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Forensic investigations into custodial deaths: Pathologists face logistical and socio-cultural challenges: Case studies

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BY Ruwan Laknath Jayakody In addition to the challenges faced with regard to establishing the causal factors in custodial deaths, pathologists also face logistical and socio-cultural issues in forensic investigations, local case studies noted. The logistical issues pertain to the lack of facilities such as equipment, radiology, photography, histology (special stains), biochemistry, microbiology, and DNA which hinders the forensic investigation, while the socio-cultural practices pertaining to deaths, where the relatives demand a quick postmortem or the release of the body without conducting a postmortem examination in order to organise the funeral, are other affecting factors. These observations were made in a research article on “Postmortem examinations of deaths in police custody: Challenges faced by forensic pathologists in Sri Lanka in relation to causal factors”, which was authored by University of Kelaniya Faculty of Medicine Department of Forensic Medicine Senior Lecturer P.A.S. Edirisinghe and published in the Sri Lanka Journal of Forensic Medicine, Science, and Law 1 (2) in January 2011. The conduct of a postmortem examination into a death that took place whilst in police custody requires, Edirisinghe noted, both prior planning and organisation, as such is aimed at finding the cause of death and addressing other medico-legal issues related to the arrest and custody. In this regard, although the detained individuals are suspected to have broken the law, all investigators have both a legal and ethical duty to safeguard and ensure their human rights. As A. Leigh, G. Johnson, and A. Ingram pointed out in “Deaths in police custody: Learning the lessons”, this dual responsibility of the investigators, especially of the Police, makes any death that takes place whilst in police custody potentially controversial. Hence, Edirisinghe presented two cases of deaths that have taken place in custody and the challenges faced by forensic pathologists in dealing with postmortem examinations concerning such. First case A 71-year-old male who actively engaged in cultivation had collapsed while being arrested by the Police for the possession of illicit liquor. He was pronounced dead on admission to the hospital. The postmortem examination revealed that the coronary arteries (arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle) were 60-80% occluded (obstructed) with sub-endocardial fibrosis (characterised by the development of restrictive cardiomyopathy [diseases of the heart muscle, where the walls of the heart chambers have become stretched, thickened, or stiff, and which in turn affects the heart’s ability to pump blood around the body] and fibrotic [the development of fibrous connective tissue as a reparative response to injury or damage] changes in the endocardium [the inner soft tissue lining of the heart within the cardiac chambers and constitutes the superficial surface of the cardiac valves]) and myocardial fibrosis (increased myofibroblast [contractile web-like fusiform – spindle-like shape that is wide in the middle and tapers at both ends – cells] activity and excessive extracellular matrix deposition). Minor injuries (abrasions and contusions/bruising) which were found on the forearms and the buttocks were diagnosed as injuries that could have resulted from an encounter with the Police, but they were deemed not sufficient enough to cause the death. A retrospective scene visit examination was conducted in order to find the extent of exertion prior to death. The final medical opinion concerning the cause of death was that “injuries, exertions, and excitement during the arrest had created an acute coronary insufficiency (patho-physiologic state that can initiate lethal cardiac arrhythmias [problem with the rate or rhythm of the heartbeat] in the absence of myocardial necrosis) which caused the death”. The police officers were subsequently charged with causing “grievous hurt”. Edirisinghe explained that although the cause of death was natural, the aggravation of the natural disease was brought on by and due to events related to the arrest – hence, the contribution of the arrest as a causal factor has to be accounted for. He cited J. Leor, W.K. Poole, and R.A. Kloner’s “Sudden cardiac death triggered by an earthquake”, which found an unexpected increase in individuals suffering from sudden cardiac deaths in the 1994 earthquake in Northridge, Los Angeles, the US, which were attributed to emotional stress-related adrenergic (working on adrenaline) stimulation, noting that in the instant case, the stress and adrenergic reactions led to the death of a cardiac compensated (heart failure means that the heart muscle does not pump as much blood as the body needs, and therefore, because the heart cannot pump well, the heart and the body attempt to make up for it, a process which is called compensation) individual. Second case A 25- year-old soldier who was arrested one night by the Police, on suspicion of robbery, was found dead in the police cell the following morning, hanging by the belt of his trousers. The mother of the victim alleged that the victim was tortured by the Police prior to death. The scene visit examination revealed that it was a complete hanging, and that the point of suspension could have been reached and thereby accessed by the individual. The autopsy revealed that there were no injuries except the ligature mark with imprint abrasions in the upper neck, which was directing upwards. The cause of death was provided as “ligature suspension of the neck”. The opinion on the analysis of the scene visit findings was that the death was compatible with self-suspension. Although a second postmortem examination was carried out one year later, there was no change made to the cause or circumstance of death. Leigh et al. and G.A. Norfolk’s “Death in police custody during 1994: A retrospective analysis” found that in the UK, 63% of deaths in police custody during the 1990-1996 period were due to actions on the part of the deceased, where deliberate self-harm from hanging was the number one cause. Moreover, J. Lohner and N. Konrad’s “Deliberate self-harm and suicide attempt in custody: Distinguishing features in male inmates self-injurious behaviour” and H. Inch, P. Rowlands, and A. Soliman’s “Deliberate self-harm in a young offenders institution” noted that deliberate self-harm is a documented phenomenon in offenders in jails or in police custody, with suicide by hanging, as per Leigh et al., Lohner and Konrad, and Inch et al., being the commonest method. As Edirisinghe explained, this case highlights the issue of the difficulty in accepting this common phenomenon, although statistics around the world show similar trends. In this case, even though comprehensive postmortem reports and scene visit reports were given to the courts, an exhumation and second postmortem examination resulted where neither the cause of death nor the number of injuries changed. This, he pointed out, highlights the issue of unnecessary expenses incurred by the Government for the mere satisfaction of the family. There are, according to Leigh et al.; Norfolk, W.L. Wobeser, J. Datema, B. Bechard, and P. Ford's “Causes of death among people in custody in Ontario”; and J. Curnow and J. Joudo’s “Deaths in custody in Australia: National Deaths in Custody Programme 2007”, three types of categorisations of deaths in police custody based on the causal factors – namely, (i) deceased on actions, (ii) deceased on medical condition, and (iii) another person’s action –  may have been associated. In Sri Lanka, forensic pathologists frequently encounter custodial deaths in the context of routine autopsy examinations. As noted in the Wijedasa Liyanarachchi murder trial, the opinion expressed by a pathologist in the investigation of police custodial death plays a crucial role in finding the culpability, especially in those cases which are related to torture.

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