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
o It can be received in four situations by the doctor/hospital:
1. A case brought by the police for examination and reporting or order of
the court for medico-legal examination.
2. 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.
3. 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

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

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

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

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

12. FORMALITIES IN MLC:
o Entry like Name / Age / Sex / Date / Time / I.P. No. /Hosp. No. / Type of M.
L. C. is done in the main Emergency Register.
o All M. L. C‘s are registered / admitted.
o Case is examined and case sheet written by the duty Casualty Medical
Officer.
o Accident Register (A. R.) two copies and Police Intimation (P.I) three copies
are written.
o 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.

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

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

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

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

19. Medico-legal purposes :
o Any MR may become evidence in accordance with Indian evidence Act.
o Insurance and other claims settlements.
o Medical certificates such as fitness for employment sickness certificate etc.
o 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.

20. Filling of Records / Preservation of Medical
Records :
o There are two common methods of numbering and filling records.
o 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.
o 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.

21. How long to preserve the case papers :
o Limitation period for filing a case is maximum up to 3 years under the
Limitation Act (2 years according to Consumer Protection Act). This
limitation period starts only after the patient comes to know the effect of
the alleged negligence on part of the doctor.
o 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.

22. Dying Declaration :
o Dying declaration is provided by section 32 , sub- section 1 , of the Indian
Evidence Act .
o 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 .
o 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.

24. PATIENTS RIGHTS
PRESENTED BY SUMBUL REZA

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

26. DIFFERENT RIGHTS OF PATIENTS ARE:
1. Right to appropriate medical care and human treatment
2. Right to informed consent
3. Right to privacy and confidentiality
4. Right to information
5. Right to choose healthcare provider and facility
6. Right to self determination
7. Right to medical records
8. Right to religious beliefs
9. Right to leave
10. Right to refuse participation in medical research
11. Right to correspondence and to receive visitors
12. Right to express grievances
13. Right to be informed of his rights and obligation as a patients.

27. Discussing patients rights in details:
1. 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
2. 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.
3. 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.
4. 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.
5. Right to choose healthcare provider and facility: patients is free to
choose healthcare provider to serve him as well as the facilities.

28. 6. Right to self determination: Patients has the right to avail
himself/herself of any recommended diagnostic and treatment
procedures
7. Right to religious beliefs: The patient has the right to refuse
medical treatment or procedures which may be against to his
religious beliefs.
8. Right to medical records: The patients has entitled to a summary
of his medical history and conditions.
9. Right to leave: The patients has the right to leave hospitals or any
healthcare institution regardless of his/her physical condition.
10. 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.

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

30. CONSENT
o 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.
o 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

31. CONT..
o . 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.

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

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

34. CHILDREN AND INFORMED CONSENT
o 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."

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

36. CONSENT IN CASE OF MEDICOLEGAL CASES
o 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.

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

39. Examples of MLC related to consent
o 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.

40. Cont…
o 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.
o 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.

41. Medical Certification of Cause of Death
o 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.

42. REGISTRATION OF DEATH
o 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.

43. CONT..
o The situation may not be so simple in medico-legal cases.
o 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.
o 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.

44. DEATH CERTIFICATE IN MEDICOLEGAL CASES
o 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.

45. CONT..
o 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.
o 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.

47. POINTS TO BE KEPT IN MIND BY THE MEDICAL
OFFICER CONCERNING THE ISSUANCE OF
MEDICAL CERTIFICATE OF CAUSE OF DEATH:
o He should not delay, for any reason, issuing the medical certificate of
cause of death, once he is sure of the cause of death.
o He can not charge any fees for issuing this certificate.
o He should not withhold issuance of medical certificate of cause of death
even if his dues have not been cleared by the relatives.
o 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.