Critical Appraisal of Autopsy Work

Abstract

Autopsy means detailed postmortem examination of a deceased by cutting open the internal organs to determine the cause, manner and time since death. Its importance in administration of justice, especially in cases of un-natural and violent deaths, cannot be denied. Settings: This study was carried out by examining the record of Medico legal autopsies conducted at a tertiary care Health institution i.e. Allied Hospital Faisalabad, two District Headquarter Hospitals of Punjab; Sheikhupura and Toba Tek Singh along with three Tehsil Headquarters Hospitals and three Rural Health Centers of Faisalabad District during calendar year 2000. Aim: The study was aimed to critically analyze the quality of autopsy work in Civil Hospitals. Objectives: To identify the lapses on part of medical officers while performing autopsies & to find out the procedural irregularities in preserving and dispatch of viscera for Chemical analysis / Histo-pathological examination. Results: Out of 756 autopsies conducted during the study period, 100 cases were selected randomly for detailed examination. Seventy-five males outnumbered the twenty-five females with male to female ratio 3:1. Majority of the victims belonged to 3^rd decade of life & died of fire arm injuries. Lapses on part of medical officers included inadequate documentation, lack of external examination on arrival, non-recording the time of death and inadequate description about extent of rigor mortis and fire arm wounds. Skull was not opened in 63% cases. Mucosa and contents of stomach were not examined in 49% cases. As regards procedural irregularities, majority of the cases were sent to the Chemical Examiner after 10–30 days of postmortem examination whereas the viscera in five cases sent for histopathology were autolyzed due to improper preservation and delayed submission of the specimen. Some of the reports of Chemical Examiner were untraceable in the record which caused further delay in finalization of the postmortem reports while most of the cases took about 2–3 months after submission of the specimen. Conclusion: Incomplete autopsies are being done by inexperienced doctors in peripheral hospitals having little knowledge of medico-legal autopsy which may lead to faulty medico legal opinions or end up without establishing exact cause of death & having negative impact on the criminal justice system. Only a few of them had true concept of it. There is prime need to provide opportunity to those involved in autopsy work to update their professional knowledge & skills. Healthcare institutions should take all necessary steps to create more awareness program on medico legal autopsy among entire community as well as training of the workers related to the medicolegal field. A national protocol regarding the standard autopsy procedures and documentation is need of the hour.