Operational Research - PSM Exam Notes

1. Origin / History

• The term "operational research" was coined during World War II in connection with the best use of a new invention - the radar.
• Since the war, it spread rapidly in Britain and America, eventually encompassing the study of whole systems of services in industry, administration, education, and health services.

2. Definition

"The application of scientific methods of investigation to the study of complex human organizations and services."

• OR is a sociological science with an immense social content - this distinguishes it from pure or applied research.
• A new area emerging is called "Health Operational Research" (WHO, 1972).

3. Main Objective

"To develop new knowledge about institutions, programmes, use of facilities, the people working in these activities and the individuals and communities served by them" - in order to secure optimal utilization of resources (men, material, and money) in the service of the community.

4. Phases in Operational Research (7 Steps)

1. Formulation of the problem
2. Collection of relevant data (if necessary, by a suitable sample)
3. Analysis of data and formulation of hypothesis
4. Deriving solutions from the hypothesis or "model"
5. Choosing the optimal solution and forecasting results
6. Testing of solution (e.g., pilot projects)
7. Implementing the solution in the whole system

5. Operational Research Team

• OR is a team job involving several workers.
• Composition varies with the type of research.
• Minimum composition in social medicine applications:
  1. Public health administrator
  2. Epidemiologist
  3. Statistician
  4. Social scientist
  • Plus ancillary workers: clerks, peons, field workers
• The team is headed by a director responsible for the whole project.

6. Operational Research in Health Services

Key concept: Whenever social medicine passes from the stage of observation and classification to that of discovering and recommending appropriate action, it is involved in operational research.

7. Exam High-Yield Points

8. Relationship to Other Research Types

• Pure research - basic science, no immediate application
• Applied research - uses basic science to create products
• Operational research - uses scientific methods to improve functioning of ongoing systems/services by optimizing resource use
• Action research - closely related; OR often leads to action/policy change

Inquest - Definition and Types

Definition of Inquest

Types of Inquest in India

1. Police Inquest (Section 174 CrPC / Section 194 BNSS)
2. Magistrate's Inquest (Section 176 CrPC / Section 196 BNSS)

1. Police Inquest

1. On receipt of information of unnatural/suspicious death, the police officer immediately informs the nearest Executive Magistrate empowered to hold inquests.
2. Proceeds to the place where the body is found.
3. Conducts inquiry in the presence of two or more respectable inhabitants of the neighbourhood (called panchas).
4. Prepares a report - Panchanama / Inquest Report - describing:
   • Apparent cause of death
   • Wounds, fractures, bruises and other marks of injury on the body
   • Manner of injury / weapon used
5. Report is signed by the police officer and panchas.
6. If no foul play suspected - body is released to relatives for disposal.
7. If foul play suspected - body is sent for postmortem examination to the nearest authorized government doctor, along with a requisition (dead body challan) and a copy of the inquest.
8. Report is forwarded to the Magistrate.

• Suicide
• Killed by another person (homicide)
• Killed by an animal
• Killed by machinery
• Killed in an accident
• Death under suspicious circumstances raising reasonable suspicion that some other person committed an offence

2. Magistrate's Inquest

• Magistrate holds an inquiry into the cause of death.
• Must inform the relatives of the deceased and allow them to be present during investigation.
• Body is sent for postmortem examination after inquest.
• Inquest papers must be handed over to the autopsy surgeon for information.
• Note: Proceedings of the Magistrate are NOT judicial proceedings - they only aim to find out the cause of death.

1. Dowry death
2. Death of a woman within 7 years of marriage if:
   • She commits suicide
   • Dies in circumstances raising reasonable suspicion of offence by another person
   • Any relative of the woman makes a request
   • Any doubt regarding cause of death
3. Exhumation
4. Death, disappearance, or alleged rape while a person/woman is in police custody or any other court-authorized custody (BNSS S.196 / CrPC S.176(1-A))

Note: "Death in police custody" was included under the old CrPC provision but was omitted by CrPC Amendment Act, 2005 and is now covered under the broader custody clause.

• A Magistrate may also conduct an inquest instead of or in addition to the police inquest in any case (S.196 BNSS / S.176 CrPC).

Difference Between Police Inquest and Magistrate's Inquest

Other Types of Inquest (Not Practiced in India - For Completeness)

High-Yield Exam Points

• Police inquest = S.174 CrPC; Magistrate's inquest = S.176 CrPC (now BNSS 2023 equivalents: S.194 and S.196)
• Panchanama = the inquest report prepared during police inquest
• Panchas = 2 or more respectable witnesses present during police inquest
• Magistrate's inquest is mandatory before autopsy in dowry deaths and custodial deaths
• Coroner's inquest is abolished in India (was used in Bombay / old Calcutta presidency town)
• Relatives must be informed only in Magistrate's inquest - not mandatory in police inquest
• Both types of proceedings are NOT judicial proceedings - they are inquiry proceedings only
• Autopsies can only be performed at government hospitals, or private hospitals with State Govt. permission

Summons (Subpoena)

Definition

Etymology

• Literally means "under penalty"
• Summons and subpoena are used interchangeably in Indian forensic medicine

Legal Provisions

Form and Issue of Summons

• Issued in writing, in duplicate
• Signed by the presiding officer of the Court
• Bears the seal of the Court
• Contains: crime number and name of the accused person

Service (Delivery) of Summons

1. A police officer
2. An officer of the court
3. Any other public servant

• By registered post
• Fixed on a conspicuous part of the house where the person resides

• The court sends the summons in duplicate to the Head of Office
• The Head of Office serves it to the concerned person
• Returns it to the court with signature and endorsement

Special Type - Subpoena Duces Tecum

• A summons that requires the witness to also bring books, documents, or other things under his control
• The person may send the document instead of attending personally (when summoned only for document production)

Duty of the Witness

• A summons must be obeyed
• Witness must appear on the specified date and time with the records called for
• Before depositing evidence, the witness must take the oath
• Witness cannot leave the court without the permission of the presiding officer
• Witness can be excused if he has a valid and urgent reason

Punishment for Non-Attendance

Priority of Courts

• After finishing evidence in the first court, attend the second court.
• Criminal Courts have priority over Civil Courts; Higher Courts have priority over Lower Courts.

Conduct Money

• Definition: Fee paid to a witness in civil cases at the time of serving the summons to meet the expenses of attending court.
• If not paid, or if the amount is felt to be insufficient, the doctor can bring it to the notice of the Judge before giving evidence.
• The Judge decides the amount.
• A witness can ignore the summons in civil cases if no conduct money is paid.

• No conduct money is paid at the time of serving the summons.
• The witness must attend in the interest of the State/justice.
• TA (Travelling Allowance) and DA (Daily Allowance) are paid by the government to attending witnesses in criminal cases as per government rules.
• Failure to attend = Contempt of Court

Specimen Format of a Summons

IN THE COURT OF SESSIONS Sessions Case No. ___ To: [Doctor's name] Whereas complaint has been made before me that accused ___ has committed the offence of ___ under section ___ IPC, and it appears to me that you are likely to give material evidence for the court as an expert, you are hereby summoned to appear before this court on ___ at ___ to give evidence and not to depart thence without leave of the court. You are hereby warned that if you shall, without just excuse, refuse to appear on the said date, warrant of arrest will be issued to compel your attendance. Given under my hand and the seal of the court. Signed

High-Yield Exam Points