Table 4: Evident Trauma and Number of Victims

electric shock while drying clothes on a wet rope. Of the 23 cases for which postmortem reports were available, fi ndings in three were suggestive of physical trauma (Table 4). In two cases, the causal relationship was a possibility, but not definite. In the remaining 18 cases, psychological trauma was definite in one case; it could have contributed to death in nine cases; and was a possibility in eight cases.

Discussion

The low number and percentage of custodial deaths for which autopsies were conducted in the Government Medical College, Thrissur, correspond to fi gures that have been cited in media reports and the findings of non-governmental organisations (NGOs). The chances of cases having been under-reported or concealed were remote because Kerala has a very vigilant media, active political organisations and knowledgeable human rights activists. In the year of its establishment, 1993-94, the NHRC received only 496 complaints of violation of human rights from all over India. The number has steadily increased over the years and it received 1,00,616 compla ints during the fi nancial year 2007-08 (NHRC 2008).

The lack of any recorded crime in the case of four victims is a matter of concern. They had been arrested and detained for interrogation by the police, who had received information on their possible involvement in crime. There appears to have been a serious violation of human rights in these cases.

Death occurred in two cases because of subarachnoid haemorrage. Subarachnoid bleeding usually causes instantaneous death even though the mechanism in which this happens is not very clear. There could be cardiac arrest caused by

For interrogation 4

No crime 1

Total 3

Table 2: Crime Details and Number of Cases

Crime Number

Subjected to interrogation 4

Convict prisoners 6

Remand prisoners 8

Under trial prisoner 1

Accused of crime 4

No crime 1

Total 23

Table 3: Causes of Death and Number of Cases

Cause Number

Coronary Artery Disease 5

HIV and infection 4

Other infection 3

Subarachnoid haemorrage 2

Hanging 2

Electrocution 1

Perforation 1

Aspiration 1

Poisoning 1

Myonecrosis 1

Pheochromocytoma 1

Unknown 1

Total 23

service or the psychiatric service. It includes death while being pursued by the police or while being detained in a prison or psychiatric institution.

Autopsies conducted in the Government Medical College, Thrissur, Kerala, during the period 2005 to 2007 were crime. Of the remaining five, four were in the custody of the police for interrogation but no charges had been fi led against them and one was not related to any crime. The last was a female trainee in the police training academy (Tables 1 and 2).

Coronary artery disease was the single largest cause of death, accounting for five cases (Table 3). Four deaths were from HIV-related infections and two from subarachnoid haemorrage or bleeding, a form of stroke. There were two cases of hanging, one of poisoning and one of electrocution. The poisoning was from excess consumption of ethyl alcohol and the electrocution was an a ccident when the victim suffered an

COMMENTARY

the sudden bathing of the brain stem in blood when a jet of arterial blood impinges on the base of brain. Life-threatening cardiac arrhythmias can also occur in patients with subarachnoid haemorrhage. Causes of subarachnoid bleeding include high blood pressure, physical exertion, emotional stress or head injury (Kadoji and Barac 2001). Strokes can occur in a paroxysm of rage or other strong emotion, possibly because of a sudden rise in blood pressure. There is evidence that the role of emotional stress is greater in patients with subarachnoid haemorrhage than in those with cerebral berry aneurysm (Storey 1969). The mere presence of a demonstrable patho logy does not exclude the possibility of trauma.

The possible contribution of alcohol intoxication to cause of death is a known phenomenon. Alcohol is capable of decreasing myocardial contractility and the amount required to do this is low if the heart muscle is damaged or there is a long history of heavy ingestion (Klatsky 1982). Heavy drinking is associated with the increased risk of sudden death (Wannamethee and Shaper 1992). Those heavily intoxicated are not adequately cared for in police custody and when a medical crisis occurs, police offi cers do not have the support, resources, skill or training to provide the required intervention.

The role of emotional stress in coronary heart disease has been scientifi cally documented (Lecomte et al 1996). Stressful cardiac sudden death occurs almost instantaneously in those with severe heart diseases, with 75% occurring during stress or in minutes after it. Episodes of acute emotional stress can have signifi cant adverse effects on the heart.

The cause of death in one victim was pheochromocytoma, a rare tumor of the adrenal glands that results in the release of too much epinephrine and norepinephrine, hormones that control the heart rate, metabolism, and blood pressure. Paroxysms or crises occur in more than half of patients suffering from this disease and they can be precipitated by any activity that displaces the contents of the abdomen. Although psychological stress does not usually provoke a crisis (Landberg and Young 2005), an assault on the abdomen can contribute to it.

Economic & Political Weekly

EPW

In natural death due to infectious diseases, the inadequacy of treatment could play a part. This could be an issue to consider when looking into deaths due to HIV-related infections. The unknown cause of death in one case may be attributed to excited delirium. The very act of resisting arrest could trigger excited delirium in some people. The bizarre and threatening behaviour of individuals in delirium usually provokes a police response (Wetli 2005).

Custodial deaths tend to occur when ordinary policemen who fi nd themselves unable to generate evidence or get a confession within a short time frame step over the line. The pressure on them to file a charge sheet within an unrealistic deadline is often added to by superior officers, social activists and the media. There is usually no vengeance as such against a victim and the police action cannot, strictly speaking, be equated with murder. However, the police or custodian is responsible for providing a decent and protective environment to all detainees. Ordinary policemen are either not very aware of this obligation or it is superseded by the pressure on them to immediately fix responsibility for a crime.

There should be a zero tolerance policy for any violation of human rights in custody. A scientific, professional and humane approach towards persons detained for investigations has to be emphasised. Full use of up to date interrogating skills and forensic science techniques will minimise the need to use physical torture during interrogations. Accordingly, police personnel should be trained to specialise in investigation procedures (NHRC and PRAJA 2006). Bifurcation of the police into two separate wings, one to deal with criminal investigations and the other to maintain law and order, would be of benefi t.

The United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment is an international human rights instrument that was signed by India in 1997. In May 2010, the Lok Sabha passed the Prevention of Torture Bill, 2010, which is aimed towards ratification of the UN convention and seeks to prohibit torture, among other places, in custody. In case

of deaths in custody, an inquiry by a judicial magistrate is mandatory and a report has to be sent to the NHRC within 24 hours of its occurrence. There is a need for scrupulous implementation of the procedure established under Section 176

(1) of the Criminal Procedure Code (CrPC). In addition, forensic experts and laboratories must be involved because their expertise and scientific mode of investigation can assist in preserving accurate and reliable evidence (NHRC 2008).

The establishment of custody centres independent of the police department has been proposed as an alternative model. Anyone taken into custody by the police has to be immediately transferred to a custody centre. The custody centres are to be run by social welfare departments and their security arrangements are to be provided by prison departments. Round-the-clock monitoring by closed-circuit cameras has been mooted and is probably advisable. Health departments are to be responsible for the healthcare of the inmates and there are to be mandatory health check-ups at the time of entry and exit. On application, the police will be able to take any inmate from this centre for interrogation. But they will have to return the person to the centre after interrogation. Only convicted criminals are to be jailed in prisons. It would be preferable to have exclusive interrogation teams in the police department that specialise in the process of gathering evidence from those detained.

Procedures for Physicians

The Istanbul protocol, which became an offi cial UN document in 1999, is a set of international guidelines for documentation of torture and its consequences. It lists the steps and procedures to be followed by physicians when they come across victims of torture. This needs to be adapted and extended to victims of torture who may have died in custody as well. It is high time a new system was evolved in India to investigate the causes of death in custody and other suspicious deaths. In many US states, a medical examiner’s inquest is a formal hearing that is held into the causes and circumstances of death that results from violence in custody or in conditions which give reason to suspect that a death

COMMENTARY

may have been due to a criminal act or criminal negligence. It is conducted to make a formal determination of the cause and manner of death to allow further legal proceedings. In addition to establishing the cause and manner of death and possible criminal liability, the open inquests serve as forums to bring about changes in laws and regulations or to create public awareness of related health and safety issues (Allegheny County 2010).

In India, the magisterial inquest system is the current procedure for investigating custodial deaths. In this, an executive magistrate holds an inquest and the body is forwarded through the police to the office of the police surgeon for autopsy. Further investigations are carried out by the deputy superintendent of police. If the death has occurred in jail, a judicial officer inspects the body before the inquest. However, this system suffers from weaknesses. The designation of a doctor as a police surgeon can raise suspicions among the public and an executive magistrate is not really a professionally qualified person to hold an inquest. A team led by a magistrate, which includes a medical professional, forensic expert and a nominee from the human rights commission, would be ideal for conducting an inquest. The way things are, the medical examiner’s system prevalent in the US seems to be a better option.

We acknowledge the limitations of this study. In cases of death in custody, the first information report (FIR) prepared by the police, the details of the inquest, views of the victim’s relatives and colleagues, interviews with the alleged perpetrators and the final verdict of the court need to be examined. This study is a preliminary one and it is expected to draw the attention of scientists from various disciplines to this area.

References

Allegheny County (2010): “Medical Examiner’s Inquest”, Allegheny County, Pennsylvania, at www.alleghenycounty.us/me/inquest.aspx, accessed on 1 August 2010.

Chan, Theodore C (2006): “Medical Overview of Sudden In-Custody Deaths” in Darrell L Ross and Theodore C Chan (ed.), Sudden Deaths in Custody (New Jersey: Humana Press, Totowa).

Kadoji, Dragutin and B Barac (2001): “Stress as a Possible Factor Facilitating Subarachnoid Hemorrhage”, Neuroepidemiology, 20, pp 45-46.

Klatsky, A L (1982): “The Relations of Alcohol and the Cardiovascular System”, Annual Review of Nutrition, 2, pp 51-71.

Lecomte, Dominique, Guy Nicolas and Paul Fornes (1996): “Stressful Events as a Trigger of Sudden Death: A Study of 43 Medico-legal Autopsy Cases, Forensic Science International, 5, pp 1-10.

Landberg, Lewis and James B Young (2005): “Pheochromocytoma” in Dennis L Kasper, Eugene Braunwald, Anthonys Fauci, Stephen L Hauser, Dan L Longo and J Larry Jameson (eds), Harrison’s Principles of Internal Medicine, 16th edition, McGraw Hill, New York, pp 2148-52.

McCall, Marissa (2003): “Deaths in Custody in Australia: National Deaths in Custody Program (NDICP) Annual Report”, Australian Institute of Criminology, Canberra.

National Human Rights Commission (2008): “Some Important Interventions of NHRC”, 21 August, New Delhi, at nhrc.nic.in/dispArchive.asp? fno=1589.

– (2008): Proceedings of Workshop on Detention, NHRC, New Delhi.

National Human Rights Commission and Penal Reform and Justice Administration (PRAJA) (2006): “NHRC’s Recommendations on Custodial Justice”, at nhrc.nic.in/disparchive. asp?fno=1375.

Storey, P B (1969): “The Precipitation of Subarachnoid Hemorrhage”, Journal of Psychosomatic Research, 13, 2, pp 175-82.

UN High Commissioner for Human Rights (1999): “Istanbul Protocol: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment”, at http://www.unhchr, accessed on 3 March 2011.

Wannamethee, Goya and A G Shaper (1992): “Alcohol and Sudden Cardiac Death”, British Heart Journal, 68 (5), pp 443-48.

Wetli, C V (2005): “Excited Delirium” in Jason Payne-James, Roger W Byard, Tracey S Corey and Carol Henderson (ed.), Encyclopedia of Forensic and Legal Medicine (London: Elsevier Academic Press), pp 276-80.

Ziegelstein, Roy C (2007): “Acute Emotional Stress and Cardiac Arrhythmias”, Journal of the American Medical Association, 298 (3), pp 324-29.

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march 24, 2012 vol xlviI no 12