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Procedure for Preservation and Disposal of Dead Bodies in Hospital

T. Millo, Arun Agnihotri, Shakti Gupta, T.D. Dogra

Page 3

Topics

3. Unclaimed body

The Punjab police rule (25:38)7 state that if a body is unidentified, the officer making the investigation shall record a careful description of it, giving all marks, peculiarities, deformities, other distinctive features and shall take the finger impressions. In addition to taking all other reasonable steps to secure identification he shall, if possible, have it photographed. In cases where such action appears desirable, a description should be published in the criminal intelligence Gazette. Unidentified body should be handed over to any charitable society which is willing to accept them, and if no such society comes forward, they should then be buried or burnt. In Delhi, the police sends telegram message called "Hue and cry notice’ to various police head quarters of the country. The "Hue and cry notice’ contained brief description of the identification features of the deceased. The body is preserved in the mortuary for 72 hours from the time telegram message is sent. If there is no one to claim the body after 72 hours the police is legally authorized to dispose off the body. But if the police think that the body maybe identified by the relatives, it should be preserved for longer time till relatives comes and claims the body. The expenditure on the disposal of body in unidentified case are born by the police department. This is applicable in medicolegal cases expired outside hospital or inside the hospital.

Again as per Punjab police rule (25:36)7 an investigating officer is empowered by law to waive off the postmortem in case he thinks that there is no foul play and death is due to natural cause. In Delhi the Assistant commissioner of police is authorized to waive off the postmortem on the recommendation of the investigating officer. However autopsy surgeon can recommend investigating officer for waiving off the case if he think it is a case of natural death, but the final authority rests with the Assistant commissioner of police.

In case of unclaimed bodies in hospital, died due to the natural cause, the hospital authority is lawfully in charge of the body. It should send telegram messages to whatever address is available. If the body is unclaimed after 72 hours, it is legally authorized to dispose off the body bearing it’s expenditure. As per human transplant act 1994, the hospital authority is authorized to give permission for removal of any human organ from the unclaimed body after 48 hours. However if the hospital has reason to believe that some near relative might object, the permission to remove the organ must not be given. The unclaimed M.L.C. bodies in hospital should be handed over to the police who shall dispose off the body after postmortem.

4. Embalmed body

The body taken for embalming should be identified properly beyond doubt and proper consent from a near relative or from the person in lawful possession of the dead body is necessary. It would also be accompanied by death certificate, postmortem certificate, if postmortem was done and no objection certificate from police. In foreign nationals, clearance from respective embassy is necessary. Embalming5 should not be done before autopsy (where autopsy is necessary) as it destroys the medicolegal evidence, especially in poisoning death, by hindering its detection’s in viscera. On completion of embalming, a certificate is issued by a competent authority (embalmer). This certificate is prerequisite for transportation of the body. Embalming is necessary to prevent putrefaction in case the relative wants to keep the body for longer time. In case of anatomical embalming it helps in the preservation and sterilization of the body besides making it suitable for dissection. It is not necessary to keep the embalmed body in the cold storage. Dehydration and hardening is a common complication in the embalmed bodies kept in the cold storage in a tropical country. For transporting the deal body, a watertight coffin is recommended by the railways and air service department.

5. Cadavers for anatomical dissection

The Anatomy Act 6 was enacted in 1949, which has been uniformly adopted in all states of the republic of India. It provides for the collection of a dead body for teaching purpose, only if death occurs in a state hospital or in a public place within the prescribed zone of medical institution, provided the police have declared a lapse of 48 hours that there are no claimants for the body and it could be used for medical purpose.

6. Pathological autopsy

It is also called clinical autopsy. Here the doctor seeks to learn the extent of the disease or cause of death for which they were treating the deceased patient. A proper consent from the near relative or in lawful possession of body is necessary. As mentioned before, any body kept for autopsy (clinical or medicolegal) should not be kept in a frozen cabin in the cold storage. It hinders the microscopic examination of tissue by destroying cells. Here it is important to mention that any sort of disrespect or unnecessary mutilation of dead body may amount to an offence under section 297 I.P.C.

7. Mass disaster

The mass disaster plan must have a proper guideline for proper identification, preservation and disposal of the dead body taking into consideration all medicolegal formalities. Ideally every victim who are alive should be labeled by color coding system i.e. white strips for non-critical cases, yellow with blue strips for more serious cases and yellow with the red strips for emergency cases. These are helpful in identifying and isolating case according to seriousness of injuries to provide first-aid meritwise. To take care of the dead bodies the disaster plan must include setting up of temporary emergency mortuary. The use of the hospital mortuary is not recommended. There is rarely enough space, access is difficult and it may hinder the accommodation of hospital dead bodies. Air conditioned tents, which may be erected conveniently at any place may be considered at every 500 and above bedded hospital. The medical man has an important role in the disaster management. He may be involved in the following ways:

  • Proper scientific numbering and tagging of the dead bodies for future identification purpose by the relatives.
  • Identification of body as far as possible by noting down the identification features.
  • Issuing of death certificates
  • Conduction of medicolegal autopsy.

In mass disaster, practically it becomes difficult to conduct postmortems (unnatural death) due to high number of cases. Therefore, the legal authority may waive of the postmortems to minimize the inconvenience to the relatives of the victims. For example, in “Uphar tragedy”, where about 58 peoples died the postmortems was waived off by the Lieutenant Governor of Delhi. The emergency mortuary may be a tent house, which can be adapted as necessary, but its use depends very much on the weather. Briefly the temporary mortuary should have the following characteristics:

  1. Privacy
  2. Ease of access
  3. Entry of mortuary area
  4. Continuity and facility for:

    • Body storage
    • Primary reception area
    • Autopsy facility including recovery of clothes
    • Encoffining

  5. Ancillary Services


    • Laying out

    • Examination of effects

References

  1. Gresham, G.A. Postmortem procedures. World Medical publications Ltd. London. 1979: 16-28
  2. Bernard Knight. Forensic Pathology. Arnold Publisher, London. 2nd edn, 1996:10
  3. Polson, C.J. The essentials of Forensic medicine. Pergamon press, Oxford. 4th edn, 1985: 677-94
  4. Parikh, C.K. Medicolegal Postmortems in India. Medical Publications, Bombay. 1985: 157-160
  5. Ajmani, M.L. Embalming-Principles and legal aspects. Jaypee Publishers, 1998:81-91
  6. Subrahmanyam, B.V. Modi’s medical jurisprudence and toxicology. Butterworths. 22nd edn, 724-27
  7. Koshy, K. Punjab Police rules, vol III. The Bright law house. 1992: 1078-83
  8. Sarkar, P.C. Criminal major acts. Orient law house, New Delhi. 6th edn, 1999
  9. Manual for control of hospital associated infections. NACO, Ministry of health and family welfare, Govt. of India.

T. Millo, Arun Agnihotri1,
Shakti Gupta2,
T.D. Dogra3

1 Senior Demonstrators, Dept. of FMT, AIIMS

2Addl Prof. Dept. of Hosp. Admn., AIIMS

3Prof. and Head, Dept. of FMT, AIIMS



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