Mlc presentation

MEDICO LEGAL CASE

1. LEGAL ASPECTS OF
MEDICAL RECORDS
PREPARED AND PRESENTED BY
R. MAHENDIRAN, M.B.A(H.A) M.com, B.M.R.Sc., PGDCA.
Sr. Manager-Medical Records,
Medical Records Department,
Apollo Hospitals, Bhubaneswar-Odisha, India

2. LEGAL ASPECTS OF MEDICAL
RECORDS
INTRODUCTION
•Medicolegalcases(MLC)areanintegralpartof
medicalpracticethatisfrequentlyencounteredby
MedicalOfficers(MO).TheoccurrenceofMLCsis
ontheincrease,bothintheCivilaswellasinthe
ArmedForces.Properhandlingandaccurate
documentationofthesecasesisofprimeimportance
toavoidlegalcomplicationsandtoensurethatthe
NextofKin(NOK)receivetheentitledbenefits.
•Allmedicalofficersworkinginhospitals/field
medicalunits/nonmedicalunitsencountermedico
legalissueswhichshouldbehandledinaccordance
withthelawofthelandanddirectivesissuedby
serviceheadquarters.

3. LEGAL ASPECTS OF MEDICAL
RECORDS
MLCs in Medical Practice:
•MLC.AMLCisdefinedas“anycaseofinjury
orailmentwhere,theattendingdoctorafter
historytakingandclinicalexamination
considersthatinvestigationsbylaw
enforcementagencies(andalsosuperior
militaryauthorities)arewarrantedto
ascertaincircumstances and fix
responsibilityregardingthesaidinjuryor
ailmentaccordingtothelaw”.
LabelingacaseasMLC.
•RMO/Casualtymedicalofficer/MOin
chargeofMIRoom/DutyMedicalOfficer
(DMO)/MOInchargeward,whois
attendingtothecase,maylabelacaseasa
MLC.

4. WHAT IS MEANT BY MEDICO
LEGAL CASE ?

5. WHAT IS MEANT BY MEDICO
LEGAL CASE?
Medicolegalis something that involves both
medical andlegalaspects, mainly:
Medical jurisprudence, a branch of medicine
Medical law, a branch of law
Medico-LegalCase:canbedefinedasa
caseofinjuryorailment,etc.,inwhichinvestigations
bythelaw-enforcingagenciesareessentialtofixthe
responsibilityregardingthecausationofthesaid
injuryorailment.Insimplelanguageitisamedical
casewithlegalimplicationsfortheattendingdoctor
wheretheattendingdoctor,afterelicitinghistoryand
examiningthepatient,thinksthatsomeinvestigation
bylawenforcementagenciesisessential.Oralegal
caserequiringmedicalexpertisewhenbroughtby

6. What are the incidents will
comes under the MLC?

7. What are the incidents will comes
under the MLC?
Thefollowingaresomeoftheexamplesof
MLCsandmedicalofficersshouldusetheir
professionaljudgmenttodecideanyothercases
notenumeratedinthelist:(a)Assaultandbattery,includingdomestic
violenceandchildabuse
(b)AccidentslikeRoadTrafficAccidents
(RTA),industrialaccidentsetc.
(c)Casesoftraumawithsuspicionoffoulplay
(d)Electricalinjuries
(e) Poisoning, Alcohol Intoxication
(f) Undiagnosed coma
(g) Chemical injuries
(h) Burns and Scalds
(j) Sexual Offences
(k) Criminal abortions
(l) Attempted suicide
(m) Cases of asphyxia as a result of hanging,
strangulation, drowning, suffocation etc.
(n) Custodial deaths
(o) Death in the operation theatre
(p) Unnatural deaths
(q) Death due to Snake Bite or Animal Bite
(r) Fire Arm injuries
(s) Drug overdose
(t) Drug abuse
(u) Dead brought to the Accident and
Emergency Dept / MI Room (Found dead) and
deaths occurring within 24 hours of
hospitalization without establishment of a
diagnosis

8. What are the incidents not
comes under MLC?

9. What are the incidents not
comes under MLC?
BattleCasualties(BC)andBattle
Accidents(BA)arenottobereportedas
MLCs.Themedicalcauseofdeathin
thesecasesmayhoweverbecertifiedby
theRMO.RMOsmustobtainthe
certificationofBC/BAfromtheunit,duly
signedbytheCO,beforementioningthe
sameinthemedicaldocuments.

10. Deathofaserviceperson,inan
accidentinvolvingamilitaryaircraftwillnot
bereportedasaMLCtothecivilpolice.
Theenquiryconductedbythecompetent
militaryauthoritieswillsuffice.AsperGovt
ofIndia,MinistryofHomeAffairsLetter
No.8/179/71-GPA,dated25Nov72,
thereisnoneedforaninquestunder
Section174or176ofCrPCindeathsdue
toanaccident,inwhichtheaircraft
belongstotheNavy,Army,AirForceor
Paramilitaryforcesandthedeceased
personisanactivememberofanyservice

11. POLICE INTIMATION
Thepoliceshouldbeinformed.Under
Section39ofCriminalProcedure.Code,the
attendingMOislegallyboundtoinformthe
policeaboutthearrivalofaMLC.Anyfailureto
reporttheoccurrenceofaMLCmayinvite
prosecutionunderSections176and/or202of
I.P.C.Simultaneously,theinformationshouldbe
giventoADH,StationHeadquarters(HQ),Corps
ofMilitaryPolice(CMP)andtotheunit
concerned (bytelephone).Theverbal
communicationshouldinvariablybefollowedby
communicationinwritingsubsequently.

12. In case of discharge / transfer / death of such a
case in the hospital, the police should be
informed.
Generally 3 copies are available in the
Police Intimation book
•1
st
copy to nearest police station
•2
nd
copy to Incident occurred place -police
station
•3
rd
copy for Medical Records or in the Police
intimation Book itself.
Generally 3 copies are available in the
Accident Injury Book
•1
st
copy to nearest police station
•2
nd
copy to Incident occurred place -Police

13. Guidelines for Preservation of
Medico legal Evidence or Foreign
body handing over procedure:
1.Medicolegalevidenceshouldbepreserved
andsubsequentlysentorhandedovertothe
investigatingauthoritiesforforensicexamination
andproductionasevidenceinacourtoflaw.All
evidenceswillbeidentified,sealedandlabeled
properly.Theywillbekeptinsafecustodyand
handedovertotheinvestigatingofficerofthecase.
Oncecollected,loss/destructionofevidenceisa
punishableoffence.Failuretocollect,destruction
orlossofsuchanexhibitispunishableunderSec
201ofI.P.C.

14. 2. The evidence required to be preserved
is related to the nature of a case. In injury
cases, the following articles should be
preserved in sealed envelopes:
•Clothing worn by the patient showing evidence
of injury such as tears, bullet holes, cuts, blood
stains etc.
•In case of multiple tears, cuts or holes etc., each
piece of evidence will be encircled and
numbered with matching description in the MLC
report and case sheet.
•Bullets recovered from a body should be
marked by etching an initial or a mark on the
bottom before preservation.
•All evidence collected should be mentioned in
medicolegaldocuments to establish the chain of

15. 3. In cases of suspected poisoning the
following articles will be preserved and
ensured that they are forwarded for
forensic examination:
•Gastric lavage/ gastric contents / vomitus
and soiled clothing
•Blood, urine and any other relevant body
fluid depending on the poison ingested.
4. In cases of Burns and Carbon Monoxide
poisoning the following articles should be
preserved in sealed envelopes:
•Articles soiled with inflammable substances
like burnt pieces of clothing, scalp hair etc.

16. 5. In Sexual offences, the following
articles should be preserved in sealed
envelopes:
•Clothing worn by the patient and showing
evidence of blood stains or seminal stains,
stains of mud, tears/cuts etc.
•Vaginal swab preferably from posterior
fornix / anal swab.

17. Guidelines for preservation of
Medico legal documents
1.Medicolegaldocumentsshould
beconsideredasconfidentialrecords
andshouldbestoredundersafe
custodytoavoidtampering.Medical
recordsmustbethorough,complete
andshoulddocumenteachandevery
significanteventinthecourseofcareof
thepatient.Allthedocumentsincluding
casesheets,X-raysandinvestigation
reportswillbepreservedmeticulouslyin
themedicalrecordsectionindefinitely
andhandedovertotheconcerned
authorities(PoliceInvestigatingOfficer/
Court/CourtofInquiry)asandwhen
required.Promptattention,correct
triageandsafetransferofapatientfrom

18. •Original copies of all medico legal documents
will be produced whenever asked for in a court
of law.
•All original copies of certificates and reports
issued for medico legal purposes are to be
preserved till the finalization of case in the court
of law.
•Commandant/CO of the hospital will ensure that
the documents are kept in the custody of an
appropriate officer till the case is finally decided
or cleared by the police and judicial authorities.
In the case of units other than hospitals, the
safe custody will be under unit arrangements.

19. SUBPOENA OR COURTS
SUMMON
•Asubpoena is awritissued by a government
agency, most often a court, to compel
testimony by a witness or production of
evidence under a penalty for failure. There are
two common types of subpoena:
•Subpoena ad testificandumorders a person
to testify before the ordering authority or face
punishment. The subpoena can also request
the testimony to be given by phone or in
person.
•Subpoena duces tecumorders a person or
organization to bring physical evidence before

20. Who MayIssue a
Subpoena?

21. Who MayIssue a
Subpoena?
Inmostinstances,asubpoenacan
beissuedandsignedbyanattorneyon
behalfofacourtinwhichtheattorneyis
authorizedtopracticelaw.Ifthe
subpoenaisforahigh-levelgovernment
official(suchastheGovernororagency
head),thenitmustbesignedbyan
administrativelawjudge.Insome
cases,anonlawyermayissuea

22. How a Subpoena is served?
•A subpoena is typically requested by an
attorney and issued by a court clerk, a
notary public, or a justice of the peace. Once
a subpoena is issued, it may be served on
an individual in any of the following ways:
•Hand-delivered (also known as “personal
delivery” method)
•E-mailed to the last known e-mail address of
the individual (receipt acknowledgement
requested)
•Certified mail to the last known address

23. How to Respond to a Subpoena?

24. How to Respond to a Subpoena?
•Thefirstthingyoushoulddoifyou
receiveasubpoenaisnotignoreit.A
subpoenaispartofacourt’slegal
processandfailuretorespondtoa
subpoenaisconsideredcontemptof
courtinmoststate.
•Thenextstepistoreadthroughthe
subpoenatodeterminewhatisbeing
requestedandorwhoisbeingasked
toappear.Subpoenarequestfor
documentsandotheritemsare

25. •Lastly you should look to see who is
requesting the information and for
what purpose, so you can adequately
prepare for any testimony you are
required to give at a trial or other
proceeding. Finally, you should check
the hearing date and time to avoid
potential penalties and other
consequences.
•A person who receives a subpoena
should otherwise consult with a
attorney, who may assist you if you

26. Penalties
•Becauseasubpoenaiscourt-ordered
command,apersonwhofailstoobeyitis
subjecttocivilorcriminalcontemptofcourt
charges.Civilcontemptoccurswhenyou
knowinglyfailtoproducepapersor
documentsrequestedorotherwisefailto
obeythetermsofasubpoenaand,thereby,
hinderthejudicialprocess.Criminal
contempt,whichisusually,intendeda
punishment,generallyreferstodisruptive
conductdisrespectfulbehavioratcourt.
Criminalcontemptcanalsoincluderefusalto
turnoverdocumentsorotherdata.
•Penaltiesforcontemptofcourtofteninclude

27. Conclusion
TheinformationfoundintheMedical
Recordismoreimportantandevidencein
thecourttoprovethecasesasmentioned
above.Theprofessionalswhocome
acrossthepatientcare&treatment
includingtheHospitalAdministrator
shouldbeveryalertinallaspects
regardingtheLawanditslatest
amendmentsissuedfromtimetotime.So
thattheycanrecordallthenecessary
informationintheMedicalRecord.Also
theMRDpersonalsshouldmakeitapoint

28. R. MAHENDIRAN, M.B.A(H.A) M.com, B.M.R.Sc., PGDCA.
Apollo Hospitals, Bhubaneswar .