INTRODUCTION
The role of a Medical expert in a criminal trial, especially in ambiguous cases, is very significant. But sometimes cases happen to be so peculiar, that even the best of experts stand in confusion. Masquerade itself means false presentation of facts or dissimulating the real issues.[1] Medico-legal masquerade occurs when violent deaths are accompanied by minimal or no external evidence of injury or when natural death shows signs of violence. In such cases, there is great doubt. But this problem must be overcome with the help of other facts relevant to the case such as medical history, circumstances of death, an object used to produce injury, injury pattern about dexterity, and the presence or absence of old and fresh hesitation cuts at the neck and elsewhere, predisposition and extent, autopsy findings, scene evidence, findings of visceral examination and ultimately the cause of death.[2] Usually, cases of suicidal cutthroat injuries, Arteriovenous Malformation, etc., are examples of suicides that are largely portrayed as homicide due to the represented injuries. However, it is not just limited to suicides and homicides, accidents, severe wounds, and injuries can also be misrepresented either intentionally or unintentionally. Such instances intrigue doctors and induce them to investigate the matter in detail. With responsibility on one side, doctors themselves might negligently misinterpret a case, which puts them under legal scrutiny. Medico-legal masquerades have large implications legally, as they can potentially turn a case upside down, while possibly letting go of an offender or punishing an innocent individual.
FORENSIC AND MEDICO-LEGAL INVESTIGATIONS
Forensic experts have certain indicators to consider to determine the cause of death and other factors to make an expert opinion. A person who appears to have died from acute alcoholic poisoning or the combined effects of alcohol and other drugs may have committed suicide by using drugs, or rarely he may have been poisoned criminally. In a suicide case, alterations may be made at the scene because of disgrace. In a homicide case, the scene may be altered or rigged to suggest that death resulted from suicide or accident. Upset furniture, overturned lamps and other disturbances, and blood stains on walls and floors are consistent with a struggle between assailant and victim. However, a similar disturbance may be seen in the case of suicide committed. At the same time, the victim was acutely intoxicated by alcohol or some drug, or he was possessed by some form of psychotic excitement. Persons dying from natural causes may become hypoxic and confused terminally. They may fall against furniture and knock items over, and the scene may appear ransacked. The doctor must look for any possible inconsistencies between the apparent death scene and his actual scientific findings. In the case of hanging, how a ligature is applied to the neck, or the mode of suspension of a body may determine the manner of death. In such cases, the real cause of death can be established by a complete autopsy and police investigation.
PROBLEMS ARISING OUT OF THE MEDICO-LEGAL MASQUERADE
Misinterpretation of the Entire Case – An entire case is wrongly interpreted if the reason for a particular injury or death is uncertain. In any case, considering the implications and factors in the present case, a medical practitioner must give his/her report in good faith with proper reasoning to the best of their ability. This results in the falsification of the entire case. Even if a fair trial is conducted in a Court of law, the crux of it would still be doubtful. The entire matter at hand is misinterpreted and stands hostile to Blackstone’s Ratio – “Ten guilty persons should escape than that one innocent suffer.”[3] This would be a disgrace to both the legal and medical systems of the country. In Smt. Reshma W/O Ramesh Sutar v. Shri. Amool Laxman Ukirde(2020), the Karnataka High Court emphasized that even if a patient denies injuries, a doctor should report the case as medico-legal if they suspect foul play based on their clinical examination[4]. In Parmananda Katara v. Union of India(1989), the apex court case reiterates the duty of a doctor to provide medical aid to victims regardless of the cause of injury, which includes properly examining and documenting medico-legal cases[5].
Fraud and Misrepresentation – One of the biggest fallouts of medico-legal masquerades is intentionally doing so to commit fraud and misrepresentation. Various Indian courts in Satwant Kaur Sandhu vs New India Assurance Company Ltd (2009)[6], Pavan Sachdeva vs. Office of the Insurance Ombudsman and Others (2019)[7], Religare Health Insurance Co. Ltd. vs. Harwant Singh and Another (2020)[8], Life Insurance Corporation of India and Others vs. Asha Goel and Another (2001)[9] and other similar cases, have recognized misrepresentation and fraud in insurance claims. This is prone to happen in the case of a medico-legal masquerade. A false accident claim, exaggerating an injury, etc., can lead to fraudulent insurance claims.
Ethical Violations and Medical Negligence – Another problem arises when the medical expert herself violates the ethos and misrepresents a case on purpose due to fear or favour. Healthcare professionals must adhere to ethical guidelines, including honesty, integrity, and impartiality, especially when providing medico-legal reports. Their role is significant in creating a framework of the facts of the case. If this is tampered with, justice would be snatched far away. When a practitioner is found violating ethics Licensing boards may take disciplinary actions, such as suspension or revocation of medical licenses. Liability also exists for incorrect labelling of a patient as fit or unfit for legal purposes (e.g., fitness to stand trial) or failure to detect malingering or fabricating symptoms.
WAY FORWARD
Medical practitioners have expressed that in cases of ambiguity, or confusion, they might have to take into consideration some other facts of the case. For example, they may request a crime scene visit, or ask for specific pieces of evidence collected at the crime scene. In a study conducted by professors at the Malla Reddy Institute of Medical Sciences, Hyderabad, there was an example where a young lady was brought to the mortuary along with an inquest and requisition from the police, who opined that the cause of death was due to high feveneighbour’sr’s allegation). On post-mortem examination, the cause of death was found to be throttling with physical evidence of contusion marks in the neck with the underlying fracture tips of the thyroid horn use. This was subsequently accepted by the police and the victim’s mother.[10] Sometimes even the fact that the door was not locked from the inside, or that the victim lived alone, how the injury took place, etc., add to the knowledge of the doctor in giving an accurate analysis[11]. Forensic analysis with the support of police investigation and circumstantial evidence, definitely boosts the working of the criminal justice system. Along with this, in case of further ambiguity recognized at the trial level, another medical expert can be consulted to come to an affirmative conclusion.
CONCLUSION
Medico-legal masquerade is not a completely popular concept in India even though there are provisions against any intentional misrepresentation. However, when it is unintentional, it becomes extremely difficult for a medical practitioner to conclude without the fear and pressure of committing a significant error. This requires more assistance from police investigation and circumstantial evidence, in such a way that together they ensure that the criminal justice system is not hampered. The importance of another medical expert to support or reject a report that has already been made has also been discussed. These experts must navigate through misleading presentations, ethical dilemmas, and instances of negligence or fraud to uncover the truth. A multidisciplinary approach, combining meticulous forensic examination, collaboration with law enforcement, and careful consideration of circumstantial evidence, is essential in resolving ambiguities. As the criminal justice system relies heavily on expert opinions, reinforcing training, resources, and procedural safeguards for medical professionals can significantly enhance the accuracy and reliability of their findings. Navigating through these natural difficulties through a multidisciplinary and cooperative approach can help in enhancing the justice system.
Author(s) Name: Namratha M & Brinda M (School of Law, CHRIST(Deemed to be University), Bengaluru & Southwest Medical University, Luzhou, China)
References:
[1] Reddy DCRR and others, ‘An Analytical Study of Medicolegal Masquerade Cases:’ (2017) 6(4) Indian Journal Of Research, accessed on 24 January 2025
[2] Singh BK and others, ‘Suicidal Cut-Throat With Medico-Legal Masquerades: Case Illustration and Review of the Literature’ (2023) 13(1) Egyptian Journal of Forensic Sciences <http://dx.doi.org/10.1186/s41935-023-00363-0> accessed 24 January 2025
[3] Xiong M, Greenleaf RG and Goldschmidt J, ‘Citizen Attitudes Toward Errors in Criminal Justice: Implications of the Declining Acceptance of Blackstone’s Ratio’ (2017) 48 International Journal of Law, Crime and Justice 14 <http://dx.doi.org/10.1016/j.ijlcj.2016.10.001> accessed 24 January 2025
[4] Smt. Reshma W/O Ramesh Sutar v. Shri. Amool Laxman Ukirde[2020], MFA NO 101647 OF 2019
[5] Parmananda Katara v. Union of India[1989] 1989 AIR 2039 (SC)
[6] Satwant Kaur Sandhu vs New India Assurance Company Ltd [2009] 2009 INSC 899 (SC)
[7] Pavan Sachdeva vs. Office of the Insurance Ombudsman and Others [2019] AIR 2021 (NOC) 253 (DEL.)
[8] Religare Health Insurance Co. Ltd. vs. Harwant Singh and Another [2020] First Appeal No.133 of 2020
[9] Life Insurance Corporation of India and Others vs. Asha Goel and Another [2001] AIR 2001 SUPREME COURT 549 (SC)
[10] Reddy DCRR and others, ‘An Analytical Study of Medicolegal Masquerade Cases:’ (2017) 6(4) Indian Journal Of Research, accessed on 24 January 2025
[11] Singh BK and others, ‘Suicidal Cut-Throat With Medico-Legal Masquerades: Case Illustration and Review of the Literature’ (2023) 13(1) Egyptian Journal of Forensic Sciences <http://dx.doi.org/10.1186/s41935-023-00363-0> accessed 24 January 2025
