LegalMD Newsletter: Oct, 2018

17 October, 2018

Medico-Legal Newsletter                                                                           Oct, 2018, New Delhi 
Talk Session Updates
In the month of September, talks sessions were organised at Peoples Tree Hospitals, Apollo Hospital, BGS Global Hospital and Aster CMI Hospital in Bangalore. 

Dr Arun Mishra also had interactive sessions with hundreds of  medical students at Sapthagiri Institute of Medical Sciences & Research Centre and RV Dental College & Hospital, Bangalore wherein the students were made aware of the litigation practicing doctors are exposed to and steps that will help in avoiding them.
LEGAL ASPECTS PERTAINING TO MLC
“The responsibility to label any case as an MLC rests solely with the attending medical practitioner”
 
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 "medico legal case" (MLC)
WHAT IS A MEDICO-LEGAL CASE (MLC)

A medico-legal case 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.
In simple words, it is a medical case with legal implications or a legal case requiring medical expertise. Accordingly, a medico-legal report is prepared for the purpose of litigation.
RECEIVING AN MLC

A doctor can receive a medico-legal case in any of the four situations:
  1. A case is brought by the Police for examination and reporting, or order of the Court for medical examination
  2. The person in question was already attended to by a doctor and a medico-legal case was registered in the previous hospital, and the person is now referred for expert management/advice
  3. When patient himself expressing his intention to register a case against the alleged accused
  4. After eliciting history and examining the patient, the attending doctor feels 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
REGISTERING MLC IS A MUST
 
Attending Casualty Medical Officer (CMO) has the authority to decide whether the case is to be registered as medico-legal or not. Even if the incident has happened several days ago, if the complaints merit an MLC, then MLC should be registered. A case should be registered medico-legal even if the patient requires an OPD treatment.

Failure to preserve the necessary samples for subsequent examination in Forensic Science Laboratory or releasing the dead body of a patient in a criminal case without inquest and Post- Mortem (PM) may render a doctor liable to be charged under section 201, Indian Penal Code, punishable with imprisonment up to 7 years and fine, for causing disappearance of evidence.
WHICH CASES QUALIFY AS MEDICO-LEGAL CASES?
 
  1. Cases of accidental deaths, injuries, poisoning or unnatural events under suspicious circumstances must be reported to the police whenever such cases are brought to the notice of Casualty, OPD or dispensaries for treatment
  2. Police should be immediately informed after patient is declared “Dead on Arrival” in casualty or dispensary, so that, an inquest can be arranged
  3. A patient may suddenly die after admission to the Hospital. It is the duty of the Medical officer to inform such a case of death to the Police, immediately. The intimation to be given to the Police should be to the effect that the patient died suddenly and the cause of death is not known. The date and time of the intimation must also invariably be recorded on the case papers
  4. The death of a patient within 24 hours of admission should be reported to the Police, so that, they can arrange for an inquest and a post-mortem examination, if necessary
  5. There may be certain occasions when cause of death of a patient attending the hospital, is not clearly mentioned in the report and there may also be suspicious circumstance. It is to be informed to the Police so that, they can arrange for the necessary inquest and give instructions for post-mortem examination
  6. Deaths in the Operation theatre during Medical Termination of Pregnancy, delivery, following sterilization or any other surgical procedure should also be reported to Police
  7. The Police should be informed about drug or alcohol related death (including deaths of drug addicts)
  8. Whenever a medico-legal case is admitted in the ward, the concerned consultant on call and the head of the unit should be informed, about such admission
  9. All burns cases should be registered as medico-legal. The Medical Officers should record on the case paper, the statement of the woman (if she is married) about the circumstances under which she had sustained burns. The Police should be informed to arrange for a dying declaration in severe cases
  10. If a patient is found absconding from the wards, MLC should be registered immediately
  11. MLC should be registered when a patient has a fall or trauma during the hospital admission and treatment. In case of medico-legal cases, if any related x-ray films or images are given to the patient, a written acknowledgement should be taken for the same
TIME LIMIT FOR REGISTERING A MLC
  1. A medico-legal case should be registered as soon as a doctor suspects foul play or feels it necessary to inform the police at arrival
  2. At any time after admission
  3. There should not be any unnecessary delay in doing so
  4. A case may be registered as an MLC even if it is bought several days after the incident if suspected
REPORTING OF MLC
  1. Reports must be prepared in duplicate on proper proforma giving all necessary details
  2. Avoid abbreviations, over writings. Correction if any, should be initiated with date and time
  3. Reports must be submitted to the authorities promptly
  4. Medico-legal documents should be stored under safe custody for 10 years
  5. Age, sex, father’s name, complete address, date and time of reporting, time of incident, brought by whom. Identification mark and finger’s impressions
  6. All MLC to be informed to the police for taking legal evidence
  7. If the patient is dying, inform the magistrate to record ‘dying declaration’
SALIENT FEATURES OF MEDICOLEGAL CASE
 
Consent for examination
 
1.  Patient arrested by the police:
  1. If the patient has been arrested and brought by the police, no consent need be taken. The doctor can proceed with examination u/s 53 Cr.P.C
  2. The doctor must still first try to take consent upholding the principle of human rights. If the consent is not given, examination must then be proceeded u/s 53 Cr.P.C
  3. Essential components of examination u/s 53 Cr.P.C:
  • Person should be arrested
  • Request should be from a police officer not below the rank of sub-inspector or any person acting in good faith in his aid and under his direction
  • If person resists, reasonable force can be used to restrain him
  • If the arrested person is a female, her examination can be performed only by or under the supervision of a female doctor (Section 53(2) Cr.P.C)
  • What must be examined - "examination" shall include the examination of blood, blood stains, semen, swabs in case of sexual offences, sputum and sweat, hair samples, and fingernail clippings by the use of modern and scientific techniques including DNA profiling and such other tests which the registered medical practitioner thinks necessary in a particular case (sec 53(2)[a] Cr.P.C)
2. If the patient reported directly to the doctor, and the doctor suspecting some foul play informed the police, he would still need patient's consent for examination until and unless the police official has arrested him. For labelling a case as medico-legal, the doctor does not need patient's consent (even if he is a victim, and does not want a police case), but for examination he would still need his consent, if the police official has not arrested him.
 
Confidentiality
A doctor is required to keep secret all information regarding the patient he provides treatment to. Medico-legal reports are no exception and are to be treated as strictly confidential. They should not be issued directly to the patient. They have to be handed over to the Police Official, after getting them duly received on the carbon copy of the same. Copy of the MLR can be handed over to the patient/his relatives, as per the prevailing rules of the doctor’s hospital, and after the requisite fee has been paid by the patient
 
Collection and preservation of samples
All relevant specimens should be collected and after proper labelling, are to be sealed under the doctor’s supervision. These should be handed over to the Police Official concerned, along with the medico-legal report and a proper requisition letter detailing the tests to be conducted on such samples. If the samples have been collected on the request of the Police, the fact is to be mentioned in the report and no requisition is necessary.
 
CONSENT IN MEDICO LEGAL CASES
  1. Consent for Medico-legal examination to be taken in Written in all cases
  2. Person below 12 yrs/unsound mind: the consent of guardian is to be taken
WHEN CONSENT IS NOT REQUIRED
  1. Medical Emergencies, Notifiable disease, Immigrants
  2. Exception: cases brought by Police being arrested on charge of committing offence
  3. New Admission to prisons
  4. Court orders for examination and treatment
  5. Under sec. 53(1) of Cr.P.C., a person can be examined on request of the Police by use of force
  6. Members of armed forces on request of competent authority in writing
  7. Consent is not required from relative for conducting post-mortems
DOCUMENTATION OF A MLC
  1. Documentation is done in duplicate in a set Performa (as per the Hospital policy) preferably with a ball-point-pen, in a clear and legible handwriting and in complete words without using shortcuts
  2. Cutting/overwriting etc should be avoided as much as possible and all corrections should be properly initialled. Abbreviations of any sort should be avoided
  3. Separate performa may be available for medical examination, examination of drunkenness etc
  4. All columns are filled up carefully and by the same doctor who had examined the patient
  5. Each MLC is given a fresh MLC number sequentially
  6. The details are completed then and there, leaving no provisions as to be completed later on
  7. Investigations advised and finding to be entered
  8. Treatment given at the site or on reporting
  9. The opinion to be recorded in MLC sheet, if opinion cannot be given, under observation be given and signed by the doctor with name written in block letters
  10. Final opinion be given by same doctor making MLC in the original MLC sheet, after all investigations are completed
  11. After completion the doctor must sign and mention his/her name in full below it with designation
  12. Police constable on duty should be informed in each case
  13. After registration of a case as MLC thereafter all documents and registration forms bear the same MLC number including the discharge slip
  14. The patient is admitted or discharged with advice be entered into the case sheet
  15. The doctor examining the patient must complete the MLC sheet before leaving the hospital
  16. All MLC X-rays be kept in department as evidence for Court of law
  17. Special samples taken to be entered into the MLC sheet
  18. If the patient is dead or died, handed over to Police for post mortem and not to relatives
  19. A copy of MLC Sheet be handed over to Police for further investigation against his signature and belt number on the copy
WHAT DOES THE LAW SAY
 
The law states that concerns like legal formalities, monetary considerations or even the infrastructural restraints of the institution should not prohibit the institution or hospital from providing basic and emergency medical treatment. Here are a few things you should know:
  1. A hospital cannot deny emergency medical care to an accident victim under Article 21
  2. It cannot deny treatment on the pretext of lack of facilities. They have to provide emergency care and then transfer the patient safely (via their ambulance) to the nearest facility. This includes government and private hospitals; it also includes private clinics and nursing homes
  3. They cannot deny a patient emergent treatment on the basis that he/she is unable to pay the required fees or that there is no close relative to sign for consent (consent is overridden in an emergency)
  4. In the case of a rape or criminal abortion the lady cannot be examined by a doctor without written consent from the victim
  5. In both cases the doctor is bound by law to keep the patients information including her name confidential
  6. In cases where a woman is being examined another woman must be present during the examination. In the case of males a male has to be present at all times
  7. In the case of suicide causing death the doctor is obligated to report the matter to the police for further investigation
  8. If the patient is alive and suicide is suspected the doctor is not obligated to report the matter to the police
All the information, facts, figures and other data used is collected from different Internet sources.
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