FIRST RESPONDERS: THE CRUCIAL ROLE OF MEDICAL PRACTITIONERS IN CHILD SEXUAL ABUSE CASES.

 

FIRST RESPONDERS: THE CRUCIAL ROLE OF MEDICAL PRACTITIONERS IN CHILD SEXUAL ABUSE CASES.

                                                                                                                                              By Adv. Emidio A. Desouza Pinho[1]

 INTRODUCTION

Child Sexual Abuse (CSA) is a serious crime that can have devastating and long-lasting consequences for victims. Medical practitioners—particularly paediatricians, emergency room physicians, and general practitioners—are often the first point of contact for these children in most cases reported to the police. Therefore, it is crucial that medical practitioners are equipped with the knowledge, skills, and sensitivity to effectively respond to suspected or disclosed cases of CSA.

The role of a medical practitioner when responding to CSA is dual in nature: one being medical care and medico-legal assistance. The immediate priority is to address any physical injuries, sexually transmitted infections (STIs), or other health concerns. Emotional support and providing a safe, supportive environment are also critical. Secondly, they assist in medico-legal proceedings, which include collecting evidence, documenting findings accurately, and following proper procedures to maintain the integrity of evidence for potential legal action.

"Medico-legal Care for Survivors/Victims of Sexual Violence," issued by the Ministry of Health & Family Welfare, Government of India,[2]  focuses on how doctors—particularly paediatricians—should respond to child sexual abuse. The document serves as a guideline for the medico-legal care of sexual violence survivors/victims. It emphasizes a sensitive, humane, and standardized approach. Additionally, it explains the legal obligations of health workers as per the Criminal Procedure Code, now replaced by the Bharatiya Nagarik Suraksha Sanhita, 2023 (BNSS).

This article will explore the important role of medical practitioners while handling child sexual abuse cases. The focus is mainly on the key roles of providing medical care and medico-legal support. It will also cover the importance of reporting of cases, the legal mandate guiding their actions, and how as healthcare professionals, they can effectively handle these responsibilities to ensure and safeguard their profession at the same time ensure justice for survivors.

KEY RESPONSIBILITIES OF MEDICAL PRACTITIONERS:

i. Recognition and Assessment: Be aware of the signs and symptoms of CSA, which may include physical injuries, behavioural changes, anxiety, depression, or unexplained illnesses. Conduct a thorough medical examination, paying attention to specific details of the victim.

ii. Consent and Communication: Explain the nature and purpose of the examination to the child (to the extent they can understand) and their parent or guardian. If the child is under 12, parental consent or consent from a trusted adult is mandatory. Respect the victim’s right to refuse evidence collection, but explain its importance.

iii. Respecting Confidentiality and Privacy: Maintain confidentiality and ensure privacy during the examination and treatment process.

REPORTING AND LEGAL MANDATES:

The Protection of Children from Sexual Offences (POCSO) Act, [3] 2012, is a gender- neutral legislation. It defines a child as any individual below 18 years and provides protection to all children from sexual abuse. The definition of child sexual abuse is comprehensive and encompasses the following: (i) penetrative sexual assault, (ii) aggravated penetrative sexual assault, (iii) sexual assault, (iv) aggravated sexual assault, (v) sexual harassment, (vi) using a child for pornographic purposes, and (vii) trafficking of children for sexual purposes. The above offences are treated as “aggravated” when the abused child is mentally ill or when the abuse is committed by a person in a position of trust or authority vis-ã-vis the child.  POCSO prescribes stringent punishment depending on the gravity of the offense, with a maximum term of rigorous imprisonment for death, life, or fine.

Section 27[4] of the POCSO Act, 2012, clearly details the initial process of medical examination of a child. It states that the examination, regardless of whether an FIR or complaint has been registered under this Act, shall be conducted in accordance with Section 164A of the Code of Criminal Procedure, 1973 (now Section 184 in the Bharatiya Nagarik Suraksha Sanhita, 2023 BNSS)[5]

Under the BNSS 2023, hospitals are required to promptly inform the police about medico-legal cases. Specifically, Section 52[6] mandates that a Medical Officer must forward the Medico-Legal Report (MLR) to the investigating officer without delay. Failure to do so can result in legal consequences for the medical professional.

The Registered Medical Practitioner or hospital is mandatorily required to report sexual offences to the police. The same is mandated under Section 19[7] 7 of the POCSO Act, 2012, any person (including medical practitioners) who has knowledge of or receives information about an offence under this Act must report it to the police immediately.

All medical practitioners, especially those working with children, should undergo periodic training on the legal aspects of reporting suspected cases of CSA and responding appropriately. Hospitals and clinics should establish protocols and procedures for handling CSA cases, including the use of specialized kits for evidence collection and referral pathways for victims.

IN CONCLUSION

While India is still working towards establishing a robust system to assist child victims of abuse, the role of every stakeholder becomes paramount. A golden thumb rule for all the medical professionals working with children, keeping in mind the provisions of POCSO Act 2013, is to report all reasonable degree of suspicion in child sexual abuse to the legal authorities. Hence, professionals need to keep watch for signs of sexual abuse and assess the child for any immediate medical aid.

Registered medical practitioners play a vital role in addressing child sexual abuse. They can help ensure the welfare of child victims and support the pursuit of justice through compassionate medical care, carefully documenting findings, and adhering to legal and ethical guidelines.

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[1] National Awardee for Child Welfare 2014, in charge of the Victims Assistance Unit for the State of Goa since 2014.

[2] Ministry of Health and Family Welfare  https: // mohfw.gov.in

[3] Act No.32 of 2012

[4] 27. Medical examination of a child: (1) The medical examination of a child in respect of whom any offence has been committed under this Act, shall, notwithstanding that a First Information Report or complaint has not been registered for the offences under this Act, be conducted in accordance with section 164A of the Code of Criminal Procedure, 1973 (2 of 1973). (2) In case the victim is a girl child, the medical examination shall be conducted by a woman doctor. (3) The medical examination shall be conducted in the presence of the parent of the child or any other person in whom the child reposes trust or confidence. (4) Where, in case the parent of the child or other person referred to in sub-section (3) cannot be present, for any reason, during the medical examination of the child, the medical examination shall be conducted in the presence of a woman nominated by the head of the medical institution.

[5] 184. Medical Examination of victim of rape: (1)Where, during the stage when an offence of committing rape or attempt to commit rape is under investigation, it is proposed to get the person of the woman with whom rape is alleged or attempted to have been committed or attempted, examined by a medical expert, such examination shall be conducted by a registered medical practitioner employed in a hospital run by the Government or a local authority and in the absence of such a practitioner, by any other registered medical practitioner, with the consent of such woman or of a person competent to give such consent on her behalf and such woman shall be sent to such registered medical practitioner within twenty-four hours from the time of receiving the information relating to the commission of such offence.

(2) The registered medical practitioner, to whom such woman is sent, shall, without delay, examine her person and prepare a report of his examination giving the following particulars, namely: -

(i) the name and address of the woman and of the person by whom she was brought;

(ii) the age of the woman;

(iii) the description of material taken from the person of the woman for DNA profiling;

(iv) marks of injury, if any, on the person of the woman. (v) general mental condition of the woman; and

(vi) other material particulars in reasonable detail.

(3) The report shall state precisely the reasons for each conclusion arrived at.

(4) The report shall specifically record that the consent of the woman or of the person competent to give such consent on her behalf to such examination had been obtained. (5) The exact time of commencement and completion of the examination shall also be noted in the report.

(6) The registered medical practitioner shall, within a period of seven days forward the report to the investigating officer who shall forward it to the Magistrate referred to in section 193 as part of the documents referred to in clause (a) of sub-section (6) of that section.

(7) Nothing in this section shall be construed as rendering lawful any examination without the consent of the woman or of any person competent to give such consent on her behalf.

Explanation. -For the purposes of this section, "examination" and "registered medical practitioner" shall have the same meanings as respectively assigned to them in section 51.

[6] 52. Examination of person accused of rape by medical practitioner: When a person is arrested on a charge of committing an offence of rape or an attempt to commit rape and there are reasonable grounds for believing that an examination of his person will afford evidence as to the commission of such offence, it shall be lawful for a registered medical practitioner employed in a hospital run by the Government or by a local authority and in the absence of such a practitioner within the radius of sixteen kilometres from the place where the offence has been committed, by any other registered medical practitioner, acting at the request of any police officer, and for any person acting in good faith in his aid and under his direction, to make such an examination of the arrested person and to use such force as is reasonably necessary for that purpose.(2)The registered medical practitioner conducting such examination shall, without any delay, examine such person and prepare a report of his examination giving the following particulars, namely:-(i) the name and address of the accused and of the person by whom he was brought;(ii) the age of the accused;(iii) marks of injury, if any, on the person of the accused;(iv) the description of material taken from the person of the accused for DNA profiling; and(v) other material particulars in reasonable detail.(3)The  report  shall  state  precisely  the  reasons  for  each  conclusion  arrived  at.(4)The  exact  time  of commencement and completion of the examination shall also be noted in the report (5) The registered medical practitioner shall, without any delay, forward the report to the investigating officer, who shall forward it to the Magistrate referred to in section 193 as part of the documents referred to in clause (a) of sub-section (6) of that section.

[7] 19. Reporting of offences. - (1) Notwithstanding anything contained in the Code of Criminal Procedure, 1973 (2 of1974) any person (including the child), who has apprehension that an offence under this Act is likely to be committed or has knowledge that such an offence has been committed, he shall provide such information to,— (a) the Special Juvenile Police Unit; or (b) the local police. (2) Every report given under sub-section (1) shall be— (a) ascribed an entry number and recorded in writing; (b) be read over to the informant; (c) shall be entered in a book to be kept by the Police Unit. (3) Where the report under sub-section (1) is given by a child, the same shall be recorded under sub-section (2) in a simple language so that the child understands the contents being recorded. (4) In case contents are being recorded in a language not understood by the child or wherever it is deemed necessary, a translator or an interpreter, having such qualifications, experience and on payment of such fees as may be prescribed, shall be provided to the child if he fails to understand the same. (5) Where the Special Juvenile Police Unit or local police is satisfied that the child against whom an offence has been committed is in need of care and protection, then, it shall, after recording the reasons in writing, make immediate arrangement to give him such care and protection including admitting the child into shelter home or to the nearest hospital within twenty-four hours of the report, as may be prescribed. (6) The Special Juvenile Police Unit or local police shall, without unnecessary delay but within a period of twenty-four hours, report the matter to the Child Welfare Committee and the Special Court or where no Special Court has been designated, to the Court of Session, including need of the child for care and protection and steps taken in this regard. (7) No person shall incur any liability, whether civil or criminal, for giving the information in good faith for the purpose of sub-section (1).