Post-mortem examination was manipulated under directions of doctor related to Maharashtra cabinet minister

02 April 2018
Dr Makarand Vyawahare personally participated in and directed the judge BH Loya's post-mortem examination. He successfully hid crucial details such as a wound on the back of Loya's head.
Anand for The Caravan

A two-month investigation into the circumstances surrounding the post-mortem examination of the judge BH Loya at the department of forensic medicine at Nagpur’s Government Medical College has uncovered chilling new facts. The post-mortem examination was directed by a doctor who dictated what details were included in and excluded from Loya’s post-mortem report—and who was later investigated by the GMC over complaints of manipulating numerous post-mortems. The doctor has succeeded in keeping his name from appearing in any medical documents related to the post-mortem, or any court documents in the Loya case. He also managed to avoid any media coverage of his enormous role behind the scenes of the case—until now.

According to official records, Loya’s post-mortem was conducted by Dr NK Tumram, then a lecturer in the forensic-medicine department at the GMC. In fact, the post-mortem was led by Dr Makarand Vyawahare, then a professor in the department and now the head of the forensic department at a separate institution, the Indira Gandhi Government Medical College, also in Nagpur. Vyawahare is a member of the powerful Maharashtra Medical Council, the supervisory body for all medical practitioners in the state. He is known in his professional circles primarily for the power he wields as a result of his political connections—Vyawahare is the brother-in-law of Sudhir Mungantiwar, the finance minister of Maharashtra, who is practically the number two in the BJP-led state government under Devendra Fadnavis.

Vyawahare showed extraordinary interest in Loya’s corpse. According to those employees interviewed for the investigation who were present during the post-mortem, he personally participated in and directed the post-mortem examination—even shouting down a junior doctor who tried to question him during the examination of Loya’s head, the back of which had a wound. Vyawahare made certain that the report made no mention of this crucial and glaring fact. The document stated that Loya’s death was caused by a heart attack. It is evident from the investigation that there was a concerted effort to conceal any observations that could raise suspicions regarding the cause of Loya’s death, and that Vyawahare led the cover-up during the post-mortem examination.

These grievous charges gain additional credibility from the fact that various employees of the GMC told me they witnessed numerous instances in which Vyawahare manipulated post-mortem examinations and falsified reports. The GMC’s investigation of Vyawahare, in 2015, came after vocal protests against his practices by resident doctors and medical students at the institution.

The Caravan’s new investigation, which reveals the role of a hitherto unknown doctor who successfully hid crucial facts such as a wound on Loya’s head, calls into question the trustworthiness of the entire post-mortem examination, and so casts doubt on the whole of the official version of the cause of Loya’s death. Soon after The Caravanfirst reported the suspicions of Loya’s family, in November 2017, a chart purportedly from an ECG test conducted on the judge shortly before his death found its way to select media outlets, which published it as evidence that he died of a heart attack. Various discrepancies in the document were pointed out on social media. The state of Maharashtra, while arguing against the need for an independent inquiry into Loya’s death, chose not to produce the ECG chart before the Supreme Court. That left the post-mortem report prepared at the GMC as the most important medical document to support the state of Maharashtra’s argument that Loya died of natural causes. Now, the entire exercise of the post-mortem examination itself fails to stand up to scrutiny.

*

The investigation uncovered testimony from 14 current and former employees of the GMC, including individuals with direct knowledge of Loya’s post-mortem. To protect the employees, The Caravan has chosen to identify them by their places in the order in which the first meetings with them took place. Many of these employees were interviewed multiple times. All the employees who spoke during the investigation, including senior professors, clearly feared retribution for speaking up—from Vyawahare, and from the administration, police and intelligence machinery of the state of Maharashtra, all of which have maintained that Loya died a natural death.

Based on these accounts, I was able to reconstruct the chain of events at the GMC beginning at 7 am on 1 December 2014, when the forensic-medicine department opened for the day. The employees I convinced to open up about their accounts did not have any knowledge of events regarding Loya’s death before this time.

According to the fifth employee I met, who was present in the department that day, Loya’s corpse had already been delivered to the department by that time. Shortly after the department opened, Vyawahare called to enquire about the schedule of post-mortems for the day. He arrived at close to 10 am—unusually early for him, as at the time he rarely made an appearance at the department before noon.

The ninth employee I met said that Vyawahare was also sometimes late for lectures he was to deliver—and that Dr PG Dixit, the head of the department in 2014 and so officially Vyawahare’s superior, substituted for him in a few such instances. The eighth employee I spoke to said, “Things like timing ... they are the subjects of the land, not for the king.”

Vyawahare was on edge when he arrived. “Uss din unka andaaz hi alag tha” (That day, his demeanor was completely different), the fifth employee told me. “He was very irritable.” Vyawahare immediately went to the department’s post-mortem room and asked whether the police had prepared the papers for Loya’s body. They had not.

Vyawahare grew more tense over the next hour. He usually took a cigarette break, in a designated smoking area near the post-mortem room, once every 45 minutes or so. That day, the fifth employee said, Vyawahare smoked a cigarette every 15 minutes. He would visit the post-mortem room, “ask [about the papers], he would go out and then he would smoke a cigarette … By the time the papers had come, he must have visited the [post-mortem] room at least thrice.”

The doctors on duty to carry out post-mortems that day were Tumram and Amit Thamke, then a post-graduate student. When the post-mortem on Loya’s body began—at 10.55 am, as per the report—Vyawahare joined them.

Mortuary attendants positioned Loya’s body on the examination table and prepared it for the post-mortem. Vyawahare donned surgical gloves for the examination—this was unusual for him too. “Vyawahare is a person who never wears the gloves … which is why this is a unique thing,” the first employee I spoke to said. In most of the instances when he had witnessed Vyawahare in the post-mortem room, the employee said, Vyawahare did not perform autopsies himself, and never put on gloves.

During Loya’s autopsy, the rolled-up sleeves of Vyawahare’s shirt unravelled and fell over his forearms. He told one of the two other doctors in the room to push them back. “Khud nahi kiya” (He did not do it himself), the fifth employee said. “Every small thing he was getting irritated by, with that body.”

In two different interviews, conducted over a month apart, the fifth employee told me there was an injury on Loya’s head, “on the back, towards the right side.” The injury was of “the kind that is there when a stone hits and the skin tears,” he said, and was not particularly large. He added that the wound was deep enough for blood to have gushed out of it, so much so that the “cloth that was covering him [Loya] was soaked with blood towards the head … it was completely red.” The hair around that portion of Loya’s head “was also matted.”

During the inspection of Loya’s head, Vyawahare reprimanded Tumram. The fifth employee said that Tumram attempted to point something out to Vyawahare, to which the senior doctor responded sharply, in Marathi, “Write only as much as I am telling you.” Towards the end of the examination, the employee recalled, Vyawhare said, “Write the findings of the post-mortem report in front of me.”

The report omits the injury to the head and states that the probable cause of Loya’s death was “coronary artery insufficiency.” Under the subheading “External Examination,” the observation under point 14—“Condition of skin—Marks of blood etc”—states “Dry and pale.” Under point 17—“Surface wounds and injuries”—also under the same subheading, the report notes, “No evidence of any bodily injuries.” Under point 18, “Other injuries discovered by external examination or palpation as fractures etc,” it says “none.” Under point 19, labelled “Head,” the entry for the first sub-point, “Injuries under the scalp, their nature,” the report notes, “No injuries.” The testimony from inside the forensic department calls into question the veracity of each of these entries.

The testimony of an injury to Loya’s head is consistent with an analysis of the post-mortem report by Dr RK Sharma—the former head of the department of forensic medicine and toxicology at the All India Institute of Medical Sciences in Delhi. As Sharma pointed out to The Caravan, the report states that Loya’s dura was congested. He explained, “Dura mater is the outermost layer that surrounds our brain. It is damaged in cases of trauma, which indicates some kind of an assault on the brain. A physical assault.”

It was Loya’s family members who first said there was an injury on his head, and also blood on his body and shirt. These details were part of The Caravan’s first report on Loya’s death. Loya’s sister, Dr Anuradha Biyani, a medical doctor in government service, said that when she saw her brother’s body for the first time after it was delivered to his family, “there were bloodstains on the neck at the back of the shirt.” In a diary entry made in 2014, shortly after Loya’s death, she had written that there was “blood on his collar.” Loya’s second sister, Sarita Mandhane, told The Caravan that she saw “blood on the neck,” that “there was blood and an injury on his head … on the back side,” and that “his shirt had blood spots.” Loya’s father, Harkishan, said, “His shirt had blood on it from his left shoulder to his waist.”

After studying the medical documents prepared after Loya’s death, which I shared with him, the ninth employee told me, “This is very strange.” The standard practice while conducting a post-mortem is to collect tissue samples from the body of the deceased, which are then sent for laboratory testing along with a viscera form. This form is supposed to be filled out immediately after the post-mortem, using the exact information in the post-mortem report. Yet, the employee noted, “in the post-mortem report, he [the doctor] has written extensively about the heart,” but these details are not reflected elsewhere. “They must have manipulated the post-mortem report later,” he said.

A story published by The Caravan in December 2017pointed out that a crucial date in the post-mortem report had been overwritten. The report also contains an additional entry made ten days after it was first prepared. Interestingly, the first page of the post-mortem report, which contains the overwritten date and additional entry, was missing from the documents submitted in the Supreme Court by the state of Maharashtra in response to petitioners arguing in favour of an independent inquiry. When this was pointed out by the counsel for one of the petitioners, one of the counsels for the state of Maharashtra told the court, on 22 January 2018, that it would be provided by the end of the day. Four days later, The Caravan pointed out that this had not been done yet. As of 2 April—over two months after the issue of the missing page was first raised in court—the state of Maharashtra had shared the page with the petitioner Tehseen Poonawalla, whose credentials and stance on the case has already raised questions. The page had still not been shared with the Bombay Lawyer’s Association, also a petitioner in the case, or the retired admiral Laxminarayan Ramdas, an intervening party in the matter. The counsels for the Bombay Lawyer’s Association and Ramdas have made the bulk of the arguments to the court in favour of an inquiry.

*

Ten of the 14 employees I spoke to said they were sure that Vyawahare was capable of interfering in the preparation of a post-mortem report and altering its contents. “If this name is involved, then it’s absolutely possible that there is manipulation in the post-mortem,” the ninth employee I met, a peer of Vyawahare’s, said.

Kar sakte hai—He can do it, I would not say he can’t. He is a man who is capable of anything,” the eighth employee I met, a colleague of Vyawahare’s, told me.

“If there is political pressure, then he could manipulate the findings,” the third employee I met, who was previously the head of a department at the GMC, said.

“For some people, a post-mortem is almost a business that is like that—for making even a little change, you can get a lot of benefits,” the seventh employee I met, a senior doctor at the GMC, said. “Because it can change an entire investigation. … He [Vyawahare] is also politically connected, so people like that tend to do this sort of thing a little more.”

Sudhir Mungantiwar, Maharashtra’s current finance minister, is Vyawahare’s bhauji—his sister’s husband. Mungantiwar was formerly the state president of the Bharatiya Janata Party. In 1995, when the BJP came to power in Maharashtra for the first time, in alliance with the Shiv Sena, Mungantiwar was made a minister in the state. He hails from Chandrapur district, in the Vidarbha region of eastern Maharashtra—also the home district of Mohan Bhagwat, the chief of the Rashtriya Swayamsevak Sangh. In 2014, when the BJP returned to power in the state, Mungantiwar was considered for the post of chief minister. After the job went to Devendra Fadnavis, Mungantiwar was installed as the number two in the government, with three portfolios: finance, planning and forests. He is also the guardian minister of Chandrapur and Wardha districts.

Vyawahare’s colleagues repeatedly mentioned that he had leveraged his relationship to Mungantiwar throughout his career. “Even when Mungantiwar was just an opposition MLA, Vyawahare would throw his weight around. Now he is in power, so you can imagine,” the third employee I spoke to, who knew Vyawahare as a post-graduate student in the late 1990s, said.

“You know how Dhritarashtra was there for Duryodhana, blind to all his crimes, because he didn’t know only what havoc Duryodhana was wreaking?” the ninth employee said, referring to the Mahabharata. “That’s what this pair is like as well.”

*

Around a month after Loya’s post-mortem, in January 2015, Vyawahare became the head of the forensic department at the GMC. A few months after that, Vyawahare was appointed the vice-dean of the college. By the end of that year his dramatic rise hit trouble, as hundreds of medical students and resident doctors came out in protest against him, and brought the GMC to a standstill. The dean of the GMC ordered investigations into charges raised against him, and Vyawahare was subsequently transferred out of the medical college. “Paani sar ke upar chala gaya tha” (Matters had gotten out of hand), the third employee said.

On 17 November 2015, Dr Nitin Sharnagat, then a 28-year-old post-graduate student, attempted suicide by locking himself in his hostel room and taking an overdose of medication. Sharnagat’s fellow students broke into his room and found him foaming at the mouth. They rushed him to the hospital just in time to be saved. In a suicide note, Sharnagat wrote that he had been driven to this step by Vyawahare’s unrelenting harassment.

In an interview to the Times of India at the time, Sharnagat said, “Dr Vyawahare would often flaunt his kin’s name who is a minister in the state cabinet and threaten me. He would often harass me by not giving signatures to the post-mortems done by me. I would be often made to sit for a whole day to get any work done from him.”

During this time, a woman student also filed a sexual-harassment complaint against Vyawahare. A teacher at the GMC told the news website Nagpur Today that, according to the complainant, Vyawahare “would often touch her inappropriately, make indecent comments about her appearance and often asked her to accompany him to parties.” Four of the employees I spoke to were aware of an incident when Vyawahare had asked the complainant, in front of other students, to point out on her own leg the locations of injuries on the thigh of a corpse she was examining. According to the ninth employee, Vyawahare had faced similar allegations in 2007, when women medical interns complained about his attempts to convince them to untie the aprons they wore as part of their uniform. No action appeared to have been taken against Vyawahare at the time. For several years after the incident, the employee said, women students were not permitted to pursue internships in the forensic-medicine department.

The news of Sharnagat’s suicide attempt spread rapidly across the state. The Maharashtra Association of Resident Doctors and the Student’s Council of Medical College launched a strike to demand Vyawahare’s removal, bringing the medical college hospital to a halt.

On 19 November 2015, a report in Nagpur Today revealed new details of enormous importance. Besides charges of harassing students, the report said, “There also about 17 serious allegations against [Vyawahare] in terms of changing the post-mortem reports. It is such a serious issue that the functional integrity of GMCH has come under threat.”

Dr Abhimanyu Niswade, then the dean of the GMC, constituted two inquiry committees—one to investigate the allegations of professional malpractice, including Vyawahare tampering with post-mortem reports, and another to look into the woman student’s complaint of sexual harassment.

The first employee said that, because of Vyawahare’s political connections, many of the professors in the forensic-medicine department were forced to “become yes-men.” The fear of him was strongest “among the teachers, because the teachers are permanent employees. Their promotion might be stopped, they may get transferred, their increment might be stopped—all these things might be possible.”

Four of the employees recalled that, in the late 1990s, when Vyawahare was pursuing his post-graduate degree, he had a disagreement with a professor advising him on his thesis. “It was a big fight, then he [Vyawahare] complained, he brought in pressure,” the third employee said. Soon after that, the professor was transferred to Yavatmal.

The eighth employee told me that, through Mungantiwar, Vyawahare could, “if he really wants, dictate who is transferred where and when at any GMC … that is the kind of power this man wields.”

“If he is talking to someone in the post-mortem room, he would say, ‘Tum mera kuch nahi bigaad sakte’”you cannot do anything to me—the fifth employee said. “It could be policemen or doctors, it didn’t matter. His bhauji’s name would come up.” The ninth employee told me he had heard that “if there would be some political connection, some VIPs … for example, someone has died from an electric shock, then he [Vyawahare] would say, ‘Don’t include it in the opinion.’” The fourteenth employee I spoke to, one of the senior-most faculty members at the GMC, told me, “In the post-mortem, I think, if it was very important VIPs or if there was some commitment through a different pressure, then he would do [changes to the post-mortem].”

“If there was a body from Chandrapur”—Mungantiwar’s district—“then 101 percent he would be there,” the first employee said. “With bodies from Chandrapur, the entire department would be shaken,” the fifth employee told me. In one case involving a corpse from Chandrapur, the employee recalled, some staff members were made to rush to the department after midnight for a post-mortem.

The fifth employee said, “In those bodies, you don’t look for any fractures—you just work quickly, with speed.” Although a post-mortem usually took about an hour to complete, in the case of bodies from Chandrapur, “it is done within 20-30 minutes.” In one such case, the employee recalled, a visible fracture in the ribs of a body was never noted in the post-mortem report.

The eighth employee said, “He will say that what you have written is wrong, so these changes should take place. Sometimes these changes, they may be”—the employee took a long pause—“okay. But sometimes what happens is that … an opinion denied is justice denied.”

Often, the changes that Vyawahare demanded could impact the deduction of the cause of death. “Say an injury has occurred at a certain spot, it is still occurring at that spot [after Vyawahare has made his changes to the report], but instead of red colour, it is blue colour,” the first employee said. “The time of the death changes with that. The timing change in injuries could actually lead to serious consequences, it could be that the accused is able to get away and the victim does not get justice.” He continued, “Or if there is a case in which myocardial infarction is the cause of death, the person’s coronaries were actually not found to be that blocked, even then you will increase the block—that is, you have found 60 percent, but you will make it 90 percent and then write ‘coronary heart disease.’”

The first employee recalled the post-mortem of the body of a person who was suspected to have been murdered. Vyawahare forced the doctor who was leading the autopsy to make “a lot of changes in the injuries in particular. … After the changes were made—basically the injuries were not like that, as they were given.” The doctor was then forced to give the police an opinion that supported the information in the post-mortem report he had signed, and so was inconclusive about the cause of death. “The police kept asking him whether it was an accident or a murder, and he said that it was ‘maybe possible’ in both conditions,” the first employee said. “But when that body was there, I had seen that body … so because of this ‘maybe possible’ word, a murder might have become an accident.”

In another instance, when the first employee was working on a report that pertained to deaths by poisoning, Vyawahare interfered to change its findings. The employee had opened and examined the stomachs of the corpses. In one case, he found the smell of the contents to be “aromatic.” In two others, he found it was “insecticidal”—indicating the presence of insecticide. Vyawahare insisted that the employee change the description of the smell in the latter two cases to “aromatic” as well. When the employee protested, Vyawahare said, “I told you, write ‘aromatic,’” before tearing the report up and throwing it in the face of the employee. The employee told me that the presence of insecticide could indicate that the deceased was a farmer. Denying the smell, and thereby ruling out the possibility of a suicide, could “reduce the number of farmer suicides … and there is a political background to that.”

Numerous employees told me that Vyawahare could easily alter the contents of post-mortem reports particularly when those performing the examinations were post-graduate students or junior doctors. The fourteenth employee, one of the senior-most faculty members at the college, told me that Vyawahare claimed he asked students to make changes to post-mortem reports because they often got details wrong, and he “wanted to build good discipline in the department.” Though this is “what he would claim, there is no honesty to that,” the employee added.

The fourteenth employee, echoing what numerous other employees also told me, said that Vyawahare’s practices were well known within the GMC. When I inquired why there had been no institutional action against Vyawahare before the protests in November 2015, he said, “Kaun lega? Kaun haath jalayega?” (Who will do it? Who will burn their hands?)

According to the tenth employee I spoke to, during the strike against Vyawahare Mungantiwar contacted Niswade, the dean. “There were a lot of phone calls—there were no letters, nothing on paper at all—but he [Mungantiwar] kept saying, ‘This should not be happening, whatever needs to be solved, you do it at the institutive level, bas.’” The employee said Niswade was intent on forming the inquiry committees autonomously, even though “there was pressure from higher-ups that ‘we will keep the committee according to our wishes.’” The fourteenth employee told me that another powerful minister in the state cabinet also called Niswade to tell him, “Dekh lenge tereko” (We will take care of you).

Towards the end of November, with the protestors refusing to back down, the state finally stepped in. Vyawahare was transferred from GMC Nagpur—but so were Niswade and Sameer Golawar, the secretary of Maharashtra State Medical Teachers Association. The government also met other demands of the Maharashtra Association of Resident Doctors, including maternity leave for resident doctors and increased stipends, and the organisation called off its strike. The inquiry committee Niswade constituted to look into the allegations of sexual harassment against Vyawahare was abruptly dissolved after the government announced that it would set up a committee of its own.

The committee Niswade constituted to look into Vyawahare’s alleged professional transgressions concluded an inquiry and submitted a report, a copy of which is with The Caravan. The fifth complaint listed in the document reads, “Department Head Dr. M. S. Vyawahare, though he is not present in person during the post-mortem, compels [one] to forcibly make changes in PM report, and if this is not done, hurls verbal abuses in front of everybody.” The committee’s finding in this matter reads, “This is true, all students have mentioned in their submission. The professors in the department have accepted that this is true and have mentioned that Dr. Vyawahare asks them to write [the reports] his way. That’s why this [complaint] has happened.”

By mid 2017, the government-instituted committee to look into the sexual-harassment allegations against Vyawahare had reportedly concluded its investigation. A senior government official told The Hindu that the committee had absolved Vyawahare of any wrongdoing.

After his transfer, Vyawahare worked outside Nagpur for a little over a year. In June 2017, he was appointed the head of the forensic department at the Indira Gandhi Government Medical College. Two months later, in August 2017, Devendra Fadnavis nominated him, alongside four others, to the Maharashtra Medical Council—whose quasi-judicial functions include prescribing an ethical code for over 80,000 doctors across the state. Vyawahare was reportedly the only doctor from government service among the five people included by Fadnavis in this round of nominations.

“He [Vyawahare] is running the system, so in that system other people have to find ways to survive,” the eighth employee said. “You can move mountains, you can say what you want … but the end result is zero. Kehte hai har kisi ke paap ka ghada kabhi na kabhi toh bhar jaata hai, lekin inke ghade mein to shayad neeche gaddha bana hua hai” (They say that everyone’s vessel of sin overflows someday, but it looks like there is a hole in the bottom of his vessel).

*

NK Tumram is currently an associate professor in the forensic department at the Indira Gandhi Government Medical College, under Vyawahare. On 28 March, I confronted both of them in their offices with the troubling details I had discovered about Loya’s post-mortem examination.

I asked Tumram why his signature was on the post-mortem report when Vyawahare had directed the examination. He said, “I don’t know anything, dekho aap baat hi kuch mat karo iss baare mein” (See, let’s not talk about this matter at all). I asked him why he had ignored the blood and the wound on Loya’s head. He said, “Sab de diya hai already” (Everything has been submitted already). When I pressed him on why he had ignored the injury on Loya’s head, Tumram said, “Kuch bhi nahi pata mereko” (I don’t know anything). He responded to all subsequent questions by saying either that he had already submitted everything or that he had no comment.

I asked Vyawahare why Tumram had signed the post-mortem report even though he was the one who directed it. “I didn’t do the post-mortem only,” he said. I said the assertion was not that he had conducted the post-mortem, but that he had directed it. “I did not even direct it,” he replied. I asked why he told Tumram to omit any mention of the blood on Loya’s head. “I did not stop him from doing anything,” Vyawahare said. “I don’t have any role only … I didn’t even go into that case.”

Nikita Saxena is a staff writer at The Caravan.

Keywords: Maharashtra BH Loya Nagpur Government Medical College Sudhir Munguntiwar Makarand Vyawahare post-mortem
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