Epidemiological Characteristics of Custodial Deaths: An Autopsy Study at a Tertiary Care Institute in Rishikesh.

Background Custodial death remains a sensitive and critical human rights issue worldwide. Identifying the causes and contributing factors is essential for developing effective interventions and ensuring accountability and dignity for individuals deprived of liberty. Methods This retrospective study analyzed records of custody-related deaths examined by the Department of Forensic Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh. A total of 34 autopsies were conducted between January 2020 and May 2025. The data were organized, coded, and charted, then analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, USA) and compared with findings from other national and international studies. Ethical approval was obtained from the Institutional Ethics Committee. Results From 2020 to May 2025, 34 custodial deaths were documented, with the highest number (10 cases) reported in 2023. Most of the deceased were men (91%) and over 40 years old (76%), suggesting increased vulnerability with advancing age. No deaths occurred inside jail; the majority took place at AIIMS, Rishikesh (62%), or during transport (26%), indicating delays or inadequacies in medical care. Although 91% of the deaths were classified as natural, many were linked to preventable conditions such as coronary artery disease and chronic liver disease. Notably, the legal status of nearly half of the deceased was undocumented, revealing major deficiencies in custodial record-keeping and accountability. Conclusions The increasing number of custodial deaths, predominantly among older male inmates, underscores inadequate healthcare and poor documentation in custody. Most deaths occurred outside jail settings, pointing to delays in medical intervention. The absence of legal status records for nearly half of the deceased highlights systemic shortcomings that demand urgent reform.