The death of 24-year-old Tabrez Ansari in Seraikela-Kharsawan district of Jharkhand on June 17, after being attacked by an irate mob on the suspicion of theft, made national headlines. A video that went viral later showed Tabrez being tied to a pole and thrashed and forced to chant “Jai Shri Ram” after he was allegedly caught stealing a motorcycle.
After the assault, Tabrez had been arrested on charges of theft and sent to judicial custody. Four days later, he was rushed to a local hospital where he succumbed to injuries sustained after the assault.
Later, as the postmortem reported mentioned cardiac arrest as the cause of death, the murder charges against the 11 men who had been arrested for the attack, was brought down to homicide not amounting to murder.
“The bone fracture is a grievous injury caused by a hard and blunt object. The combined effect of the bone fracture and blood in heart chambers resulted in a cardiac arrest,” says the document signed by five doctors who did the autopsy.
Citing the postmortem report that said that Tabrez died of “cardiac arrest”, and that it was “not a case of pre-meditated murder”, police filed the chargesheet last month under Section 304 (culpable homicide not amounting to murder).
Can autopsy report be wrong?
The most recent development in the case is a document signed by five heads of departments of the MGM Medical College in Jamshedpur which suggests that Tabrez did eventually die due to cardiac arrest, which was the result of severe injuries (a combination of a skull fracture, pale organs and filling up of blood in his heart chambers).
However, many professionals from the medical fraternity feel that the diagnosis of cardiac arrest is being misused to protect the murderers and have opined on how postmortem reports could be misleading.
Public health doctor and researcher Dr Sylvia Karpagam feels that 50-60 per cent of postmortem reports are incorrect and divert the issue away from the facts or the crime itself.
“When you simply say cardiac arrest in the report, you are basically erasing the patient’s history. No matter what has happened with the victim, the heart will eventually stop beating,” she says.
“The biggest issue is that the forensic department in our country is poorly funded and doesn’t have even the most basic facilities. It also oversteps its boundaries sometimes and the reasons could be lack of medical ethics or the intention to protect the accused. The postmortem reports are misleading because it is either done deliberately or there are people who can influence the outcome of the reports and negotiate with the family members of the deceased,” she says.
Dr Sylvia says such reports will help only in minimal ways, even for rape cases. “There is also the caste/class discrimination that comes into play. We have seen in many cases how the police is openly affiliated to the people in power. I have even seen large private hospitals favouring the accused.”
Cardiac arrest can’t be the cause, say docs
A postmortem report contains only possible factors which have contributed to the death, and do not mention other ailments that are irrelevant to the cause of death.
Doctors say that there are hierarchies in medical specialties too, in which cardiology, paediatrics and general medicine/surgery come on top. Forensic medicine itself is on the sidelines in our country as it is often associated with dead bodies, unlike in the west, where forensic science is considered lucrative. It is also important to note that not every doctor is specialised in forensic medicine.
Dr Mohan Rao, a former professor at the Centre of Social Medicine and Community Health, JNU, New Delhi said that cardiac arrest could be a proximate cause, but not the forensic cause. “I agree that the diagnosis of cardiac arrest is used in many cases to defend the perpetrators and one of the reasons could be political pressure,” he said.
Others feel, it could also be due to ignorance by doctors, who are perennially overworked in public health system. Consultant paediatric surgeon, Dr Antony Robert said, “Doctors are taught this right at the time of training that cardiac arrest cannot be stated as the cause of death – it can be a mode. If a person consumes poison, his heart will eventually stop – but can cardiac arrest be the reason for his death? Of course, not! Medically speaking, cardiac arrest can never be the cause. Many junior doctors write postmortem reports without proper thought, because they are simply ignorant. Instead of pointing fingers at the medical or legal fraternity alone, we need to look at the collective conscience of society which we are also a part of. Media has to play the role of a watchdog.”
How a fabricated report can change stories
Social activist Teena Xavier of Karnataka Janarogya Chaluvali (Kalaburgi) said that the cause of death written for several maternal deaths in Gulbarga, Raichur and Bidar, is cardiac arrest, wherein she was part of the team which did the MDR (Maternal Death Review)/verbal autopsy. In the 2016-17, Gulbarga had reported the highest number of maternal deaths in Karnataka.
The victims’ families, most of whom are illiterate, were given the impression that the mother died due to heart attack, while the reasons were maternal sepsis, postpartum haemorrhage and unavailability of an ambulance among others. This happened in government as well as private hospitals, either to avoid allegations of medical negligence or fear of violence from the deceased’s family. “The death note or discharge summary was made too technical, just so that a non-medical person wouldn’t understand it,” Xavier added.
Dr Veena Shatrugna, former deputy director of National Institute of Nutrition (NIN) points out that cardiac arrest is not a diagnosis, it is rather a cause of death. And the cause of death depends on circumstances and findings of the forensic report.
“We need to look at what resulted in the death in these circumstances (including the video evidence) which are staring at us. Something has led to cardiac arrest. But who’s to tell? The police is supposed to prosecute. I feel it is unusual that the media is giving this case so much coverage; there are many such cases where justice is denied. In my experience with NIN, I have seen several cases of starvation deaths wherein the main cause (starvation) doesn’t show up in the post-mortem,” she said.
Dr Karpagam quotes the case of a 10-year-old girl who was allegedly gang raped in 2015, one of the accused being an Assam minister’s son. “Though the pediatrician at MS Ramaiah hospital said it was sexual assault, the postmortem report stated it was dengue. Dr Karpagam had submitted the following observation after visiting Sanjay Nagar police station on July 14, 2017.
“The postmortem said that the child had a cut inside the mouth. She also had a cut in the rectum around which there were signs of bleeding. This does not correlate with the signs associated with dengue hemorrhagic fever (DHF) although the forensic report claims that to be the cause of death. DHF is associated with gradual onset of bleeding and often over a period of a few hours to days. The postmortem in DHF will show small bleeding spots (petechiae) due to platelet deficiency in multiple parts of the body due to decreased platelet count,” she added.
“However in this instance there is very much localised point of bleeding in the rectum which makes a diagnosis of DHF unlikely. In this instance, going by the history offered by the ‘mother’, although the child had fever, there were no clinical signs or symptoms suggestive of dengue hemorrhagic fever.”
Dr Karpagam feels that justice was denied to the minor girl and the reason this case fell through was primarily because of the postmortem report. They later approached the Child and Welfare Committee (CWC) too, but CWC couldn’t counter the medical report.
The case of 21-year-old undertrial Syed Firoz who died in January this year after he was allegedly assaulted by prison staff at the Parappana Agrahara Bengaluru Central prison is another prominent example of doctors obstructing justice by fabricating the postmortem report. The medical reports state that Syed died of “pneumonia and acute respiratory distress syndrome, which could have been caused to due to secondary complications of injuries that were found on the body”. According to the letter by the fact finding team addressed to the DCP (South East), prison doctor Dr Pramila in her statement said that “Firoz’s fresh injuries had nothing to do with the alleged assault at DJ Halli police station.”
But medical observation based on photographs and information gathered during the fact finding visit stated that from the photos and history it appears that Fairoz sustained blunt injuries on his lower limbs and the reddish bluish discoloration shows that it was not more than a week old. It was found that the immediate cause was “multi-organ failure”, the antecedent cause was gangrene (blood clots) and the underlying cause was a blunt injury.