Medico-legal cases

detail knowledge of medico-legal cases, introduction,types, reports, consent,death certificate, patient right. it will help you to understand the concept of medico-legal cases

1. MEDICO-LEGAL CASES IN HOSPITAL PRESENTED BY: DR. ANJALI PRATAP SUMBUL REZA AKANKSHA THAKUR TANVI KAUSHAL

2. DEFINITION Medico legal cases can be defined as a case of injury or ailment, etc. in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment. In simple language it is a medical case with legal implications for the attending doctor where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential.

3. DOCTOR AND MLC Every doctor under law bound by a contract to serve its patient and cannot refuse treatment. Every doctor has to fulfill certain legal requirements in service by compulsion or voluntarily as defined under law. Medico-legal case (MLC) examination and reporting is one of the legal responsibility of all doctors working in hospital.

4. RECEIVING A MLC It can be received in four situations by the doctor/hospital: A case brought by the police for examination and reporting or order of the court for medico-legal examination. The person in question was already attended by doctor and MLC was already registered in a previous hospital and the person is now referred for the expert management/advice. By the doctor himself after eliciting history and examining the patient, if he feels so that the case in accordance with the law of the land.

5. 4. When the patient himself expresses his intention to register a case against the alleged accused.

6. DOCTORS WORKING IN A HOSPITAL REPORT HOMICIDAL POISONING TO THE POLICE(U/S 39 CRPC) FAILURE TO DO SO IS PUNISHABLE U/S 176 IPC

7. TYPES OF MLC All road traffic accident All rail traffic accident Burns Scalds Hanging Electrocutions Poisoning Drowning Bomb blasts and explosions vitriolage

8. All air and sea accidents Any other cases having legal implications Assault- known, unknown Legal investigations Natural disasters- earthquake, flood, Molestations- rape, kidnapping, husband wife beating, child abuse Inhalation of gas vapors Fall from height Brought dead

9. Industrial accidents Bull gore/animal bite/snake bite Bullet injury Hijacking Hostage taking Anything related to smuggling

10. MEDICOLEGAL RECORDS PRESENTED BY - AKANSHA THAKUR MHA SEM 3

11. FORMALITIES IN MLC : Entry like Name / Age / Sex / Date / Time / I.P. No. /Hosp. No. / Type of M. L. C. is done in the main Emergency Register. All M. L. C‘s are registered / admitted. Case is examined and case sheet written by the duty Casualty Medical Officer. Accident Register (A. R.) two copies and Police Intimation (P.I) three copies are written. The original P. I. from should be dispatched to the assigned Police Station as quick as possible (not later than 24 hours) and the signature of the receiving Police Officer should be obtained.

12. In most of the Government hospitals, police stations are inside the hospital premises. In private hospitals - dispatch the accident register and police intimation to nearby police station.

13. Writing a Medico Legal Case : 1. Road Traffic Accident - Write the following details in the case file : Mode of Accident Time of Accident Place of Accident Brought by Name is a must Brought in time Condition of the patient after accident Condition of the patient at the time of admission Injuries 3 I.D. Marks Preferable (2 I.D. Marks must)

14. 2. Rape - Write as Alleged by rape by known / unknown /single person / group Patient should be examined by the Gynecologist. 3. Kidnapping - Write as Alleged to have kidnapped by known / unknown / single person / group. 4.Wife / Husband Beating - Medico Legal is registered, provided one of them insists on it. Write as Alleged to have beaten up by husband /wife

15. Medical Record Definition and function 1. The medical record is a document which contains statements by trained observers of conditions found and results of treatment. 2.Hospital records shall contain data to permit a basis for a complete audit of professional service given and for gathering statistical information. 3.Proper recording methods and procedures shall be maintained to assure compilation of data for proper administration of services.

16. Medico-legal purposes : Any MR may become evidence in accordance with Indian evidence Act. Insurance and other claims settlements. Medical certificates such as fitness for employment sickness certificate etc. Workmen‘s compensation Act : The clinical data recorded by medical practitioner to indicate the extent of injury and the degree of disability of the individual is taken as documentary evidence to settle the claims for payment by certain classes of employees to give their workmen, some compensation for by certain arising out of and in the course of his employment under the Workmen‘sCompensation Act.

17. Filling of Records / Preservation of Medical Records : There are two common methods of numbering and filling records. One is the assignment of a new register number to each patient at time of admission. This is known as serial numbering and chart may be filed either separately under numbers as assigned to together under the most recent number. The second methods, called ―unit numbering, is the assignment of one number to a patient on first admission, using that same number of subsequent admissions.

18. How long to preserve the case papers : Limitation period for filing a case is maximum up to 3 years under the Limitation Act (2 years according to Consumer Protection Act). T his limitation period starts only after the patient comes to know the effect of the alleged negligence on part of the doctor. Maharashtra government has issued a resolution (G.R. No. JJH-29 66/49733) which states that OPD paper should be kept for 3 years, indoor for 5 years, and papers of Medico Legal Cases for 30 years.

19. Dying Declaration : Dying declaration is provided by section 32 , sub- section 1 , of the Indian Evidence Act . According to this section , dying declaration is the declaration of a dying person as to the cause of his death or as to any of the circumstances of the transaction which resulted in his death when the cause of his death is in question . If the declarant survives after making the dying declaration, the statement is inadmissible as dying declaration but the statement can be used under section 158 of the Indian evidence Act , in order to contradict or confirm the credit of the person by whom it was made .

20. PATIENTS RIGHTS PRESENTED BY SUMBUL REZA

21. PATIENTS RIGHTS IN LEGAL ASPECTS Patients rights in healthcare are those rights a person owes when he/she is in hospital. If any of patients rights are violated in hospital, patients can go for legal actions against the hospital or healthcare professionals Patients rights are legal interests of persons

22. DIFFERENT RIGHTS OF PATIENTS ARE: Right to appropriate medical care and human treatment Right to informed consent Right to privacy and confidentiality Right to information Right to choose healthcare provider and facility Right to self determination Right to medical records Right to religious beliefs Right to leave Right to refuse participation in medical research Right to correspondence and to receive visitors Right to express grievances Right to be informed of his rights and obligation as a patients.

23. Discussing patients rights in details : Right to appropriate medical care and human treatment: Every person has a right to health and medical care corresponding to his state of health, without any discrimination. Ex: triage in emergency Right to informed consent: The patients has the right to a clear, truthful, and sustainable explanation, in a manner of language understandable to the patients, of all proposed procedure whether diagnostic, preventive curative, rehabilitative or threaupeutic . There are some exception in this right. Right to privacy and confidentiality: The patients has the right to demand that all information, communication and records pertaining to his care be treated as confidential. Some exception are their. Right to information: In the course of his/her treatment and hospital care, the patients or his/her legal gurdian has a right of evaluation of his/her disease, any other additional medical treatment and procedure. Right to choose healthcare provider and facility: patients is free to choose healthcare provider to serve him as well as the facilities.

24. Right to self determination: Patients has the right to avail himself/herself of any recommended diagnostic and treatment procedures Right to religious beliefs: The patient has the right to refuse medical treatment or procedures which may be against to his religious beliefs. Right to medical records: The patients has entitled to a summary of his medical history and conditions. Right to leave: The patients has the right to leave hospitals or any healthcare institution regardless of his/her physical condition. Right to be informed of his/her rights and obligation as patients: every person has the right to be informed about his rights and obligation as a patient.

25. Consent and medico-legal cases PRESENTED BY: TANVI KAUSHAL

26. CONSENT Consent is-permission granted in full knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits. Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention

27. CONT.. . The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention.  Informed consent is both an ethical and legal obligation of medical practitioners and originates from the patient's right to direct what happens to their body.

28. ELEMENTS OF INFORMED CONSENT The following are the required elements for informed consent discussion: (1) describing the proposed intervention, (2) emphasizing the patient's role in decision-making, (3) discussing alternatives to the proposed intervention, (4) discussing the risks of the proposed intervention and (5) eliciting the patient's preference (usually by signature).

29. EXCEPTIONS TO INFORMED CONSENT Several exceptions to the requirement for informed consent include (1) the patient is incapacitated, (2) life-threatening emergencies with inadequate time to obtain consent, and If the patient's ability to make decisions is questioned or unclear, an evaluation by a psychiatrist to determine competency may be requested. 

30. CHILDREN AND INFORMED CONSENT Children (typically under 18) cannot provide informed consent.  As such, parents must permit treatments or interventions. In this case, it not termed "informed consent" but "informed permission." 

31. Clinical Significance Informed consent is required for many aspects of health care. These include consent for: Treatment,  dissemination of patient information,  specific procedures,  surgery,  blood transfusions, and  anesthesia.  

32. CONSENT IN CASE OF MEDICOLEGAL CASES In emergencies, resuscitation and stabilization of the patient will be carried out first and medico-legal formalities may be completed subsequently. The consent for treatment is implied in all emergencies.

33. THE LEGAL BASIS OF CONSENT Consent is perhaps the only principle that runs through all aspects of health care provisions today. It also represents the legal and ethical expression of the basic right to have one's autonomy and self-determination. If a medical practitioner attempts to treat a person without valid consent, then he will be liable under both tort and criminal law . Tort is a civil wrong for which the aggrieved party may seek compensation from the wrong doer. The consequences would be payment of compensation (in civil) and imprisonment (in criminal). 

34. Examples of MLC related to consent In one case, a 44-year-old unmarried female consulted her doctor and was advised to undergo a laparoscopy. A few consent forms were taken from her of which one was for admission and another one was for the surgery. The relevant one among such consent forms gave the doctor an allowance to carry out a “diagnostic and operative laparoscopy” and there was an additional endorsement that a “ laparotomy may be needed”. When the patient was in the operation theater (and was unconscious), another proxy consent was taken from her attending mother for a hysterectomy. Her uterus, ovaries, and fallopian tubes were removed. Subsequently, when an action was brought, it was held that the operation was conducted without real consent and the doctors were held liable.

35. Cont… A patient was operated on for sterilization. While giving consent he deposed that he is married and has two baby girls. In fact, he was undergoing an operation only for getting the money as incentive. After the operation, his father contended that the patient was of unstable mind and was not competent to give consent. The court held that if there are no circumstances for a doctor to sense foul play or doubt about the capacity of the patient, he is protected. The case demonstrates that a doctor acting reasonably under normal circumstances is always protected and he is never expected to play the role of an investigative agency.

36. Medical Certification of Cause of Death Medical Certificate of Cause of Death, commonly called Death Certificate, is the most frequently issued certificate, at least by a government employed medical officer, if not by a private practitioner. It is common knowledge that many medical officers, even some of those with incomparable medical knowledge and expertise, do not fill up this document of immense medical and legal importance correctly. The reasons may be many, ranging from ignorance to indifference.

37. REGISTRATION OF DEATH For registering a death, identity of the deceased, date and time of death and cause of death are to be provided to the registering authorities. If any of these details are not available death can not be registered. Providing these details is not a difficult task for a medical officer when the death is of one of his patients suffering from a known disease, who dies attended by the doctor.

38. CONT.. The situation may not be so simple in medico-legal cases. Most of these deaths are unattended, hence, exact time and date is not known and since terminal symptomatology is not available, cause of death can not be decided. Many times the identity of the deceased is also not known. Hence, a medico-legal postmortem is carried out, as a part of the inquest, to establish the cause of death, time of death and identity of the deceased.

39. DEATH CERTIFICATE IN MEDICOLEGAL CASES If the death is not clearly of natural category i.e.other than natural or cause not known/doubtful, the medical officer having carried out first task i.e. declaration of death, informs the police of occurrence of the death for further course of action. He will not issue a medical certificate of cause of death. Since the bottom portion of the medical certificate of cause of death is required to be produced by the relatives at the cremation ground/the municipality office giving permission for cremation, non-issuance of the same will automatically ensure that the body can not be cremated.

40. CONT.. The medical certificate of cause of death is filled up either by the medical officer who carries out the medico legal autopsy or by the hospital administrative authorities immediately on conclusion of the autopsy. Since the medico legal postmortem is carried out on orders of the investigating police officer/coroner/magistrate, the medical certificate of cause of death is forwarded to these authorities only, by the certifier, and not directly handed over to the relatives of the deceased.

41. POINTS TO BE KEPT IN MIND BY THE MEDICAL OFFICER CONCERNING THE ISSUANCE OF MEDICAL CERTIFICATE OF CAUSE OF DEATH: He should not delay, for any reason, issuing the medical certificate of cause of death, once he is sure of the cause of death. He can not charge any fees for issuing this certificate. He should not withhold issuance of medical certificate of cause of death even if his dues have not been cleared by the relatives. No medical officer should sign medical certificate of cause of death in advance (i.e. before the individual has died) or without viewing and examining the dead body personally.