medico-legal and toxicology module phase ii · the medico-legal and toxicology module is conducted...
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MEDICO-LEGALANDTOXICOLOGY
MODULE
PHASEII
StudentHandBook2017
Faculty of Medicine University of Kelaniya
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CONTENTS
Page
1. MessagefromtheModuleCommittee 22. AimandObjectives 3,4
3. Intendedlearningoutcomes 54. Learningresources 65. Coursecontents 76. AssessmentofMedico-LegalModule 117. Self-assessment 138. Suggestedreadingmaterials 13
“Thosewhohavedissectedorinspectedmanybodieshaveatleastlearnedtodoubt,whilethosewhoareignorantofanatomyanddonottakethetroubletoattendtoit,areinnodoubtatall”GiovanniMorgagniFatherofMorbidAnatomy
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MESSAGEFROMTHEMODULECOMMITTEEDearMedicalStudent,TheMedico-legalandToxicologymoduleisconductedduring4thyearoftheMBBSmedicalcourse.Itwillbetheonlyopportunityforyoutolearnaboutthemedico-legalresponsibilitiesofdoctors,ifyoudonotgoontospecializeinForensicMedicine.ThismoduleisdesignedforyoutogaintherequiredbasicknowledgeandskillsinForensicMedicinetofunctionasamedicolegalexpert.Furtheritincludesprogressindicatorswhichwillenableyoutoassessyourselfduringandattheendofthemodule.Itisadvisableforyoutofollowtheinstructionscarefullyandachieveyourlearningoutcomesattheendofthemodule.Ifyouencounteranydifficulties,youarewelcometoseekhelpfromthemembersoftheacademicstaffattachedtothedepartmentofForensicMedicine.BestWishes,Dr.P.ParanitharanChairperson,Medico-LegalandToxicologyModule
Medico-LegalModuleCommittee
• Dr.P.Paranitharan-DepartmentofForensicMedicine• (Chairperson)
• Dr.IndiraKitulwatte-DepartmentofForensicMedicine• (Co-Chairperson)
• Dr.NirmalaPerera-DepartmentofForensicMedicine
• Prof.PAS.Edirisinghe-DepartmentofForensicMedicine
• Prof.KithsiriGunawardane-DepartmentofParasitology
• Dr.ShalukaJayamanna-DepartmentofMedicine
• Dr.N.V.Luke-DepartmentofPharmacology
• Dr.AsiriRodrigo-DepartmentofPsychiatry
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ExtendedFaculty
• ProfessorRavindra Fernando - Senior Professorof ForensicMedicine&Toxicology, Faculty of
Medicine,Colombo
• Dr.L.B.L. deAlwis – Chief JudicialMedicalOfficer (retired), Instituteof ForensicMedicine andToxicology,Colombo
• Mr.PalithaFernando–AttorneyGeneralofSriLanka(retired)
• Dr.P.R.Ruwanpura–ConsultantJMO,TeachingHospital,Karapitiya
• Dr.HandunWijewardena-ConsultantJMO,ColomboNorthteachingHospital
• Dr. Angelo de Alwis – Consultant Psychiatrist, Forensic Psychiatry Unit, National Institute ofMentalHealthSriLanka
• Dr.JayaniWeeraratne–ForensicOdontologist,InstituteofLegalMedicine&Toxicology,Colombo
AIMToenablestudents togatheradequateknowledgeandskills toattendtotheirMedico-Legaldutiesefficientlywhentheypracticeasdoctors.
OBJECTIVESOFTHEMEDICO-LEGALANDTOXICOLOGYMODULE
Attheendofthemodule,youshouldbeableto;(1) Describedifferentmedico-legaldutiesrequiredofadoctorworkinginthefollowingroles:-
o MedicalOfficerintheout-patientdepartmentofahospital.o HouseOfficerinchargeofawardinahospital.o SpecialistinanyfieldorDirectorofahospital.o DistrictMedicalOfficerorMedicalOfficer(Medico-legal)o GeneralPractitionero Doctorworkinginanyothercapacity.
(2) Outline the medico-legal frame work and the relevant sections of the Penal Code, Criminal
ProcedureCodeandTransplantationofHumanTissueActofSriLanka.
(3) Identify, record, formanopinion and report ondifferent types of injuries anddescribe theirmedico-legalsignificance.
(4) Describethedifferentinjurypatternsandcircumstancesunderwhichtheyoccur.
(5) Explaintheconceptofdeath,makethediagnosisofdeath,issueoftheCertificateofCauseof
Deathanddescribetheprocedureinvolvedindisposalofdeathandexhumation.
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(6) Describethechanges,whichtakeplaceinabodyafterdeathandtheirmedico-legalsignificance.
(7) Performpostmortemexaminations,recordobservations,formulatecausesofdeath,carryout
furtherinvestigationsanddrawconclusions.(8) Examine victims and suspects in cases of assault, accidents, sexual offences, abortion, child
abuse,wifebattery/genderbasedviolence,elderabuse,torture,drug&alcoholabuseandanysuchpersonthattheCourtdirects.
(9) Fillrelevantmedico-legalreportsandgiveoralevidenceinthecourtoflawasanexpertwitness.(10) Explainthemethodsinestablishingtheidentityofthedeceasedortheliving.(11) Visitandexamineasceneofcrimewithateam,collectevidenceandformulateconclusions.(12) Describe the medico-legal investigations of sudden, unexplained, unexpected, obscure and
suspiciousdeaths.(13) Describethemedico-legalinvestigationsofdeathsduetoaccidents,suicides,homicides,civiland
criminalnegligence.(14) Describemedicolegalimportanceofmentaldisorders.(15) Developanunbiasedattitudetowardssocietyespeciallywithregardtovictimsandsuspects.(16) Cultivateattitudesnecessarytofunctionasamemberofateamininvestigationofcrime.(17) Identifythetypes,circumstances,principlesofmanagementofcommonpoisonsinSriLanka. TheseobjectiveswillbecoveredintheMedico-legalModuleandduringthemedico-legalrotationinthefourthyear.
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IntendedLearningoutcomesofthemoduleinrelationtothefacultyoutcomes
FacultyOutcomes Broadcontentareasareincludedunderfollowing
Doctorasapractitioner
Clinicalskillsandpatientmanagement
• Historytakingphysicalexaminationandmedico-legalmanagementofclientsproducedbypolicewithanMLEFormagistrateorderandotherwardreferrals.
• Performpost-mortemexaminations• Requestlaboratoryandradiologicalinvestigationasappropriate.
Communicationskills
• Verbalcommunicationwithvictims,perpetrators,lawenforcementauthorities,healthcareworkers,mediaandthepublicindealingwithmedico-legalissues
• Writtencommunicationwithlaw-enforcementauthoritieshealthcareofficialsandpublicindealingwithmedico-legalissues
Populationhealth&healthsystems
• Workingwiththeexistinghealthsystemindealingwithmedico-legalissues
Informationmanagement
• Retrievinginformationfromrelevantsourcesforevidence-basedpracticeinrelationtomedico-legalduties
• Accuratedocumentationandrecord-keeping
Doctorasascientist
ScientificbasisofMedicine
• Normalstructureandfunctionofeachanatomicalarea,• Mechanismsofcausationofinjuries,• Medico-legalimplicationsofdifferenttypesofinjuries,• Expertevidenceinthecourtoflaw,• Pathogenesisofdiseases,theiraetiology,pathology,• Investigationsandcontributioninarrivingatacauseof
death.• Toxicologicalanalysisofdifferenttypesofpoisonsand
medico-legalaspects.Criticalthinking&research
• Followingprotocols/guidelinesandcomplywithevidenceinmedico-legalpractices
Doctorasaprofessional
Professionalvalues,attitudesðics
• Possessingattributeslikehonesty,integrityandtruthfulnessinperformingmedico-legalduties
• Maintainingconfidentialityandprivacyinmedico-legalexamination
• Identifyingownlimitationsandseekforhelpinmedico-legaltaskswhereappropriate
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LEARNING RESOURCES
I.Lectures
YouwillbegivenanopportunitytolistentolecturesonthemostimportantaspectsinForensicMedicineandToxicology.ThePowerPointpresentationsusedforselectedlectures(includingrelevantphotographs)willbeavailable.
II.Handouts
HandoutsonthelecturetopicswillbeavailableintherelevantsectionoftheVirtualLearningEnvironmenttogetherwithadditionallearningmaterial.
III.VideoDemonstrations
• Theprocedureofperformingapostmortemexaminationwillbedemonstratedwithadocumentary
filmduringthelectures/clinicalappointment.• Theprocedureofperforminganexhumationwillbedemonstratedwithanotherdocumentaryfilm
duringthelectures/clinicalappointment
IV.TutorialsThe tutorialswill be arrangedon selected important topics. You are expected to attend all tutorials. Theattendancewillbemarked.Thesatisfactoryattendanceoftutorialsisaprerequisitetositthefinalmoduleexam.V.PostmortemDemonstrationsandWardClasses
Duringtheclinicalappointmentyouwillbeabletoobserveandalsotoassistinacaseofpostmortemandexaminationofpatientswithmedico-legalproblems.
VI.FixedLearningMaterials
Museumspecimensofsofttissues,bonesandphotographsofvariousmedico-legalcaseswithdescriptionsareavailable(indigitalformandhardcopies)atthedepartmentofForensicMedicineandthefacultyForensicMedicinewebsite.Inadditionasetofselectedspecimensandphotographswillbedisplayedinthemuseumwithquestionspertainingtomedicolegalissuesorthevirtuallabwouldbeutilizedtodemonstratethesamesetofforensicmaterials.VII.E-LearningMaterialSelectede-learningmaterialsareavailableinthenewlyestablished‘VirtualLearningEnvironment’whichcanbeaccessedfromthedepartmentofForensicMedicinewebsite.VIII.QUIZAfriendlycompetitionamongdifferentgroupsofmedicalstudentstopromoteactivelearningwillbeheldduringmodulehours.IX.Self-studySelf-study is strongly recommendedwithmuseum specimens,medico-legal reports andmedico-legal textbooksavailableintheForensicMedicinelibraryandtheMainlibrary.
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Fixedlearningmaterialsbasedonphotographsofmedico-legalrelevanceinquestionandanswerformatisavailableintheForensicMedicineMuseum.
COURSECONTENTS
Thecoursecontentsarelistedbelowtogetherwithakeythatguidesyouindifferentiatingbetweentherequiredcoreknowledgeandskillsandareasthatare‘’nicetoknow’’*KEYTOBETTERUNDERSTANDINGOFTHECOURSECONTENTS.
(A) Comprehensiveknowledgeofspecifiedareaandcompetencyinspecifiedmedico-legalwork(B) Knowledgeofthebasicprincipleswithabilitytoidentifywherereferralisneeded(C) Nicetoknow
CoreKnowledge=(A)+(B)
(1)IntroductiontoForensicMedicine(a)DefinitionandScopeofForensicMedicine-B(b)AimsandObjectivesoftheModule-B(c)Whatweexpectfromthestudents-B
(2) MechanicalTrauma(a)Typesofinjuries,definitions,featuresandcausations-A(b)Interpretationofinjuriesinrespectof;-Ai.Causativeweaponii.Circumstancesofcausation
(accidental/suicidal/homicidal/self-inflicted/fabricated/defenseetc.)iii.Datingofinjuriesiv.Ante-mortemandpostmorteminjuries
(3) RegionalInjuries
Medico-legalsignificance,sequelae&complicationsinrelationtofollowingregionsofthebody-A(a)Head/face
(b)Neck(c)Chest
(d)Abdomen(e)Pelvis/genitals(f)Limbs
(4) Medico-legaldocuments&categoryofhurtinrelationtoPenalCodeSec.311
(a) MLEF-A(b) MLR-A(c) Givingoralevidenceasexpertwitness-A(d) Dyingdeclaration,Testamentarycapacity-B
(5)Road-TrafficAccidents
Injurypattern,methodofcausationandpreventionofinjuriesin;(a)Pedestrian-A
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(b)Driver,frontseatpassenger,occupant-A(c)Motorcyclist/PillionRider/Pedalcycler-A(d)Investigationinacaseof‘HitandRun’-A(e) Investigationofbody foundonorby the rail tract. (Accidental, suicidal,homicidalorpostmortem
disposal)-B(6) FirearmInjuries
(a)Typesoffirearms(smoothboreandrifled),mechanismsoftheiroperationandcausationofinjuries-A
(b)Identifyentry/exitwounds-A(c)Estimaterange/direction/angleofdischarge-B(d)Circumstances–homicide/suicide/accident–B
(7) BlastInjuries (a) Whatcausesblastinjuries-A(b) Componentsoftheblastandtheinjuriescausedbythosecomponents-A(c) Interpretationofinjuriescausedbyablast-A(d) Investigation/Visittoasceneofmassdisasterfollowingabombexplosion-A(e) Problemsencounteredattheautopsyofvictimofamassdisasterfollowingabombexplosion-A
(8) InjuryfromPhysicalAgents
(a)Heat&cold(general)-B HyperthermiaandHypothermia Bothclinicalandpostmortemfindings (b) Burns-A-Flameburns,
-Moistburns,-Corrosiveburns
(Identificationofburnsfromtheirfeatures)Medico-LegalInvestigationofacharredbodyfoundinaburntdownhouseHeatartifacts
(c) Electrocutioninjuries-AAppearanceofaninjuryMechanismofdeathPostmortemfindings
(d) Lightning-AMechanismofcausationofinjuryPostmortemfindingsMechanismofdeathInvestigationinacaseofdeathduetolightning
(9) PhysicalandSexualChildAbuse (a)Typesofchildabuse-A(b)Diagnosisofchildabuse-A
(c)Classicalclinicalfeatures/autopsyfindingsincaseofchildabuse-A(d)Differentialdiagnosisofchildabuse-A(e)Caseconference–B
(10)Battering&Torture (a)Circumstancesofbattery&torture-B
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(b)Methodsused-A(c)Diagnosisofbattery&torture-A
(11)SexualOffences
(a) LawsonRape/Incest/Unnaturaloffences/Gravesexualoffence-A(b) Clinicalexaminationofavictimofrape,ethicalaspect&thecollectionofsamples-A(c) Interpretationofinjuriesfoundonavictimofrape-A(d) Clinicalexamination&collectionofsamplesofanassailant-A(e) Examinationofvictim&assailantinacaseofanalintercourse-A(f) Examination,interpretationofinjuries&reportinginacaseofchildsexualabuse–A
(12). Abortion
(a)Definition(MedicalandLegal)-A(b)LawsrelatedtoabortioninSriLanka-A
(Sec.303ofthePenalCode) (c)Methodused-A (d)Complication&theCauseofDeath-A(e)Diagnosisofcriminalabortion–clinical&atautopsy-A
(13). Infanticide
(a)LawsrelatedtoinfanticideinSriLanka-A(b)Diagnosisoflivebirthandstillbirth-A
(c)Estimationofthematurity-B(d)Actofcommissionoromission-A(e)Autopsyinacaseofsuspectedneonataldeath-B(f)Examinationofthemother-B
(14) Death
(a)Definitionofdeath(Somaticdeath/moleculardeath/braindeath)-B(b)Diagnosisofdeath-A
(c)Certificationofdeath,writingdeclarationofdeathform-A(d)Disposalofdeath-B
(15) InquirerintoSuddenDeathsandInquestProcedure (a)DefinitionandrelevantsectionsofCriminalProcedureCode-B(b)Typesofdeaththatneedaninquest-A
(c)Inquestprocedure-A(d)Dutiesofinquirerintosuddendeath-A(e)Doctor’sroleinaninquest-A
(16) PathologicalAutopsy
(a) Requirementsforpathologicalautopsy–A(17) Medico-legalautopsy
(a)Aims&objectivesofmedico-legalautopsy-A(b)Proceduretobefollowedinmedico-legalautopsy–A
(18) TransplantationofHumanTissueAct (a) Basicconceptsrelatedtotheaboveact–A
(19) SceneofCrime
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(a)Whatisasceneofcrime-A(b)Who,Why,When,tovisit-A
(c)Recordandcollectevidenceatascene-A(d)Dispatchofabodyfromthescenetothemortuary-A
(20) Exhumation
(a)Legalrequirement-A(b)Howtocarryoutanexhumation-B
(21)Postmortemchangesinabody
(a)Earlychanges-A(b)Latechanges-A
(c)Remotechanges-Adipocere,Mummification&Skeletonisation-A
(22) Estimationoftimesincedeath (a)Medicalmethods-A
• Postmortemchanges• Cessationofphysiologicalfunctions
(b)Non-medicalmethods(circumstantial)-A(c)Limitationsofavailablemethods-A
(23)Identificationofliving&dead(a)Externalfeatures-A(b)ClothingandPersonalbelongings-A(c)Dentition-A(d)Fingerprints-A(e)IntroductiontoForensicAnthropology-B(f)SpecialTechniquese.g.VideoSuperimposition,FacialReconstructionetc.-B(g)DNAprofiling–B
(24)Suddenadultdeath(a)Definition-A
(b)Causesofsuddendeath-A(c)Postmortemfindingsofsuddendeath-A(d)Conceptofobscure&negativeautopsy-B
(25)SuddenInfantdeath(a)Definition-A(b)PostmortemexaminationofSuddenInfantDeathSyndrome–B
(26)Starvation&Neglect(a)Causes&circumstances-B
(b)Postmortemfindings–A
(27)Asphyxia (a)Definition-A(b)Features,Pathophysiologyofvarioustypesofasphyxia-A(c)Differentmodesofasphyxia-A(d)Mechanismsofdeath-A(e)Postmortemfindings-A(f)InvestigationofAsphyxialdeaths-A
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(28)Alcohol (a)Stagesofintoxication-A(b)Clinicalexaminationfordrunkenness-A (c)Othermethodsavailabletoestablishdrunkenness-A
(d)Effectsofalcoholontheabilitytodrive-A(e)Lawsrelatedtodrunkenness-A(f)Differentialdiagnosisofalcoholintoxication-A(g)Suddendeathduetoalcoholabuse-B
(29)CollectionofTraceEvidence
(a)Samplecollection-types&methodsused-A(b)Examinationofbloodstains&otherstains-C
(30)Deathsduetosurgery&anesthesia
(a)Definition-B(b)Howtoconductanautopsy-A(c)Specialinvestigations-B
(31)DutiesofMedicalOfficersinthefollowingroles;
(a)AMedicalOfficerintheout-patientdepartment-A (b)AHouseOfficerinchargeofawardinahospital-A
(c)ASpecialistinanyfieldoradirectorofahospital-B(d)ADistrictMedicalOfficerorMedicalOfficer(Medico-legal)-A(e)AGeneralPractitioner-A(f)ADoctorworkinginanyothercapacity-A
(32)IntroductiontoForensicPsychiatry-B
(33)Basicsofcriminallaw,criminalresponsibility,culpablehomicide/murder–B(34)IntroductiontoForensicOdontology-B
(34)ForensicToxicology
(a) Agrochemicals(OP,Paraquat&others)-A(b) Metalsandnonmetals-A(c) Corrosives-A(d) Irrespirableagents-B(e) Plantpoisons-A(f) Therapeuticdrugs-A(g) Envenomationbyanimals-A(h) Principlesofmanagementincasesofpoisoning-A
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ASSESSMENTS
KnowledgeonForensicMedicineandToxicologywillbeassessedin
1. ContinuousAssessment82. Unit4ofthe2ndexaminationforMedicaldegree
CONTINUOUSASSESSMENT
CA8Consistsof
• StructuredEssayQuestions• Practicalcomponent
CA8contributewith10%oftheUnit4examinationmarks.ThepracticalcomponentwillbebasedontheEvaluationofaMedico-legalExaminationofa livingpersonduringtheForensicMedicineClinicalattachmentinthecourseof4thyear.
UNIT4EXAMINATION
Unit4examinationconsistsof
• StructuredEssayQuestions• MultipleChoiceQuestions/Singlebestresponse• OSPE
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SELFASSESSMENT
Attheendofthemoduleandclinicalappointment,thestudentshouldbeabletoassesshim/herself.Ifhe/shefindshim/herselfatalowerrankingthepersonshouldtakeappropriateremedialmeasurestocorrecttheshortcomings.
SUGGESTEDREADINGMATERIALS
• Simpson’sForensicMedicine;Eds:JasonPane-James,RichardJones,StevenKarch,JohnManlove13thEdition
• MargaretMStark:ClinicalForensicMedicine,Aphysician’sGuide2ndEdition• PekkaSaukko&BernardKnight:Knight’sForensicPathology,:3rdEdition• VincentJMDiMaioandZuzannaEDana:HandbookofForensicPathology;2ndEdition• PathologyoftraumabyJKMason&BNPurdue3rdEdition1999• ForensicMedicineClinicalandPathologicalAspects.JasonPane-James,AnthonyBusuttil,
WilliamSmock2002• Prof.RavindraFernando:ManagementofPoisoning;4threvisededition• LBLDeAlwis:LectureNotesinForensicMedicine;volumeI,II,III,IV
S.Agree3marks
Agree2marks
Disagree0marks
Myoveralllevelofknowledge,skills&applicationinForensicmedicineisimprovedduringthemodule&clinicalappointment
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DepartmentofForensicMedicine
FacultyofMedicineUniversityofKelaniya
2017