The Case of The Missing Death Certificate, part 3

As I stated in my previous post, Dr. Safaya’s declaration of death, issued on April 24, 2011, is little more than a very brief press release. The cause of death mentioned (cardio-respiratory failure) is in no way a valid one, an Indian physician argued the very same day. I went even further in saying that it is no cause of death at all, legal or not: it is at best a way of dying. The question remains if this release by Dr. Safaya was indeed the only document issued by the hospital or not. Indian law requires quite a bit more, I discovered.

Was Sathya Sai Baba’s death properly registered?
In order to make sure there really is no formal death certificate, I recently made enquiries through Indian state registries if a registration of a death report or a death certificate was available on Sathyanarayana Raju, which was Sai Baba’s real name. I found none. To place this apparent absence of any publicly known or accessible death certificate concerning Sai Baba into context, the following information may be helpful.

If you are hospitalized in India, and inadvertently die there, the law requires the attending physician to issue a so-called Medical Certification of Cause of Death, usually within 72 hours.

India is a member of the World Health Organisation since its inception in 1948. The WHO is divided into regions, one of which is SEAR, the South East Asia Region. The following is part of a 2007 WHO-conference contribution on MCCD (Medical Certification of Cause of Death) in India.

Legal framework

Medical Certification of Cause of Death under Civil Registration System has statutory backing under sections 10(2) and 10(3) of the Registration of Births & Deaths Act, 1969.

Medical Certification of Cause of Death (MCCD) in India is carried out under the government Medical Certification Scheme, which includes training of medical practitioners, and is mainly carried out by allopathic general practitioners, but also registered medical practitioners of other systems of medicine. As per the RBD Act, the treating doctor during the last 14 days of the patient’s life may issue cause of death only after being fully satisfied as to the clinical diagnosis and corroborative diagnostic tests.

In case of unexpected death, or suspicion of death due to unnatural causes, the doctor may certify death, but not the causes of death and must notify the police for further investigations and postmortem. The doctor must politely decline to issue a medical certification of cause and explain the situation to the family of the deceased. He or she is also expected to guide the family on further steps for obtaining the death certificate. It is the responsibility of the signing medical practitioner to forward the death certificate to the registering authority, although this is usually sent through a relative of the deceased, who receives a permit from the municipality to dispose of the dead body only after presenting the death certificate for registration – as per the RBD Act.

Under Section 23(3) of the RBD Act, any Medical Practitioner who neglects or refuses to issue a certificate under section 10(3) and any person who neglects or refuses to deliver such certificate shall be punishable with fine, which may extend to fifty rupees.

The death certificate used in India is the one recommended by the World Health Organization to ensure national and international comparability. The causes are coded according the International Classification of Diseases, 10th Revision, as of 1999.


So how does the system in India work exactly?

Obtain Death Certificate

What is a Death Certificate and Why is it Needed?
A Death Certificate is a document issued by the Government to the nearest relatives of the deceased, stating the date, fact and cause of death. It is essential to register death to prove the time and date of death, to establish the fact of death for relieving the individual from social, legal and official obligations, to enable settlement of property inheritance, and to authorise the family to collect insurance and other benefits.

The Law
In India, it is mandatory under the law (as per the Registration of Births & Deaths Act, 1969) to register every death with the concerned State/UT Government within 21 days of its occurrence. The Government accordingly has provided for a well-defined system for registration of Death, with the Registrar General, India, at the centre and the Chief Registrars in States, running through district registrars to the village and town registrars at the periphery.

What You Need to Do to Obtain a Death Certificate
A death can be reported and registered by the head of the family, in case it occurs in a house; by the medical in-charge if it occurs in a hospital; by the jail in-charge if it occurs in a jail; and by the headman of the village or the in-charge of the local police station in case the body is found deserted in that area.

To apply for a Death Certificate, you must first register the death. The death has to be registered with the concerned local authorities within 21 days of its occurrence, by filling up the form prescribed by the Registrar. Death Certificate is then issued after proper verification.

If a death is not registered within 21 days of its occurrence, permission from the Registrar/Area Magistrate, along with the fee prescribed in case of late registration, is required.

The application form in which you are required to apply is usually available with the area’s local body authorities, or with the Registrar who maintains the Register of Deaths. You might also need to submit proof of birth of the deceased, an affidavit specifying the date and time of death, a copy of the ration card, and the required fee in the form of court fee stamps.


Definition of Death Certificate
Now, note that legally, a death certificate is the death report issued by the municipal registrar, based on the Death Report (Form 2) and the Medical Certificate of Cause of Death (Form 4) he receives from the attending physician(s).

Death Report
Let us first have a look at an example of a Death Report. As can be seen, this Form 2 consists of 3 pages and 17 items.

Death report p.1

By clicking on the image the first series of 6 questions can be seen. They specifically refer to the exact date of birth, the name, sex, age (in completed years) and the place of death of the deceased. Under normal circumstances quite straightforward information. In the case of Sathya Sai Baba, though, they are fraught with uncertainty. What was his exact date of birth? This is a hotly debated topic, and directly related to the answer to the question of his exact age at death. Was Sai Baba 85, 84, 81 (or a ‘lunar’ 94/95) when he died? The answer to this question depends on whether you believe the hagiographic date of birth, November 23, 1926, or more credence is given to an entry in retrieved school records of Sai Baba, which would put his date of birth somewhere around October 4, 1929 (See here). If the ‘official’ date of birth is filled out, then the answer to question 4, the age at death in completed years would have to be 84. If the school records are used as a more reliable source, Sai Baba would have been 81 at death. And then there is the issue of sex of the deceased. Again, normally speaking quite unambiguous. However, much was written about Sai Baba supposedly being able to morph his genitals. So what was he? Male? Female? Hermaphrodite?

Death report p.2

Again, by clicking on the image, the second series of questions can be zoomed in on. They pertain to the town or village of residence, the religion and the occupation of the deceased, and to the type of medical attention received prior to death. I wonder what Sai Baba himself would have answered as to his religion: Love? Sarva Dharma? (I myself would say Hindu). And his occupation? Divine Teacher? Master? Avatar? (I myself would say Nil).

 

Death report p.3

By clicking on the last image, the final series of questions becomes visible. They have to do with whether the death was medically certified, what the name of the disease or actual cause of death was, and lastly whether the deceased smoked, chewed tobacco, chewed arecanut or drank alcohol habitually. Now, the matter of the areca nut is an interesting one, as it is known that Sathya Sai Baba chewed betel nut for a very long time, and at least in earlier years promoted its use, whereas it is a known carcinogenic, and has various other significant negative effects on a person’s health. See here for a fuller account: areca nut.

Medical Certificate of Death
What does an Indian Medical Certificate of Death look like, and how is it to be filled out? Below, I have copied a standard issue as it is used in India. Notice that a number of primary data are required, as on the Death report, which need to have been checked as thoroughly and independently as possible.

Medical Certificate of Death

Cause of death
The cause of death is to be subdivided in a logical sequence, stating the Immediate cause, the Antecedent cause, and, if appropriate, Other significant conditions contributing to death. The medical part of the certificate is designed by the WHO to facilitate reporting the underlying cause of death and to obtain information of the causal and pathological sequence of events leading to death. It consists of two parts, the first relating to the sequence of events leading to death, and the second to other significant conditions that contributed to the death. This part should be written by the attending medical practitioner having personal knowledge of the case history. The name of the disease should be written in full and legibly to avoid the risk of their being misread. Abbreviations and short form of disease condition should not be used. Only one cause is to be entered on each line of Part I. The underlying cause of death (the condition that started the sequence of events between normal health and the direct or immediate cause of death) should be entered on the lowest line used in this part. Part II comes into play if there existed any premorbid condition or conditions, which contributed to the death, though not directly related to the disease or conditions causing death.

Comments on my first post
I received a couple of thought-provoking reactions on my first post regarding the missing death certificate.  Robert Priddy, esteemed expose writer over many years now, wrote this in January:

As I suspected and stated from the start – the death of Sathya Sai Baba was covered up. There can be little doubt that, since he had been on massive life support for up to weeks (respirator, dialysis not least), his reported time of death was decided in advance by those involved – both so it should coincide with Easter Sunday (to make the bogus association with Jesus Christ) and to allow the already-scheduled arrangements for the funeral, including travel plans for visiting dignitaries to go ahead as organized.

My contention is that Sathya Sai Baba, who had multiple organ failure after having lost weight until he weighed only 28 kilos, most likely died as a result of AIDS. A former student, who claimed to have been sexually abused by him, contacted me and told that Sai Baba had been very angry with one of his sex partner students who had contracted HIV and had not told him.

See http://robertpriddy.wordpress.com/2011/04/24/sathya-sai-babas-death-no-miracles/

The student wished to remain anonymous because of the threat to his life – after the murders by police while he stood by and his brother Janakiramiah and high officials in the Sai Trust and ashram negotiated with the police on what they should do. That students still in India wish to remain anonymous is wise is now being validated in the Sydney High Court, where an assassination attempt hit man is under trial, a man who claims he and another were paid $75,000- to eliminate this person.

A few weeks later, Robert Priddy added the following comment:

How did he actually die? Ah! That is the multi-crore rupee question. The medical report states cardio-respiratory failure. Now that is very neutral medical terminology, but what caused this breathing and heart failure? This happens if one is taken off vital life support. So did he jump or was he pushed? Your guess is as good as mine… Those who really know will be tighter than clams if it was a deliberate act by those in charge. If he jumped, then it fitted in extremely well with all the massive planning of the authorities for a big screen send-off, new helicopter pads for VIPs all preparing to descend just today! A miracle of timing from Vishnu Baba, reclining on his serpent bed on the sea of milk? If there is any body one cannot trust in India (rhetorical) then it is certainly the Sathya Sai Central Trust and their minions! See the certificate issued by Dr. Safaya here (The Case of the Missing Death Certificate)

An example
Sai Baba dying as a result of AIDS? Not at all avataric, to say the least. Whether or not Robert Priddy is right in his assumption that Sathya Sai Baba died as a result of an HIV-infection (one could think of quite a few other viable possibilities), the appropriate MCCD would in such a case have read something like this, IF and only IF the death was entirely due to natural causes (the last part of the Form, Manner of Death) and IF we take the medical bulletins into account:

I. Immediate cause: Heart disease, both electrical and muscular, causing heart block and low blood pressure

I. Antecedent cause: Bronchopneumonia carii due to contraction of Acquired Immune Deficiency Syndrome as a consequence of HIV-infection

II. Other significant conditions contributing to the death but not related to the disease or conditions causing it: Multiple system failure: lungs, liver, heart, kidney. The patient died after being taken from life support.

Mind you, this is merely A RANDOM EXAMPLE of how a medico-legally adequate MCCD would read in the case of someone dying of the causes suggested above. We probably will never know exactly what happened in Sathya Sai Baba’s case, as he was interred so quickly. Unless some government authority would request a proper post-mortem and have Sai Baba unearthed from his final resting place, we will probably have to live with an undisclosed cause of death. I am willing to bet, though, that a close examination of his bodily remains would turn out the be as much a treasure trove as his other earthly dwelling turned out to be last year!

For those interested in the whole process of reaching a proper judgement, and of the importance of filing out the form correctly, the following article is useful, among many others. It was published by Dr. P C Srivastava, Dr. Shikha Saxena and Professor M K B Sahai, Rohilkhand Medical College, Bareilly (UP), India, and appeared in IJMU, volume 4, January 2009, titled: MEDICAL CERTIFICATION OF CAUSE OF DEATH.

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One comment on “The Case of The Missing Death Certificate, part 3

  1. […] Long since assured that the world would never accept him as God Almighty (as he repeatedly claimed), especially not after he was revealed as a secretive hoarder of countless valuables, gold and currency under his 3X3 meter bed etc., even down to old biscuits and dried fruit etc. In fact, he had only given even his most privileged devotees false gemstones which he claimed were diamonds! All the significant facts of his tremendous weight loss (down to 30 kg), his illness and death – were very assiduously suppressed, and no devotee has asked for them to be brought forth!  (They would not wish to know if his illness was indeed the result of AIDS, of which it showed many tell-tale symptoms See Sathya Sai Baba’s death – no miracles). His (cover-up) death certificate was not a legal document, stating he died of ‘heart failure’ (see The Case of The Missing Death Certificate). […]

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