Dr.Shyam MLC .ppt

MLC

1. MEDICO LEGAL CASES -FACTS
DR.V.SHYAM KUMAR

2. DISCLAIMER/CAUTION
THISPRESENTATIONBRIEFLYOUTLINESTHEPROTOCOLFOR
PREPARATION OF MEDICOLEGAL REPORTS.THESE
GUIDELINES ARENOTTHEFINALANDCOMPLETE
DOCUMENT OFTHEMEDICOLEGAL SYSTEM.THE
GUIDELINESARESUBJECTTOREVISIONFROMTIMETOTIME
ASPERCENTRALGOVT/STATEGOVTORCOURTDIRECTIVE
ASTHECASEMAYBE.
THEGUIDELINESAREBESTUTILIZEDIFTHEMEDICAL
PROFESSIONALUSESKNOWLEDGE ANDSKILLTOTHEBEST
OFHIS/HERCAPABILITIESFORPATIENTCAREAND
MEDICOLEGALDOCUMENTATION ASPERPROVISIONSOFTHE
LAWOFTHESTATE.THEHEALTHCAREPROFESSIONALSARE
ALSOADVISEDTOCONSULTSTANDARD REFERENCESIN
SUCHMATTERSWHENEVERNECCESSARY.

3. Why to manage MLC
ML Cases are just as Non MLC sick/injured patients and doctor
is duty bound to treat as well as document the details.
Crucial piece of evidence
Communication to law enforcing agencies is required under section 39
of CrPC and failure to do so will attract legal penalty
Liable to be prosecuted under section 201 of IPC

4. DUTIES OF REGISTERED MEDICAL
PRACTITIONER TOWARDS PATIENT
1.Duty to exercise reasonable degree of skill and knowledge.
2.Duties in regard to attendance and examination.
3.Duty to furnish proper and suitable medicines.
4.Duty to give instructions.
5.Duties towards children and adults.
6.Consultation with a specialist.
7.Duties in regard to psychiatric patients.
8.Duties in regard to poisoning.
9.Duty to notify certain diseases.
10.Duties in regard to operative procedures.
11.Duties under Geneva convention.
12.Duties in convention with X-rays.
13.Professional Secrecy.

5. 1.Consent
2.Confidentiality
3.Maintenance Of Records
4.Collection And Preservation Of Samples
5.Dying Declaration
DUTIES OF REGISTERED MEDICAL PRACTITIONER
TOWARDS STATE

6. OVERVIEW
•WHAT
•WHO
•WHERE
•WHEN
•HOW
•LEGAL PROVISIONS

7. WHAT IS A MEDICOLEGAL CASE?
No legal definition
Pre-labeledcase:Itisacaseofinjuryorailment
whereanattendingdoctoraftertakinghistoryand
clinicalexaminationofthepatientthinksthatsome
investigationbylawenforcingagenciesisessential,
soastofixtheresponsibilityregardingthecasein
accordancewiththelaw.

8. Receiving an MLC
Adoctorcanreceiveamedico-legalcase–
•Broughtbythepoliceforexaminationandreporting.
•AlreadyregisteredMLCreferredfromotherhealthcaresystemfor
expertmanagement/advice
•Afterhistorytakingandthoroughexamination,ifthedoctorsuspects
thatthecircumstances/findingsofthecasearesuchthatregistration
ofthecaseasanMLCiswarranted
•Directiveofcourt.

9. Who?
Any doctor who
Possess permanent registration with MCI/State MC
Some experience (preferable)
The doctor who has -First contact with patient should
prepare an ML case report
In rape victims by the examination and preparation of MLC is
done by female doctors.

10. Where?
No specified area is defined for ML case
Emergency Department is the area where
majority of ML reports are prepare but sometimes
may be in wards after detection of new findings

11. When?
Some of the Pre-labeled MLC
[This list is not comprehensive]
RTA’s, Rail accidents, factory accidents or any other
unnatural mishap
Suspected or evident homicides or suicides
Suspected or evident poisoning
Burn injuries due to any cause
Injury cases where foul play is suspected
Injury cases where there is likelihood of death in near
future
Sexual assault cases
Suspected or evident criminal abortions
Unconscious cases where cause of it is not clear
Brought in dead cases where suspicion of foul play
Cases referred from court

12. Consent in Medico legal cases
Consent for medicolegal examination to be taken in
written in all cases
Exception : Cases brought by police being arrested on
charge of committing an offence
Person below 12 years/unsound mind-consent of
guardian is to be taken.

13. Life saving is the foremost duty of a doctor and a
hospital, in accident or medico-legal cases (MLC).
Patient treatment is priority
Doctor has to do is to COMPLETE the injury
sheet, which is a part of the assessment of the
patient.
NO DELAY FOR PROVIDING FIRST AID
REMEMBER

14. TREATMENT is PRIORITY
THE PRIME RESPONSIBILITY
OF
DOCTOR IS THE INSTITUTION OF
PROPER TREATMENT TO THE PATIENT
PROMPTLY

15. MLC should be registered as early as possible
ThereisnotimelimitforpreparinganMLRorregisteringacaseas
MLC
AcasewhichotherwisequalifiestobeanMLCwasnotregistered
earlieristoberegisteredasMLCbytheconcerneddoctor
Acaseduetounravelingofnewfindings–history/clinical
examinationetc.lateronqualifiestobeanMLCtoberegisteredby
theconcerneddoctor

16. DOCUMENTATION OF A MEDICOLEGAL CASE
Documentation is done in duplicate in a set Performa as per
hospital policy
Separate performas may be available for medical
examination, examination of drunkenness etc.
All columns are filled up carefully and by the same doctor
who had examined the patient
Each MLC is given a fresh MLC number sequentially or
parallel series as per hospital policy

17. The details are completed then and there only, leaving
no provisions as to be completed later on.
After completion doctors sign and mention his/her
name in full below it with designation
Police constable on duty informed in each case.
After registration of a case as MLC , thereafter all
documents and requisition forms bear the same MLC
number including the discharge slip.
DOCUMENTATION OF A MEDICOLEGAL CASE contd..

18. 1.REGISTRATION NUMBER
2.MLC NO
3.NAME
4.S/D/W OF
5.AGE
6.SEX
7.RELIGION
8.OCCUPATION
9.RESIDENTIAL ADDRESS
10.BROUGHT BY …….
11.DATE AND TIME OF EXAMINATION
12.NAME OF POLCE STATION
GENERAL DETAILS

19. DETAILS OF EXAMINATION
•ALLEGED HISTORY
•TO BE PRECICISE AND TO THE POINT
•LEGIBALY/CLEARLY WRITTEN
•DESCRIPTION OF INJURIES
•ABBREVIATIONS AVOIDED
•WHEN IN DOUBT CONSULTATION OBTAINED
•MINOR INJURIES ALSO NOTED IN CASE OF
POLYTRAUMA/MULTIPLE INJURIES
MARKS OF IDENTIFICATION ARE NOTED AND DOCUMENTED

20. CERTIFY FITNESS
and
OPINION

21. CERTIFYING FITNESS
AsapartofdocumentationofMLCasereportorwheneverthe
I.Orequeststhedoctorforcertifyingfitnessofthepatientto
makeastatementtheexaminingdoctorwillcertifythesameon
theoriginalMLCsheet.He/shewillmentiondateandtime
clearlywithsignature,nameinfullwithdesignationbelowthe
certification.

22. OPINION REGARDING INJURIES
Simple
Underobservation and reference for a specialist opinion
Grevious (after consideration of all findings/x-ray etc)
Caused by sharp/blunt objects

23. Time limit for registering a
Medico legal case
A medico-legal case is registered as soon as a
doctor suspects foul play or feels it necessary to
inform the police, at any time after admission.
A case is registered as an MLC even if it is brought
several days after the incident.

24. Can a doctor refuse to attend MLC
NO
GOVT SERVICE DOCTORS -DUTY BOUND
ROLE OF PRIVATE PRACTITIONERS?
A doctor cannot refuse to examine medico legal case
on the basis of being a private practitioner or citing
a jurisdiction problem.

25. ML CASE
Discharged after initial treatment
Admitted as in patient
Referred to other hospital after providing
First Aid / stabilization for expert
management after completion of all
necessary documentation

26. If the case brought is a referred case and is
already registered as medico legal case
FRESH REPORT is NOT REQUIRED

27. •A case that is admitted and on treatment, later on
found out be MLC, is made MLC by the
concerned doctor.
•If death is inevitable, arrangement to take the
dying declaration is made.
•All the materials such as vomit, gastric lavage
sample, blood urine, etc. in poisoning cases,
vaginal swab and pubic hair in sexual offences,
foreign bodies found in the wounds, etc are
collected
•Samples are properly preserved, packed and
sealed then handed over to the police.

28. How?
First aim is to preserve life
Registration at designated area
1.Specified Register
2.Cases already registered and referred
i.Duty of referring doctor
ii.Duty of receiving doctor
Entertaining requests of patient/relative
Whenever there is doubt, doctorstake second
opinion/consult specialists
All reports and documents of a medico legal case are
labeled as MLC with the number assigned

29. Information is given only to I.O. or any person
designated by I.O.
If the I.O. gives requisition for any clarification
regarding certain points mentioned in the report
given, answer is given in writing.
DOCTORS MAINTAIN CONFIDENTIALITY
IN ALL MLC CSES

30. •If the I.O. demands an original document/
photocopy of the same, of a MLC, it is given
and a receipt obtained.
•If the court demands X-Ray films, P.M. report
etc. they are deposited in the court and a
receipt obtained.

31. •Gastric lavage/ vomitus in poisoning cases
•Blood in alcoholic/poisoning cases/drug abuse or
for DNA test
•Clothes in assault/injury/fire-arm/burn cases
•Nail clippings in assault/rape cases
•Pellets/bullet etc. if recovered
•Vaginal swabs/public hair in rape cases
•Swabs in un-natural sexual offence cases
•Swabs from fire-arm entry wounds
•Washing from hands in fire-arm suicide cases
COLLECTION AND PRESERVATION OF SAMPLES

32. •Urine for pregnancy test in rape cases
•Undergarments
•Swabs from glans penis in rape/unnatural sexual offences
•Swab from bite marks for blood/DNA test
•Nails and hair in chronic poisoning of heavy metals
•Any other material which may be useful in investigation
•Any other exhibit e.g. bottle of poison or tablet or weapon if
recovered should be properly labeled and sealed. It is
essential to give sample of seal on separate cloth/paper
putting initials. The endorsement of sample of seal should
also be made in MLR.
COLLECTION AND PRESERVATION OF SAMPLES

33. AGE DETERMINATION
•VICTIM
•ACCUSED
1.GENERAL PHYSICAL
EXAMINATION
2.DEV. OF SECONDARY
SEXUAL
CHARACTERS
3.DEVELOPMENT AND
ERUPTION OF TEETH
4.OSSIFICATION OF
BONES
It is necessary that to estimate age all precautions to be taken so that
range of estimation should not be more than ±6 months up to 16 years
of age and ±1 year up to 21 years.
Generally
X-ray of
•Wrist
•Elbow
•Shoulder
is advised for age
determination-juvenile or
not

34. RELEVANCE OF AGE DETERMINATION
1.CRIMINAL CULPABILITY Section 82 IPC child < 7 years
Section 83 IPC child 7 years -12 years
2.CONSENT FOR MEDICAL EXAMINATION
3.CONSENT for any harm not intended to cause death or grievous hurt can
be given by a person> 18 years age Section 87 IPC
4.IMPRISONMENT –Juvenile < 18 years not to be kept in prison
5.CASES OF SEXUAL ASSAULT/RAPE

35. Issues regarding MLC
Dying declaration
Dying deposition
Custody of ML Records
Attending court of Law

36. Admission and Discharge of MLC
oWhenever a medico-legal case is admitted the same is
documented in admission papers and hospital records
oWhen discharged, the same should be intimated to the
police authorities of the hospital
PoliceisinformedifaMLCistakingdischarge
againstmedicaladvice
Atthetimeofdischarge,detailedinstructionsto
thepatientregardingtreatment,followupgeneral
care,diet,exerciseetcaregiveninwriting.

37. Death of a person admitted as a medico-legal case
The following are the do's and don'ts in case a person
admitted as a medico-legal case expires.
•Police Informed immediately.
•Body sent to the hospital mortuary for
preservation, till the legal formalities are
completed and the police releases the body to the
lawful heirs.
•Death certificate not issued –even if the patient
was admitted.
•Dead body never released to the relatives directly

38. BROUGHT IN DEAD PATIENTS
•POLICE TO BE INFORMED IF NOT ALREADY DONE
•NO INJURIES NOTED IN MLC RECORD
•ARTICLES IN POSSESSION DOCUMENTED AND HANDED
OVER TO RELATIVES/POLICE
•DEAD BODY TO BE SENT TO HOSPITAL MORTUARY

39. MEDICAL EXAMINATION OF VICTIMS
OF SEXUAL ASSAULT
Section 164A of CrPC
•Examination only by female registered medical practitioner
•Without delay
•Consent -documented
•Note down particulars
•Complete history
•Examination –Genital examination and injuries:
Standard protocols and guidelines
•Preserve samples-DNA profiling
•Emergency Contraception if required
•Treatment /prophylaxis as required
•Opinion

40. EXAMINATION OF PERSON ACCUSED OF
SEXUAL ASSAULT
Section 53A CrPC
•Brought by police written and signed request
•Details of examination findings
•Sample preservation –Clothing/Blood/Semen sample/Pubic hairs for
DNA profiling
•Opinion
•Age determination
Consent not required

41. CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL
ASSAULT/ABANDONED CHILDREN
Guidelines laid down by hon’ble court
A detailed description of assault/abuse history be mentioned
In case of girl victim medical examination preferably by a female doctor
As far as practical –psychiatrist help be made available to victim
Report to be prepared as early as possible
Parents/ guardian whom child should trust should be allowed to be present
In case of results of examination are likely to be delayed the same should be
mentioned
Emergency medical treatment/prophylaxis against STD to be provided when
necessary
After examination child permitted to wash up and provide fresh clothing if
clothing is taken as evidence
Preserve samples according to guidelines –SAFE [Sexual abuse Forensic
Evidence] Kit provided in Govt. hospitals

42. LEGAL PROVISIONS
•Section 191 IPC (Giving false evidence)
•Section 192 IPC (Fabricating false evidence)
•Section 193 IPC (Punishment for false evidence)-
Imprisonment up-to 7 years+ fine
•Section 201 IPC(Causing disappearance of evidence
of offence, or giving false information to screen
offender)

43. LEGAL PROVISIONS (cont.)
•Section 202 IPC (Intentional omission to give
information of offence by person bound to inform)
•Section 203 IPC (Giving false information respecting
an offence committed)-Under Sections 201 and 202
and in this section the word “offence”, includes any
act committed
underSection302,304,382,393,394,395,396,397,398,4
02,435,436,449,450,457,458,459 and 460

44. LEGAL PROVISIONS (cont.)
•Section 204 IPC (Destruction of document or
electronic record to prevent its production as
evidence) Imprisonment up-to 2 years or fine or both
•Section 88 IPC (Act not intended to cause death,
done by consent in good faith for person’s benefit)
•Section 89 IPC (Act done in good faith for the
benefit of child or insane person, by or by consent of
guardian)

45. LEGAL PROVISIONS (cont.)
•Section 92 IPC (Act done in good faith for
benefit of a person with out consent)
•Section 93 IPC (Communication made in good
faith)
•Section 39 CrPC (Public to give information of
certain offences-Section 302-304)

46. LEGAL PROVISIONS (cont.)
•Section 53 CrPC (Examination of accused by
medical practitioner at the request of police officer)
•Section 53A CrPC (Examination of person accused
of rape by medical practitioner)
•Section 54 CrPC (Examination of arrested person by
medical practitioner at the request of the arrested
person)

47. MLC REPORTS FILLED LEGIBALY
AVOID SUPERLATIVES,ABBREVATIONS Etc.,
ALL RELEVANT DETAILS NOTED
SIGNATURE / NAME IN FULL CAPITAL LETTERS BELOW
ALL RELATED FORMS ARE LEGAL DOCUMENTS FILLED IN DUPLICATE
WITH MLC NUMBER AND DETAILS
ALL COULUMS COMPLETED
CONFIDENTIALITY MAINTAINED
NONJUDGEMENTAL ABOUT ANY CASE –DUTY IS TO EXAMINE THE PATIENT
AND DOCUMENT THE FINDINGS AND PATIENT MANAGEMENT.
THE ONUS OF FIXING RESPOSIBILITY OF GUILTY IS FOR THE COURT
SUMMARY