Memoirs of a forensic medical practice* Professor Niriellage Chandrasiri, President, College of Forensic Pathologists of Sri Lanka Memoirs can be a collection of pleasant and unpleasant reminiscences over a period of time arising from personal experience. Life without pleasant and unpleasant experiences is not worth the while. What is important is that we should learn about human nature and the subject we profess to know from these experiences and shape our lives, and enhance our knowledge and skills in relation to our work, to live as happily as possible till we die. I will therefore speak of some of my personal experiences as well to highlight human nature and some of the difficulties of my chosen profession. These comments are made without an iota of anger, vengeance, rancor and disrespect, but rather to highlight the weaknesses in the present medico-legal services in Sri Lanka. It is my belief that these comments will be taken in the intended spirit and those affected will reflect on the issues addressed. Beginning a career in forensic medicine I commenced my full time judicial medical career in 1970, as a lecturer in forensic medicine at the University of Peradeniya, under the tutelage of former professor Harischandra Ranasinghe, who later migrated to United Kingdom and became a Home Office Pathologist to Newcastle area. I moved to Galle in 1981. Since then I have been fortunate to practice clinical forensic medicine and forensic pathology in Sri Lanka and forensic pathology intermittently in the UK, USA, Singapore, Cyprus, Bosnia and East Timor. Early in my career I had to conduct autopsies on makeshift tables. A significant feature of section 370 of the Criminal Procedure Code is that it neglects to stipulate the minimum conditions in which autopsies are to be conducted. This resulted in situations where the investigating police would hurriedly construct temporary autopsy tables with coconut or bamboo rafters. Often only a single bucket with a little water was supplied! Obviously this must have been the standard practice, because the doctor never did the autopsy examination, but was a passive onlooker. I must say that things have changed now, and only a stupid doctor would allow an untrained and unskilled labourer to do the autopsy examination. The place of the Judicial Medical Officer in Sri Lankan society Most common folk look upon Judicial Medical Officers as glorified cutters of dead bodies, “menee kapana dosthara”, while a few more educated people look upon them as Sherlock Holmes-style characters. In fact they do not belong to either category. The public is unaware of the role played by the Judicial Medical Officers. Some members of the public even consider them to be lapdogs of the police and the state counsel. There are many reasons that people have been misguided. One reason is the poor attitude of fellow specialists in the medical profession. A Judicial Medical Officer sometimes has to give evidence against a practicing colleague, and this has lead to antipathy towards them. This attitude is unfair when it is realized that a lawsuit against a careless and errant doctor is the only safety mechanism available for the patients. The other main reason for misunderstanding is that up to recent times the judicial medical services—except in the metropolitan areas—have been managed by untrained doctors rendering a poor quality service. The shabby treatment of forensic officers by the courts The surgeons who have treated patients are often reluctant to give evidence in civil trials, because they don’t want to face stiff cross-examination and undergo humiliation in court. It is in these instances that the respondent has to obtain the services of a forensic expert. The experienced Judicial Medical Officer is an anathema to both state and defence counsels. One or two state counsels have made disparaging remarks to me when I did not agree with them. Oftentimes defence lawyers, and even the prosecution lawyers, object when the forensic medical expert gives an opinion in compensation cases. Clinical forensic medicine is a distinct entity and includes examination of persons who are hurt from various agents, subjected to sexual assaults and produced by police and courts to the forensic expert. Their objections are on the grounds that the forensic expert has not treated the person concerned. The unfortunate part is that some judges are quick to accept this line of thinking. This is a frivolous objection, because the forensic expert is fully entitled to express opinions on the nature of temporary and permanent injuries sustained. It is also ironic that a forensic medical person is considered an expert and darling of both the prosecuting and defence counsels whenever it suits them, but at the same time is requested to leave the courtroom when lay witnesses give evidence in court. Judges too hastily uphold this request, humiliating the medical expert. In my career only one trial judge had the courage to say that medical experts are entitled to stay in the courtroom at all times, which is the practice in the UK, from where we have imported our legal system. No one seems to bother about the loss of time incurred by a forensic expert appearing in court. The judges and lawyers must realize that most forensic experts have other responsibilities to their paymasters. Those in the universities have to publish research papers or perish. The District Medical Officer may have had to cancel clinics and even come to court when there is a patient requiring close attention. Cases are postponed without a whimper when senior and well-known lawyers make requests, but some judges are swift in issuing bench warrants to young forensic experts who fail to appear in courts for genuine reasons like non-receipt of summons or police messages. Sometimes I have wondered whether I have been made the accused. I am sure some of my colleagues will have faced such embarrassing situations. These are instances that call for dialogue between the Chief Justice, council of the Bar Association and the College of Forensic Pathologists of Sri Lanka, to arrive at a consensus on where medical experts should be offered minimum courtesy. Role of the Inquirer into Sudden Deaths in Sri Lanka Sri Lanka has a unique officer called an Inquirer into Sudden Deaths, appointed by the Minister of Justice to conduct inquests according to the provisions of the Criminal Procedure Act and the Judicature Act. The inquirer is the only layman appointed to a quasi-judicial post in Sri Lanka without a law degree or without being registered as a lawyer in the law college. According to sections 370, 371 and 373 of the same Criminal Procedure Act, magistrates and inquirers are only expected to ascertain the identity of a dead person, and to ascertain whether their death was due to accident, suicide, homicide or natural causes. There is nothing binding on the inquirers to ascertain the true cause of death of a person by getting an autopsy examination done from a government medical officer. Both magistrates and inquirers too often depend on the statements of witnesses to arrive at a final verdict. In fact, many inquirers avoid getting autopsies done by a medical officer. The reasons for their reluctance include a willingness to yield to pressure from relatives, politicians and others, and a few other reasons only too well known to the inquirers themselves. Avoiding autopsies and giving verdicts that indicate death by natural causes has led to failure in detection of secret homicides. The second post-mortem examinations done after several days or months of delay often make detection of true cause of death difficult even for a highly experienced forensic pathologist. Inquirers in the provinces have the habit of finding fault with a person or persons apparently associated with the death of another person on the basis of the evidence submitted at the inquest. In my opinion this is highly irregular, because the inquirer has no powers of a judge conducting a trial, and yet often these proclamations appear in the national newspapers. Forensic pathologists and the scene of a crime The next issue I would like to stress is the extremely poor quality of scene examination in secret and open homicides in Sri Lanka. Too often we see uniformed police officers, magistrates and clerical staff in their civil clothes—none wearing gowns, masks and gloves—gazing at dead bodies in front of massive crowds. More often, bodies are covered with dried thatched coconut palm leaves, an act that is insulting to the dead. Matters are made worse when these scenes are videotaped and shown on television. The police department should train police officers on how they should behave and assist the Judicial Medical Officer at the scene of a homicide. Each headquarters police station should have a still-photography and video unit, and the local police should be able to obtain their services quite easily. After receiving information that a homicide has occurred, at present the police should inform the area magistrate. Most magistrates do not come to the crime scene until they finish hearing all the cases for that day, usually late in the afternoon. By the time the magistrate comes, the body may have undergone some drying due to exposure by the sun, and decomposition, and so many things may have been added to or even removed from the scene because of police inattentiveness. Meanwhile, the unfortunate Judicial Medical Officer has to wait twiddling his thumbs and kicking up his heels till the arrival of the magistrate, after which the magistrate may give orders to the medical officer to do the autopsy at an unsuitable time. In fact the situation in the UK was similar to what is happening at present in Sri Lanka, but under the coroners’ rules of 1953, coroners in the UK were relieved of the authority to investigate the crime scene. Secret homicide Secret homicide has occurred since time immemorial and will continue so long as the human race survives. I conducted about 30 cases of secret homicide in my forensic practice in the Southern Province. All these cases were challenging. Detection of secret homicide is perhaps an instance where the skills of the forensic pathologist are stretched to the limits. To detect secret homicide, the investigating police, crime scene officer and Judicial Medical Officer should work in close cooperation with the necessary back up facilities such as the services of a photographer, toxicologist, histopathologist, ballistic expert, serologist, finger print experts and molecular biologist. This is not happening in Sri Lanka. There is a severe lack of these ancillary facilities. One often wonders why they conduct judicial autopsies under such primitive conditions at all. Torture by the police Torture is still practiced by police officers in Sri Lanka. Even with the establishment of the National Human Rights Commission by an act of Parliament, torture of those arrested by the police takes place. Several workshops held have been of no avail. The Commission will have to seriously think of adopting new methods to curtail torture. Conclusion A forensic expert has to obtain accurate background information regarding the case that is being examined or subjected to autopsy and it is the responsibility of the investigating police to provide such information. This is exactly what is lacking in Sri Lanka. Often the police officer submitting the person for examination or bringing the autopsy order is quite unaware of the background details. The police should realize that the medical officer compares the findings with the history obtained and gives an opinion. However the experience of the medical officer is the most important factor in arriving at the correct interpretation. The value of an accurate history in a chronological order cannot be overemphasized. * This text consists of extracts from the inaugural lecture given by Professor Niriellage Chandrasiri as new president of the College of Forensic Pathologists of Sri Lanka, 5 October 2002. The concluding paragraph in particular has been taken from a different part of the original speech.