Sumanth Bindumadhav, Director, Wildlife Department, HSI/India & Shreya Paropkari, Lawyer and Consultant, HSI/India emphasises that sensitisation of medical professionals to prioritise health care over fear of tedious, legal processes, speedy processing of MLC cases so the afflicted families may receive the ex-gratia amounts due to them and continued reinforcement of people-friendly policies, especially with enforcement agencies, will help victims get timely medical attention required for this neglected, life-threatening disease
Nearly 60,000 human deaths caused by snakebite annually is a monumental challenge to solve in a country as complex as India is. It is the single most prevalent human-wildlife conflict issue, a public health concern, and a complicated socio-economic problem. Beyond these, the impact it has on the mental health of victims and their families remains largely undocumented.
The task of ‘solving’ this crisis needs firefighting on four fronts – capacity building of medical infrastructure and relevant institutions, understanding snake ecology so we may have insights into the ‘why’ of snakebites, availability of better quality antivenom, where it is required the most, and massive public education campaigns to encourage measures of prevention and right bite management practices.
Lack of awareness and conversations around snakebite in public leads to poor practices when it comes to bite management at the community level. Even today, it’s common to see a torniquet tied around the site of bite, or an incision made to ‘let the venom flow out’, or even worse- burn the site of bite. The greatest challenge for organisations and individuals working to solve this crisis is to educate the public to rush to a hospital in case of snakebite and not delve into home remedies or religion-based cures. Presuming public education programs succeed in victims being taken to hospitals, another major hurdle presents itself- snakebite is a Medico-Legal Case (MLC) in India.
What is MLC?
A MLC is a situation where injuries or illnesses that requires medical intervention or examination has legal implications- such as suspected intentional harm or malicious intent.
Every person, including medical/healthcare professional, having information of an intention to commit or the commission of an offence punishable by the Indian Penal Code 1860 (IPC) is obligated by law to report it.
One may look to the recent incident in of Kerala, where the accused intentionally ‘purchased’ a venomous snake and caused it to bite his wife, the victim. The successful investigation was a joint effort of the law enforcement officers, forensic experts and medical practitioners.
Why is snakebite MLC in India?
Medical practitioners are bound to register as MLC most cases where the nature of injury or death is suspicious or allegedly intentional. Snakebites or animal bites, especially involving toxins, are also included in this. In a host of judgements, courts have refrained from convicting on charges of culpable homicide, murder or attempts to murder where death was determined to be caused by snakebite. However, incidents like those in Kerala, may draw more scrutiny to medical examination of snakebites.
Procedure and stigma
While writing this article, several medical practitioners were consulted to understand the procedure upon the registration of MLC in cases of snakebites. While the practitioners are bound to examine upon request of a police officer or a court order, most public and private healthcare facilities refuse to provide treatment for suspected MLC situations due to the tedious procedures involved, despite the Supreme Court ruling that refusal to provide emergency care amounts to a violation of Article 21. This makes it even more difficult for patients to receive timely treatment and care.
Several states have deemed for provision of ex-gratia in case of snakebite under sections of the disaster management acts and policies. The receipt of this amount, however, is mired in red tape and bureaucracy. For instance, a snakebite victim’s family in Karnataka spent nearly 14 lakhs on treatment, lost a member of their family and were passed around from one person to another at police station and hospital for over 6 months to receive a clean chit that would’ve enabled them to receive an ex-gratia amount of 2 lakhs. In another case, a claim made by a next of kin for ex-gratia for the unfortunate demise of a 47-year-old man by snakebite, came to an absolute standstill. Several laboratories across the State rejected the police request to conduct an examination of the victim’s viscera, stating lack of resources and/or forensic expertise.
With over one million snakebites in India every year, resulting in nearly 200,000 cases of morbidity, over and above the nearly 60,000 deaths, the last thing victims and their families need is to tussle with the complexities and challenges that medicolegal cases bring with them. Reinforcing public’s faith in the existing medical infrastructure for snakebite treatment needs minimal bureaucracy, efficient systems, trained healthcare workers, and above all, empathy for afflicted families. Sensitisation of medical professionals to prioritise health care over fear of tedious, legal processes, speedy processing of MLC cases so the afflicted families may receive the ex-gratia amounts due to them and continued reinforcement of people-friendly policies, especially with enforcement agencies, will help victims get timely medical attention required for this neglected, life-threatening disease.
The rationale to not have this be a medicolegal case, unless suspected so by the treating doctors or the family of the victim, is overwhelming. It is now in the hands of policy makers to enable this landmark change and reduce the burden of snakebite that India carries.
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