He is neither an MBBS graduate nor a forensic expert. He is a Class five dropout. But Santosh Sidhu, 61, knows how to wield a scalpel, cut and stitch a dead body and look for assault marks, skills he learnt by observing medical officers. Now retired, Sidhu claims he conducted more autopsies than medical officers at St George Hospital in South Mumbai, where he was posted as a peon but not only swept the floor but also lifted dead bodies, conducted autopsies and presented his observations to doctors who signed autopsy reports at the state-run hospital. That, despite the hospital having 13 medical officers to conduct autopsies, was his job profile since 1983. He retired in May 2015, having been a mortuary assistant for 32 years.
“Ab aur dead body nahiho payega (no more dead bodies now),” he sighs.
Across the 10 post-mortem centres in Mumbai, there is either a shortage of forensic experts or dependence on class IV employees to conduct autopsies. Also, there are now few takers for post graduate specialisation in forensic sciences. Says Dr Pravin Shinghare, director at the Directorate of Medical Education and Research (DMER), “Very few want to deal with the dead. They would rather treat live patients.”
Since 2013, Maharashtra’s four seats for a diploma in forensics have gone vacant. The government offers 19 seats for an MD in forensics. In 2014, 16 of the 19 seats went vacant, in 2015 eight were vacant.
With fewer doctors specialising in forensics, the existing 27 MDs in forensics in Mumbai shoulder the burden of over 60 autopsies each day, aided by Class IV workers.
“India has a low conviction rate indirectly linked with forensics. In several cases, because the post-mortem reports are erroneous or conducted by inexperienced MBBS doctors, the conviction of the accused is affected,” said Dr Rajesh Dere, assistant professor at Sion hospital’s forensic department.
In 2011, an MBBS doctor at R N Cooper hospital conducted the autopsy of a post-graduate student Mukund Kedia and stated cause of death in his report as “suggestive of coronary artery heart disease”. Kedia was found dead in his Santro car and police suspected foul play. A second opinion was taken from KEM, Sion and Nair Hospital, all of which unanimously stated Kedia died due to smothering, not a heart attack. This year, the Maharashtra Medical Council finally suspended the licence of the Cooper Hospital doctor who wrote the original autopsy report.
Sidhu discusses how MBBS doctors are not even trained to conduct autopsies. After he was transferred from the general ward to the post-mortem center in 1983, Sidhu started observing a forensics expert from JJ hospital and then began cutting bodies himself.
Data gathered by The Indian Express indicates that of 64 sanctioned posts for doctors in all autopsy centers combined, there is a 34 per cent vacancy. Five post-mortem centres in Mumbai are handled by the state government, three by the civic body, and two by DMER. The situation is worse in the centres of the state government, in which seven posts of 16 have been vacant for two years. A new centre at Siddharth hospital has not seen doctors’ posts yet.
Dr S M Patil, police surgeon of the four state-run centers, admitted, “For the last three years there have been no recruitments. I have forwarded the request to the home department several times.” The recruitments are conducted by Maharashtra Public Service Commission (MPSC) which has been slow in filling up posts.
The reason for the low interest in forensic sciences is multi-pronged. Job opportunities lie in only government hospitals, which pay less, and private hospitals are not permitted to conduct autopsies.
Dr Pawan Sabale, lecturer at Nair Hospital since 2009, is due for promotion since August 2014. “Despite a vacancy for assistant professor’s post, administrative delay has hampered my promotion. The civic body and the MPSC are both to be blamed,” he complains. A lecturer is eligible for promotion to assistant professor after five years of joining service. According to Sabale, several colleagues quit due to slow growth.
Like him, Dr Vinod Chaudhay waited for two years till 2013 before he quit Nair hospital to join Puducherry-based Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). “I had several seniors lined up for promotion ahead of me. None of them was getting promoted on time. One waited for 12 years. I knew I had to quit to get better growth opportunities,” Chaudhay, now an assistant professor in forensics at JIPMER, said.
With the pool of forensic experts draining, state government, police and judiciary is relying heavily on MBBS doctors and unqualified mortuary workers in medico-legal cases. An MBBS doctor gains theoretical knowledge from books such as ‘Parikh’s textbook of Medical Jurisprudence and Toxicology’ or ‘Modi’s textbook of Medical Jurisprudence’. “Just observing is not enough. When they are made to actually conduct one in service, they don’t know what to look for,” said Dr Indrajit Khandekar, forensic expert in Wardha.
At JJ hospital, a 45-year-old Class IV worker who cuts bodies says that whenever a body is brought in, if the case is not “high-profile”, the medical officer simply stands by the autopsy table. They ask what the injuries are and note these down. “The entire autopsy is done by us. They just come, fill the form and sign,” says the man who has worked here for 10 years.
Diwan Singh, a retired mortuary attendant from KEM hospital, admitted that in the past, a worker had accidentally cut open the heart while attempting to open a body for examination. “Such incidents happen a lot. It can also change the post-mortem results,” he said, adding that family of deceased was then told that the body was cut accidentally.
So far, neither any guidelines nor any instructions have been issued by the state government for training staffers and medical officers for sensitization in post-mortem procedures. They all learn by observing their seniors. Patil, who heads the state-run centres, said, “State-run mandate is not there but there are accepted procedures about conducting post-mortems that are followed by everyone.”
Qualifications for experts MBBS doctor: A plain MBBS is supposed to observe, not conduct, 10 autopsies during graduation. Therefore there is no hands-on-experience until they conduct their first post-mortem. Several doctors The Indian Express spoke to admitted to have bunked autopsy classes in mortuaries due to either foul smell or lack of interest.
Diploma in Forensics: This is a one-year course pursued after graduation which mandates autopsies by the student under supervision.
MD in forensic medicine: This is a two-year course at post-graduate level. An MD is eligible for the post of lecturer in a medical college.
Concern over autopsy conditions
Dr Indrajit Khandekar, in-charge of state’s first Clinical Forensic Medicine Unit (CFMU), summarised the current autopsy services as “inadequate, incomplete, loose and lackadaisical, hence not reliable,” adding, “Such records are stumbling blocks in administration of criminal justice system.” Khandekar filed a public interest litigation in 2013 drawing attention towards the state of post mortem centers in Maharashtra, and has also submitted his recommendations to improve current practices in a study in 2013.
MBBS course lines up no practical session for post-mortem except for observation of 10 autopsies. The report advises to have practical tests in curriculum.