particulars to the inquest authority who in turn should send
it to NHRC.

44. TORTURE
• The World Medical Association (Declaration of Tokyo, 1975) defines
Torture in relation to detention and imprisonment as “The deliberate,
systematic or wanton infliction of physical or mental suffering by one or
more persons acting alone or on the orders of any authority, to force another
person to yield information, to make a confession or for any other reason.”

45. IPC 330
Voluntarily causing hurt to extort confession, or to compel restoration of property.
Punishment – imprisonment upto 7 years.
IPC 331
Voluntarily causing grievous hurt to extort confession, or to compel restoration of
property.
Punishment – imprisonment upto 10 years.
IPC 339
Wrongful restraint.
Punishment – Imprisonment upto 1 month. (IPC 341)

46. Types of Torture
1. Physical Torture:
i. Beating
ii. Heat torture
iii. Electrical torture
iv. Pilling and/ or twisting of hair/nails/tongue/teeth/breast/genitals.
v. Suspension
vi. Keeping in abnormal position
vii. Irritant torture
viii.Ear torture
ix. Cold torture
x. Sexual torture
xi. Roller torture etc.

47. 2. Psychological Torture:
i. The Deprivation technique: Social, Sensory, Perceptual, Sleep,
Nutritional, Hygiene, Healthy service.
ii. The Coercion technique: Humiliations, Threats, Blind obedience of
rule, Sexual Torture.
iii. The Communication technique: Counter – effect techniques, Double
Binding, Disinformation, Distortion of perception, Conditioning of new
reflexes.

48. Examination : Istanbul Protocol
International guidelines for documentation of torture and its consequences.
• Obtain complete history about the methods of torture.
• Symptoms and disabilities following torture are to be recorded.
• Record the injuries in detail and mark on the body diagrams.
• Take the photographs of the injury with scale placed near it.
• Examine all the system of the body.
• To detect minute fractures and soft tissue injury do the X rays and CT scan.

49. Post- Mortem detection of Torture
Torture technique Physical findings
1. Beating
General Scars, Bruises, Lacerations. Multiple fractures at
different stages of healing, especially in unusual
locations, which have not been medically treated.
To the soles of the feet, or fractures of the bones
of the feet.
Haemorrhage in the soft tissues of the soles of the
feet and ankles. Aseptic necrosis.
With the palms on both ears simultaneously Injuries to external ear. Ruptured or scarred
tympanic membranes.
On the abdomen, while lying on a table with the
upper half of the body unsupported (operating
table).
Bruises on the abdomen. Back injuries. Ruptured
abdominal viscera.
To the head Scars, Skull fractures, Bruises. Haematomas.

50. Torture technique Physical findings
2. SUSPENSION
By the wrists Bruises or scars about the wrists. Joint
injuries.
By the arms or neck Bruises or scars at the site of binding.
Prominent lividity in the lower extremities.
By the ankles Bruises or scars about the ankles. Joint injuries.
Head down, from a horizontal pole placed under
the knees with the wrists bound to the "Jack".
Bruises or scars on the anterior forearms and
backs of the knees. Marks on wrists and ankles.
3. NEAR SUFFOCATION
Forced immersion of the head in water, often
contaminated (wet submarine, pileta, latina)
Faecal matter or other debris in the mouth,
pharynx, trachea, oesophagus or lungs, Intra
Thoracic petechiae.
Tying of a plastic bag over the head (dry
submarine)
Intra thoracic petechiae

51. Torture technique Physical findings
4. SEXUALABUSE
Sexual abuse Sexually transmitted disease. Pregnancy. Injuries
to the breasts, external genitalia, vagina, anus or
rectum.
5. FORCED POSTURE
Prolonged standing Dependent edema. Petechiae in the lower
extremities.
Forced straddling of a bar (saw horse) Perineal or scrotal hematomas.
6. ELECTRIC SHOCK
Cattle prod Burns: appearance depends on the age of the
injury. Immediately: red spots, vesicles. Within a
few weeks: circular, reddish macular scar, white,
reddish or brown spots resembling telangiectasis.

52. Torture technique Physical findings
6. ELECTRIC SHOCK cont….
Wires connected to a source of electricity
Prolonged Heated metal skewer inserted into the
anus (Black Slave)
7. MISCELLANEOUS
Dehydration Vitreous Humour electrolyte abnormalities
Animal Bites (Spiders, insects, rats, mice, dogs) Bite marks

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