Death investigation delays at Colombo South Teaching Hospital causes havoc: Study

• Researcher proposes uploading unidentified decedents info on hospital web and specific legal procedure

BY Ruwan Laknath Jayakody

Constant delays in the process of initiating the procedures pertaining to the investigation of deaths, including in the performing of postmortem examinations, have been found to be extremely high at the Colombo South Teaching Hospital in Kalubowila, thus causing immense difficulties to the hospital.

Furthermore, it has been observed that even though the Code of Criminal Procedure does not explicitly recognise the investigation of deaths involving unidentified dead bodies and there is also no written document containing the procedure to be followed for the disposal of an unidentified dead body, the process of the disposal of such bodies would be less problematic for the health sector if the inquest procedure identified such bodies.

These issues were raised in an original article titled “A study on the disposal of unidentified dead bodies in a tertiary care hospital in Sri Lanka along with legal provisions and procedural circumstances”, authored by H.T.D.W. Ariyarathna (attached to the University of Sri Jayewardenepura Faculty of Medical Sciences Department of Forensic Medicine) and published in the Medico-Legal Journal of Sri Lanka’s Ninth Volume’s First Issue on 30 June 2021.

Owing to the lack of a proper history, the absence of an identity card, severe decomposition, acute facial injuries (due to blunt force trauma such as in the case of injuries resulting from road traffic or rail track accidents), postmortem injuries, and the absence of comparable ante-mortem data, as noted by A. Kumar, H. Dasari, and A. Singh in “Cause of death in ‘John Doe and Jane Doe’: A five-year review”, the process of identifying decedents poses a challenge to both the Police and forensic experts. Ariyarathna explained that the successful disposal of an unidentified dead body involves the commitment of the Police, the Inquirer into sudden deaths (ISD), magistrates, hospital staff members including the workers at the Judicial Medical Officer’s (JMO) office, and florists.

A retrospective data analysis was therefore performed by Ariyarathna using the registers maintained by the hospital at the JMO office and the overseer’s office while the communication file with the Police and the file maintained for the hospital coolers were also perused. All the postmortems/postmortem examinations registered as unidentified dead bodies (141/3% dead bodies from August 2016 to August 2020) were included while the total number of dead bodies that were investigated was 4,472.

In terms of biological sex, the majority (130 – 92%) was male while the rest (11 – 8%) was female, with a male to female ratio of approximately 13:1. The majority (81 – 57-58%) belonged to the 61-80 years age group, followed by those in the age groups of 41-60, below 80, 21-40 (very low figure), and below 20.

Regarding the place of death, the majority (74 – 52%) of the bodies had been handed over to the hospital upon death while less than half (67 – 48%) had died upon admittance to a ward in the hospital as patients and while they were receiving treatment. It was the Police that had handed over the majority (71 – 51%/50%) of decedents and patients, while a total of 58 (41%) patients had been self-admitted or handed over to the hospital by passers-by, or by untraceable persons who had given false details, while 11 (8%) had been submitted for admittance to the hospital by the toll-free ambulance service (1990).

According to Ariyarathna’s experience, guardians or relatives of patients had on occasion provided false details to the hospital at the time of admission (rendering them unable to be traced by the hospital authorities) and also had admitted the patients when they were in critically ill condition, as they did not want to shoulder the burden of looking after such patients. In a certain percentage, the hospital records indicated that the deceased was a beggar or a road dweller, hence there being no claimant for the deceased. Also, the involvement of the Police in such instances is as a result of a person not having a relative or responsible party to look after them, which in turn allows the hospital staff members to arrive at the indirect assumption that most such descendants may be street beggars or psychotic patients who had lost contact with their families.

The maximum number of days a patient was admitted to a hospital ward before their death was 19 days, with the mean number of days a patient was treated in the hospital being 2.35 days. The average time taken to register the death of an unknown individual was 4.9 days. The average time taken to complete the autopsy from handover was 90 days (three months), while it had only taken five days to dispose of the bodies upon the completion of the postmortem examinations.

In Ariyarathna’s study, instances were found where corpses had been kept in the hospital mortuary’s limited number of coolers (36 in total) for around a year, simply because the relevant police officer had not visited to initiate the postmortem examination. With such a lengthy interval, Ariyarathna observed that postmortem changes would set in, where the bodies would sometimes become mummified or putrefied (when refrigerators go out of order and repairs get delayed), in turn making the interpretation of external and internal injuries difficult.

A significant percentage (114 – 81%) had died from natural diseases, followed by deaths due to injuries sustained on rail tracks (12 – 9%) and trauma from road traffic injuries (six – 4%), while one had died due to self-suspension (suicidal hanging) and the other due to being stabbed (homicide), and seven (5%) cases where the cause remained unascertained.

Previously, the Sri Lanka Police’s “Departmental order book. C 9. Identification of unknown dead bodies: Fingerprints and obtaining photographs” revealed that it had taken 52 days in the Western Province and 21 days in peripheral units to conduct the postmortem examinations, while for burial it had taken 79 days in selected tertiary care units and 25 days in some selected peripheral areas. The burial in a “marked place” for exhumation in the event of any future investigation is the only option for unidentified dead bodies, as cremation is not allowed for such.

Therefore, Ariyarathna’s study had shown that there had been a significant delay from the undertaking of the body to the mortuary and to the time of performing the autopsy. Explaining the findings further, Ariyarathna noted that as per the existing national practices and laws, the Police are informed to take measures if a dead body has not been claimed by relatives, where upon confirmation by the Police that the decedent is unidentified, a police officer should, upon being informed by the relevant JMO’s office, be present at the JMO’s office in order to commence the death investigation according to the inquest law. However, Ariyarathna observed that police officers, though routinely informed to be present at the JMO’s office as soon as they are informed of the requirement of their presence, rarely comply with such – a fact which is also demonstrated by the perusal of the hospital’s police communication file.

As per the hospital records, it was found that occasionally, the refrigerators were out of order and that in such situations, putrefaction of the bodies accommodated in the mortuary occurs. “Nevertheless, with repeated requests, finally, the postmortem is done, and the disposal of the dead body takes place, regularly.”

An inquest/postmortem examination cannot be commenced and performed until a decedent is declared as an unidentified person by the Police upon the completion of their investigations. In short, prior to starting the investigation into the death, the Police should, Ariyarathna explains, initially declare that the attempt to identify the decedent through their investigations is impossible. The parameters used in identification in these instances are fingerprints, dental data, radiology/X-rays, and deoxyribonucleic acid (DNA), and Ariyarathna points out that out of these methods, owing to cost-related factors and the unavailability of ante-mortem data for purposes of comparison, only fingerprints are widely and routinely used.

According to the practice, it would take at least two weeks for the Police to investigate the case where once an unidentified dead body is present, the relevant police station is informed to gather information about the decedent and towards this end, and fingerprints are obtained and sent to the Registrar of Fingerprints to be compared with already available fingerprints at the Criminal Records Division of the Police, while the Police also take photographs and uploads them into the virtual private network (VPN) of the Police to be shared with all police stations (if a person complains about a missing person, the police stations islandwide access the VPN and provide information to trace any missing person).

Once it is confirmed that even after all of this, the decedent cannot be identified, then a letter from the Police Officer-in-Charge (OIC) of the area should be provided either to the relevant magistrate or to the ISD, noting that the identification of the deceased is presently impossible according to the procedural rules (Police Departmental Orders), and then proceed with the disposal of the dead body after the conclusion of the death investigation. If the relevant police officer comes with the proper order, there is no delay on the part of the hospital service as the latter performs the postmortem on the same day or the day after. “It is therefore obvious that the significant delay is with the Police.”

In this regard, Ariyarathna recommended the uploading of at least the details pertaining to the biological sex, age, place of discovery, and the attire pertaining to the unidentified decedent in the official web page of the hospital as a separate menu item or sub-menu item.

An unidentified decedent is not disposed of without an inquest (procedure laid down in Sections 369-373 of the Code of Criminal Procedure Act No. 15 of 1979 as amended), although the legal proceedings related to inquests do not explicitly mention about unknown decedents and does not mention a special procedure to be followed regarding unidentified dead bodies. Instead, there is a working guideline and departmental orders adopted by the responsible stakeholders such as the Police, the ISD, the Judiciary, and forensic pathologists (in this case, the hospital’s consultant JMO), hospital directors, the area Registrar of Birth, Marriage, and Death, and florists. However, according to Ariyarathna, the existing procedure covers almost all the necessary steps to be followed when an unknown dead body is encountered. The definition used for the purpose is “an inquest is a judicial inquiry in common law jurisdictions, particularly to determine the cause of death”, which however does not cover the aspect of the identification of the decedent. A broader definition of the inquest used in the Sri Lankan academia reads as “a public and judicial inquiry held to determine the facts related to incidents and deaths such as the cause of death and the manner of death and to identify the deceased in the case it is of an unknown”.

Regarding the matter, Ariyarathna opined that though there is no stipulated law as to how to investigate unidentified decedents and the procedure to be followed is entirely satisfactory, it, however, results in limitations, especially with regard to the part and role played by the Police. Hence, Ariyarathna proposed that having a specified legal procedure rather than having “working guidelines” will help to lessen the unwanted delays that occur during the procedure of the disposal of unidentified decedents.