Specialist board autopsies in alleged medical negligence: An urgent necessity for India

To The Editor,

Sir,

Autopsies in alleged medical negligence cases in India are pivotal for establishing both medical accountability and the truth. However, current practices are often deficient, as autopsies are typically conducted without clinical specialists from the relevant discipline. This limits the assessment of whether the doctor's conduct met the standard set by peers in that specialty. To safeguard justice, I argue that every such investigation should involve a multi-specialty board, including a forensic medicine expert and a clinical specialist, appointed by the Medical Superintendent (MS). This approach better aligns with jurisprudence, medical ethics, and practical realities.

Legal precedent in India already supports the importance of peer standards in assessing negligence. The Bolam test, for instance, mandates that a doctor's conduct be judged against what a reasonable body of medical opinion in that field would sanction. ¹ Similarly, the Supreme Court of India's decision in Jacob Mathew vs State of Punjab emphasises that a negligence evaluation must rely on standards recognised by peer practitioners. ² Without relevant clinical input in the autopsy, evaluating whether the medical standard of care was met becomes speculative.

This multi-specialty autopsy board should minimally comprise: (a) a forensic medicine specialist to conduct the post-mortem examination and interpret findings as to the cause of death; and (b) a clinical specialist from the field relevant to the allegation (e.g. obstetrics, surgery) to assess whether diagnostic decisions and interventions met the standard of care. The administrative responsibility to constitute this board should rest with the Medical Superintendent (MS), who has the necessary oversight across clinical departments to appoint appropriately qualified specialists.

This system is feasible where qualified experts are available or where the body can be shifted to another government institution. To ensure impartiality, such autopsies should preferably be conducted within government setups. Crucially, to avoid any perceived or actual conflict of interest, the autopsy should be conducted at a different institution if the allegation concerns a doctor practicing at that same government hospital.

Observations from practice show clinician reluctance to engage in medico-legal work, often due to discomfort with legal proceedings. Yet, those same clinicians would expect peer specialists to assess their practice if ever accused of negligence. Addressing this paradox requires integrating targeted medico-legal training – covering autopsy norms and legal expectations – into medical curricula and continuing professional development. ³

The police, who formally request the autopsy, are essential stakeholders. Therefore, clear Standard Operating Procedures issued by the ministries are needed to mandate this board-based approach and ensure police and hospital administrators are sensitised to the requirement.

A uniform policy mandating a specialist board autopsy in negligence cases would enhance the credibility of medico-legal findings, align practice with legal expectations, and justly protect both patients’ families and clinicians. ⁴ This is not about penalising doctors but about ensuring transparent, scientifically grounded investigations that withstand legal scrutiny.

I urge the National Medical Commission, the Ministry of Health & Family Welfare and the Home ministry in India to issue national guidelines requiring this board structure. Without such standardisation, investigation outcomes will continue to depend more on chance than on principle.