Implementing the duties contained in the standard operating procedure (SOP) of the Health Ministry in all medico-legal units pertaining to the desired quality of post-mortem samples and the College of Forensic Pathologists together with the Ministry developing updated recommendations on sample collection with a particular emphasis on appropriate containers, equipment, and registers at such units, are essential.

These recommendations were made in a concept paper on the “Challenges in forensic sampling in the pre-analytical phase, while maintaining the chain of custody in Sri Lanka and system improvement in the Medico-Legal Unit of the District General Hospital, Matale”, which was authored by P. Appuhamy (attached to the District General Hospital in Matale Office of the Judicial Medical Officer [JMO]) and published in the Medico-Legal Journal of Sri Lanka 10 (2) in December 2022.

Suboptimal standards were observed at the Medico-Legal Unit of the District General Hospital, Matale, in the post-mortem sample collection and storage until dispatch to the laboratory for testing. There needed to be proper, separate containers available to collect specific post-mortem samples. Though it is recommended, the post-mortem samples were not sealed at the time of initial collection as there was no proper wax seal. There was also no separate secure refrigerator to store the post-mortem samples, and therefore, the post-mortem samples were stored in a place accessible to other healthcare workers in the hospital who were not attached to the Medico-Legal Unit. There were deficiencies in the documentation of the post-mortem sample register. 

A knowledge gap was also observed among the medico-legal medical officer and morgue healthcare assistants regarding the maintenance of the chain of custody. There was no internal standard operating procedure at the Medico-Legal Unit. The post-mortem samples were in the custody of morgue healthcare assistants. The Asian Human Rights Commission’s “Developmental proposal for the medico-legal service of Sri Lanka” identified three broad issues related to medico-legal work in Sri Lanka, namely that sterile containers (screw-capped bottles or rubber-top vials), standard labels (adhesive type), and standard tags and sample sealing tapes are essential in investigations.

The medico-legal medical officers and the morgue healthcare assistants of Matale were educated on the importance of maintaining the chain of custody. A new wax seal was prepared. The standard operating procedure used at the Institute of Forensic Medicine and Toxicology (IFMT) was improved with the approval of the Head of the IFMT and implemented at the Medico-Legal Unit. The standard operating procedure at the Medico-Legal Unit was developed with a Sinhala language translation in order to benefit morgue healthcare assistants not literate in English. The implementation of the standard operating procedure is to ensure that all activities involving post-mortem samples are collected and stored in order to maintain the proper chain of custody. 

This standard operating procedure complies with the circular issued by the Ministry. A centrifuge was installed in the morgue of the Medico-Legal Unit for separating serum in serological testing. A newly printed register was prepared with printed pages indicating the details of the deceased, the sample, the JMO, the healthcare assistant who assisted in the autopsy, and details of the intermediate person who took over the sample to dispatch to the Government Analyst’s Department. Several steps were taken to improve the security of the post-mortem samples such as a separate refrigerator that could be locked with a key, limited accessibility of the keys to the sample room, dual authentication with no single officer having access to all the keys of the sample room, and the installation of closed circuit television cameras (CCTV) at the Medico-Legal Unit and morgue complex.

Appuhamy further recommended that the Ministry needs to upgrade the Medico-Legal Unit by appointing an authorised officer such as a forensic nurse, development officer, or a medico-legal medical officer to handle forensic samples and by properly training morgue healthcare assistants with an appropriate curriculum.