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J Indian Acad Forensic Med. October- December 2011, Vol. 33, No. 4 ISSN 0971-0973 Original Research Paper Natural Deaths in Custody: A 10 Year Mortality Study *Rajesh Bardale, **Pradeep Dixit Abstract Death in custody is usually associated with apprehension and community concern, and raises the suspicion of violation of human rights. Studies conducted in few countries have shown that people in custody have increased rate of morbidity and mortality than those not in custody. Many of these deaths are premature deaths and can be prevented with proper care and treatment. The present postmortem examination based retrospective study was undertaken to examine natural deaths in custody and provide mortality pattern in this population. A total 165 autopsies were performed during the 10 year period out of which 142 (86.06%) cases were of natural deaths. The study population consists of 138 (97.18%) males and 4 (2.81%) females and their age ranged from 21 to 78 years (mean age 46.80 years). It was noted that most common cause of death was diseases of the respiratory system (40.8%) followed by cardiovascular system (19.01%). Key Words: Death, Forensic, Autopsy, Custody, Police Cell, Prison Introduction: Death in custody whether during arrest, in police lock-up, or in jail, is usually associated with apprehension and community concern, and raises the suspicion of violation of human rights. If such death is due to natural cause then various issues such as negligence in providing medical aid or improper health care facilities etc are raised. Correspondingly studies conducted in few countries have shown that people in custody have increased rate of morbidity and mortality than those not in custody. [1, 2] Many of these deaths are premature deaths and can be prevented with proper care and treatment. In addition, having knowledge and data regarding such deaths is important to focus attention on prison medical services and can facilitate the implementation of preventive programs. Such studies would also guide the prison authorities in setting priorities for the allocation of their healthcare services and budget. [3] But for this purpose updated studies of morbidity and mortality are required and such data is lacking in India. Therefore, we undertook this study to examine natural deaths in custody and provide mortality pattern in this population. Corresponding Author: * Lecturer, Dept. of Forensic Medicine, Govt. Medical College & Hospital, Nagpur-440 003 Email: bardalerv@yahoo.co.in **Professor & Head, FMT Deptt, Govt. Medical College & Hospital, Nagpur 328 Material and Methods: This is a postmortem examination based retrospective study conducted in Department of Forensic Medicine, Government Medical College and Hospital, Nagpur. We examined all available files of inquest papers, autopsy reports, toxicological analysis reports, histopathology reports and case papers into the death of people in custody through 2000 to 2009. A standard Proforma was designed to collect the information to ensure consistency for the whole sample. Information collected includes age, sex, and type of custody (jail or police cell), place of death, medical attention received, and presence of any associated disease, history of any psychiatric illness, substance abuse and cause of death. Only deaths due to natural causes were included in the study. Results: During the 10 year period, total 165 autopsies were performed out of which 142 (86.06%) cases were of natural deaths. The year-wise distribution of the cases is presented in fig 1. Age and Sex: The study population consists of 138 (97.18%) males and 4 (2.81%) females and their age ranged from 21 to 78 years (mean age 46.80 years) (table 1). The age-wise distribution of case is provided in table 2 and maximum number of deaths were recorded in the age group of 61 years and above (19.01%) followed by 31-35 years age group (13.38%). About 28.87% of deaths were noted in age group 21 to 35 years.
J Indian Acad Forensic Med. October- December 2011, Vol. 33, No. 4 ISSN 0971-0973 Type of Custody: Table 3 provides the type of custody and it was observed that 95.07% death occurred in jail while 4.92% death occurred in police lockups. Cause of Death: Table 4 provides system-wise affection of the diseases and it was noted that most common cause of death was diseases of the respiratory system (40.8%) followed by cardiovascular system (19.01%). Table 5 provides the cause of death and it was observed that maximum number of deaths were caused due to tuberculosis (n = 36, 25.35%) followed by ischemic heart disease/myocardial infarction (n =24, 16.90%) and consolidation (n=20, 14.08%). The division of tuberculosis related death is given in table 6. While analyzing age and cause of death, it was found that the majority of deaths from respiratory system causes were due to pulmonary tuberculosis and consolidation and the mean age at death was 45.70 years while majority of deaths from cardiovascular causes were due to ischemic heart diseases and the mean age at death was 51.29 years. Associated Conditions: Table 7 shows the presence of associated illness/ condition present in the deceased individuals. It was noted that systemic hypertension was common disorder (n=24, 16.09%) followed by presence of HIV (n = 20, 14.08%), cerebrovasculr episode/paresis (n = 15, 10.56%) and anemia (n=15, 10.56%). Similarly 10 (7.04%) individuals had chronic renal disease, 10 (7.04%) had alcoholic liver disease while 8 (5.63%) had seizure disorder. Discussion: In legal parlance custody is defined as any point in time when a person‘s freedom of movement has been denied by law enforcement agencies such as during transport prior to booking or during arrest, prosecution, sentencing and correctional confinement. [4] However, the persons held in custody retain their basic constitutional right except for their right to liberty and a qualified right to privacy. [5] The custodians are bound by the law to provide adequate necessary amenities to ensure the health and safety of persons in their custody, including medical assistance and treating the inmates in a humane manner. [4] The person who is held in custody is totally dependent on his or her custodian for proper care and enough medical attention. [6] Therefore whenever death occurs in custody, a thorough investigation is needed. 329 This investigation will not only ascertain the cause and circumstances leading to death but many times will alleviate the anxiety and speculations of the relatives as to what might have happened inside a police or prison cell. Studies of deaths while in custody show that natural death is much more common than both suicides and homicides combined. [4-6, 7] On global scenario, many of the custodial deaths are related to natural causes. A study in Ontario showed 41% natural death, England and Wales had 44.3% natural deaths while in California it accounts for 62% of custodial deaths. [1, 4] In a study conducted by Wobeser et al (2002) in Ontario, Canada, the authors had noted that the rate of death by both violent and natural causes in custody exceeded by far the rates in the general population. [2] It was noted that rate of death from cardiovascular diseases were higher than the rate in the Canadian male population and about 24% deaths occurred in inmates having age less than 30 years. In one of the larger retrospective study conducted by the Police Research Group (PRG) of the Home Office in England and Wales over the 6 year period between 1990 to 1996, the common five cause of death were heart problems (39%), head injury (33%), lung problems (10%), epilepsy (5%) and liver problems (4%). [8] Considering India, in recent years few studies have looked at the cause of death among people in custody but most of these studies dealt with all types of death and very little information is available regarding the natural deaths in custody. [4-6] About 97.18% deaths were noted in men and the finding is consistent with other studies conducted worldwide. [7, 9-12] While analyzing the death by age, it was noted that about 28.87% deaths were in the age group of 21 to 35 years while 19.71% deaths were noted in above 61 years age group. Death occurring in early age is of great concern and highlights the importance of effective implementation of screening and diagnostic program. Routine enquiry about presence of any disease or taking treatment for any aliment will solve the problems in many cases. Similarly the elder prisoners should undergo routine evaluation and necessary treatment should be provided. The majority of deaths from respiratory system causes were due to pulmonary tuberculosis and consolidation and the mean age at death was 45.70 years while majority of deaths from cardiovascular causes were due to ischemic heart diseases and the mean age at death was 51.29 years.
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