|Year : 2016 | Volume
| Issue : 3 | Page : 133-134
Medicolegal cases: What every doctor should know
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||28-Sep-2016|
Department of Forensic Medicine, Regional Institute of Medical Sciences, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Meera T. Medicolegal cases: What every doctor should know. J Med Soc 2016;30:133-4
Medicine is a noble profession and doctors have the highest responsibilities over the life of a patient. However, this profession requires advanced education and training which calls for continuous updating. At the same time, a doctor has ethical and legal obligations, and he needs to abide by the laws of the land while discharging his duties. In medical practice, most of the doctors would come across which at the time or subsequently, would be called a "medicolegal case" (MLC). An MLC is a case of injury/illness where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land.  It can also 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.  Cases that are to be treated as medicolegal are:  (1) All cases of injuries and burns - the circumstances of which suggest commission of an offense by somebody (irrespective of suspicion of foul play); (2) all vehicular, factory, or other unnatural accident cases specially when there is a likelihood of patient's death or grievous hurt; (3) cases of suspected or evident sexual assault; (4) cases of suspected or evident criminal abortion; (5) cases of unconsciousness where its cause is not natural or not clear; (6) all cases of suspected or evident poisoning or intoxication; (7) cases referred from court or otherwise for age estimation; (8) cases brought dead with improper history creating suspicion of an offense; (9) cases of suspected self-infliction of injuries or attempted suicide; (10) any other case not falling under the above categories but has legal implications. Sadly, doctors are usually apprehensive in dealing with these "MLCs." The usual impression is that MLC implies a lot of disputes, unwanted burden, rough speaking police officials, inordinate hours in the court, unrelenting defense counsels, etc. Because of this fear-factor, they either try to avoid the cases or try to get rid of them as soon as possible. ,
What every doctor should remember is that their service and knowledge may be required for the administration of law and justice. Hence, their assistance may be sought by police and law in various circumstances and situations. A doctor may be summoned in the court of law, and he is bound to answer all questions posed to him. He has to take care of medicolegal aspects while discharging his duties as a caregiver or a lifesaver. Nevertheless, while attending to an emergency, the doctor should understand that his first priority is to save the life of the patient. He should do everything possible to resuscitate the patient and ensure that he is out of danger. The doctor should record a proper history and analyze the injuries so as to find out whether it should be classified as a medicolegal case or not. If it is an MLC, he should inform the nearest police station. A "medicolegal register" should be maintained in the emergency department of every hospital and details of all MLCs should be entered in this register. This should include the time, date, and place of examination and the name of the examining doctor. A case may be registered as an MLC even if it is brought several days after the incident. Police should be informed upon the discharge or death of such a case in the hospital. No female patient should be examined unless a female attendant is present and consultation with colleagues is always encouraged. Similarly, in the suspected poisoning cases, doctors must assist in finding out the manner of poisoning. Any suspected materials, articles of food, excreta, gastric lavage samples, etc., should be preserved and handed over to the investigating agencies.
On the other hand, there is a rise in the cases of violence against women and children in the last few years. Doctors and all health professionals play a dual role in providing medical treatment and psychological support, as well as in assisting survivors in the medicolegal proceedings by collecting evidence and documentation of the findings. The Ministry of Health and Family Welfare, Government of India, has issued "guidelines and protocols for medicolegal care for survivors/victims of sexual violence."  The following steps are followed for the examination of such cases which include: (1) Initial resuscitation/first aid; (2) informed consent for examination; (3) detailed history; (4) medical examination; (5) age estimation (physical/dental/radiological) - if requested by the investigating agency; (6) evidence collection; (7) documentation; (8) packing, sealing, and handing over the collected evidence to police; (9) treatment of injuries; (10) testing/prophylaxis for sexually transmitted infections, human immunodeficiency virus, hepatitis B, and pregnancy; (11) psychological support and counseling, and referral for further help (shelter, legal support). Apart from this, doctors must be also aware of the Model Guidelines under Section 39 of "The Protection of Children from Sexual Offences (POCSO) Act, 2012".  According to this, when a doctor has reason to suspect that a child has been or is being sexually abused, he/she is required to report this to the appropriate authorities (i.e., the police or the relevant person within his/her organization who will then have to report it to the police). Failure to do this would result in imprisonment of up to 6 months, with or without fine. A detailed guideline regarding the medical examination of such victims is given in the provisions of the Act.
Further, after examination of a medicolegal case, a medicolegal report should be issued. The reports must be handed over to the police officials after getting them duly received on the duplicate copy of the same. The records should be kept under lock and key, in the custody of the doctor concerned or may be kept in the record room of hospitals, where such facility is available. There is no specified time limit after which the medicolegal reports can be destroyed; hence, they have to be preserved. In view of the multitude of cases against the doctors under the Consumer Protection Act, it is advisable to preserve all the inpatient records for a period of at least 5 years and outpatient department records for 3 years. 
To conclude, doctor should be well acquainted about the existing guidelines when dealing with medicolegal cases. In an MLC, he should carefully examine and treat the patient, record date, time, place, brought by whom and examination finding, and he should also record dying declaration if the person is on the verge of death. What a doctor should remember is that he should not issue death certificates in deaths under suspicious circumstances and recommend postmortem examination for the cause and nature of death, and police should be informed. Reorientation courses and Continuing Medical Education programs of medical practitioners are recommended for getting acquainted with the management of medicolegal cases.
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