Medico-legal Services Research Articles

Operations of a Student-Run Asylum Clinic: Frameworks, Challenges, and Recommendations

Abstract Student-run asylum clinics within medical schools represent a promising alternative to costly medicolegal services for people seeking asylum by providing pro bono forensic medical evaluations. However, there exist significant operational barriers to creating and developing such clinics, which depend largely on volunteerism and limited financial budgets. This policy and practice note not only presents a framework aimed at navigating these barriers in developing a student-run asylum clinic but also outlines critical challenges and recommendations for addressing them. We describe three principal components of clinic structure: community outreach and service, administration of forensic medical evaluations, and continuity of care. We also highlight challenges, such as access to a physical space for evaluations, maintenance of interpreter access and quality, standardization of clinician evaluator expectations, clinician evaluator availability, and evaluator wellbeing. Recommendations include the incorporation of a diversity of referral sources, opportunities for clinician-clinician shadowing, evaluation quality assessment, affidavit standardization, and development of interdisciplinary partnership.

Variation in Resource Supply of Mortuary for Autopsy at Tertiary Care Center - A Nation-Wide Survey

Mortuaries and medicolegal services are essential support services to the administration of healthcare. There is a lack of information and uniformity regarding various resource supplies especially day to day consumables for medico-legal services in India. For this reason, a study was undertaken to evaluate the current status of mortuaries and resource supplies for autopsy work as well as the elements that contribute to it. A cross sectional study was conducted in several Indian tertiary care facilities using both qualitative and quantitative methods of data analysis. 74 faculty members from 71 institutes, including 5 AIIMS and AFMC Pune, participated in this study using data from 61 districts across 19 states and the union territories. Information about these health care institutions was gathered using a Google form that included 18 carefully crafted questions with options to observe and interview the faculties who are directly related to autopsy work. Across all the health care facilities we looked and discovered a wide range in resource availability and reluctance on the part of the institute to provide various resources for postmortem services. Polythene and cloth to wrap the body after the postmortem were arranged by relatives and NGOs in 34% and 46% of institutes, respectively; even in 14% of institutes, containers for the preservation of viscera have been arranged by relatives of the deceased. In 57% of institutes, doctors and 45% of institute mortuary workers are not receiving any postmortem allowance; in 30% of institutes, doctors received less than 500 rupees; and in 22% of institute mortuary workers received less than 50 rupees. In 39% of institutes, mortuary workers are outsourced by the institute on a temporary basis, and in 24% of institutes, departmental sweepers are employed as mortuary workers. Most mortuaries did not have adequate and trained human resources. Thus the present study attempts to highlight the variation of resource supply for medico-legal cases in autopsy block, mortuary workers, their recruitment method, and the lowest rank of investigating officer handling PM, highlights the value of uniform guideline for these services at institute, state or national level.

A Quality-Assured Medico-Legal Service Through Human Resource Management in the Medico-Legal Unit of Sri Lanka

A specialist in forensic medicine has a dual role in Sri Lanka. These are conducting autopsies on death and the medico-legal examination of living cases of physical and sexual assault, poisoning or alcohol intoxication, etc. To deliver a quality-assured forensic service human resources play a pivotal role. The present workforce of a medico-legal unit consists of a specialist in forensic medicine, a medical officer medico-legal, a development officer, a morgue assistant, and a female healthcare assistant. Due to the lack of necessary professional skills among non-medical staff members and the lack of proper job descriptions for the non-medical staff members some pivotal functions in the medico-legal unit are handled by the less qualified staff members. We suggest that the relevant professional bodies in collaboration with ministries, develop standardized job descriptions and allocation of roles for non-medical staff members across the medico-legal units in the country so that the institutions and all the stakeholders adhere to the duties specified to improve the desired quality of the medico-legal unit.

The medico-legal death investigation system in Nepal.

In Nepal, police inquests have several limitations. When they receive information about a death, the police visit the crime scene and write an inquest report. Then, they arrange for the body to be autopsied. However, most autopsies are performed by medical officers in government hospitals who lack specialised training in conducting autopsies. Although all Nepalese medical schools teach forensic medicine to undergraduate students and require them to witness some autopsies, most private institutions are not authorised to perform them. Autopsies performed without expertise can be subpar and, even when trained personnel are available, these facilities are inadequately equipped. In addition, there is a lack of sufficient manpower to provide expert medico-legal services. The Honourable Judges and District Attorneys of all district courts believe that the medico-legal reports prepared by the doctors are inappropriate, incomplete and inadequate for use as evidence in court. Moreover, the police are more concerned with establishing criminality than other aspects of medico-legal death investigation, such as autopsies. Therefore, the quality of medico-legal investigations, including death investigations, will not improve until government stakeholders recognise the importance of forensic medicine in the judiciary and for the resolution of crimes.

Assessment of Forensic Medical Expert’s Involvement in Primary Crime Scene Investigation in Nairobi

It is of great importance to include Forensic Medical Experts (FMEs) in Primary Crime Scene (PCS) investigation team especially in murder, rape and defilement in investigation framework. The criminal justice system in Kenya has not been effective due to the shortage of FMEs as well as the poor specialization among forensic experts and police officers in implementing Medico-legal services within the country. This research sought to assess the need to involve FMEs in PCS investigation in Starehe sub-county, which comprises of five stations, for the purpose of improving the quality of criminal investigation in the country. A systematic random sampling technique of case files brought back from court was used. The sample size was calculated by dividing the entire case files by interval. There were one hundred and thirty-five (135) case files numbered from one to one hundred and thirty-five (135), then picked at an interval of two from a random number. Sixty-seven (67) case files were sampled, studied and analyzed. Three hypotheses were developed to be tested. The main objective was to assess forensic medical expert’s involvement in PCS investigation in starehe police division, Nairobi County, Kenya. Data analysis was done using SPSS and presented with tables, and narrative. From the tested hypothesis we were able to discover that the FMEs in Kenya are not well trained and professional in the use of SOPs for collecting forensic evidence at PCS H1 (p=0.754); the Kenyan criminal justice system framework does not involve FMEs at all primary stages of investigations H2 (p=0.878); Cases in Kenyan courts are not very successful without the use of FMEs H3 (p=0.247). Involvement of the FMEs in primary crime scenes investigation ensures that there is adequate and sufficient evidence to prosecute criminals convicted of such criminal acts. Cases without forensic evidence component failed to secure a conviction indicating that their absence impacts the quality of evidence submitted to present a sound case to prosecute offenders. FMEs should respond alongside police crime scene investigators and be linked to crime scenes at all stages of investigation to collect forensic evidence to identify suspects responsible for committing criminal activities at the PCS. Forensic evidence should be presented by a qualified professional who complies with standards that enhance efficiency and fairness. The forensic medical evidence at the primary crime scene is best armed with skills, knowledge and tools that are required to aid the investigators to make maximum use of scanty resources available with regard to collection and analysis of biological and chemical evidence. There should be clearer guidelines on the steps to follow in regard to evidence collection. The results of this study will be used by policy makers and health care providers to improve forensic evidence gathering for better and successful prosecution.

Survivor-Centered Care in Gender-Based Violence Treatment Protocol for Healthcare Providers: A Medico-legal Review

The gender-based violence (GBV) treatment protocol for healthcare providers (HCPs) is an essential element for building the capacity of HCPs to provide better quality care to the survivors. A protocol helps to ensure that all survivors of GBV regardless of their age, background or ethnicity receive appropriate and effective care when they enter a health facility. Concern for patient welfare extends to ensuring that patients’ dignity is respected after an assault that may leave them feeling humiliated and degraded. Additionally, medical and forensic services should be provided in a manner that minimizes the number of invasive physical examinations and interviews of the patient. Rape management is generally considered as a medical emergency and the provision of medico-legal services thus takes secondary importance to general healthcare services [such as trauma treatment, evaluation and management of pregnancy and sexually transmitted infections (STIs)]. Performing a forensic examination may be considered as a negligent practice without meeting the primary healthcare needs of the patients. Health facilities are often the first entry points for GBV survivors – so, it is crucial for HCPs to be skilled and well-equipped to manage the care to the survivors. A protocol emphasizes the importance of providing survivor-centered care with an empathetic attitude to people affected by GBV includes identifying GBV, taking medical history, maintaining privacy and confidentiality and gathering medico-legal evidence. J Monno Med Coll June 2022;8(2): 53-56

A guide to classify tattoo motives in Mexico as a tool to identify unknown bodies

JustificationIn Mexico, the number of unidentified bodies has been steadily rising for years. By now, more than 50,000 bodies are considered unidentified. Forensic laboratories that could perform comparative molecular genetic investigation are often overburdened and examinations can take months. Therefore, pragmatic approaches that can help to identify more unknown bodies must be sought. The increased use of distinctive physical features might be one, and the high rate of tattooed people in Mexico points towards a great potential of tattoos as a tool for identification. The prerequisite for a comparison of antemortem (missing persons) and postmortem (unknown bodies) data is an objective description of the particularities, e.g., of the tattoos. The aim of this study was to establish an objective classification for tattoo motives, taking into consideration local preferences.MethodsIn the database of the medicolegal services of the Instituto Jaliscience de Ciencias Forenses (IJCF) in Guadalajara, postmortem data of 1000 tattooed bodies from 2019 were evaluated. According to sex and age, the tattooed body localization and the tattoo motives were categorized.ResultsThe 1000 tattooed deceased showed tattoos on 2342 body localizations. The motives were grouped and linked to the following 11 keywords (with decreasing frequency): letters/numbers, human, symbol (other), plant, symbol (religious), animal, object, fantasy/demon/comic, tribal/ornament/geometry, other, unrecognizable.ConclusionUsing the proposed classification, tattoo motives can be described objectively and classified in a practical way. If used for antemortem (missing persons) and postmortem (unknown bodies) documentation, motives can be searched and compared efficiently—helping to identify unknown bodies.

Medicolegal Practice in India

In India, most of the medicolegal records are still kept as paper documents, even though technology has become integral in every other field of the health sector. Digitalization of the medicolegal processes would allow records to be easily stored and accessed. In addition, it would improve security, accuracy, and readability. Despite some steps in the right direction, most Forensic Medicine departments in India seem to be lagging behind. The authors will attempt to highlight the pressing need for the digitalization of medicolegal services in our country.

HIV Surveillance and Research for Migrant Populations: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia.

BackgroundEpidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming.ObjectiveWe describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia.MethodsRespondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia.ResultsData collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022.ConclusionsTailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming.International Registered Report Identifier (IRRID)DERR1-10.2196/36026

COVID-19 pandemic: a reminder to develop forensic radiology facility.

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.

MEDICOLEGAL SERVICE PROCEDURE (VISUM ET REPERTUM) DURING THE COVID-19 PANDEMIC

During the COVID-19 pandemic, the crime rate, especially against the human body, has increased. For the sake of law enforcement, one of the services needed to obtain evidence is medicolegal services (visum et repertum). This study uses a qualitative approach, type of research is descriptive, namely research that describes information data based on facts obtained in the field. This study was conducted at the Bhayangkara Raden Said Sukanto Hospital, Jakarta. This study indicates that medicolegal service procedures have changed during the pandemic to adapt to the implementation of health protocols to prevent the transmission of COVID-19. The procedure emphasizes arrangements related to the implementation of services with strict health protocol standards from both doctors and patients to prevent the transmission of COVID-19. The application of medicolegal services (visum et repertum) from the aspect of service procedures during the pandemic changed procedure. Service procedures continue to follow the procedures before the pandemic through Standard Operating Procedures Number B/46-52/V-VIII/2017/VISUM regarding Standard Operating Procedures, but during the current pandemic, service procedures adjust to the implementation of health protocols to prevent transmission of covid-19 during the pandemic with the issuance of Standard Operating Procedures through letter Number B/01/XI/2020 concerning Medicolegal Examinations in the Era of the Covid-19 Pandemic. The procedure emphasizes arrangements related to the implementation of services with strict health protocol standards from both doctors and patients to prevent the transmission of COVID-19.

Direct coupling of MEPS to ESI-QqTOF-MS for the simultaneous analysis of tricyclic antidepressants and benzodiazepines in postmortem blood

The combination of chromatography and mass spectrometry is the golden standard in forensic sciences. Although this approach provides high sensitivity and selectivity levels, it is time-consuming. The circumvention of the chromatography can increase the sample throughput, but the selectivity must be compensated by using a selectivity enhanced instrumental technique, such as high-resolution mass spectrometry (HRMS), and designing an appropriate sample preparation step. Microextraction by packed sorbent (MEPS) has proven potential to treat complex biological samples in a fast and reproducible way. It allows processing low sample volumes, remaining a green procedure due to low solvent consumption. This article presents the direct coupling of a MEPS syringe to the electrospray ionization source (ESI) of a quadrupole time-of-flight mass spectrometer (QqTOF) using an infusion pump for sample introduction, as a proof of concept. The developed method was validated for the simultaneous analysis of benzodiazepines and tricyclic antidepressants in postmortem blood samples. Limits of quantification (LOQ) were between 25 and 50 ng mL−1 for all compounds. Accuracy and precision were evaluated at three concentration levels (50, 125 and 350 ng mL−1) and expressed in terms of relative error (%RE) and relative standard deviation (%RSD), respectively. Both parameters were better than 20% for the lower concentration evaluated and better than 15% for the other two concentration levels. The developed method was used to analyze authentic postmortem blood samples, to test the applicability in the forensic toxicological context. The results are in agreement with the data provided by the medico-legal services. Also, the application of HRMS has allowed the identification of unexpected targets in the samples.

Post-rape medicolegal service provision and policy in East Africa: a scoping review protocol

BackgroundSexual and gender-based violence (SGBV) is an epidemic that continues to affect both men and women in East Africa. Despite the high prevalence of SGBV in this region, sexual offense policies are often unclear, poorly enforced, or completely lacking. When policies do exist practitioners who assist survivors in the aftermath of the violation often are unaware of them, or may not implement them for a host of reasons (e.g., culture, personal beliefs, and resource limitations). This scoping review seeks to evaluate the literature on existing sexual offense policies in East Africa and understand the consequences of its implementation, or lack thereof, on a survivor’s justice and medical and psychological wellbeing.MethodsThis scoping review will be guided by the amended Arksey and O’Malley framework recommendations (Levac et al., Implementation Science. 2010) and the 2015 Joanna Briggs Institute guidelines (Peters et al., Joanna Briggs Institute Reviewer’s Manual, 2020). The results will be presented using the adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews chart (PRISMA-ScR). The search strategy for this scoping review will include entering search terms into electronic databases, including PubMed, SCOPUS, CINAHL Plus, The British Library, and Web of Science. A “cited by” search will be conducted, which will also include entering references from the reference lists from other articles. Grey literature will be included in the review, which will be identified through searching individual country’s government websites, and other websites, such as the World Health Organization and the United Nations Human Rights Council. All references will be exported to Endnote library. Two independent reviewers will screen titles, abstracts, and full articles. Thematic analysis will be used to evaluate the included articles.DiscussionUnderstanding the legal and regulatory context of SGBV in East Africa and its associations with service provision will generate knowledge on implications for wellbeing. This information can be used to evaluate potential human rights violations and inform future policy.Systematic review registrationOpen Science Framework https://osf.io/vh3gm

Utilising the due diligence standard to interrogate Kenya's accountability efforts with regard to survivors of sexual violence in the 2007-2008 post-election violence

SUMMARY Sexual violence is a human rights violation and is addressed under a growing number of international agreements including the 1993 Declaration on the Elimination of Violence against Women, among others. This article uses the due diligence standard, as elaborated on by the UN Special Rapporteur on Violence against Women, to interrogate Kenya's domestic accountability efforts with regard to sexual violence in the 2007/2008 post-election violence. It finds that Kenya suffered from a number of structural and systemic shortcomings that resulted in its failure to meet its obligation to prevent, investigate, prosecute and compensate for such acts of sexual violence perpetrated by both state and non-state actors. Key among them are a lack of well-coordinated multi-sectoral approaches to address sexual violence; human capacity gaps in the provision of medico-legal services to survivors; and systemic failures in the investigation and prosecution of sexual violence cases. The article further highlights the hope for future accountability inherent in the recent ruling in Constitutional Petition 112 of 2013 which held the state accountable for all gaps and shortcomings in responding to sexual violence during the post-election violence. The article concludes by advocating community-based multi-sectoral approaches in prevention and response to sexual violence in the Kenyan context with an emphasis on improving both human and technical capacities for provision of medico-legal services to survivors. Key words: sexual violence; human rights; Kenya 2007-2008 postelection violence; medico-legal responses to sexual violence

Unspoken victims: A national study of male rape incidents and police investigations in South Africa.

The burden of sexual violence has been well described in children of both sexes and in women, but there is minimal literature on adult male rape victims. Studies of adult male rape victims have mainly been conducted among incarcerated males or military personnel, and in high-income countries. To describe the epidemiology, occurrence and reporting of rape cases involving male victims, both child (<18 years old) and adult, in South Africa (SA). The study consisted of a nationally representative sample of case dockets maintained by the SA Police Service of rape incidents reported in 2012. A retrospective review of the dockets provided sociodemographic information on the victim and suspect, the circumstances of the rape and the medicolegal services provided to the victim. Data on male victims were analysed using Stata 13 to test for significant differences between child and adult male victims. The study comprised 209 male victims, including 120 (57.4%) children and 89 (42.6%) adults. The findings showed that there were significant differences in the occurrence and reporting of rape of male victims by age. Adult males experienced more violent rapes, perpetrators were more likely to be armed and often humiliated the victim, and rapes were more likely to occur in institutional settings. Adult males reported incidents of rape earlier and therefore had visible non-genital injuries during the medical examination. In contrast, more child rapes involved known perpetrators, occurred in a home and perpetrators were more likely to act kindly to the victim after the incident. This parallels the patterns in rape circumstances seen in female adult and child victims. While there is political commitment to understanding sexual violence against women as a societal problem, work on such violence against men lags behind and is little understood. Rape of males needs to be acknowledged, and their vulnerabilities to sexual abuse and rape need to be addressed. Prevention efforts to end violence against women and girls, especially in relation to children, can be used to address violence against men and boys.

Considerations of coronavirus (COVID-19) impact and the management of the dead in Brazil

During a pandemic such as COVID-19, the forensic community plays a key role in the management of the crisis, both nationally and internationally. Much has been written and disseminated regarding protocols for death investigation, infection mitigation and risks, and management of dead. However, in many contexts, the ability of forensic practitioners to follow best-practice procedures is limited by the resources available to them. This article examines some of the impact of the novel coronavirus (COVID-19) in Brazil, with emphasis on management of the dead and challenges faced by medicolegal services.

Medico-Legal Profiling of Sher-i-Kashmir Institute of Medical Sciences Srinagar under Consumer Protection Laws of Union Territories of Jammu and Kashmir

The Jammu & Kashmir (J&K) Consumer Protection Act, 1987 needs a closer scrutiny from the standpoint of medico-legal services in the wake of J&K Union Territories’ (UTs) uneven health profiling and developmental progress. The doctor-patient’s relationship needs an analysis in terms of access to health care and medical and para medical services. The consumer rights under Consumer Protection Act, 1986, Jammu and Kashmir Consumer Protection Act, 1987 and Consumer Protection Act, 2019 represents a trajectory of deficiency of medical service and lack of medical professionalism and capacity building among health personnel. The paper is a medico-legal profiling of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar in regard to diligence and negligence of doctors and para legal medical inspectorate in auguring health care and medical services to patients.

Descriptive study on socio-demographic profile, pattern of injuries, aetiology and outcome of domestic violence at a tertiary care centre of Batticaloa district

Introduction Domestic violence is common serious health problem in South Asian countries including Sri Lanka which has an immense impact on people's physical, psychological and social health in a community. Objectives To determine the socio-demographic characteristics, thepattern of injuries and outcome among patients with domestic violence injuries at a tertiary care centre in Batticaloa, Sri Lanka. Methods Fifty nine female patients with domestic violence injuries were recruited in our descriptive, cross-sectional study. A predesigned interviewer based questionnaire was used to collect data from the participants and was analysed statistically by simple proportions and percentage using SPSS analytical package (version 21). The Ethical Review Committee, Faculty of Health Care Sciences, Eastern University granted the ethical approval for the study. Results Fifty nine female respondents were recruited. The common demographic characteristic observed were the 21 to 40 years age group was poor socio-economic and educational status. The husbands acted as the perpetrators among most victims (42.4%). Majority of the respondents (71.2%) reported that their husbands abuse them under the influence of alcohol. Most respondents had sustained minor injuries including contusion (64.4%), laceration (15.3%) and fractures (18.6%) among them. The common reasons for violence encountered among them were arguments (67.8%) and financial reasons (16.9%). Even though 45.8% of respondents had been abused on multiple occasions, 86.4 % of them have not reported previous abuse legally. Most people denied seeking medicolegal action due to fear of family separation and poor knowledge of services available for domestic violence. Conclusion Domestic violence commonly affects the young female and is associated with illiteracy and poor socio-economic status of the victims. Arguments and financial issues are the commonest reason for violence. Most people are not aware of the potential of seeking medico-legal action and available services to help them.

A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice

The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.

Historical landmarks of the evolution of forensic medicine and comparative development of medico-legal services in Sri Lanka

Historical landmarks of the evolution of forensic medicine and comparative development of medico-legal services in Sri Lanka