Date Published: December , 2017
Publisher: Makerere Medical School
Author(s): Meel Banwari.
The quality of autopsies is always questioned in courts, especially in developing countries. Wrong decisions or misjudgments are undesirable in medicine, but they are very dangerous in forensic medicine. If a wrong opinion is given, either a culprit can be acquitted or an innocent person can be sentenced. Therefore, an expert opinion is always required before the announcement of a judgment.
To highlight the problem of accuracy in determining the cause of death in forensic autopsy.
A 19- year old young adult male (Mr E), who had a history of alcohol abuse, was brought to a hospital casualty department by police, on an allegation of theft. He was unconscious and died within two hours of arrival. A post-mortem report was requested by a private attorney for an expert opinion. A post-mortem examination was conducted and multiple superficial injuries were recorded on his body. Head injury was given as a cause of death. The author seeks to critically analyze the post-mortem findings in relation to the cause and manner of death.
An erroneous opinion was reached regarding cause and manner of death in this autopsy report.
The importance of an autopsy in establishing the cause of death accurately is important in natural deaths, but it is even more important in the event of unnatural deaths. Often the cause of death looks quite obvious, especially in mechanical injuries. To determine the underlying or immediate cause of death, the manner of death and conditions contributing to death can be problematic.1 The cause of death is that which produces an effect. It is a combination of circumstances that must precede and that invariably result in an effect.2
A 19-year-old young adult male, who had a positive history of (abusively) drinking alcohol, was alleged to have stolen cell phone in a gathering. The incident was reported to police. They took him to hospital, as he was under the influence of alcohol. On arrival at hospital, his blood pressure was 237/135, pulse 72 per minute, and glucose 11 mmol. His temperature was 36 degrees centigrade and his respiratory rate 24 breaths per minute. Blood oxygen saturation was 99%, hemoglobin was 10 grams per deciliter. He was unable to stand on his feet and could not pass urine. His general condition was poor, he was unresponsive and the Glasgow Comma Scale was 3/15.There was bleeding from a laceration on his cheek. There were multiple bruises on his forehead and right orbit. Both legs were bruised and swollen, with abrasions on both knees. His condition deteriorated fast and he was confirmed dead within two hours of arrival.
Courts tend to rely heavily on the post-mortem report, which must be conducted by an expert in this field. It reveals the full truth that could not be picked up by clinicians or radiologists in their investigations. Therefore it is considered a gold standard in certifications of death. There are very few trained specialists in forensic pathology in South Africa, despite the fact that there is a high rate of non-natural deaths. Most autopsies are carried out by medical practitioners who have limited knowledge in the field.
An erroneous opinion was reached regarding the cause of death. It is difficult to implicate head injury alone as a cause of death where there was a positive history of alcoholic intoxication. It is reasonable to accept that alcohol has contributed, directly or indirectly, in causing this death. It is wrong to presume the manner of death as homicide, especially without any patho-physiologic derangement sustained through a lethal injury and its consequences.
The name of the victim and medical officer were not revealed. The name and signature of the medical officer is covered with black ink in the sketch diagram.