Custodial Death - Forensic Pathology & Autopsy Findings

Definition

• P.C. Dikshit Textbook of Forensic Medicine and Toxicology, p. 284

Situations Under Which Death May Occur in Custody

• Physical struggle during attempt to control or overpower a resisting offender
• Police use of truncheons, riot sticks, or firearms to subdue an armed offender
• Arrest of an intoxicated person (poses particular problems)

Causes of Death During Arrest

1. Traumatic Asphyxia

2. Arm-locks / Neck Holds

• Compression of the front and sides of the neck
• Death from reflex cardiac arrest (carotid compression)
• Cerebral ischemia from carotid compression
• Asphyxia from airway obstruction

3. Blunt Injury

• Fist, arm, leg, or weapons (truncheon, riot stick, pistol butt)
• Head injuries from falls against the ground, walls, or obstructions
• Heavy punch to the face: nasopharyngeal bleeding blocking airway (particularly dangerous in intoxicated persons)
• Blow on side of neck: reflex cardiac arrest or subarachnoid haemorrhage from vertebrobasilar vascular damage
• Backward elbow blow to face, neck, or abdomen
• Kicking and stamping: unusual but not uncommon in custodial deaths
• Abdominal blow with sufficient force can be fatal
• Use of elbow, knee, or head butt can deliver extreme force

4. Alcohol

• Alcohol is a frequent direct cause of death in custody and a major factor in provoking violent resistance
• Blood alcohol >350 mg/100 mL: risk of coma and central respiratory depression
• At lower levels: risk of aspiration of vomitus and choking on gastric contents
• At autopsy, aspiration must be distinguished from common agonal phenomenon (gross blocking of trachea/bronchi with vomit = accepted cause of death)
• Alcohol also contributes to accidental falls during custody, especially head injuries from falls on the ground, down steps/stairs
• Falls onto hard surfaces often on the occiput, producing frontal and temporal contrecoup brain damage - good evidence of deceleration injury rather than assault with a weapon
• Drugs (amphetamine, cocaine, hallucinogens) may cause physical damage; drug overdose and hypersensitivity deaths are seen in prisons

5. Suicide in Custody

• Quite common - police typically deprive prisoners of objects usable for hanging (belts, braces, cord, bootlaces)
• Police cells are designed to avoid suspension points (bars, hooks, door handles)
• Nevertheless, prisoners manage: hanging can be accomplished by traction on the neck at low levels using bed-heads, chairs, and other unlikely objects
• At autopsy: homicidal hanging must be ruled out by absence of signs of struggle and other ante-mortem injuries
• Possibility of hanging after killing to simulate suicide must be considered
• Scene visit with the body in situ is preferred

6. Natural Causes

• Usually of cardiovascular origin
• The emotional and physical upset of arrest and confinement may precipitate an acute cardiac crisis through adrenaline response, particularly in the presence of severe pre-existing disease
• Important conditions to seek: diabetes, epilepsy, asthma, and other diseases capable of causing sudden unexpected death
• Sought via medical history and autopsy findings

7. Causes in Torture / Prolonged Custodial Situations

• Sepsis (from infected wounds)
• Haemorrhage
• Internal organ injury
• Sheer exhaustion

Investigations of Custodial Deaths (Forensic Approach)

1. All deaths in custody must be examined with care to ensure custodians are cleared of any suspicion of ill-treatment
2. Torture and custodial deaths are confirmed by circumstantial and corroborative evidence
3. Non-cooperative attitude of authorities is often encountered
4. Cases may be referred to bodies such as the Red Cross, Amnesty International, Physicians for Human Rights
5. There is usually a delay before examination - injuries may have healed, body may be decomposed, sometimes disposed of early
6. The pathologist should, when possible, visit the scene of death, especially if caused by hanging or mechanical trauma

NHRC Protocol for Custodial Death Autopsies (1993, Amended 2001)

Mandatory Photographs Include:

• Face (front, right lateral, left lateral views), back of head
• Front of body (chest + abdomen) and back
• Upper extremity - front and back
• Lower extremity - front and back
• Each injury/lesion (numbered and zoomed in)
• Internal examination findings
• Soles and palms after incision (to show absence/evidence of old or deep-seated injury)
• In firearm injuries: distance from heel and midline documented for each injury

Documentation:

• Clothing removed, documented, sealed by physician only; sent to FSL
• Each injury described with reference to heel and midline
• PM report must be typed/computerized; fingerprints of deceased appended

Submission Timeline:

• Magistrate's inquest, autopsy report, and video to reach NHRC within 2 months
• FSL reports (toxicology, histology) forwarded promptly to NHRC; viscera report sent separately once received

Compensation:

• Next of kin entitled to compensation from the State Government and the offending officer

NHRC Recommendations (Key Points)

1. Failure to report a custodial death within 24 hours leads to a presumption by the Commission that an effort is being made to suppress the occurrence
2. Commission recommends insertion of Section 114(B) in IEA 1872: rebuttable presumption that injuries sustained by a person in police custody were caused by a police officer
3. A mandatory enquiry by a Sessions Judge in each case of custodial death, rape, or grievous hurt is endorsed
4. Permissive use of "third degree methods" violates the rights of citizens and is not justified for successful investigation

• The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), pp. 127, and NHRC Protocol section
• P.C. Dikshit Textbook of Forensic Medicine and Toxicology, pp. 284-285

Summons (Subpoena)

Definition

• The word is derived from Latin: sub = under, poena = penalty
• It may also require the witness to bring with him any books, documents, or other things under his control that he is bound by law to produce in evidence - this specific form is called subpoena duces tecum (Sections 94 & 195, BNSS; Section 165, BSA)
• The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), p. 26
• P.C. Dikshit Textbook of Forensic Medicine and Toxicology, p. 12

Legal Provisions

• Dealt with under Sections 63 to 71, BNSS (formerly Sections 61 to 69, Cr.P.C.)

Form and Issue of Summons

• Issued by the court in writing, in duplicate
• Signed by the presiding officer of the court
• Bears the seal of the court (Section 63, BNSS)
• States the crime number and name of the accused person

Service of Summons

1. A police officer
2. An officer of the court or other public servant
3. By registered post
4. By fixing it on a conspicuous part of the house in which the person resides

Duties of the Summoned Witness

• A summons must be obeyed
• The witness must produce documents if asked (Section 94, BNSS)
• The witness will be excused from attending only if there is a valid and urgent reason

Punishment for Non-Compliance

Priority Rule

Criminal Courts have priority over Civil Courts.

Specimen Wording of a Summons (from a Sessions Court)

"...it appears to me that you are likely to give material evidence for the court, you are hereby summoned to appear before this court on [date] at [time] 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, a warrant of arrest will be issued to compel your attendance."

• Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology

• The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), pp. 26-27
• P.C. Dikshit Textbook of Forensic Medicine and Toxicology, p. 12
• Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology