Standard Protocol and Medico Legal Proforma of Health Service Providers to be Considered as Documentary Evidence of Medico Legal Examination of POCSO Victims...

1. Jeetendra Biswal
Senior Administrative Executive
AIIMS Bhubaneswar
Standard Protocol and Medico Legal Proforma of Health
Service Providers to be Considered as Documentary
Evidence of Medico Legal Examination of POCSO Victims
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2. Case Scenario
 A 14-year-old Sexual Assault victim visited Gynae Doctor to
undergo MTP. The Doctor had informed the police and
proceeded to do MTP without waiting for the police to
arrive. The doctor did not preserve samples for DNA from
products of conception.
 S. 19 POCSO: Mandatory Reporting.
 S. 357 (C) Cr.P.C: Free treatment for sexual assault victims at any hospital.
 S. 201 IPC: Causing disappearance of evidence. 2

3.  An 11-year-old female child came to Gynae OPD with complaints of pain
during micturition for the past three days. She also seemed depressed and
afraid of adults, and wanted to be accompanied only by her mother. The
doctor found contusions on the inner thigh regions and the vulva on
examination.
Case Scenario
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4. POCSO- An Introduction
 Before 2012, there was No Separate Legislature to deal with sexual
offences against children, especially male children.
 Protection of Children from Sexual Offences Act: Implemented in 2012 for;
 Any Child <18 years [Male, female, transgender] - Gender Neutral
 Establishment of Special Courts & Child-Friendly Environment
during Trial
 Speedy Disposal of Cases
 With the Criminal Law Amendment Act, 2013, the definition of Rape has
been changed.
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5.  Data by Ministry of WCD on ‘Child Abuse’ in 2007 - 53.22% of children had faced sexual abuse.
 UNICEF report 2018  65% Indian girls sexually abused before teenage.
 The report of NCRB: 2018 - 2020 
No. of POCSO cases registered in India during 2018: 22077 (on an average of 61 cases daily).
No. of POCSO cases registered in India during 2019: 26497 (on an average of 73 cases daily).
No. of POCSO cases registered in India during 2020: 28327 (on an average of 78 cases daily).
No. of POCSO cases registered in Odisha during 2018-2020:
Statistics
Year Below 18 years
2018 1431
2019 1505
2020 1629
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6. Offences Against POCSO Victims
 Penetrative Sexual Assault: [S. 3 POCSO]
 Similar to Rape definition under s. 375 IPC.
 Aggravated Penetrative Sexual Assault [S. 5 POCSO]
 When the offender is a person of trust, authority, etc.
 Sexual Assault: Physical Contact (touching vagina, penis, anus breast) with sexual intent without
penetration. [S. 7 POCSO]
 Aggravated Sexual Assault: When the offender is a person of trust, authority, etc. [S. 9 POCSO]
 Sexual Harassment [S. 11 POCSO]
 Child Pornography [S. 13 POCSO]
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7. Role of a Doctor
 Treatment of a victim: Prime responsibility*; Free
of Cost
 Informed Consent
 Medical Examination
 Sample Collection
 Forensic Examination
 Intimation to the Police
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8. Informed Consent
 4 objectives:
 Treatment of the Victim
 Medical & Forensic Examination
 Sample Collection
 Police intimation
 The doctor has to explain the complete details of
the examination – local/vernacular language,
which they understand.
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9. Informed Consent
 Consent from Guardian when child’s age: <12 years.
 In case of a mentally ill child or hearing or speech impaired survivor (through interpreter):
 Parents or Local Guardian
 Panel of Drs from the hospital (Senior Doctors/in administrative positions)
 Child Welfare Committee (CWC)
 Jurisdictional Court
 Copy of Medical & Medicolegal Examination Report: Issued to the victim at Free of cost.
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10. Treatment
 Should be Initiated even before informing to the
police.
 Types of treatment:
 Medical
 Psychological
 At Free of cost.
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11. Police Intimation
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 Consent should be sought from the child/ parent or Guardian.
 Information to be sent to the Police ( Child Welfare Committee) even though denied by the
child/ parent or Guardian.
 Mandatory Reporting : S. 19 POCSO
 Failure to Report: In charge of institution/company: 1 year/Fine [S. 21 (2) POCSO]
 Any other person: 6 months/Fine [S. 21 (1) POCSO]
 Inform the police, even after survivor and the relatives denied for the same.
 The Informed refusal must be documented.

12. Why Medical Examination?
 S. 27 POCSO - Medical examination of a child
Objectives:
 To provide ‘First –aid’ or subsequent Treatment, if required.
 To register the ‘Identity’ with proper ‘Identification marks’.
 To determine - ‘Major’ or ‘Minor’ based upon Age.
 To document the victim’s general health status including Physical and Mental disability or limitation.
 To look for any ‘Injury’ on the body with any mark of Violence or Resistance.
 To Collect and Preserve any pieces of Evidence – e.g. ‘Trace Evidence’ maintaining proper ‘Chain of
Custody’.
 To record ‘Dying declaration’, if there is apparent death.
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13. History Taking
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DYNAMICS OF CHILD SEXUAL ABUSE:
Children rarely disclose sexual abuse immediately, Disclosure tends to be a process rather than a single
episode .
Initiated following a physical complaint or a change in behavior.
Evaluation of children requires special skills and techniques .
Definitive signs of genital trauma are seldom seen, Physical force is rarely involved. .
.Presumptive treatment of children for STIs is not generally recommended.
 A follow-up consultation is strongly recommended
 Use Illustrative Books, dolls, body charts to elicit history
 In case of difficulty, Expert should be called.

14. Red Flags Signs & Symptoms
MoHFW Guidelines
 Pain on urination and/or defecation
 Abdominal pain / generalized body ache
 Inability to sleep
 Sudden withdrawal from peers / adults
 Feelings of anxiety, nervousness, helplessness
 Weight loss
 Feelings of ending one’s life
MoWCD Guidelines
 Vaginal discharge
 Abdominal pain
 Encopresis (Soiling)
 Enlarged hymenal ring
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15. Medical Examination
 By Female RMP (Not necessarily by Gynae. Specialist).[S. 27 POCSO]
 If unavailable, by a male doctor with a female attendant.
 Any person on whom the child repose trust can be present. [S. 27
POCSO]
 Police personnel may not be allowed.
 If no parent/guardian present: In the presence of a woman
nominated by the head of the medical institution
 Without Delay.
 At any hospital (govt/private), Free of Cost [S. 357 (c) Cr. P.C.]
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16. Steps of examination
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17. How Should the Examination Be?
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18. (A) (B)
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19. (C) (D) 19

20. (E) (F) 20

21. (G) (H) (I)
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22. (I) (J) 22

23. (K)
(L)
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24. 24
 Two finger test: Inhuman/Degrading/Violating rights to privacy & dignity
 Over emphasis on Hymen: Comments on Tear / Rupture of Hymen –Relevant only when there
is fresh tear/bleeding/edema.
 Size, elasticity of Vaginal & Anal orifices.
 Documentation of old hymenal injuries
 Past abortions
 Past contraceptive use
Some Dont’s

25. Age Estimation
 Not necessary to do in all cases. [Ashwani Kumar Saxena vs. the State of MP]
 Should be considered when reliable age proof documents are unavailable.
 By Board of Doctors,
 Physical development
 Dentition
 Radiological assessment
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26. Evidence Collection
 Depends upon the type of alleged sexual offence, post assault activities.
 Should be done WITHIN (MAX) 96 h of Assault.
 Sample for DNA: Must in all cases of sexual offenses [164-A Cr.P.C.]
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27. Evidence to
be Collected
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28. Absence of Injuries??
 Reasons:
 Victim was unable to resist : Threat / Fear / Shock / Surprise / Intoxication
 Delay in Reporting
 History should be corroborated with medical evidence.
Testimony of the victim/survivor in Rape/Sexual Assault cases Crucial piece of
evidence  Could be considered Sole basis for Conviction.
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29. Opinion Framing
 Should consist,
1. Evidence of sexual Violence
2. Mental incapacity / intoxication that had a role in consent for the act
3. Medical age determination
4. Identification of the assailant
 Rape & Sexual assault are legal terms  Doctors can only do medical examination.
 Reasoned opinion - As per MoHFW Guidelines & Protocols.
 Provisional Opinion
 Final Opinion: After FSL report. 29
P.S: No opinion about ‘Whether the victim is Habituated to sex’?

30. Provisional Opinion writing
Genital
injuries
Physical
injuries
Opinion
Present Present There are signs suggestive of recent use of force/
forceful penetration of vagina/ anus. Sexual violence
cannot be ruled out
Present Absent There are signs suggestive of recent forceful
penetration of vagina/ anus.
Absent Present There are signs of use of force, however vaginal or anal
or oral penetration cannot be ruled out
Absent Absent There are no signs of use of force; however final opinion
is reserved pending availability of FSL reports. Sexual
violence cannot be ruled out.
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31. Final Opinion Writing :
Penile Penetration
Genital
injuries
Physical
injuries /
diseases
FSL report Final opinion
Present Present Positive for presence of
semen
There are signs suggestive of forceful vaginal/anal
intercourse
Present Absent Positive for presence of
semen
There are signs suggestive of forceful vaginal/anal
intercourse
Absent Present Positive for presence of
semen
There are signs suggestive of forceful vaginal/anal
intercourse
Absent Absent Positive for presence of
semen
There are signs suggestive of vaginal/anal intercourse
Absent Absent Positive for drugs /
alcohol and semen
There are signs suggestive of vaginal/anal intercourse
under the influence of drugs/ alcohol 31

32. Final Opinion Writing:
Non-penile Penetration
Genital
injuries
Physical
injuries /
diseases
FSL report Final opinion
Present Present FSL report is negative for presence of
semen/alcohol/ drugs/ lubricant
There are no signs suggestive of vaginal/ anal intercourse,
but there is evidence of Physical & Genital Assault
Present Absent FSL report is negative for presence of
semen/alcohol/ drugs/ lubricant
There are no signs suggestive of vaginal/ anal intercourse,
but there is evidence of Genital Assault
Absent Present FSL report is negative for presence of
semen/alcohol/ drugs/ lubricant
There are no signs suggestive of vaginal/ anal intercourse,
but there is evidence of Physical Assault
Absent Absent FSL report is negative for presence of
semen/alcohol/ drugs/ lubricant
There are no signs suggestive of penetration of vagina /
anus.
Absent Absent FSL report is positive for presence of
lubricant only
There is a possibility of vaginal/anal penetration by
lubricated object
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33. Findings Final opinion
Bite marks present and / or FSL detects salivary
stains
There are signs suggestive of evidence of bite mark/s on ………. Site (time of injury)
Sucking marks (discoid, subcutaneous
extravasation of blood, with or without bitemarks)
present and / or FSL detects salivary stains
There are signs suggestive of sucking mark/s on ………. Site (time of injury)
Forceful fondling, with presence of bruises or
contusions with or without finger nail marks
There are signs suggestive of forceful physical injuries on ………. Site (time of injury)
(which may be due to fondling)
Only forceful kissing and FSL detects salivary stains There are signs suggestive of salivary contact (which may be due to kissing)
If the history suggests forced masturbation of the
assailant by the survivor and if there is evidence of
seminal stains detected on the hands
There are signs suggestive of the survivor in contact with the seminal fluid (which may
be due to masturbation)
In case there are no signs of sucking, licking……
detected but history suggests some such form of
assault
It is still important to document a good history because the survivor may have had a bath
or washed him / herself
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Final Opinion Writing:
Non- Penetrative Assault

34. Documents in relation to Medico Legal
Examination of POCSO Victims
 Requisition from competent authority
 Medical and Medicolegal Examination Reports including Age Estimation Report
 Requisition/Forwarding letters of Sample collection
 Hospital & FSL Reports
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35. Negative FSL Results / Limitations
 Normal examination findings: Neither refute nor confirm whether the sexual offence occurred or
not.
 They must ensure that a medical opinion cannot be given on whether ‘Rape' occurred, because
‘Rape' is a legal term.
 Sometimes, No Medical Evidence found suggestive of Sexual Violence This never be construed
as a child lying about the abuse.
Delayed reporting
Post Assault activities
Mucosal injuries/ Healing of injuries
Use of Condom which is not recovered 35

36. Role of Examining Doctors
 CSA  Often leaves no physical evidence & Involves children who cannot give conclusive testimony 
Challenging to prove & decide.
 Expert witness [S. 45 IEA] –Conclusive opinion based on History & Medical examination  admissible as
Corroborative Evidence in court.
 He/she should uphold science through their depositions in Court by Scientific Reasoning and Scientific
Practices & Without Delay [S. 164-A Cr.P.C]
 Knowledge on the limitations in medical evidence.
 Confidentiality & Privacy should be well maintained.
 Standard Protocols & Guidelines should be followed. 36

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