medico-legal case&report forensic science

Forensic science

1. MEDICO-LEGAL CASE AND ITS REPORT DEPARTMENT OF F.M.T IGIMS, PATNA

2. CONTEXT Introduction. Category of cases. Who can label it? Medicolegal case report & its types. MLC report vs MLC case report. Guidelines for examine MLC. Consequences f/b MLC. Dealing with conflicts. Code purple.

3. INTRODUCTION DEFINITION: Medicolegal case (MLC) is one where a doctor, after examining the patient, thinks that some investigation by law enforcement is essential to establish & fix responsibility for the case.

4. CATEGORY OF CASES ARE LABELLED AS MLC Injury related 1) injury, 2) RTA, 3) Fall from height, 4) thermal injuries 5) factory/railway/aviation accidents. Poisoning 1) snake bite, 2) consumption of poison or toxic plants. Sexual assault e.g. Rape, sodomy, sexual abuse Asphyxia e.g. hanging, strangulation, suffocation, drowning. Comatose patients Brought unconsciousness. Death during OT e.g. surgical procedures, MTP, Criminal abortion, etc. Suspicious death Suspect suicide or homicide Brought dead cases Dead on arrival or dies after admission

5. WHO CAN MAKE MLC? Government as well as private practitioner. Referral to avoid MLC cases – if patient dies, it can be sued under (S.106, BNS) cause death by negligence

6. MEDICO-LEGAL REPORT Medicolegal reports are the documents prepares by medical officers in obedience to a demand by an authorized police officers or magistrate. Its chiefly referred for , Assault Rape Murder Poisoning accidents

7. KIND OF MEDICOLEGAL CASE REPORTS Injury certificate Death certificate Age estimation certificate Autopsy report Vaginal swab report

8. MLC REPORT vs MLC CASE REPORT FEATURE MLC REPORT (MLR) MEDICO-LEGAL CASE REPORT Prepared when At time of first examination After treatment or death Length Brief and structured Detailed and narrative Focus Initial findings and opinion Full case history, treatment, final opinion Audience Police, legal authority Courts, legal counsel, academic boards Legal use Immediate documentation Comprehensive expert evidence Common in Casualty/emergency departments Court summons, forensic reporting

9. EXAMINATION OF MEDICO-LEGAL CASES What category of case should be labelled as medicolegal?. If a case has been registered MLC at some other hospital, there’s no need to label again. Labelling the case as MLC: It’s the Doctors judgement to label the case as MLC. Whether patient agrees or not, if pt’s relatives may stress a doctor not to make MLC. If there’s delay in labelling, it can be labelled at later.

10. consent : Consent is required if patient not arrested. Any persons of sound mind of >12 years of age. If <12 years of age or unconscious, can be get from the guardian. Should get sign/left thumb impression of patient as well as witness. We should explain the purpose and outcome of such examination before going to do. If patient denies, then we can examine the accused of case at request of police (not below the rank of SI). -

11. Should be examined without delay at any time of day or night. A private hospital can treat & admit medicolegal cases except victims and accused of rape cases. Medical officers has no jurisdiction to omit the cases to examine. Note at least two identification marks which are individualistic. e.g. describe about mole, scar marks, if any tattoo marks present.

12. Accident register Details of patient History about incidence Details of examination Treatment given If a patient admitted and later it turns out to be MLC., has to be made MLC by entering in AR. The certificate will have to be issued by a doctor who labels as MLC by consulting with treating doctor .

13. Inform to police : The police should be informed about all cases labelled as MLC as early as possible. If doctor IN CASUALTY failed to inform police – may punish with 1 month of prisoning or fine- Rs.5000 under [S.203, BNS]. For furnishing information to police- 6 months of prisoning or fine- Rs. 5000 under [S.204, BNS].

14. Which is more important, treatment or prepare inquiry report? It depends on seriousness of the patient. We should give priority for treating patient then we can prepare injury report later., If patient is in serious or death occur during treatment, should prepare for dying declaration and inform to police as soon as possible. Hand over the body to police officials, not to relatives .

15. In case of criminally accused person, no attempt should be made any history about the specific incident. It should be limited to causation of injuries only. If accused says, that might be incriminate him/her, it should be neither recorded nor reported. Mention in report if pt’s treated as out patient. Immunization Prepare wound certificate. All documents & materials collected as a evidence. Secondary opinion from experts. To avoid Overwriting, alteration & using abbreviations

16. Where the doctor has to wait to give opinion : To find out nature of injury- should kept under observation. For collection of investigation reports, what we sent. Opinion: Opinion must be kept pending till the reports are available in cases where necessary investigations are required . Should be mention even negative points out in the report. Subsequent opinion: Its updated new opinion given based on new findings get from all the collected reports.

17. All form filled for radiological/lab investigations should be labelled as MLC. In case of discharge or death of MLC cases, should be informed to police who having local jurisdiction and death certificate should not be issued. Do not issue death certificate & releasing body to relatives if; Brought dead case Crime has already registered by police The police has already informed about case Cause of death is not known. Autopsy to be conducted or not is the discretion of police and not of the doctor.

18. Always write injuries are antemortem in autopsy report. Doctor should not conduct autopsy for, if the deceased was treated before by him/her and close relatives, friend of the doctor. If opinions are given to police before completion of data, they should be labelled as preliminary impressions. Reading reference or consult an expert if they need to give opinion. Report should be given on the same day as early as possible. MLC report must be made in triplicate and all copies must be marked as medicolegal case. The concerned party can obtain copy of report from the police or court, which will be issued only after filing a charge sheet for the purpose of payment of cost of reproduction in accident and claims compensation if natural death occur.

19. No time limit is prescribed by law for preserving medicolegal reports. [S.180,BNSS]- If investigating officer(IO) give requisition for any clarification regarding reports, the answer should be given in writing. [S.90,BNSS]- For the request of any documents and investigation reports by the court, they should deposited in it and a receipt obtained. [S.179,BNSS]- The doctor should summon to the police station fpr recording statement if investigation demands. [S.205,BNS]- Refusal to answer the questions is punishable up to 6-months of imprisonment. [S.181,BNSS]- Oral statement made to the police and recordings should not be signed.

20. Disappearance of evidence: If a doctor fails to preserve samples in suspicious death or evidence related to crime events, he may sued under [S.112,BNS] for causing disappearance of evidence with the intention to screen offenders from legal punishment. Punishment may according to follows, PRESCRIPTION FOR OFFENCE PUNISHMENT FOR DOCTOR Punishable with death 7Y + FINE, in case of murder Punishable with life imprisonment or >10 years. 3Y + FINE Punishable with <10Y IMPRISONMENT One fourth of imprisonment provided for that offence. E.g. in case of suicide

21. Challenges faced by doctors in MLC : Challenges could be easily addressed by acquiring knowledge of handling MLC through various workshop, seminars and trainings. Doctor side : Decide or differentiate b/w a MLC & non-MLC Delay in inform to police and handling them. Non-cooperative police officers. Handling of relatives of patient. Inadequate sampling Lack of knowledge to do, -handling of evidence -consent taking & opinion writing -mishandling consequences of MLC.

22. Patient side : Improper history given by patient/ relatives. Refusal of MLC labelling. Threats by pt’s/attenders in political influenced or high profile cases. Violating against doctors

23. Patient absconds: Institutional side: -Non-cooperative authority -Inadequate tools -Lack of resources for investigation. Cases referred from other hospital without any MLC.

24. Challenges faced by courts: Illegible handwriting Incomplete MLC When Docters who made MLC not traceable.

25. Challenges while conducting autopsy: Lack of knowledge & experience about forensic autopsy. in rural region- unscientific manner of dissection by mortuary technicians

26. In actual ground what will happen(while conducting autopsy) What if an autopsy was done by MBBS doctor/any specialist in the clinical field? Role of mortuary attenders in rural region hospitals?

27. Dealing with conflict with patients and attenders: Open communication Remain calm and composed. Don’t let conflict situation fester. Don’t react without thinking. Don’t personalise the dispute. Maintain respect throughout. Choose appropriate time to explain. Neutral location to discuss. Neutral stand.

28. CODE PURPLE Code Purple is commonly used in hospitals to indicate a violent or aggressive situation , often involving a medico-legal case (MLC) such as : Assault cases Domestic violence Police custody cases Aggression from patients or attendants It signals the security team and medical staff to respond immediately to prevent harm, protect staff, patients, and preserve legal evidence .

29. Thank You All!!!