A case of sudden natural death in a custody: Medico-legal perplexity in determining the manner of death

• K Sathish,*  
• Vinod Ashok Chaudhari,  
• Sathish Ayyappan

Abstract

Death arising during police custody or in prison always raises suspicion and creates public rage regarding the cause and particularly the manner of death. On the contrary, in most instances, the manner of death is natural as reported in many literature and the role of an autopsy surgeon is vital in determining the same. Here we present a 42-year-old male prisoner who was brought dead to the casualty with history of sudden onset of breathlessness and giddiness. On autopsy, there were no signs of injuries both externally and internally. In the heart right coronary artery showed near complete occlusion 2cm from its origin, left anterior descending, and left circumflex artery showed 60% and 80% occlusion respectively. The walls of the coronaries, and aorta showed deposition of calcified and ulcerated atheromatous plaques (Grade VI atherosclerosis). Histopathology showed evidence of atherosclerosis by deposition of calcified fibroatheromatous plaques and multiple vessels showed critical narrowing. Chemical analysis of viscera was turned negative. The final opinion to the cause of death was acute myocardial infarction (sudden natural death). Among the natural causes of death during custody cardiac causes contribute the majority of fatality. This case report emphasizes the need for a complete and meticulous forensic autopsy which aids in solving the grievances of the deceased’s family on the cause and manner of death and also aids in the legal standing of the country.

Keywords

Sudden natural death, Custody, Prison, Autopsy, Acute coronary insufficiency, Natural death