MEDICOLEGAL CASESMEDICOLEGAL CASES

DR KSH MANGLEM SINGHDR KSH MANGLEM SINGHChief Medical Officer/Director,Chief Medical Officer/Director,

District Health Mission, Imphal EastDistrict Health Mission, Imphal EastCum Senior Medico-legal SpecialistCum Senior Medico-legal Specialist

Government of ManipurGovernment of Manipur

Common Medico legal Common Medico legal CasesCases• Accidental injury casesAccidental injury cases• Alleged cases of Alleged cases of

assaultassault• Cases of burnsCases of burns• Cases of alcoholic Cases of alcoholic

intoxicationintoxication• Victim to animal Victim to animal

ferocityferocity• Snake and insect Snake and insect

bite/stinging casesbite/stinging cases• Unconscious/Unconscious/

Comatose patientsComatose patients

• Alleged criminal Alleged criminal abortionabortion

• Drug Drug overdose/anaphylaxis overdose/anaphylaxis reactionsreactions

• Dead on arrival to Dead on arrival to hospitalhospital

• Brought dead to Brought dead to hospitalhospital

• Sudden unexpected Sudden unexpected death casesdeath cases

• Surgical deathSurgical death• Anaesthetic deathAnaesthetic death

Points to be remembered in Points to be remembered in handling Medicolegal Caseshandling Medicolegal Cases

• Cannot refuse to examine Cannot refuse to examine MLCMLC

• Never delay examinationNever delay examination• Patient may be Patient may be

hospitalized or referred, hospitalized or referred, preparing injury reportpreparing injury report

• A referred case and A referred case and already registered fresh already registered fresh report not necessaryreport not necessary

• Always obtain informed Always obtain informed consent prior to giving consent prior to giving treatmenttreatment

• Note at least 2 Note at least 2 identification marks from identification marks from exposed parts of the bodyexposed parts of the body

• If death is inevitable arrange If death is inevitable arrange to take dying declarationto take dying declaration

• In case of poisoning perform In case of poisoning perform gastric lavage and gastric lavage and administer specific antidote administer specific antidote and admit the patient,collect and admit the patient,collect necessary samplesnecessary samples

• Don’t make un-necessary Don’t make un-necessary delay in issuing MLReportsdelay in issuing MLReports

• In case of discharge or death In case of discharge or death of a MLC in the of a MLC in the hospital;inform the police,in hospital;inform the police,in case of death don’t issue case of death don’t issue death certificatedeath certificate

• If a MLC is discharged If a MLC is discharged against medical against medical advice,inform police.advice,inform police.

Injury/Wound ReportInjury/Wound Report

• Record details of the injuries found in the Record details of the injuries found in the Accident Register cum Injury or Wound Accident Register cum Injury or Wound Report/CertificateReport/Certificate..

• The original is the The original is the Injury or WoundInjury or Wound Report/CertificateReport/Certificate,which is to be detached ,which is to be detached and issued to the Police Officer,the carbon and issued to the Police Officer,the carbon copy will remain in the register and serve copy will remain in the register and serve as a permanent record for the Medical as a permanent record for the Medical OfficerOfficer

Referring a MLC to second Referring a MLC to second hospitalhospital

• MO who examined first should give MO who examined first should give necessary first aidnecessary first aid

• Copy of Copy of accident/woundaccident/wound certificate which certificate which is sent to IO should invariably accompany is sent to IO should invariably accompany the patient to next institution along with the patient to next institution along with discharge certificate.This when produced discharge certificate.This when produced before the MO in the second hospital,can before the MO in the second hospital,can allow him to continue treatment for the allow him to continue treatment for the injuresinjures

DrunkennessDrunkenness

• Consumption of alcohol in any form is an Consumption of alcohol in any form is an offence in an area where there Prohibition offence in an area where there Prohibition Act is in forceAct is in force

• In case of assault,rape or homicideIn case of assault,rape or homicide• The victim and the driver have to be The victim and the driver have to be

examined in traffic accident casesexamined in traffic accident cases• Person who has intoxicated himself is Person who has intoxicated himself is

responsible for his acts,but not at all if responsible for his acts,but not at all if another person forces it on himanother person forces it on him

• Intoxicated person cannot give valid consentIntoxicated person cannot give valid consent

Drunkenness(contd)Drunkenness(contd)

Blood for chemical examination :Blood for chemical examination :

Collect 2 to 3 ml by venepuncture.Use Collect 2 to 3 ml by venepuncture.Use soap and water for disinfection.The soap and water for disinfection.The container is stopped tightly and mouth container is stopped tightly and mouth sealed with paraffin or candle wax.Put sealed with paraffin or candle wax.Put name of the person,date,time of name of the person,date,time of collection along with signature of collection along with signature of MO.Sample duly sealed and delivered to MO.Sample duly sealed and delivered to IO.Get a receiptIO.Get a receipt

Drunkenness(contd)Drunkenness(contd)

Opinion:Opinion:

11 Consumed alcohol and is under Consumed alcohol and is under its its influenceinfluence

22 Consumed alcohol but is not Consumed alcohol but is not under its under its influenceinfluence

33 Not consumed alcoholNot consumed alcohol

Documents of ML natureDocuments of ML nature

• Consent in medical practiceConsent in medical practice

• Birth/Death certificateBirth/Death certificate

• Medical/Sick leave certificateMedical/Sick leave certificate

• Fitness CertificateFitness Certificate

• Court attendance exemption certificateCourt attendance exemption certificate

• Dying declarationDying declaration

• Mental illness certificateMental illness certificate

Consent in medical practiceConsent in medical practice

• Examination of a patient without consent Examination of a patient without consent amounts to assaultamounts to assault

• Expressed consentExpressed consent is to be obtained wherever an is to be obtained wherever an invasive procedural techniques to be adopted for invasive procedural techniques to be adopted for treatingtreating

• In In emergencyemergency treatment cases,a patient can be treatment cases,a patient can be examined and life saving emergency procedures examined and life saving emergency procedures carried out in good faith even without consent carried out in good faith even without consent (IPC 92).Age for consent for operation is 18 yrs(IPC 92).Age for consent for operation is 18 yrs

• In a MLC simply because a person is brought by In a MLC simply because a person is brought by police police implied consentimplied consent cannot be taken for cannot be taken for grantedgranted

Consent(contd)Consent(contd)

• Accused can be examined by MO at the Accused can be examined by MO at the request of police officer,not below the rank of request of police officer,not below the rank of SI,without consent and even by use of force SI,without consent and even by use of force -Cr PC 53(i)-Cr PC 53(i)

• When examination of female When examination of female person,examination shall be made only by or person,examination shall be made only by or under the supervision of a female MO -Cr PC under the supervision of a female MO -Cr PC 53(ii) 53(ii)

• Consent of legal guardian if person is below 12 Consent of legal guardian if person is below 12 yrs/18 yrs for undergoing operationyrs/18 yrs for undergoing operation

Death CertificateDeath Certificate

Issued only :Issued only :• If cause of death is known beyond all If cause of death is known beyond all

doubtsdoubts• A person is admitted in hospital,clinical A person is admitted in hospital,clinical

diagnosis is made based on diagnosis is made based on signs,symptoms and diagnostic signs,symptoms and diagnostic proceduresprocedures

• Death occurs due to natural Death occurs due to natural consequences after diagnosis is madeconsequences after diagnosis is made

Death certificate (contd)Death certificate (contd)

Don’t certify death in the following conditions:Don’t certify death in the following conditions:• Person brought death/dead on arrival to casualtyPerson brought death/dead on arrival to casualty• Persons dying after admission and before making Persons dying after admission and before making

a diagnosisa diagnosis• In all alleged cases of unnatural In all alleged cases of unnatural

death(accident/suicide/homicide)death(accident/suicide/homicide)• Anaesthetic deathsAnaesthetic deaths• SnakebitesSnakebites• Death of a woman in her husband’s house within Death of a woman in her husband’s house within

7 yrs of marriage7 yrs of marriage

Dying DeclarationDying Declaration

Statement of a dying person, relating to the Statement of a dying person, relating to the cause and circumstances of his deathcause and circumstances of his death

• Magistrate having jurisdiction should be Magistrate having jurisdiction should be called to record the declarationcalled to record the declaration

• Before recording doctor should certify that Before recording doctor should certify that person and his/her mental faculties are person and his/her mental faculties are normalnormal

• If situation demands the doctor himself can If situation demands the doctor himself can record in the presence of two witnessesrecord in the presence of two witnesses

• The declaration is then sent to the The declaration is then sent to the magistrate in a sealed envelope with a lettermagistrate in a sealed envelope with a letter

Medical NegligenceMedical Negligence

• ““the ommission to do something the ommission to do something which a reasonable man guided by which a reasonable man guided by those ordinary considerations which those ordinary considerations which ordinarily regulate human ordinarily regulate human affairs,would do,or the doing of affairs,would do,or the doing of something which a reasonable and something which a reasonable and prudent man would not do”prudent man would not do”

Classification of negligenceClassification of negligence

• CivilCivil negligencenegligence-breach of duty to use -breach of duty to use reasonable skill and care,resulting in reasonable skill and care,resulting in damage.Burden of proof is on the patient damage.Burden of proof is on the patient or his relativesor his relatives

• CriminalCriminal negligencenegligence-negligence of such a -negligence of such a degree that it amounts to a criminal degree that it amounts to a criminal offence,whereby the medical practitioner offence,whereby the medical practitioner may have caused the death of his patientmay have caused the death of his patient

• ContributoryContributory negligencenegligence-damage to the -damage to the patient is caused partly by his own and patient is caused partly by his own and partly by the doctor’s negligencepartly by the doctor’s negligence

Instances amounting to Instances amounting to negligencenegligenceFailureFailure• to obtain informed to obtain informed

consent for diagnostic consent for diagnostic and therapeutic and therapeutic proceduresprocedures

• to employ necessary to employ necessary and recognised and recognised diagnostic proceduresdiagnostic procedures

• to attend a patient to attend a patient who is under the who is under the doctor’s active clinical doctor’s active clinical carecare

• to inform the patient to inform the patient about toxic or harmful about toxic or harmful side effects of drugsside effects of drugs

• to inquire,test for and to inquire,test for and precautions against precautions against anaphylactic reactions anaphylactic reactions to drugsto drugs

• to sterilize to sterilize instruments like instruments like needles,syringes etcneedles,syringes etc

• to remove foreign to remove foreign body like body like instruments,gauze etcinstruments,gauze etc

Instances of Instances of negligence(contd)negligence(contd)FailureFailure• to discover the disease,delay in treatment of to discover the disease,delay in treatment of

which may be harmful and even dangerous which may be harmful and even dangerous to the life of the patientto the life of the patient

• to obtain consent of both partners in case of to obtain consent of both partners in case of operation leading to sterility of either of themoperation leading to sterility of either of them

• to exercise care in selecting assistants and to exercise care in selecting assistants and delegating duties to themdelegating duties to them

• to assume responsibility of post operative to assume responsibility of post operative carecare

Instances of Instances of negligence(contd)negligence(contd)• withdraw active withdraw active

clinical care without clinical care without giving adequate notice giving adequate notice or providing or providing alternative care to the alternative care to the patientpatient

• misdiagnosing non misdiagnosing non existing conditionsexisting conditions

• operative operative procedures,except in procedures,except in emergency,expressedlemergency,expressedly not authorised by y not authorised by the patientthe patient

• anaesthetic anaesthetic mishaps,and mishaps,and accompanying accompanying ancillary ancillary responsibilities-responsibilities-transfusion,intravenoutransfusion,intravenous s injection,catheterisatioinjection,catheterisation,diathermy,hot water n,diathermy,hot water burnsburns

Defence against negligenceDefence against negligence

• Actual denial of negligence taken placeActual denial of negligence taken place• Delegation of duty to the subordinateDelegation of duty to the subordinate• Contributory negligence by the patientContributory negligence by the patient• Assumption of risk by the patientAssumption of risk by the patient• Emergency of the situation Emergency of the situation • release of tortfeasor-settlement wth third party release of tortfeasor-settlement wth third party

and releaseand release• Res judicata (”the thing has been decided”)Res judicata (”the thing has been decided”)• Statutes of limitationStatutes of limitation• Immunity to charitable and ggovernment Immunity to charitable and ggovernment

institutionsinstitutions

Prevention against Prevention against negligencenegligence• Do not criticise another doctorDo not criticise another doctor• Employ qualify staff & associate with Employ qualify staff & associate with

good partners good partners• Udate your knowledgeUdate your knowledge• Keep accurate and complete recordsKeep accurate and complete records• Obtain valid consentObtain valid consent• Establish good professional relationshipEstablish good professional relationship• Take reasonable skill and careTake reasonable skill and care• Guard against therapeutic hazardsGuard against therapeutic hazards

Prevention against Prevention against negligence(contd)negligence(contd)

• Good conduct of the doctorGood conduct of the doctor

• Maintain professional secrecyMaintain professional secrecy

• Relationship with legal professionRelationship with legal profession

• Medical Indemnity InsuranceMedical Indemnity Insurance

• Countersuit against patientsCountersuit against patients

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