A CASE OF NEGLIGENCE

A seven year old girl from TRICHUR was admitted for squint correction in a famous teaching hospital in Cochin.

After pre anaesthetic medication she was taken to theatre for conducting the surgery. During induction of anaesthesia cardiac arrest occur ed. She was revived & again on induction she died on the table. Death was declared only by 1800hrs in the evening. Till that time she was put on ventilator& nothing was reveled to the relatives till evening. The body was brought for autopsy at Trichur Medical college,the next day. During autopsy I was not able to make out any surgical incision in the affected eye. As per IP case records surgery was completed?WHAT A CONTRADICTION!!. Even though by autopsy I was not able to make out anything except petechiae of internal organs with congestion; by histopathologiacl examination of internal organs reveled the existence of allergic reaction. Opinion as to cause of death was given as due to inhalation of anaesthetic gas after getting histopathological opinion from Pathologist. Later on from the investigating officer it was known that there was only one anaesthesiologist looking after 09 or 10 operation table. In that case thereis no wonder for this incident to occur. The concerned lady ophthalmicsurgeon from north India returned back to her native place.

In order to bring out the role of negligence of the doctor concerned as routine procedure;a meeting was convened by Eranakulam DMO, the medical boardconsisting of DMO,Superintendent of Police,Ernakulam,Public Prosecutor Ernakulam & Police surgeon from Alleppey Medical college. The opinion given by the police surgeon was " NO EVIDENCE OF ANAPHYLATIC REACTION". Later on I happened to meet the concerned & asked why such an opinion was given."The answer was I did not read the post-mortem certificate issued by You". This shows the motive of the concerned to safe guard the interest of the particular teaching Institution.The surgeons are having a feeling that in the event of death of a person in the operation table;if the matter is not disclosed to the relatives by them at that moment ,it will not be known to the concerned. They are forgetting about other theater staff working along with them. Another disgusting fact is that hooking up of case records in the event of death of the person. They are forgetting the doctrine"RES IPSA LOQUITOR"

Photographs of "MISINTERPERTED FINDINGS"

MISINTERPERTED FINDING

This particular case dates back to 2000 when I was working as Associate professor of Forensic medicine,Government Medical college,TRICHUR. A dead body involved in DELHI crime recovered from a park in an half naked condition over the picket fences where one of the spike had penetrated into the chest cavity.The deceased was a native of TRICHUR,KERALA. The body was subjected to medico-legal autopsy at Delhi& the relatives were not satisfied with the cause of death given. I conducted the re-autopsy. I was able to make out 07 ante mortem injuries on the body;out of which injury number 01 included 26circular lacerated injuries spread over forehead & face which could only be produced by shot gun fired at a distance. There was also another circular punched out lacerated wound over the front of left side of chest.The wound was communicating with the chest cavity without injuring any organs.Five postmortem injuries were also made out.( previous postmortem incisions & injuries produced during embalming.)I was able to recover a pellet piece from one of the wounds on the face. Out of the few pellet wounds over the face only two penetrated into the skull cavity. X- ray examination prior to autopsy did not bring anything in favor.As a routine procedure the fragment of pellet recovered,the vault of skull,X-rays taken & were handed over to the authorities under protest The father of the deceased approached the Supreme court demanding CBI inquiry & as demanded it was ordered. The CBI team appointed a medical board & the conclusion of the medical board is funny. It goes like this.1) The deceased was a mentally ill person,2) He was haunted by spirits,3) The multiple injuries described over the face as shotgun wound of entry are nothing but HESITATION WOUNDS.( Hesitation wound means a person who is going to commit suicide by inflicting injuries over ones own body will produce multiple parallel tentative superficial cuts to begin with & when he regains courage sufficiently he will make the fatal wound. These hesitation cuts as it is called are seen over the front of neck,front of wrists etc)This is very unusual for a person to produce multiple injuries spread over face by striking his head over the picket fences.I may say that there is degradation of academic thinking by our own experts.
The doctor who conducted the first autopsy gave his opinion as " CRANIO-CEREBRAL TRAUMA" I gave my opinion as " THE DECEASED DIED OF SHOT GUN INJURY" sustained. THE MEDICAL BOARD gave its verdict as " SUICIDAL & HE WAS MENTALLY ILL & HAUNTED BY SPIRITS". who was right????

This incident happened in the year 2001. A man of age 30-35 was shot by the gun man of superintendant of police on one evening. The former was running a video cassette shop in Trichur district & both of them knew each other well. The deceased sustained a wound of entry over the right side of chin & it made an exit over the back of neck. He was hospitalised & the surgeon misinterpreted the entry to exit & vice versa. He failed to notice the abrasion collar in the wound of entry. The direction of the wound was backwards & downwards through the white matter of brain. The occipital bone was fractured & fragmented. No powder tattooing was there, The history put forward by the police is that the deceased was trying to examine the revolver brought by the accused & while the deceased was examining the gun the accused snatched it from him & this resulted in the firing. Taking into consideration of the absence of tattooing I strongly suspects whether this theory holds good. Since this was a treated case, I was not able to make out any smudging. No flame effect was there. The police were not able to recover the exit bullet; the motive behind the firing is still unknown, the trail of the case is not started yet.

RE ENTRY

After a span of three months, Iam thinking of posting rest of my cases shortly.

dr.n.rajaram

court jokes

1) This one happened at the principal sessions court, Trichur, when Sri. Gopakumaran Nair was theHon: Judge. In one murder trial the defence lawyer was very much keen & adamant to see that I should give an answer to the question put forward by him as follows:- how much time it will take for the blood smear on the weapon to get completely dried up ? The Hon: judge prevented him from asking this question to an expert witness & more over the doctor is not the person to answer the question ;because it is depended on so many factors. But the defence won't give up. Finally the Hon: judge came with a solution. I will ask a question to you, If you can answer, the doctor will answer. The question goes like this." You are on a holiday all alone in your home. You are having a good quantity of clothes to wash. After the washing, you have put some clothes in the sun &some in the shade. When these two group will get completely dried up? The defence counsel had a very pathetic look & replied he can't".



2) In another case myself presented before the Principal sessions court, Kassargode. Hon: Judge Sir. James was the presiding officer. During trial the prosecution showed me a dried small branch of a tree to know whether this could produce injuries on the extremities (# of forearm & leg bones). I told him it can produce these injuries in its" original state". The judge was frowning his forehead for few seconds & suddenly began to laugh with stamping his feet on the ground& clapping his hands. He was asking the Public prosecutor whether you followed the answer. He made a comment" YOU ARE THE REAL POLICE SURGEON". What I meant was at this stage the twig is a dried peace of wood & it will only break if used with force. In its original state means when it is fresh.
After hearing the comment I was in an elated mood & answering questions put forward by both advocates. When everything was over the Hon judge was making a comment again. You have given answers to the questions put forward by both prosecutor & defence & after hearing your answers I am having certain doubts to clarify. You can get down from the defence box only after clearing all my doubts. By hearing this I felt a little bit perplexed & confused. On total I have spent more than four hrs in the witness box.
3) In another sessions case at Trichur The defence lawyer did not get any answers as anticipated to those questions put forward in his favor. At last he made a comment " your opinion as to cause of death is not correct" I replied back " in that case I would request the learned defence counsel to give a correct answer so that I will be benefited in future".

Dr.N.Rajaram

Dead man tell tales

This particular case was presented as the deceased suffering from diarrhea & he was taken to hospital & while the doctor examined him, he was found dead. The dead body was buried in Baddiudukka/Bandudukka Muslim burial ground. We reached the burial ground by 1500hrs. There was huge crowd & found it difficult to get inside. With the help of deputy superintendant of police Sri.Ponnan Bhaskaran, we managed to get inside. There was pin drop silence. No body came forward to dig the grave & we were able to hear some murmurs in the form of protest.
Immediately the deputy superintendant of police requested the head man to start the digging. Then the head man was saying” who ever had made the compliant can do the job. Then one tall lean figure came forward & started the job. After few minutes we saw him falling into the partly dug grave. Then the whole police force was yelling with rage. It is well known that only Muslims are allowed to do the last rites & also in the preparation of grave when a Muslim dies. On seeing the non-cooperative attitude of the local inhabitants, the DYSP ordered his men to complete the job. The police personnel removed their uniform & did the job well. The body was taken out & put in a wooden table. Immediately I could notice # of both angle & wrist joint. & because of erosion of soft tissues due to decomposition it was clearly visible. There was some kind of blackening (degradation of hemoglobin) indicating ante mortem nature. The above finding was also noticed by Sri. Mohandas, my assistant. His observation is superb not only with this case, but to all cases he used to assist. He needs a good compliment. The soft tissues over the neck region was completely gone . Closer examination revealed # of thyroid & cricoid cartilages. Another interesting finding was the presence of carbamate (insecticidal compound) as violet colored granules. It will be having sandy texture because the chemical is imbibed in sand. Viscera were preserved for chemical analysis & later turned out to be positive for carbamate.
Now we try to analyze what happened contrary to the first information report. The deceased was a man aged 50-60 yrs & job was selling fish. Most of the time he won’t be in the house & in his absence his wife indulged in prostitution with proper support from her own father. To begin with he was a silent spectator, later on he used to quarrel with them & one day it ended in his death. In order to escape from the crime committed they first sought the story of the deceased developing uncontrolled diarrhea & died on the way. Next they got the silent support of MULLAKA to bury the dead body in the grave.
The deceased was a brother in Bombay & he came to know of the sudden demise of his elder brother due to diarrhea. He suspected some foul play & raised his voice to find out the truth. He was immediately overpowered by the people concerned & locked in a room. Somehow he escaped & reported the matter to police. He was the man who was asked to dig the grave & later on collapsed into the grave.
The opinion that I gave was the deceased died of strangulation & poison was administered into his system prior to death. The long bone injuries could have also contributed in the causation of death.
The case for posted for trial before the Principal Sessions court Kassargode & Sri. James was the Judge & culprits were convicted.
Some interesting incidents occurred to me during trial & will narrate separatley.
Dr.n.rajaram