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Answer (KSN Reddy - Essentials of Forensic Medicine and Toxicology, 36th Ed.)

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(a) Examination, Report Preparation & Preservation/Despatch of Trace Evidence (8 marks)

Objectives of Medical Examination

1. Search for physical signs (injuries) corroborating the victim's history
2. Search, collect, and preserve all physical (trace) evidence for laboratory examination
3. Treat the victim for injuries, prevent venereal disease or pregnancy, and minimize psychological damage

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General Procedure

• Examine when there is a written requisition from the investigating police officer or Magistrate
• The Court or police cannot force a woman for medical examination against her will
• Written, witnessed consent is mandatory - for collection of specimens, photographs, treatment, and release of information to police
• Since she is a minor (17 years), consent of her parent/guardian must also be taken in writing
• She has been brought in altered sensorium - her condition must be stabilized first; medical care takes priority

• Victim identified by the escorting police constable (name and number recorded)
• Identification marks noted
• Record: name, parent's name, marital status, residence, occupation, date and time, place of examination, and who gave the requisition
• Date and time are important - the interval between the alleged incident and examination is material

• Taken in privacy, in a child-friendly environment
• Record her own words as far as possible
• History includes: date, time, place of assault; nature of assault; whether she bathed, changed clothes, douched; whether she has been sexually active before; last menstrual period

• Assess her mental and physical state - since she is in altered sensorium, assess for intoxication, head injury, or drug influence
• Ask to undress completely; examine under ultraviolet light to detect seminal stains
• Note all soiling areas, swab with plain cotton swabs
• Collect any loose hair or foreign substances on skin surface
• Take large and close-up photographs of injuries, especially the sexual area
• Examine entire body for marks of violence: scratches, bruises, lacerations, tenderness
  • About mouth and throat (forcible silencing)
  • About wrists and arms (seizure marks)
  • On back, shoulders, buttocks
  • Inner and outer thighs (especially inner aspect of upper thigh)
  • Breasts - bite marks, suction lesions
  • Petechiae on face/conjunctivae suggest partial asphyxia

• Examine pubic area: any matted area should be cut close to skin and combed; loose pubic hairs retained
• Inspect tops of thighs, labia, and perineum; note injuries
• Take swabs from introitus and perineum
• Examine hymen: separate labia majora and minora by gentle traction
  • Take low vaginal swab before speculum insertion
  • Tears most commonly occur posteriorly, at 5-7 o'clock position
  • Hymenal tears from penile penetration extend to the margin
• Vaginal speculum examination: take high vaginal swab and cervical os swab under direct vision
• Note abrasions, bruising, lacerations of vaginal walls
• Two-finger test is banned by the Supreme Court (2013) - it violates the right to privacy
• Note: "Rape can occur without causing any injury; negative evidence does not exclude rape"

• For evidence of buggery (anal intercourse)
• Examine for fissures, bruises, lacerations

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Preparation of Report and Framing the Opinion

• Personal details: name, age, identification marks
• Requisition number, date/time of examination
• History as given by the victim (in her own words)
• General condition: pulse, BP, consciousness level, signs of intoxication
• Findings of general examination and injuries (described systematically)
• Findings of genital examination - hymen, vagina, cervix
• Laboratory results when available (semen, blood group, DNA)

• Whether signs of recent sexual intercourse are present
• Whether signs of forcible intercourse are present
• Whether injuries are consistent with the history given
• Age estimation
• The doctor should mention only the negative facts, but should NOT give an opinion that rape has not been committed, as rape can occur without injury

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Preservation and Despatch of Trace Evidence

• Examine for tears, loss of buttons, seminal stains, blood
• Dry the clothes, store in a clean paper bag (not plastic - prevents decomposition of evidence)
• Send to the Forensic Science Laboratory

• Sealed, labelled with date, time of collection, name of victim
• Chain of custody maintained - signed by examining doctor

• Lose motility within 1-6 hours in vagina
• May be recovered up to 24 hours from vagina

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(b) Medicolegal Issues (Amendments) Related to this Scenario (5 marks)

1. POCSO Act, 2012 (Protection of Children from Sexual Offences)

• This girl is 17 years - a minor - so POCSO applies
• Section 3: Penetrative Sexual Assault - insertion of penis/object into vagina, anus, etc. - Punishment: 20 years to life imprisonment + fine
• Section 4: Aggravated Penetrative Sexual Assault - Life imprisonment or death penalty + fine
• Section 19: Mandatory reporting - any person (including doctors) aware of sexual offence against a child MUST report to police or Special Juvenile Police Unit (SJPU); failure to report is punishable
• Section 24: Child-friendly investigation and trial - in-camera proceedings, child's statement in non-threatening environment
• Section 29 & 30: Reverse burden of proof - accused is presumed guilty unless proven innocent
• Section 35: Compensation to victims for medical treatment and rehabilitation

2. POCSO Amendment, 2019

• Introduced death penalty for aggravated penetrative sexual assault (Section 6)
• Increased fines and imprisonment terms
• Criminalized storage of child pornography

3. BNS 2023 (Bharatiya Nyaya Sanhita) - Replaced IPC

• Section 64 BNS (formerly Section 376 IPC) - Rape: Imprisonment minimum 10 years, extendable to life
• Consent of a woman below 18 years is not valid (since she is 17, consent is immaterial)

4. BNSS 2023 (Bharatiya Nagarik Suraksha Sanhita) - Replaced CrPC

• Statement of victim of sexual assault recorded by female police officer
• Examination of victim by female doctor only (or in presence of female attendant)
• Medical examination must be done within 24 hours

5. MTP Act relevance

• If pregnancy results from rape, MTP is permitted up to 24 weeks (MTP Amendment Act, 2021)
• For rape victims, only one RMP's opinion needed (up to 20 weeks); two RMPs required up to 24 weeks
• For minor rape victims, guardian consent is required

6. Child Line involvement

• Child Line (1098) is a national emergency phone service for children in distress
• The doctor must cooperate with Child Line and the SJPU for proper legal process

7. Two-Finger Test

• Banned by Supreme Court in 2013 - violation of right to privacy of rape survivors

8. Section 120 BSA (formerly S. 114-A IEA)

• If victim states in evidence she did not consent, the court shall presume she did not consent (corroborated by 120 BSA)

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(c) One Stop Centre (2 marks)

• Recent guidelines from the Ministry of Women and Child Welfare have created ONE STOP CENTRES at all District Hospitals across the country
• The Union Health Ministry has asked all hospitals to set up a designated room for forensic and medical examination of rape victims

1. Medical assistance - emergency treatment, forensic examination, collection of evidence
2. Legal aid - assistance in filing FIR, legal counseling
3. Psychological support - counseling, crisis intervention
4. Social support - shelter, rehabilitation
5. Police facilitation - to register the complaint

• Available 24 hours, 7 days a week
• Staffed by trained professionals including female doctors, nurses, counselors, legal aid workers, and police
• Maintains confidentiality and dignity of the victim
• Child-friendly environment as mandated under POCSO
• Funded under the Nirbhaya Fund (Government of India)
• One-stop service so the victim does not have to run from department to department

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Duties of a Doctor in Case of a Rape Survivor

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1. IMMEDIATE DUTY - MEDICAL CARE FIRST

• The primary duty is to the patient - life-saving treatment and stabilization takes priority over medico-legal formalities
• Treat all injuries, control hemorrhage, manage shock
• The victim may come directly to a doctor (without police requisition); the doctor must examine her, and after examination, inform the concerned police station so that due legal process can be set in motion
• Advise the victim (via police/escort) not to change clothes, bathe, or douche prior to examination - to preserve evidence

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2. DUTY REGARDING CONSENT

• Written, witnessed consent must be obtained before examination, collection of specimens, photography, treatment, and release of information to police
• If the victim is under 12 years of age or of unsound mind, consent of her parents/guardian must be taken in writing
• The Court or police has NO power to force a woman for medical examination against her will
• Consent must be obtained for: examination, specimen collection, photographs, and disclosure of findings to police/court

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3. DUTY REGARDING REQUISITION

• Examine the victim when there is a written requisition from the investigating police officer or Magistrate
• Record the requisition number, date, and the name of the officer
• If the victim comes directly without police requisition, examine her and then inform the police

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4. DUTY REGARDING IDENTIFICATION & DOCUMENTATION

• Victim should be identified by the escorting police constable (name and number recorded)
• Note identification marks of the victim
• Record: name, parent's name, marital status, residence, occupation, date, time, year, place of examination, and who gave the requisition
• Date and time are critical - the interval between the alleged incident and examination is material (spermatozoa lose motility within 1-6 hours; may be recovered up to 24 hours)

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5. DUTY REGARDING HISTORY TAKING

• Take history in privacy, in a sensitive and non-threatening manner
• Record the victim's statement in her own words as far as possible
• Record statements of the victim and of others separately regarding:
  • (a) Whether she knows the accused; whether food or drink was given prior to the act; whether threats were used
  • (b) Date, time, and place of alleged incident
  • (c) Whether there has been a recent history of consensual intercourse (relevant for VD and semen interpretation)
  • (d) Menstrual history - date of last period
  • (e) Whether she bathed, changed clothes, or douched after the incident

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6. DUTY REGARDING EXAMINATION

Presence of Third Person

• Examination must be conducted in the presence of a third person, preferably a female nurse or female relative of the victim - to protect the doctor from being accused of misconduct

Examination Without Delay

• Must be done without delay - minor injuries fade rapidly; swelling and tenderness of vulva may disappear within hours; spermatozoa detection diminishes with time

(A) Clothes Examination

• Check whether clothes are those worn at the time of assault
• Patient should stand on a clean sheet of paper while undressing - anything that falls (earth, buttons, hair, fibres, gravel, leaves) must be preserved
• Examine clothes for stains (blood, semen, mud, grease, grass), soiling, tears, and loss of buttons
• Clothes dried, stored in a clean paper bag (not plastic), and sent to the laboratory

(B) General Examination

• Examine under ultraviolet light to detect seminal stains
• Note and swab all areas of soiling
• Collect loose hair or foreign substances found on skin
• Take large and close-up photographs of injuries, especially the genital area
• Examine the whole body for marks of violence - scratches, bruises, lacerations, areas of tenderness:
  • Around mouth and throat (forcible silencing)
  • Wrists and arms (seizure marks)
  • Back, shoulders, and buttocks
  • Inner and outer thighs (especially inner upper thigh)
  • Breasts - bite marks, suction lesions, discoid bruises
  • Petechiae on face/conjunctivae (partial asphyxia from restraint)

(C) Local (Genital) Examination

• Examine pubic area; cut matted hair close to skin; comb and retain loose pubic hairs
• Inspect tops of thighs, labia, and perineum; note all injuries
• Take swabs from introitus and perineum
• Examine hymen: separate labia gently; note condition, tears (typically 5-7 o'clock position posteriorly)
• Take low vaginal swab before speculum introduction
• Introduce vaginal speculum gently; take high vaginal swab and cervical os swab under direct vision
• Note abrasions, bruising, lacerations of vaginal walls
• Two-finger test is BANNED by the Supreme Court (2013) - it violates the rape survivor's right to privacy
• Examine for VD: smears from cervix and urethra for gonococci (Gram-negative intracellular diplococci); blood for syphilis serology

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7. DUTY REGARDING COLLECTION & PRESERVATION OF TRACE EVIDENCE

• All containers must be sealed, labelled with date, time, victim's name, case number, and place of examination
• Chain of custody maintained - signed by examining doctor
• Blood samples refrigerated but NOT frozen (freezing causes cell lysis)

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8. DUTY REGARDING REPORT WRITING & OPINION

• The report should contain both positive and negative findings
• The doctor should NEVER make a diagnosis of rape - rape is a legal definition, not a medical diagnosis
• The doctor may state:
  • Signs of recent vaginal penetration
  • Signs of recent sexual intercourse
  • General physical injuries and/or intoxication present
  • Signs are consistent with the history given
• The doctor should mention negative facts but should NOT give opinion that rape has not been committed, as rape can occur without any injury
• Questions to be answered in the report:
  1. Is there evidence of recent sexual intercourse?
  2. Is there evidence of previous sexual intercourse?
  3. Do signs confirm use of force or stupefying drugs?
  4. Are physical findings consistent with the history?
  5. Does medical evidence confirm the allegation?
  6. Have all relevant specimens been collected?

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9. DUTY REGARDING TREATMENT

• Treat all injuries
• Emergency contraception (within 72 hours of assault) to prevent pregnancy
• STI prophylaxis - treat or prophylax against gonorrhoea, syphilis, chlamydia, HIV (post-exposure prophylaxis within 72 hours)
• Tetanus prophylaxis if indicated
• Refer for MTP if pregnancy has resulted (permissible up to 24 weeks in rape cases under MTP Amendment Act, 2021)

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10. DUTY REGARDING PSYCHOLOGICAL SUPPORT

• Prevention or lessening of permanent psychological damage
• Refer for counselling - post-traumatic stress disorder (PTSD), nightmares, phobias are common complications of rape
• Refer to One Stop Centre (OSC/Sakhi) at the District Hospital - provides medical, legal, and social support under one roof

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11. DUTY REGARDING MANDATORY REPORTING (POCSO)

• If the victim is a child (below 18 years), the doctor has a mandatory duty to report to the police or Special Juvenile Police Unit (SJPU) under Section 19 of the POCSO Act, 2012
• Failure to report is punishable under Section 21 of POCSO
• For adult victims, the doctor informs the police after examination (no mandatory reporting requirement, but standard practice)

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12. DUTY REGARDING CONFIDENTIALITY

• Maintain strict confidentiality
• Information disclosed only to investigating officer and in court as required
• Identity of victim must be protected (in-camera proceedings under POCSO)

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SUMMARY TABLE

Key medico-legal principle (KSN Reddy): "Rape is not a medical diagnosis; it is only a legal definition. The doctor should never make a diagnosis of rape. Medical evidence is always corroborative."