From
The Secretary,
Kerala Medico Legal Society,
Kerala.
To
The Medical Council of India,
We the Kerala Medico Legal Society, the organization of Police Surgeons and Forensic Medicine specialists of Kerala, appreciate the undergraduate education working group 2010 for coming up with much awaited modification in MBBS curriculum and for recognizing Health for all as a national goal and aim at producing capable “physician of first contact” towards meeting this goal.
The introduction very well recognizes the large quantum of burden of diseases in India
India is also facing unprecedented increase in the number of Road Traffic Accidents, air craft or transportation accidents, compensatable industrial tragedies, newer insecticidal poisoning of often epidemiological proportion (endosulphan) besides personal violence resulting in bodily injury, rape, domestic violence, child abuse, sex rackets, organ robbing rackets explosion and horrific methods used against the person resulting in homicide and genocide. Human right violations are being reported in media in unbelievable proportion. The curriculum conveniently forget the role played by the physician of ‘first contact’ in being responsible to reporting effectively, honestly and boldly before the appropriate forum to control these crimes/atrocities and there by contribute to the concept of health for all concept of goal of India. We also find that out of the seven members and convener of the working group 2010, none represent the specialty of Forensic Medicine, which is also known as Legal Medicine/ State Medicine and there by the interest of the state in creating its medico legal service providers in future. Effective consultation with Forensic Medicine practitioners, investigating authorities and lawyers are lacking and it clearly shows in the neglect meted out to this aspect.
The subject as we understand is no longer considered as one of the core subject but certain topics taught under Forensic Medicine like Ethics and Medical Education, Ethics and Legal Medicine are considered as electives. This would mean summative evaluation (separate University examination) for this subject will not be there. Discrepancy has been crept in (table 3, additional requirement of teaching faculty) the current short fall is maximum in Forensic Medicine 1500 and total additional need is shown as 3500 where as the next maximum is for other pre-clinical subjects. The subject, which does not have a private practice aspect but entirely as state medicine does not have enough followers compared to creative specialties as shown by the same table. This is equivalent to deciding no army shall be there since less people opt to join in army, instead army meets the same problem in making the post lucrative.
The curriculum positively brings out its wrong notions regarding the specialty of Forensic Medicine under para 2 of need to reviewed curriculum in telling that the Forensic Medicine can be effectively taught during Gynecology and Obstetrics (rape, assault), surgery (injuries), Pharmacology (toxicology), legal experts can be called for medico legal crimes, Forensic Medicine skills can be acquired during internship such as documentation of medico legal cases alcoholism suicide/homicide, rape, assault and injury cases. We understand that the working group because of its ignorance of the work pattern or the type of cases attended by the simplest Government Hospital casualty to apex level Government Medical College
The number of medico-legal postmortem examination in the state of Kerala alone is about 30,000 per year. The projected estimate at national level on population basis will be definitely more than 500,000 per year and still medico-legal postmortem examination does not get even a mention in the proposed curriculum to be taught to those authorized by the Law to undertake it. Considering the knowledge and experience of the members of the curriculum committee it may appear pardonable, but from the perspectives of State, Law, Law enforcing system and the Common man this omission makes obvious the lack of minimum social commitment of the parties concerned, in the least. The complexity of most medico legal situations like date rape (rape and intoxication), assault rape and poisoning followed by suicidal attempt by hanging/ drowning multiple serial methods at difference timings in assault, fabricated history or no history mistaken identity consent or lack of consent factors in giving aggressive medical care/surgical care mind altering drug / withdrawing terminal care and consideration of reporting to authorities (police and court) against consent of subject in certain cases may be faced by any physician in any Government Hospital causalities. These are the elements of state medicine taught under the subject heading forensic medicine (state medicine) till date as a subject which an MBBS students would learn being taught by the faculties of Forensic Medicine from 19th centaury onwards ( Prof. Jaising Modi’s time onwards, father of Forensic Medicine in India
We have the new graduates who follow the newly prescribed curriculum will only have the legal status of BAMS or BHMS Doctors who can effectively treat persons using alternative medicines drugs and gadgets but will not be qualified enough to serve the state as Registered Medical Practitioner who are in fact the ‘medico legal Doctor of first contact’. This will hamper the police investigation as well as judicial proceedings who will have to blindly depend on the status of lay witnesses with no real expert witness evidence at hand to cross check the veracity of the statement of lay witnesses.
We fear the justice will be miscarried due to no fault of these Doctors but due to the mistakes of curriculum alone. We the reputed single body of medico legal specialties in the state warn that due to defect in curriculum by shattering the core topics of clinical Forensic Medicine into bits and pieces and placing them in the hands of practicing clinician who so far have shown no genuine interest in uplift or development of Forensic Medicine will definitely result in the hapless victim of crime with no place to report to. How can health for all be achieved by this? Crimes will thrive in such a milieu and judicial court will be effectively blinded.
Internship is a period for refreshment of what has been learned during the course period by actual observation improved hands on training and acquirements of skills. What we cannot learn effectively and not evaluated by the examination is not learned during internship period as known to every one of us. The Law does not authorize an internee to undertake any medico-legal case on his own and an internee can not undertake a medico-legal work on behalf of another qualified person.
The principles of Forensic Medicine have got their implications in almost all the stages during the course of a doctor-patient relationship. Any medical student who is going to examine a patient for academic purpose should also be aware of these principles. Forensic Medicine being a clinically oriented specialty, various aspects of topics covered by this subject can only be understood with an in depth knowledge in the non-clinical subjects and along with the clinical subjects. Hence we are of the opinion that Forensic Medicine should be taught along with clinical subjects, as was being done in the past, preferably during the third year in the proposed scheme of curriculum.
Medical negligence allegations and prevention and evaluation of this, human right violation issues, non participation in narco analysis and custodial tortures, adhering to the law regarding PNDT, MTP etc are so far dealt with only forensic medicine. Doctors who are if not taught as core subjects will most probably in future will cause and contribute to these during later life. Every society has a duty to develop its medical Doctors taking care that they don’t develop as moral monsters and respect law and should be able to render equitable justice during service. We there fore suggest that:
- Forensic Medicine should be retained in the curriculum for M.B.B.S., as a core subject to be taught in the third year of the proposed scheme with teaching hours increased adequately to include topics which would enable the Registered Medical Practitioner who are in fact the ‘medico legal Doctor of first contact’ to meet the requirements of the Law and Law enforcing systems. Their competency in the subject should be assessed through a University examination, as is being done now
- A panel of suitable qualified Forensic Medicine specialists should be constituted to identify the core topics in Forensic Medicine, learning and methodology of teaching of this in time with modern concept adopted by the working group 2010 that the new graduates can effectively serve as a physician of first contact in establishing national goal of health for all.
- National Judicial Academy Hyderabad, National Law Academy Bangalore and / or similar in states and National Police Academy Hyderabad which are proven teaching institutes who may enlighten the working group regarding the usefulness of forensic medicine for the society.
- Diploma courses in forensic medicine may be started to meet the medico legal need of the community
Looking forward sd/
THRISSUR Secretary
13-01-11 Kerala medico legal society
Address for communication:
Office of the secretary
Dr.Hitheshsanker.TS
Assistant Professor and Deputy Police Surgeon
Government Medical College, Thrissur
PHONE: 09447465319
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