Bringing the science back into forensic science in death investigations in the Philippines during the COVID-19 pandemic

After a pandemic-filled 2020 had finally come to an end, many were looking forward to a new year filled with renewed hope and fresh beginnings. Unfortunately for a 23-year old Filipina, the first day of the year would turn out to be her last day on earth. While a single individual’s death on New Year’s day would typically not be a newsworthy event in the Philippines, this particular case sparked a media frenzy. It exposed the flaws of a death investigation system still reeling from the many unsolved cases of extrajudicial killings brought about by the war on drugs [9]. To date, the Philippines does not have an independent, science-based medico-legal death investigation system [6], [14]. This commentary aims to provide a case narrative to highlight the urgency of adopting a systematic death investigation system, seek justice for the victim’s family, reduce the possibilities of wrongful accusations and convictions, and maximize the use of limited and costly forensic resources in the Philippines.

Case background

A 23-year old female flight attendant was found lifeless inside the bathtub of a room in a hotel on 1 January 2021, where she attended a party with her friends to celebrate New Year’s Eve. After attempts to revive her failed, she was taken to the hospital, where she was declared dead on arrival, reportedly due to a ruptured aortic aneurysm [10].

At 9:00 a.m. of the following day, 2 January 2021, a police medico-legal officer ordered the embalming of the victim’s body before he conducted an autopsy. Both the embalming and the autopsy were done without the family’s consent in a funeral home and not in a police medico-legal facility. The police authorities later explained that the body had to be immediately embalmed because the victim was “presumed” to be undergoing isolation having been brought to the hospital from a hotel quarantine facility for new arrivals to the Philippines (GMA [5]). Due to the pandemic, the Philippine National Police (PNP) had adopted the so-called “new normal” guidelines in investigating crimes, one of which is that the autopsy procedure may be waived and postmortem certificates issued in its place. If the investigator or family decides on pursuing the case, “the cadaver will be embalmed first, and conduct of autopsy shall be done after five hours” [18]. Notably, the new protocol does not include a COVID-19 test that has been recommended to confirm a suspected case of infection before autopsy [12]. There was no information on any SARS-CoV-2 test done on the victim.

The initial postmortem findings on 2 January 2021 indicated that the cause of death was due to a ruptured aortic aneurysm. This was consistent with what was originally reported upon arrival of the deceased woman’s body at the hospital. However, postmortem examination also identified bruises on the right hand, right thigh, knees, ankles, and right foot, and a linear abrasion on her right thigh. Deep healed lacerations and abrasions were also found during the postmortem genital examination.

On 3 January 2021, the local police reported details of the death to the media. The following day, 4 January 2021, the police released a separate statement to the press, describing the case as “rape-slay”. They indicated that they had “solved” the case, had arrested three of the men tagged as suspects, and had filed a provisional complaint for rape with homicide during inquest proceedings before the prosecutor’s office. Not surprisingly, this media statement created confusion because the initial postmortem report had declared a natural cause of death and had not indicated any findings to support the subsequent allegation of sexual assault.

On 5 January 2021, in light of the alleged sexual assault, the victim’s family announced that they had requested a second autopsy to dispute the authorities’ initial finding that she had died of natural causes.

The next day, 6 January 2021, the Secretary of Justice stated that a second forensic medical team from the National Bureau of Investigation (NBI), different from the original police investigators, coordinated with the authorities to determine the actual cause of death. Meanwhile, the prosecutor’s office ordered the release of the three suspects arrested earlier. The prosecutor returned the case to the police for further investigation, citing the need to submit the results of toxicology tests, DNA analysis, and histopathological examination. At the same time, the police authorities admitted that the samples collected from the body might have been contaminated with fluids from the embalming process that was performed before the first autopsy on 2 January [11].

On 7 January 2021, a friend of the victim’s family informed reporters that the body had been submitted for a second autopsy before it was brought home to the province for a private funeral [1].

On 12 January 2021, the Deputy Director of the NBI disclosed that bodily fluids retrieved from the autopsy conducted sometime during the wake had been forwarded to the Death Investigation Division for examination. It is unclear whether this was a third autopsy or the second autopsy mentioned in the earlier report. The Secretary of Justice revealed later that around 100 ml of “urine” had been collected from the victim’s body [19], [3].

During the first preliminary investigation held on 13 January 2021, the legal counsel for the three suspects claimed that the police had pressured them into admitting that illegal drugs had been used during the party [10].

On 27 January 2021, the PNP reported their latest findings. At this time, they ruled out homicide as the manner of death and declared that a ruptured aortic aneurysm remained the cause of death. They indicated that a sachet found in the woman’s hotel room had contained only table salt that had been used when the partygoers drank tequila on New Year’s Eve. This report was submitted to the prosecutor’s office during the second preliminary investigation [10].

On 29 January 2021, the victim’s family insisted on having a DNA test performed on the tissue samples and organs mentioned in the second medico-legal report to determine whether they belonged to the victim [21]. The victim’s family alleged that the deceased was young and in good health and could not have died due to a heart attack. Hence they suspected that the samples tested were not those of the victim, and the cause of death was incorrectly reported. Unfortunately, since the body had been exposed to formaldehyde, a known inhibitor for PCR-based DNA tests, the likelihood of generating a DNA profile from the embalmed organs is low [22]. Also, a biological reference sample from the victim should have been collected before burial. The reference DNA profile is needed for comparison with those of the alleged victim’s organs. By this time, the family has issued statements expressing their willingness for the victim’s body to be exhumed, if needed, to prove that the organs were not those of the victim [13].

Discussion

The timely and correct application of forensic science should be able to help investigators determine whether a crime had been committed and identify the perpetrators of the crime.

This particular case, which is not an isolated one in the Philippines even before the pandemic, exemplifies a criminal investigation gone wrong. Forensic science principles were not sufficiently understood or adequately utilized, thereby casting doubts on the final results [14], [6].

The basic rules on the disposition of dead bodies in the Philippines are presently provided for in the 1975 Code of Sanitation (Presidential Decree No. 856) and the Implementing Rules and Regulations issued by the Department of Health [15], which has a brief section on autopsy and dissection of remains. While efforts have been made in Congress to pass a law to modernize the death investigation system, the Philippines continues not to require a mandatory autopsy for crime victims or deaths under mysterious or suspicious circumstances.

An autopsy is performed to determine the cause of death, particularly when an external examination of the body does not show signs of life-threatening injuries. In the case under review, the body was first embalmed before the autopsy was conducted under the “new normal” guidelines in investigating crimes during the COVID-19 pandemic.

While the procedure of embalming the body first before conducting the autopsy may have been intended to minimize the risk of exposure to the SARS-CoV-2, the same method would have adverse impacts on any investigation. The process of embalming materially affects the integrity of fluids and other samples taken from the body. It dramatically reduces the chances of recovering vital physical evidence from the body itself. For instance, a toxicological examination to determine the existence and amounts of drugs or alcohol in the victim’s system is significantly compromised. Unless samples had been taken following established collection procedures [4], the chemicals introduced during the embalming process would mix with the body fluids, eliminating or contaminating any evidence of drugs or alcohol in the system [17]. Embalming would erase any semen, saliva, or other physical evidence that could have established recent sexual contact before the victim’s death. Thus, even the victim’s family is questioning the autopsy results to the extent of casting doubt on the identity of the tissue samples tested [20]. Without direct physical evidence, investigators are left with no other choice but to rely on testimonial evidence which can be highly subjective, unreliable, and prone to errors and omissions [7], [8] and result in numerous delays at trial.

During this pandemic, it may be difficult to strike a balance between the requirements of public health, safety and welfare, and the need to conduct a thorough and comprehensive investigation. However, it is still possible for investigators to collect samples without exposing themselves to SARS-CoV-2 by wearing the appropriate personal protective equipment (PPE) and exercising the necessary precautions. Other countries have developed protocols for dealing with infectious diseases, which the Philippines could learn from [16], [2], [23].

Because of the lapses in managing this case, numerous personnel hours were spent, and costly resources were used. The conduct of at least two maybe three separate autopsies by two law enforcement agencies, the additional demands of processing fluids from embalmed bodies, the DNA tests on tissues to remove doubts about their human source, and the cost of exhuming the victim’s body demanded by the family drains the limited forensic resources of the country. Besides, this investigation places an unusual burden on the Philippine criminal justice system, already suffering from a massive backlog of cases, understaffing, and limited budgets. More importantly, the delays have already caused pain and suffering to the victim’s family, the suspects, and their families, all of whom face a highly drawn-out investigation and a very public trial in social media.

Indeed, the SARS-CoV-2 pandemic has required us to adjust the way investigations are done. However, forensic practitioners should continue to use science to modify old protocols or adopt new strategies, as may be needed. Institutions must balance the need to continuously conduct investigations and to maintain public order while maintaining biosafety requirements of protecting their human resources with overall scientific integrity. This balance can only be achieved with the national government’s support, the much-needed promulgation of a law that governs death investigations, careful planning by institutional administrators, technical input from experienced forensic practitioners, and awareness of sound scientific guidelines provided by internationally recognized forensic associations and local academic research institutions.

Funding

This work was supported by the Natural Sciences Research Institute of the University of the Philippines Diliman. MCADU is a Career Scientist II of the Department of Science and Technology and Civil Service Commission of the Philippines.

CRediT authorship contribution statement

Jose M. Jose: Conceptualization, Formal analysis, Writing - original draft. Maria Corazon A. De Ungria: Conceptualization, Formal analysis, Writing - review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.