Sudden suspicious looking unexpected natural cardiac deaths: A case series study and in-depth review

Background Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD). Though it is one of the commonest causes of natural death but is contested too often. SCD of someone under the suspicion of violence means differently to different persons. Larger perception of the death due to suspected or known violence ignites an intolerance debate “Pro SCD versus Anti SCD”. Controversy into the cause of death ultimately ends but acrimony lingers.

Aim: To study autopsy physician's limitation, the role of general presumptions and biases in meeting with the expectation and demand of unwavering and unequivocal medical opinions. It is also to know & identify how embarrassments took place, who embarrassed and who tried to hit the clinician.

Material & method: A total of 13 SCD cases retrospectively reviewed and these cases were reported between 2009 to 2018. These cases landed into controversy due to the conflicting cause of death and missing injury. Dispute revolved around linking or delinking the injury to SCD. Re-examination was either solicited or ordered for further clarification as autopsy opinions either did not work or worked after rectification. In some cases, the issue over SCD was decided after multiple reviews. In other cases, the dispute over injury related SCD was decided after the trial in the court.

Results: Issues came up in cases who were brought in dead (BID). Also, in those who were declared dead in hospital. Absence of medical history, deceptive tampered background story created perception issues. False implicating tendencies and brazing campaigns too lead to erroneous determination of autopsy. Suspicion of scuttling the autopsy to cover up homicide is autopsy surgeon's big apprehension. Risk of one's being blamed or charged u/s 120B, 201 & 218 of IPC haunts a medical man. Mistakes in tangible cardiac damage was seen. Autopsy surgeon's misinterpretation of cardiac tamponade as traumatic tear did mislead the investigators. Intangible cardiac damage was too difficult to be diagnosed. Faulty transfer of background medical information is one reason of diagnostic errors of autopsy. Autopsy surgeon's dependence for timely correct information on cops is a limitation.

Conclusion: It was difficulties to get perfect diagnosis of CAD or the trauma that triggering the cardiac death. When investigators rely upon the incorrect autopsy opinion that may leads to custodial violence. Combination of both physicians and investigators perspective can help to identify accurate cause of death. Our study will help to in-service doctors, death investigators, future forensic medicine practitioners and lawyers to reach at right conclusion.