Possibility of fabrication if any Yes/No
Practice which prevails among the medical examiners is to tick on or circle around YES or NO without furnishing any cogent reasons for rendering such opinion. Rendering such opinion without offering convincing reasons/justification is not in accordance with the settled norms of justice. On 08-04-2008 instructions were issued by Surgeon Medicolegal, Punjab to all the chairmen of District standing Medical Boards (DSMB), Punjab that the practice of writing “possibility of fabrication/manipulation cannot be ruled out” is wrong and unjustified in the absence of substantial grounds/supporting evidence and should be stopped immediately. It is pertinent to mention that Chairmen of DSMB turned a deaf ear to such instructions. Subsequently revised Standard Operating Procedures were issued on 13-10-2020. According to the revised SOPs for medico-legal cases bearing No. S.O (H&D) 7-2/2019-(MLC) dated 13th October 2020, the Medical Officer/Women Medical Officer, after physical examination of an injured person, while issuing the Medico-legal Certification, holding the possibility of fabrication of any injury as “Yes”, he/she must record reasons in an unambiguous term (s) on the basis of principles of Medical Jurisprudence. In case of more than one injury, the Medical Officer/Women Medical Officer shall mention regarding which injury, there exists possibility of fabrication. Unfortunately, these SOPs also had never been followed for the reasons best known to medical examiners.
No probative and evidentiary value can be attached to an opinion rendered by the medical examiner without furnishing cogent reasons in support of his opinion. Medical examiners are under a bounden duty to furnish reasons in support of their opinion in order to make it having evidentiary sanctity in court of law. Opinion of an expert should be buttressed by the reasons or it shall lose its sanctity. A proposed amended specimen of Medico Legal Certificate (MLC) has also been placed on the record with a space for furnishing reasons in support of opinion rendered by the medical examiners. It has been stated before the Court by the officials of health department that such amended MLC shall be used by the medical examiners sooner than later.
• Both, Primary & Secondary Health Care and Specialized Healthcare & Medical Education Departments shall ensure that medical examiners should meet the minimum qualification threshold and no unqualified and inexperienced doctor shall be posted to perform such crucial and sensitive job.
• Minimum qualification threshold should be improved gradually as one-month practical training course seems inadequate and too short to perform such a sensitive and complex job.
• Every medical examiner shall be bound to furnish his reasons in support of his opinion and for that purpose a space shall be provided in the Medico Legal Certificate.
Present provincial medico legal system is comprising of 90% doctors, who do not meet the minimum qualification threshold, which is offensive to right to fair trial as ensured under Article 10-A of the constitution. Opinion of medical examiner without furnishing supporting reasons loses its sanctity.
Medico-legal or Forensic medicine or legal medicine are deeply connected with criminal justice system and plays a pivotal role in dispensation of justice in criminal cases. Terms ‘medico legal’ or ‘forensic medicine’ or ‘legal medicine’ are used interchangeably and considered to be the field of study and accumulation of materials that deals with the application of medical knowledge to the administration of justice. Medical legal is “a subject that deals with application of principles of medical knowledge to purposes of law and furthering of justice”. Forensic Medicine is the branch of medicine that establishes or interprets evidence using scientific or technical facts, such as ballistics. -Also termed medical jurisprudence.Medical examiners play a crucial role in criminal justice system therefore their competence, training and skills are of utmost importance to ensure right to fair trial. The term medico legal relates to both medical and law. When medical test or examination is conducted to be used in legal proceedings it is called medico legal. Medico legal is the application of medical knowledge to the legal arena for dispensation of justice in criminal justice system. It provides the elementary legal guidelines which should be followed by a medical examiner while conducting autopsies, examining the injuries and determining the cause of death.
A system to carry out Medico legal examination, forensic analysis and autopsies is part of right to fair trial as ensured under Article 10-A of the Constitution of Islamic Republic of Pakistan, 1973 (‘Constitution’), hence it should be impeccable and unerring. Medical examiner plays a key role in medico legal system and criminal justice system. His competence, expertise and ability should be unquestionable. The phrase" Medical Examiner" has been used in several contexts. Medical examiner is a trained forensic pathologist who works within the framework of a medical-legal investigative facility.
In order to demonstrate the significance of Medical Jurisprudence, one must traverse through the history and origin of when and how Medical Science first became part of the Criminal Justice System. Before doing so, it must be observed that Medical practitioners and their governing bodies seem to have forgotten how close to the roots of our Criminal Justice to their area of expertise is, for intercommunication between the two disciplines, which make up medicolegal can be traced as far back as the Code of Hammurabi dating all the way back to 2200 B.C. Based on that, an inference canbe drawn that Medical Science and Law have been intertwined since the dawn of time, so to speak.
Some of the earliest records, dating all the way back to Ancient Egypt in circa 17 B.C., reveal that Stab Wounds were differentiated from other Wounds while Egyptians had through knowledge of Poisons.Cyril H. Wecht writes that there is evidence that priests made determinations regarding the cause of death and whether it was natural or not. Persians had seven different categories of Wounds, ranging from Simple to Mortal.
It is believed that the Romans around circa 600 B.C. promulgated legislation that required the corpses of women bearing children to be immediately opened. However absurd that may seem, there was wisdom & design behind this piece of legislation, which was an attempt to save the “unborn child”.Medical Jurisprudence even helped in determining that the cause of death of Great Roman General Gaius Julius Ceasar, who had been assassinated by stabbing. It was determined that out of 23 stab wounds, only one of the Stab Wounds was in fact fatal which resulted in his death.
The Greeks, like their counterparts in the Romans, utilized their knowledge and various medical techniques as a means to decipher the kind of poison which was used. Although scribes remain silent as to whether Medical Knowledge was used in establishing claims in a Court of Law, thus no concrete assertion can be made in that regard. Although other scribes allude to assertions that the Greek physician, Hippocrates of Kos and his companions used to ponder over, what we now term as Medico-Legal Questions.
Dr. Edward Bulkley, an east India company’s surgeon, is considered the pioneer of modern medico legal. The surgeons Edward Bulkley and Samuel Browne on August 16, 1693, issued the earliest medical certificate in India after examining Mr John Nicks. The first wound certificate was issued by Dr Edward Bulkley on August 9, 1695 (Friday). Lieutenant Seaton in a drunken brawl at midnight drew his sword and wounded through the arm of a Portuguese soldier who was on guard at the Choultry. Dr Edward Bulkley was ordered to view the wound. The wound certificate given by him stated that the wound was not dangerous. The first recorded medicolegal autopsy was performed in India by Dr Edward Bulkley on the afternoon of August 28, 1693 (Monday). When Mr. James Wheeler, Member of Council, Sea Customer and Chief Justice of Choultry in Chennai, died on August 28, 1693. Dr Samuel Browne accepted in writing that due to his fateful mistake pearl was powdered in a stone mortar wherein arsenic had been beaten before. The mixture was given to Mr. Wheeler as physic who showed the symptom of poison before death. Dr Samuel Browne and his servant were committed to custody. Dr Edward Bulkley, the surgeon of the hospital who was asked to conduct an autopsy on the body of Mr. Wheeler.As a result of autopsy report issued by Bulkley transpired that it was not arsenic poisoning as suspected and Browne was acquitted.
Field of medico legal plays a vital role and provides great assistance for determining the guilt or innocence of an accused. Due to great significance and reliance of criminal justice system on medico legal mechanism, great responsibility is imposed on the medical experts performing such job. But with this significance comes the immense responsibilities on the medical examiners. Where a medico legal system is comprising of untrained, inexpert and unqualified medical examiners, it is bound to result in miscarriage of justice.
Writ Petition-Criminal Proceedings-Registration of Case17716-21MUHAMMAD NASIR VSJOP ETC Mr. Justice Ali Zia Bajwa
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