There is space for a more standardised practice in medico-legal death investigation in order to assure a high quality systematic approach so as to overcome the shortcomings of the present system and because there are advantages of converting to the medical examiner-based system.
These observations were made in a concept paper on “From colonial coroner to the American medical examiner: A way forward in the Sri Lankan death investigation system” which was authored by D.A.H. Samadhi and P.R. Ruwanpura (attached to the Office of the Judicial Medical Officer of the Karapitiya Teaching Hospital), and R.R.G.S. Amararatne (attached to the same Office of the Kalutara District General Hospital) and published in the Medico-Legal Journal of Sri Lanka’s Eighth Volume’s Second Issue in December 2020.
R. Hanzlick’s Death investigation: Systems and procedures notes that the examination, correlation, and interpretation of deaths are carried out under different legislations in different States which is critical for criminal justice while it also aids civil litigations. Its’ contribution in public health, especially in research, mortality analysis, the assessment of medical care, surveillance, prevention and control, personal liberty and freedom, and financial wellbeing are equally important. B. Carpenter, G. Tait, C. Quadrelli and I. Thompson’s “Investigating death: The emotional and cultural challenges for the Police” observes that one of the main challenges faced by the legal system is to facilitate a credible and objective process in order to investigate a death, and thence mete out justice by convicting the guilty and protecting the innocent.
History of forensic science
The origin of forensic science has a long history going way back to thousand years and is documented in China in an early transcript of the text titled the Washing Away of Wrongs by Sung Tz’u written in 1248 Anno Domini (AD). T.C. Chao’s “Forensic medicine: The changing roles for the challenges ahead” mentions the first recorded case of a death investigation by a medical expert, referring to the assassination of Roman General and Statesman Julius Caesar in 44 Before Christ where ancient Roman physician Antistius examined the dead body and concluded that out of the 23 stabs, only one penetrating injury between the left third and fourth ribs was fatal.
E.J. Rodrigues and M.P. Kantak’s “Panel autopsy” mentions that the first case of a magistrate ordered post-mortem examination was conducted in Bologna, Italy, in 1302 AD by a panel of three physicians on a body of a young man who had died under questionable circumstances. C.A. Wijebandara’s “Critical analysis of the present death investigation system in Sri Lanka” and L.J.M. Cooray’s “An introduction to the legal system of Ceylon” note that in ancient Ceylon, during the Kandyan Kingdom (1593-1815 AD), there had been an independent death investigation tribunal named the ‘Saakshi Balanda (look into the evidence)’, which inquired into the manner of suspicious deaths; but there is no evidence about a physician’s involvement in death investigations. R.P. Ruwanpura and M. Vidanapathirana’s “Historical landmarks of the evolution of forensic medicine and the comparative development of medico-legal services in Sri Lanka” observes that the British coronial system was implemented through 1883 AD as a modified model of the English coroners’ system. In 1958 AD, the United States (US) passed the Model Post-mortem Act which outlines the general classes of deaths that need to be investigated and was the framework for the states to develop their own laws regarding death investigation in their states. Over the years, these systems were indefinitely modified to fit the advancement of forensic investigations and social needs.
Autopsy systems around the world
There have been a number of systems of death investigations adopted in different geographical regions, which primarily differ by the office of the investigating authority. However, irrespective of the legal authority of the investigation, the autopsies are exclusively conducted by forensic pathologists.
R.G. Menezes and F.N. Monteiro’s Forensic Autopsy notes that in India, the Caribbean, and the Middle East, the death investigations are accomplished in the form of the inquest which is carried out by the Police and/or referred to the coroner or magistrate depending on the circumstances.
Scottish and Russian studies noted that certain types of deaths are investigated as fatal accident inquiries by a procurator fiscal who has the ability to impose a fiscal fine or a district attorney in continental Europe, the Russian Federation and Scotland.
A Scandinavian study noted that in their system, the investigation is done concurrently by the prosecutor general and the State pathologist.
A US study noted that in the medical examiner system, medical examiners who are trained physicians, pathologists, or forensic pathologists with jurisdiction over a county district or State can initiate an inquest and investigate a death or conduct a post-mortem examination in certain instances.
J. Moore’s “Coroners’ recommendations and the promise of saved lives” mentions that in the coronial investigation system, the office of the coroner originated in medieval England and then spread to countries subjected to the British empire such as Australia, Canada, and in certain States in America, with Sri Lanka inheriting the coroners system in the early 19th century, but that unlike in England and Wales, did not change the system significantly during the last 100 years.
Per C. Perera’s “After the tsunami: Legal implications of mass burials of unidentified victims in Sri Lanka”, regarding the death investigation system in Sri Lanka, the Coroners Act of 1887 led to the English death investigation system being adopted in Sri Lanka according to the provisions in Sections 367-373 of the Code of Criminal Procedure Act, No. 15 of 1979. There are however some differences in our system to what currently exists in England. The inquest conducted under the above legal provisions is different from legal or administrative inquiries. The inquest is essentially a fact finding exercise in order to reveal the cause and circumstantial background of a particular death and should not be confused with an inquiry against the accused/responsible persons. L.B. Fernando’s “Inquests and doctors” points out that therefore, an inquirer into sudden death is empowered to call upon any person, including treating physicians, documentation or any other relevant material.
Every inquirer, on receiving information through the Police, citizens or a medical officer in the case of a hospital death, that a person has committed suicide or has been killed by an animal, machinery or by accident or has died suddenly or from a cause which is not known, shall hold an inquest and the duly signed inquest report by such inquirer shall be forthwith forwarded to the nearest magistrate. If the notice or other material before him/her discloses a reasonable suspicion that a crime has been committed, the magistrate shall take a proceeding under Chapters XIV and XV of the said Code and in such event, the record of the inquiry and the inquirer’s report shall be annexed to the record of the proceedings before the magistrate. The inquest procedures are coordinated by the Police. R. Samaranayake’s “Inquest procedure: Medical officers’ point of view” notes that under special provisions of national security related enactments, an order for an autopsy may be issued by a High Court.
The significant advantages of the current coronial investigation system in Sri Lanka are autonomy, access to power, and the ability to represent the will of the electorate. However, this system is currently outweighed by its disadvantages.
Challenges and discrepancies
The medico-legal death investigation is a process in which there is an interconnection between few components and if any element is lacking, the investigation seems incomplete.
Most of the parts of the death investigation process are medically oriented which in turn needs the assistance of a medical professional, and apart from that, some investigations are more complex and necessarily need specially trained physicians. When a coroner/inquirer into sudden death gives his/her opinion to a medico-legal finding, it may not correctly refer to a medical opinion. This discrepancy has led to the unrelated and unpopular determination of the cause and manner of death for years in Sri Lanka.
R. Fernando’s “A study of the investigation of death (coroner system) in Sri Lanka”, which was done in 1995 in the Colombo University’s Faculty of Medicine, to analyse the causes and circumstances of deaths reported for an inquest, found that in 868 cases reported to the inquirer, the circumstances were not determined in 94 cases at the initial inquest proceedings.
S. Kodikara’s “Over a century old death investigation system in Sri Lanka: An appraisal for reforms” noted that there are enough incidents where the inquirers interpret the injuries and formulate their opinion beyond their limitation, and which contradict the view of the forensic pathologist. R. Fernando’s “Hadisi marana parikshana (sudden death investigations)” notes a case where the inquirer has reported post-mortem artefacts due to ant bites as injuries caused by a rifle butt.
Medical examiners are almost always physicians, usually pathologists and occasionally forensic pathologists. But, in certain states in America, a physician and not necessarily a pathologist, assists in the death investigation or functions like a coroner, when ideally, a medical examiner must be a forensic pathologist, thus assuring that the certification of death may be more reliable and accurate and will positively modify the quality of the death investigation system.
Inquirers into sudden death/coroners, mostly being laypersons, have no ability and power to take any decisions and recommendations regarding public health and related hazards, and there is no proper communication with the epidemiological database in relation to mortality statistics and healthcare deliveries.
A.T. Balachandra, A.N. Vadysinghe and A.L. William’s “Practice of forensic medicine and pathology in Sri Lanka” notes that coroners/inquirers into sudden death are appointed by the Secretary to the Ministry of Justice, but are often politically nominated and have their political ties which interfere with the independence of the procedures of the investigations. That places the coroner/inquirer into sudden death in a higher position and as one who has an unnecessary power to summon the professionally qualified pathologists and physicians. According to Kodikara, there were such reported unpleasant experiences between those two parties in the recent past, which ended with long-term conflicts between them, ultimately affecting a proper investigation. On the other hand, there may be conflicts of interest towards some parties like funeral directors, prosecutors, etc.
J.H. Davis’s “The future of the medical examiner system” mentions that over the years, there has been a worldwide trend of converting the coronal death investigation system to appoint a medical examination system. The State-wide distribution of the medical examiner system in the US is the best example that highlights its advantages related to the quality of death investigation, uniformity, and central administration. However, per a US study, after the 1990s, there is a considerable degree of decline in this conversion which is justified with issues concerning administrative and legislative matters, geographical and financial issues, etc.
Overcoming challenges in SL
The introduction of a new system of death investigation to Sri Lanka is quite arguable. The establishment of it is not a one day target; hence, a step-wise approach is needed. It is wise to consider the common challenges faced by and the resolutions of the countries which adopted the medical examiner system.
Regarding administrative and legislative, statutory, and Constitutional issues, the present cadre of forensic medical experts in Sri Lanka, through their postgraduate training and experience, do possess sufficient skills and knowledge to conduct death investigations according to the requirement of the law, undoubtedly better than an inquirer into sudden death/coroner. The current death investigation system can be swiftly converted into a medical examiner-centred system with minor modifications to the Criminal Procedure Code. There needs to be a provision to appoint a forensic medical specialist as a death investigator with all the powers of the existing inquirer into sudden death/coroner, and the medical examiner can conduct an inquest to decide whether an autopsy examination is necessary or not and the medical examiner needs to be made accountable to the magistrate regarding the outcome of the inquest and the autopsy. Being designated as a medical examiner imposes an additional legal responsibility on the forensic pathologist.
According to the National Criminal Justice Reference Service’s “Death investigation: A guide for the death scene investigation”, medical examiners or trained death-scene investigators can visit the scene of death or house and can also replace the duty of the Grama Niladhari (a village officer)/the inquirer into sudden death in the certification of the death, and finalise the cause and manner of death in a more scientific context, thus avoiding unnecessary delays and time consuming costly investigations. Even one medical officer can cover an entire administrative district in this manner, provided that adequate transport facilities are arranged. Such initiations can subsequently be expanded into a widespread service system which may cover the whole country.
Regarding financial issues, this process does not require any infrastructural modifications as the existing facilities of the forensic units of the health institutions and human resources can be utilised for this purpose with no additional financial burden to the Government. The medical examiner can use the current facilities under his/her inventory in a more efficient manner. Presumptive estimations suggest that medical examiners can operate more economically than the coroners as they share the same duties with adequate compensation.
Regarding political and elective issues, there may be political issues in changing the death investigation system, especially when coroners are replaced since coroners are historically an integral part of the Government and politics which partially explains their continued existence. The current coroner appointments are made on three-year-long contracts and these political issues could be eased through a step by step process of transformation.
Regarding geographical and population based issues, at present, there is an adequate number of forensic pathologists stationed in all the major centres in line with the population density of different regions of the country. According to the current training statistics, within the next 10 years, the estimated number of board-certified forensic pathologists may exceed 100, and all parts of the country will be comprehensively covered by the services of the specialised forensic medical expertise. It is however necessary to launch a public awareness campaign in order to enhance the awareness of the general masses about the advantages of the medical examiner system over the coroner’s inquest.
During the initial stage of the introduction of this new system, it is more appropriate to establish the medical examiners first in the teaching hospital centres as done in America and to then gradually decentralise the system. It may also lead to eliminating the desired local contacts provided by the coroners.
Regarding the human resources availability and distribution, there may be a need for trained clerical and technical assistants in order to help medical experts in the investigation procedure. The supporting staff who are already attached to the medico-legal units are thorough with the necessary medico-legal procedures, especially concerning death investigations. The same workforce can therefore be used to proceed with the new system with some advanced professional training.
Regarding any lack of interest, the population and the law enforcement authorities must be educated regarding the outcome, and the benefits of the medical examiner system so as to overcome the lack of local interest in changing the procedures.
Regarding market saturation, conversion to the new investigation system needs more intensified effort with changing laws, continuous funding, and staff.