Duty of Doctors-Duty of Doctors-Medicolegal AspectMedicolegal AspectProf. S. BatabyalHead, Dept of FSMMedical College, Kol...
Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspectAspect• IntroductionIntroduction• Obtaining consentObtaining...
Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspect contd.Aspect contd.• Legal problems faced by M.O.Laws relat...
Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspect contd.Aspect contd.• Intervention: Preparing the patient fo...
IntroductionIntroduction• Every registered medical practitioner has toEvery registered medical practitioner has toperform ...
IntroductionIntroduction• Here brief history of the case is necessary. TheHere brief history of the case is necessary. The...
IntroductionIntroduction• In addition, during examination of the case aIn addition, during examination of the case amale/f...
IntroductionIntroduction• Here, may have to makeHere, may have to make “dying Declaration“dying Declaration”. It”. Itis a ...
IntroductionIntroduction• Another important medicolegal duty of theAnother important medicolegal duty of thedoctors in the...
IntroductionIntroduction• Now, in the operation theatre,Now, in the operation theatre, the doctor inthe doctor incharge of...
IntroductionIntroduction• If any one of them remains in side the operationIf any one of them remains in side the operation...
Duty to take consent inDuty to take consent inmedical practice: -medical practice: -• Consent meansConsent means voluntary...
ConsentConsent• But theBut the convicted person can be examinedconvicted person can be examinedwithout his/her consent by ...
Requirement of consentRequirement of consent :-:-• In various field of medical practice writtenIn various field of medical...
• ForFor organ transplantationorgan transplantation, the organ of the dead, the organ of the deadperson should not be remo...
Suspected PoisoningSuspected Poisoning• In case ofIn case of homicidal poisoninghomicidal poisoning, the doctor is duty, t...
Suspected PoisoningSuspected Poisoning• Non-compliance is punishable under Sec.201 IPCNon-compliance is punishable under S...
Suspected PoisoningSuspected Poisoning• A government medical officer is required toA government medical officer is require...
Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• A criminal abortion is...
Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• If theIf the woman die...
Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• If the miscarriage is ...
The civil and criminalThe civil and criminalnegligencenegligence• Professional negligenceProfessional negligence is absenc...
Examples of civil negligenceExamples of civil negligence• Loss of earning of the patient due to negligent act of theLoss o...
• A doctor is not liable for an error ofA doctor is not liable for an error ofjudgement or of diagnosis, if he hasjudgemen...
Criminal negligenceCriminal negligence• Criminal negligence occurs when the physicianCriminal negligence occurs when the p...
Criminal negligenceCriminal negligence• Administration of a wrong medicine in toAdministration of a wrong medicine in toth...
• A single professional act by a physician mayA single professional act by a physician maysubject him tosubject him to bot...
• Lastly, another very important medicolegal dutyLastly, another very important medicolegal dutyof the doctors is to hold ...
Cases for medico legalCases for medico legalpostmortem examinationpostmortem examination• All unnatural death cases.All un...
Cases for medico legalCases for medico legalpostmortem examinationpostmortem examination• Death occurring inDeath occurrin...
LEGAL PROBLEMS FACED BYLEGAL PROBLEMS FACED BYTHE DOCTORS .THE DOCTORS .• In the past, litigations were less in India,In t...
LEGAL PROBLEMS FACED BYLEGAL PROBLEMS FACED BYTHE DOCTORSTHE DOCTORS• When a doctor is showing absence ofWhen a doctor is ...
SOME LAWS IN RELATION TOSOME LAWS IN RELATION TOMEDICAL PRACTICEMEDICAL PRACTICE• Criminal Law.Criminal Law.• Civil Law.Ci...
CRIMINAL LAWCRIMINAL LAWSECTIONSECTION OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS193 IPC193 IPC PerjuryPerjury Imprisonment u...
SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment fro...
SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment fro...
The legal protection for DoctorsThe legal protection for Doctors• Sec.88 to 93 IPCSec.88 to 93 IPC• To follow the rules of...
(A)(A) LAW OF CONTRACTLAW OF CONTRACT• Here, there is a specific contract between aHere, there is a specific contract betw...
LAW OF TORTLAW OF TORT..• Certain duties are imposed on every personCertain duties are imposed on every personin the socie...
CONSUMER PROTECTION ACTCONSUMER PROTECTION ACT ::• This act is most hot subject in the medicalThis act is most hot subject...
• At any centre mention below with/withoutAt any centre mention below with/withoutengaging a Lawyer and paying a nominal f...
Apprehensions :-Apprehensions :-• Bad doctor-patient relationship.Bad doctor-patient relationship.• Tendency for extensive...
MEDICAL COUNCILMEDICAL COUNCIL..• A patient can file a complaint with theA patient can file a complaint with therespective...
OTHER LAWS :OTHER LAWS :• Under M.T.P. Act, Drug Act, BombayUnder M.T.P. Act, Drug Act, BombayNursing Home act etc. patien...
CONCLUSIONCONCLUSION :-:-• TO AVOID ALL THE MEDICOLEGALTO AVOID ALL THE MEDICOLEGALPROBLEMS CERTAIN PRECAUTIONS TO BEPROBL...
• Sensitivity tests to be done where applicable.Sensitivity tests to be done where applicable.• When diagnosis is obscure ...
PROTOCOL FOR POLICE CASES &PROTOCOL FOR POLICE CASES &RAPE/SEXUAL ASSAULT.RAPE/SEXUAL ASSAULT.• A patient when comes to ER...
If patient is unconscious andIf patient is unconscious andunknown thenunknown then• Name of persons brought the patientNam...
Other special points which shouldOther special points which shouldbe done in the ward.be done in the ward.• After receivin...
RAPE/SEXUAL ASSAULTRAPE/SEXUAL ASSAULT• The victims and accused should be examined as perThe victims and accused should be...
What is Rape?What is Rape?• Rape is defined as an unlawful carnal knowledgeRape is defined as an unlawful carnal knowledge...
Nursing AlertNursing Alert :-:-• The management of the sexual assault isThe management of the sexual assault isimportant b...
Interviewing the patient :-Interviewing the patient :-• Consent should be obtained for the examinationConsent should be ob...
Interviewing the patient :-Interviewing the patient :-• Record time of admission, time of examination,Record time of admis...
Intervention : Preparing forIntervention : Preparing forphysical examinationphysical examination– Assist the patient to un...
Physical ExaminationPhysical Examination..• Examine the patient ( from head to toe) for injuryExamine the patient ( from h...
Providing follow-up services.Providing follow-up services.• Make an appointment for follow up surveillanceMake an appointm...
Obtaining LaboratoryObtaining LaboratorySpecimenSpecimen• Collect vaginal aspiration which is examine forCollect vaginal a...
• Examination of the VictimExamination of the Victim ::• It must be remembered that the police or courtIt must be remember...
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Dutyof doctors medico legal aspect

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In ancient days, medical profession was considered to be a noble field. The patient’s faith and trust in doctors was so much that a doctor was equated to an "Angel or Semigod". Gradually, this relationship is turning into a love and hate phenomenon. In this era of specialisa-tion and super specialisation, the focus of medical profession is progressing from a noble one to a commercial one. The increasing cost of medical education, equipments, construction of clinics and hospitals are to some extent responsible for the commercial approach on part of doctors. Patients now are also more interested in facilities and good looking hospital rather then quality of care and competency of doctors. In this scenario, litigations related to medical practice are on the rise. The intent of this article is to sensitise the readers to the basics of legal aspects in medical practice in India. Usually, legal problems start if there is a controversy regarding the duties and rights of doctors.

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Dutyof doctors medico legal aspect

  1. 1. Duty of Doctors-Duty of Doctors-Medicolegal AspectMedicolegal AspectProf. S. BatabyalHead, Dept of FSMMedical College, Kolkata
  2. 2. Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspectAspect• IntroductionIntroduction• Obtaining consentObtaining consent• Different consenting ageDifferent consenting age• Duty of M.O. in case of suspectedDuty of M.O. in case of suspectedpoisoningpoisoning• Duty of M.O. in case of criminal abortionDuty of M.O. in case of criminal abortion• Civil and Criminal negligenceCivil and Criminal negligence• Cases for medicolegal postmortemCases for medicolegal postmortem
  3. 3. Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspect contd.Aspect contd.• Legal problems faced by M.O.Laws related toLegal problems faced by M.O.Laws related tomedical practicesmedical practices• Civil law: Law of contract, Law of Tort,Civil law: Law of contract, Law of Tort,Consumer Protection ActConsumer Protection Act• Medical CouncilMedical Council• Other lawsOther laws• ConclusionConclusion• Protocol for police cases & Rape/Sexual assault:Protocol for police cases & Rape/Sexual assault:Introduction to Rape/Sexual assaultIntroduction to Rape/Sexual assault• Interviewing the patientInterviewing the patient
  4. 4. Duty of Doctors- MedicolegalDuty of Doctors- MedicolegalAspect contd.Aspect contd.• Intervention: Preparing the patient forIntervention: Preparing the patient forexaminationexamination• Physical examinationPhysical examination• Providing follow up servicesProviding follow up services• Obtaining laboratory SpecimenObtaining laboratory Specimen• Examination of the VictimExamination of the Victim• Proforma for examination of the accused in aProforma for examination of the accused in arape case: Medicolegal Certificate for Malerape case: Medicolegal Certificate for Male• Medicolegal Certificate for FemaleMedicolegal Certificate for Female
  5. 5. IntroductionIntroduction• Every registered medical practitioner has toEvery registered medical practitioner has toperform some medicolegal duty during dischargeperform some medicolegal duty during dischargeof his/her dutyof his/her duty• In the emergency room, they have to makeIn the emergency room, they have to makeinjury report in all unnatural casesinjury report in all unnatural cases• But if the patient is moribund, arrangement ofBut if the patient is moribund, arrangement oftreatment is to be made first. In case the patienttreatment is to be made first. In case the patientis not admitted, only PC (police case) is done. Butis not admitted, only PC (police case) is done. Butif the police case is admitted, IPC (indoor policeif the police case is admitted, IPC (indoor policecase) is to be done.case) is to be done.• In both the cases government prescribed form isIn both the cases government prescribed form isthere. If the form is not available, it may be donethere. If the form is not available, it may be donein plain paper under seal and signature of thein plain paper under seal and signature of themedical officer.medical officer.
  6. 6. IntroductionIntroduction• Here brief history of the case is necessary. TheHere brief history of the case is necessary. Theinjuries are to be mentioned one by one with theirinjuries are to be mentioned one by one with theirposition,position, approximate measurement and type ofapproximate measurement and type ofthe injuries ie, abrasion, bruise, lacerationthe injuries ie, abrasion, bruise, lacerationinjuries etcinjuries etc• Lastly, the provisional diagnosis of the case andLastly, the provisional diagnosis of the case andthe prognosis of the case are to be mentioned. Itthe prognosis of the case are to be mentioned. Itis a very important duty for EMO (emergencyis a very important duty for EMO (emergencymedical officer).medical officer).• If he fails to discharge this duty he may beIf he fails to discharge this duty he may becharged under Sec.201 IPCcharged under Sec.201 IPC and the punishmentand the punishmentmay be 3 months of imprisonment or fine uptomay be 3 months of imprisonment or fine uptoRs.500.00 or bothRs.500.00 or both
  7. 7. IntroductionIntroduction• In addition, during examination of the case aIn addition, during examination of the case amale/female attendant should be present for amale/female attendant should be present for amale patient and a female for a female patient.male patient and a female for a female patient.Otherwise the doctor may be charged withOtherwise the doctor may be charged withindecent assaultindecent assault under Sec.354 IPC and theunder Sec.354 IPC and thepunishment may be imprisonment upto 2 yearspunishment may be imprisonment upto 2 yearswith and/or finewith and/or fine• NextNext in the wardin the ward, the doctor is to examine the, the doctor is to examine thecase very carefully and treat the patient with acase very carefully and treat the patient with areasonable degree of skill, care and knowledge toreasonable degree of skill, care and knowledge toavoid charge of negligence.avoid charge of negligence.• BHT (bed head ticket)BHT (bed head ticket) is to be maintainedis to be maintainedproperly with care and skill. The doctor shouldproperly with care and skill. The doctor shouldgive proper and suitable prescription. He shouldgive proper and suitable prescription. He shouldmention the exact quantities and precise timingmention the exact quantities and precise timingfor taking medicinesfor taking medicines
  8. 8. IntroductionIntroduction• Here, may have to makeHere, may have to make “dying Declaration“dying Declaration”. It”. Itis a statement of a person, written or oral, whois a statement of a person, written or oral, whois dying as a result of some unlawful act.is dying as a result of some unlawful act.• The doctor is to assess that the patient is inThe doctor is to assess that the patient is ingood mental condition before the declaration isgood mental condition before the declaration isrecorded. The declaration is made in questionrecorded. The declaration is made in questionand answer form.and answer form.• The declaration should be noted down inThe declaration should be noted down inverbatim or the patient in presence of twoverbatim or the patient in presence of tworeasponsible witnesses. It should be signed byreasponsible witnesses. It should be signed bythe doctor, the patient and the witnesses.the doctor, the patient and the witnesses.
  9. 9. IntroductionIntroduction• Another important medicolegal duty of theAnother important medicolegal duty of thedoctors in the ward, is to help in the preparationdoctors in the ward, is to help in the preparationofof “Dying Deposition“Dying Deposition”.”.• It is the statement of a dying man, before aIt is the statement of a dying man, before aMagistrate and the accused or his Counsel, onMagistrate and the accused or his Counsel, onOath. In a ward, it is a bed side court.Oath. In a ward, it is a bed side court.• Here, the doctor has to certify the mental andHere, the doctor has to certify the mental andphysical fitness of the patient to make such aphysical fitness of the patient to make such astatement.statement.
  10. 10. IntroductionIntroduction• Now, in the operation theatre,Now, in the operation theatre, the doctor inthe doctor incharge of the operation should be very carefulcharge of the operation should be very carefulbefore going to operation properbefore going to operation proper..• He should note that all the formalities haveHe should note that all the formalities havebeen completed. Thebeen completed. The written consentwritten consent of theof thepatient and the guardian should be taken beforepatient and the guardian should be taken beforegoing for operation.going for operation.• Before closing the operation, theBefore closing the operation, the swab countswab countand the instrument count should be made soand the instrument count should be made sothat none of them remains in the operationthat none of them remains in the operationfield.field.
  11. 11. IntroductionIntroduction• If any one of them remains in side the operationIf any one of them remains in side the operationarea, the doctor may be charged with criminalarea, the doctor may be charged with criminalnegligence undernegligence under “Res Ipsa Loquitur“Res Ipsa Loquitur” which” whichmeans “The thing speaks of itself”.means “The thing speaks of itself”.• The doctor may be charged with criminalThe doctor may be charged with criminalnegligence undernegligence under Sec.304A IPCSec.304A IPC causing the deathcausing the deathof any person by doing rash and negligent act notof any person by doing rash and negligent act notamounting to culpable homicide and theamounting to culpable homicide and thepunishment is imprisonment upto 2 years or withpunishment is imprisonment upto 2 years or withfine or with both.fine or with both.• In addition, administrative proceedings will startIn addition, administrative proceedings will startagainst the doctor and he may be dismissed fromagainst the doctor and he may be dismissed fromthe service and his name may be erased from thethe service and his name may be erased from theState Medical Council.State Medical Council.
  12. 12. Duty to take consent inDuty to take consent inmedical practice: -medical practice: -• Consent meansConsent means voluntary agreementvoluntary agreement, compliance, complianceor permission when a patient is coming to aor permission when a patient is coming to adoctor for treatment, the consent is implied.doctor for treatment, the consent is implied.There is no need of taking written consent.There is no need of taking written consent.• But in someBut in some special cases written consentspecial cases written consent isisrequired. In criminal cases, the victim and therequired. In criminal cases, the victim and theaccused can not be examined without his/heraccused can not be examined without his/herwritten consent. The court also can not compel awritten consent. The court also can not compel aperson to get medically examined against his/herperson to get medically examined against his/herwill.will.• A)A) In case of rapeIn case of rape, the victim should not be, the victim should not beexamined without her written consent.examined without her written consent.• B) In medicolegal cases ofB) In medicolegal cases of pregnancy, deliverypregnancy, deliveryand abortionand abortion, the woman should not be examined, the woman should not be examinedwithout her written consent.without her written consent.
  13. 13. ConsentConsent• But theBut the convicted person can be examinedconvicted person can be examinedwithout his/her consent by applyingwithout his/her consent by applyingreasonable forcereasonable force. Because the convicted. Because the convictedperson has no civil right.person has no civil right.• Different consenting age: -Different consenting age: -• For medicolegal examinationFor medicolegal examination 1212 years andyears andabove.above.• For sexual intercourseFor sexual intercourse 1616 years and above.years and above.• For operation to suffer any bodily harmFor operation to suffer any bodily harm 1818years and above.years and above.• A childA child under 12 yearsunder 12 years of age and anof age and an insaneinsaneperson can not give valid consent.person can not give valid consent.
  14. 14. Requirement of consentRequirement of consent :-:-• In various field of medical practice writtenIn various field of medical practice writtenconsent is required. Only some example areconsent is required. Only some example aregiven here :-given here :-• ForFor contraceptive sterilizationcontraceptive sterilization written consent ofwritten consent ofboth the husband and wife should be obtained.both the husband and wife should be obtained.• ForFor artificial inseminationartificial insemination written consent of bothwritten consent of boththe donor and the recipient side should bethe donor and the recipient side should beobtained.obtained.• ForFor medical termination of pregnancymedical termination of pregnancy the writtenthe writtenconsent should be obtained from the woman asconsent should be obtained from the woman aswell as from the guardian.well as from the guardian.
  15. 15. • ForFor organ transplantationorgan transplantation, the organ of the dead, the organ of the deadperson should not be removed without theperson should not be removed without theconsent of the person having lawful possessionconsent of the person having lawful possessionof the body.of the body.• Pathological autopsyPathological autopsy should not be conductedshould not be conductedwithout the consent of the guardian or legalwithout the consent of the guardian or legalheirs of the deceased. But for medicolegalheirs of the deceased. But for medicolegalautopsy no consent is required. Only inquest isautopsy no consent is required. Only inquest issufficient to hold this autopsy.sufficient to hold this autopsy.• In case ofIn case of emergencyemergency, no consent is required to, no consent is required tosave the life of the patient in good faith.save the life of the patient in good faith.• If the doctor fails to follow these rules ofIf the doctor fails to follow these rules ofconsent, he may be charged with professionalconsent, he may be charged with professionalnegligence (malpractice) both civil and criminalnegligence (malpractice) both civil and criminalnegligence. The punishment may be issuing ofnegligence. The punishment may be issuing ofwarning noticewarning notice for infamous conduct, erasure offor infamous conduct, erasure ofnames civil negligence and criminal negligencenames civil negligence and criminal negligencewhere the patient dies after operation and thewhere the patient dies after operation and theconsent has not been taken.consent has not been taken.
  16. 16. Suspected PoisoningSuspected Poisoning• In case ofIn case of homicidal poisoninghomicidal poisoning, the doctor is duty, the doctor is dutybound to inform the police officer or thebound to inform the police officer or theMagistrate. But the doctor should confirm hisMagistrate. But the doctor should confirm hissuspicion before expressing an opinion. For thissuspicion before expressing an opinion. For thishe must :he must :• (a)(a) CollectCollect urine, vomit and faeces and submit forurine, vomit and faeces and submit foranalysis.analysis.• (b) Carefully observe and record the(b) Carefully observe and record the symptomssymptoms ininrelation to food.relation to food.• (c) Consult in strict confidence with(c) Consult in strict confidence with seniorseniorpractitioner.practitioner.• (d) Either remove the patient to hospital or(d) Either remove the patient to hospital orengage nurses of his confidence.engage nurses of his confidence.• (e) Any(e) Any suspected articlessuspected articles of good, excreta andof good, excreta andstomach wash samples should be preserved.stomach wash samples should be preserved.
  17. 17. Suspected PoisoningSuspected Poisoning• Non-compliance is punishable under Sec.201 IPCNon-compliance is punishable under Sec.201 IPCif it is proved that the doctor did it with theif it is proved that the doctor did it with theintention of protecting the accusedintention of protecting the accused. If the doctor. If the doctoris sure that the patient is suffering from suicidalis sure that the patient is suffering from suicidalpoisoning, he is not bound to inform the police.poisoning, he is not bound to inform the police.• If the doctor is summoned by the investigatingIf the doctor is summoned by the investigatingpolice officer, he is bound to give all informationpolice officer, he is bound to give all informationregarding the case that has come to his notice.regarding the case that has come to his notice.• If heIf he conceals the information, he is liable to beconceals the information, he is liable to beprosecuted under Sec.202 IPCprosecuted under Sec.202 IPC if he gives falseif he gives falseinformation, he is liable to be charged with theinformation, he is liable to be charged with theoffence of giving false information under Sec.193offence of giving false information under Sec.193IPC.IPC.
  18. 18. Suspected PoisoningSuspected Poisoning• A government medical officer is required toA government medical officer is required toreport to police all the cases of suspectedreport to police all the cases of suspectedpoisoning, whether accidental suicidal orpoisoning, whether accidental suicidal orhomicidal in nature.homicidal in nature.• If a case of suspected poisoning dies, deathIf a case of suspected poisoning dies, deathcertificate should not be issued but deathcertificate should not be issued but deathdeclaration should be made and it should bedeclaration should be made and it should becommunicated to the nearest police station.communicated to the nearest police station.
  19. 19. Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• A criminal abortion is the induced destruction andA criminal abortion is the induced destruction andexpulsion of the foetus from the womb of theexpulsion of the foetus from the womb of themother unlawfully when there ismother unlawfully when there is no therapeuticno therapeuticindication for the operation.indication for the operation.• The doctor’s duty in this case is to guard all theThe doctor’s duty in this case is to guard all theinformations obtained by him as ainformations obtained by him as a professionalprofessionalsecrecysecrecy. He must urge the patient to make a. He must urge the patient to make astatement about the induction of criminalstatement about the induction of criminalmiscarriage.miscarriage.• If she refuses to make a statement, he shouldIf she refuses to make a statement, he shouldnot pursue the matter. He must treat her to thenot pursue the matter. He must treat her to thebest of his ability. He must consult a professionalbest of his ability. He must consult a professionalcolleague.colleague.
  20. 20. Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• If theIf the woman dieswoman dies,, he should not issue a deathhe should not issue a deathcertificatecertificate, but should inform the police for, but should inform the police formaking arrangement for postmortemmaking arrangement for postmortemexamination.examination.• Under sec. 312 IPC whoeverUnder sec. 312 IPC whoever voluntarily causesvoluntarily causescriminal miscarriagecriminal miscarriage is liable for imprisonmentis liable for imprisonmentupto 3 years and or fine and if the woman isupto 3 years and or fine and if the woman isquick with the child the imprisonment mayquick with the child the imprisonment mayextended upto 7 years.extended upto 7 years.• In this case,In this case, bothboth the person procuring thethe person procuring themiscarriage and the woman aremiscarriage and the woman are liableliable forforpunishment. If this case, both the personpunishment. If this case, both the personprocuring the miscarriage and the woman areprocuring the miscarriage and the woman areliable for punishment.liable for punishment.
  21. 21. Duty of a doctor in a case ofDuty of a doctor in a case ofcriminal abortion :-criminal abortion :-• If the miscarriage is causedIf the miscarriage is caused without thewithout theconsentconsent of the woman, the imprisonmentof the woman, the imprisonmentmay be upto 10 years under Sec.313 IPC.may be upto 10 years under Sec.313 IPC.• If the woman diesIf the woman dies from the act of criminalfrom the act of criminalabortions, the punishment is upto 10 yearsabortions, the punishment is upto 10 yearsunder sec.314 IPC, under sec.316 IPCunder sec.314 IPC, under sec.316 IPCcausing death of quick unborn child bycausing death of quick unborn child byany act amounts to culpable homicide, andany act amounts to culpable homicide, andthe punishment may extend upto 10 yearsthe punishment may extend upto 10 yearsof imprisonment.of imprisonment.
  22. 22. The civil and criminalThe civil and criminalnegligencenegligence• Professional negligenceProfessional negligence is absence of reasonableis absence of reasonabledegree of care and skill or willful negligence of adegree of care and skill or willful negligence of amedical practitioner, in the statement of a patientmedical practitioner, in the statement of a patientso as to lead bodily injury of death of the patient.so as to lead bodily injury of death of the patient.• The question ofThe question of civil negligencecivil negligence will come,will come,when a patient in case of death, any relative bringwhen a patient in case of death, any relative bringsuit in a civil court for realization of compensationsuit in a civil court for realization of compensationfrom his doctor, if he has suffered injury due tofrom his doctor, if he has suffered injury due tonegligence.negligence.• Similarly the doctor can bring a civil suit forSimilarly the doctor can bring a civil suit forrealization of his fees from the patient or hisrealization of his fees from the patient or hisrelatives who refused to pay the same on therelatives who refused to pay the same on theground of professional negligence.ground of professional negligence.
  23. 23. Examples of civil negligenceExamples of civil negligence• Loss of earning of the patient due to negligent act of theLoss of earning of the patient due to negligent act of theattending doctor.attending doctor.• Expenses incurred eg. Hospital expenses, specialExpenses incurred eg. Hospital expenses, specialinvestigation, special diet, etc.investigation, special diet, etc.• Reduction of expectation of life of the patient due toReduction of expectation of life of the patient due towrong treatment.wrong treatment.• Reduced enjoyment of life of the patient.Reduced enjoyment of life of the patient.• Pain and suffering, either physical or mental.Pain and suffering, either physical or mental.• Loss of potencyLoss of potency• Death of the patient.Death of the patient.
  24. 24. • A doctor is not liable for an error ofA doctor is not liable for an error ofjudgement or of diagnosis, if he hasjudgement or of diagnosis, if he hassecured all necessary data in which tosecured all necessary data in which tobase abase a sound judgementsound judgement..• Contributory negligenceContributory negligence on the part of aon the part of apatient is very good defence forpatient is very good defence fornegligence.negligence.
  25. 25. Criminal negligenceCriminal negligence• Criminal negligence occurs when the physicianCriminal negligence occurs when the physicianexhibits gross lack of competency, grossexhibits gross lack of competency, grossinattention, criminal indifference to the patient’sinattention, criminal indifference to the patient’ssafety or gross negligence in the secretion andsafety or gross negligence in the secretion andapplication of remedies.application of remedies.The followings are some examples of the criminalThe followings are some examples of the criminalnegligence :-negligence :-• Gross mismanagement of the delivery of aGross mismanagement of the delivery of awoman.woman.• Gross incompetentGross incompetent administration of a generaladministration of a generalanaesthesiaanaesthesia
  26. 26. Criminal negligenceCriminal negligence• Administration of a wrong medicine in toAdministration of a wrong medicine in tothe eye causing loss of vision.the eye causing loss of vision.• Amputation of wrong finger or operationAmputation of wrong finger or operationon a wrong limb.on a wrong limb.• Leaving instruments, tubes, sponges orLeaving instruments, tubes, sponges orswab in abdomen.swab in abdomen.• Performing criminal abortionPerforming criminal abortion
  27. 27. • A single professional act by a physician mayA single professional act by a physician maysubject him tosubject him to both civil and criminal liabilityboth civil and criminal liability, eg,, eg,if a physician performs an unauthorizedif a physician performs an unauthorizedoperation on a patient, he may be sued civilly foroperation on a patient, he may be sued civilly fordamages and prosecuted criminally for assault.damages and prosecuted criminally for assault.• The doctor may have to pay damages in termsThe doctor may have to pay damages in termsof monetary fine as well as convicted forof monetary fine as well as convicted forcriminal negligence undercriminal negligence under Sec.304A IPCSec.304A IPC withwithimprisonment upto 2 years or with fine or withimprisonment upto 2 years or with fine or withboth.both.
  28. 28. • Lastly, another very important medicolegal dutyLastly, another very important medicolegal dutyof the doctors is to hold medicolegalof the doctors is to hold medicolegalpostmortem examination and to examine thepostmortem examination and to examine thevictim girl and the accusedvictim girl and the accused person.person.• Every doctor who has permanent registrationEvery doctor who has permanent registrationnumber of State Medical Council is entitled to donumber of State Medical Council is entitled to dothis job.this job.• Although, it is the job of service doctor, theAlthough, it is the job of service doctor, theprivate practitioner may be asked to do this jobprivate practitioner may be asked to do this jobduring National Emergencyduring National Emergency. Hence, here is some. Hence, here is someidea about it.idea about it.
  29. 29. Cases for medico legalCases for medico legalpostmortem examinationpostmortem examination• All unnatural death cases.All unnatural death cases.• Sudden death, where cause of death isSudden death, where cause of death isnot known.not known.• All cases of death due to poisoning.All cases of death due to poisoning.• Traffic accidents death cases.Traffic accidents death cases.• Traffic accidents death cases.Traffic accidents death cases.• Death occurring during operation orDeath occurring during operation orunder anaesthesia.under anaesthesia.
  30. 30. Cases for medico legalCases for medico legalpostmortem examinationpostmortem examination• Death occurring inDeath occurring in prisonprison, police custody, jail, police custody, jailcustody, asylum, Borstal school, etc. Here,custody, asylum, Borstal school, etc. Here,postmortem examination is to be done underpostmortem examination is to be done underVideo Photography as per directive of HumanVideo Photography as per directive of HumanRights Commission.Rights Commission.• In case ofIn case of dowry deathsdowry deaths. Here, postmortem. Here, postmortemexamination is preferably to be conducted atexamination is preferably to be conducted atleast by two doctors.least by two doctors.• Death certified as due toDeath certified as due to postoperativepostoperative shock orshock orhaemorrhage.haemorrhage.• InIn exhumationexhumation cases.cases.• Before holding medicolegal autopsy inquest isBefore holding medicolegal autopsy inquest isrequired from the police authority or Magistraterequired from the police authority or Magistrate
  31. 31. LEGAL PROBLEMS FACED BYLEGAL PROBLEMS FACED BYTHE DOCTORS .THE DOCTORS .• In the past, litigations were less in India,In the past, litigations were less in India,because people were not aware of their rights.because people were not aware of their rights.In developed countries like U.S.A. , U.K., CanadaIn developed countries like U.S.A. , U.K., Canadaetc., there is Medical Law specially for medicaletc., there is Medical Law specially for medicalprofession.profession.• Unfortunately, there is nothing like Medical LawUnfortunately, there is nothing like Medical Lawin India; so litigations are based on criminal Law,in India; so litigations are based on criminal Law,Law of Torts, Law of Contracts, Consumers’Law of Torts, Law of Contracts, Consumers’Protection act, etc.Protection act, etc.• Medical Law does not mean doctor’sMedical Law does not mean doctor’snegligence. It includes doctor-patientnegligence. It includes doctor-patientrelationship, their duties and rights, M.T.P. Act.relationship, their duties and rights, M.T.P. Act.Family Planning etc. etc.Family Planning etc. etc.
  32. 32. LEGAL PROBLEMS FACED BYLEGAL PROBLEMS FACED BYTHE DOCTORSTHE DOCTORS• When a doctor is showing absence ofWhen a doctor is showing absence ofreasonable degree of care and skill inreasonable degree of care and skill intreating his patient, he may be chargedtreating his patient, he may be chargedwith Civil negligence.with Civil negligence.• When a doctor is showing gross lack ofWhen a doctor is showing gross lack ofcompetency and gross in attention, hecompetency and gross in attention, hemay be charged with Criminal negligence.may be charged with Criminal negligence.So the doctors should possess some legalSo the doctors should possess some legalknowledge to protect themselves fromknowledge to protect themselves fromnegligence.negligence.
  33. 33. SOME LAWS IN RELATION TOSOME LAWS IN RELATION TOMEDICAL PRACTICEMEDICAL PRACTICE• Criminal Law.Criminal Law.• Civil Law.Civil Law.• Consumer Protection Act.Consumer Protection Act.• Medical CouncilsMedical Councils• Other Laws.Other Laws.
  34. 34. CRIMINAL LAWCRIMINAL LAWSECTIONSECTION OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS193 IPC193 IPC PerjuryPerjury Imprisonment upto 7Imprisonment upto 7yrs.+/- Fine.yrs.+/- Fine.197 IPC197 IPC Issuing FalseIssuing Falsecertificatecertificate-do--do-191 IPC191 IPC Hostile WitnessHostile Witness -do--do-354 IPC354 IPC Indecent assaultIndecent assault Imprisonment upto 2Imprisonment upto 2Yrs. +/- Fine.Yrs. +/- Fine.
  35. 35. SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment fromImprisonment from3 Yrs. To 10 yrs.3 Yrs. To 10 yrs.+/- Fine.+/- Fine.TOTO316 IPC316 IPC376 IPC376 IPC RapeRape Imprisonment upto 7Imprisonment upto 7yrs. May be 10yrs. May be 10yrs, may be lifeyrs, may be lifeimprisonment +/-imprisonment +/-fine.fine.
  36. 36. SECTIONSSECTIONS OFFENCESOFFENCES PUNISHMENTSPUNISHMENTS312 IPC312 IPC Criminal AbortionCriminal Abortion Imprisonment fromImprisonment from3 Yrs. To 10 yrs.3 Yrs. To 10 yrs.+/- Fine.+/- Fine.TOTO316 IPC316 IPC376 IPC376 IPC RapeRape Imprisonment upto 7Imprisonment upto 7yrs. May be 10yrs. May be 10yrs, may be lifeyrs, may be lifeimprisonment +/-imprisonment +/-fine.fine.497 IPC497 IPC AdulteryAdultery Imprisonment upto 5Imprisonment upto 5Yrs. +/- FineYrs. +/- Fine
  37. 37. The legal protection for DoctorsThe legal protection for Doctors• Sec.88 to 93 IPCSec.88 to 93 IPC• To follow the rules of consent.To follow the rules of consent.CIVIL LAWCIVIL LAW :-:-• This can be divided into TWO groups:-This can be divided into TWO groups:-• Law of ContractLaw of Contract• Law of Tort.Law of Tort.
  38. 38. (A)(A) LAW OF CONTRACTLAW OF CONTRACT• Here, there is a specific contract between aHere, there is a specific contract between apatient and a doctor, which may be ORAL,patient and a doctor, which may be ORAL,WRITTEN or IMPLIED one, under which theWRITTEN or IMPLIED one, under which thedoctor is supposed to treat the patient and thedoctor is supposed to treat the patient and thepatient is liable to pay the specific or reasonablepatient is liable to pay the specific or reasonablefees to the doctor.fees to the doctor.• In operative cases, usually the contract isIn operative cases, usually the contract isbetween surgeon and patient ONLY; andbetween surgeon and patient ONLY; andanaesthesists, cardiologists, paediatricians, andanaesthesists, cardiologists, paediatricians, andother doctors may NOT be a party.other doctors may NOT be a party.• They have an implied contract with the surgeonThey have an implied contract with the surgeononly. Hence the surgeon may be vicariously liableonly. Hence the surgeon may be vicariously liablefor his negligencefor his negligence
  39. 39. LAW OF TORTLAW OF TORT..• Certain duties are imposed on every personCertain duties are imposed on every personin the society irrespective of monetaryin the society irrespective of monetaryconsideration. Thus a doctor is also havingconsideration. Thus a doctor is also havingcertain specific duties towards his patient,certain specific duties towards his patient,paying or complimentary.paying or complimentary.• ““ If a doctor commits an act, which otherIf a doctor commits an act, which otherreasonable doctor of his standard would notreasonable doctor of his standard would notcommit; or a doctor OMITS to do somethingcommit; or a doctor OMITS to do somethingwhich other doctor would certainly do is awhich other doctor would certainly do is aNEGLIGENT ACT” . The doctor is liable for thatNEGLIGENT ACT” . The doctor is liable for thatunder Law of Tort.under Law of Tort.
  40. 40. CONSUMER PROTECTION ACTCONSUMER PROTECTION ACT ::• This act is most hot subject in the medicalThis act is most hot subject in the medicalworld today. This act is enacted in 1986 as a partworld today. This act is enacted in 1986 as a partof an international agreement seeking to provideof an international agreement seeking to providefor better protection to the interest of consumerfor better protection to the interest of consumerand to provide speedy and simple redressal toand to provide speedy and simple redressal toconsumer’s disputes.consumer’s disputes.• The purpose of the act :-The purpose of the act :-• To protect the interest of the consumers ofTo protect the interest of the consumers ofdifferent commodities for which they pay but dodifferent commodities for which they pay but donot get standard quality of service.not get standard quality of service.• Example – daily commodities of use, Banking,Example – daily commodities of use, Banking,Food Transport, Electricity supply et etc.Food Transport, Electricity supply et etc.• Procedure of lodging complaintsProcedure of lodging complaints :-:-
  41. 41. • At any centre mention below with/withoutAt any centre mention below with/withoutengaging a Lawyer and paying a nominal fees.engaging a Lawyer and paying a nominal fees.• AtAt District levelDistrict level – District Consumer Dispute– District Consumer DisputeRedressal Forum - to be chaired by a DistrictRedressal Forum - to be chaired by a DistrictJudge and two other members. CompensationJudge and two other members. Compensationtowards damagestowards damages upto Rs.20 lakhsupto Rs.20 lakhs• AtAt State levelState level – State Consumer Dispute– State Consumer DisputeRedressal Commission – chaired by a High courtRedressal Commission – chaired by a High courtJudge and two other members. CompensationJudge and two other members. Compensationaboveabove Rs.20 lakhs to 1 CroreRs.20 lakhs to 1 Crore..• AtAt National LevelNational Level – National consumer Dispute– National consumer DisputeRedressal Commission – chaired by a Judge ofRedressal Commission – chaired by a Judge ofSupreme Court and four other members.Supreme Court and four other members.CompensationCompensation more than Rs.1 Croremore than Rs.1 Crore..
  42. 42. Apprehensions :-Apprehensions :-• Bad doctor-patient relationship.Bad doctor-patient relationship.• Tendency for extensive laboratory investigation.Tendency for extensive laboratory investigation.• Tendency to make differentTendency to make differentIndemnity/Insurance policy for payingIndemnity/Insurance policy for payingcompensation.compensation.• The treating Physician will charge more from theThe treating Physician will charge more from thegeneral patients.general patients.
  43. 43. MEDICAL COUNCILMEDICAL COUNCIL..• A patient can file a complaint with theA patient can file a complaint with therespective council for doctor’s negligence.respective council for doctor’s negligence.Unfortunately the council has power to punishUnfortunately the council has power to punishthe doctor but does not have the power to orderthe doctor but does not have the power to ordercompensation even if the negligence is proved.compensation even if the negligence is proved.• The punishment which can be given to theThe punishment which can be given to thedoctor by the Medical Council/state Medicaldoctor by the Medical Council/state MedicalCouncil –Council –• Issuing a warning notice.Issuing a warning notice.• Temporary erasure of name from MedicalTemporary erasure of name from MedicalRegistrar.Registrar.• Permanent erasure of name from MedicalPermanent erasure of name from MedicalRegistrar.Registrar.
  44. 44. OTHER LAWS :OTHER LAWS :• Under M.T.P. Act, Drug Act, BombayUnder M.T.P. Act, Drug Act, BombayNursing Home act etc. patient can file aNursing Home act etc. patient can file acomplaint to the respective authority. Herecomplaint to the respective authority. Herealso they do not have power to orderalso they do not have power to ordercompensationcompensation
  45. 45. CONCLUSIONCONCLUSION :-:-• TO AVOID ALL THE MEDICOLEGALTO AVOID ALL THE MEDICOLEGALPROBLEMS CERTAIN PRECAUTIONS TO BEPROBLEMS CERTAIN PRECAUTIONS TO BETAKENTAKEN :-:-• Keep full and accurate Medical Records.Keep full and accurate Medical Records.• Employ standard care and skillEmploy standard care and skill• Do not fail to get written informed consent.Do not fail to get written informed consent.• Diagnosis to be confirmed by laboratory tests.Diagnosis to be confirmed by laboratory tests.• Proper investigation to be advised.Proper investigation to be advised.• Proper immunization schedule to be followed.Proper immunization schedule to be followed.
  46. 46. • Sensitivity tests to be done where applicable.Sensitivity tests to be done where applicable.• When diagnosis is obscure consult anotherWhen diagnosis is obscure consult anothersenior/specialists.senior/specialists.• Do not criticize another practitioner.Do not criticize another practitioner.• To check the condition of the equipmentTo check the condition of the equipmentfrequently.frequently.• The drug to be identified with expiry dateThe drug to be identified with expiry datebefore introduction.before introduction.• The patient must not be abandoned.The patient must not be abandoned.• No female patient should be examinedNo female patient should be examinedwithout any female attendant.without any female attendant.• Anaesthesia should be given by a qualifiedAnaesthesia should be given by a qualifiedperson.person.• NEVER GUARANTEE A CURE.NEVER GUARANTEE A CURE.
  47. 47. PROTOCOL FOR POLICE CASES &PROTOCOL FOR POLICE CASES &RAPE/SEXUAL ASSAULT.RAPE/SEXUAL ASSAULT.• A patient when comes to ER/OPD of Govt.A patient when comes to ER/OPD of Govt.Hospital C/O any injury/Accidental/Self-Hospital C/O any injury/Accidental/Self-Infected/Homicidal/Poisoning/Sex assault/BurnInfected/Homicidal/Poisoning/Sex assault/Burninjury etc. proper reporting in papers suppliedinjury etc. proper reporting in papers suppliedfrom Police Dept. – the named as indoor Policefrom Police Dept. – the named as indoor Policecases/outdoor police cases where history takencases/outdoor police cases where history takenand other points are written.and other points are written.• The form should be properly filled up withThe form should be properly filled up withsignature of patient/patient party and witnesssignature of patient/patient party and witnessshould be taken marks of identification of patientshould be taken marks of identification of patientshould be noted.should be noted.• The size of injury in which part of the body theThe size of injury in which part of the body theinjury is present. Age of injury, type of weaponinjury is present. Age of injury, type of weaponused should be noted.used should be noted.• If there are minor injury patient should beIf there are minor injury patient should betreated properly at ER with advice to attendtreated properly at ER with advice to attendSOPD/OPD next morning and or to attend ER inSOPD/OPD next morning and or to attend ER in
  48. 48. If patient is unconscious andIf patient is unconscious andunknown thenunknown then• Name of persons brought the patientName of persons brought the patientshould be noted with full address and theirshould be noted with full address and theirsignature should be taken.signature should be taken.• The valuable materials with the patientThe valuable materials with the patientshould be seized. These should beshould be seized. These should beproperly packed labeled and handed overproperly packed labeled and handed overto Ward Master with records kept in theto Ward Master with records kept in theward.ward.
  49. 49. Other special points which shouldOther special points which shouldbe done in the ward.be done in the ward.• After receiving the patient in the ward the doctorAfter receiving the patient in the ward the doctorand Nurse should note for –and Nurse should note for –– Airway – if obstruction, proper managementAirway – if obstruction, proper management– Bleeding – if present, proper managementBleeding – if present, proper management– Cardiac – condition of the heart should be noted withCardiac – condition of the heart should be noted withB.P./Pulse.B.P./Pulse.• The weapon should be seized. It should beThe weapon should be seized. It should benoted that whether the patient come alone ornoted that whether the patient come alone orwith some persons.with some persons.• If police personnel brought the patient then hisIf police personnel brought the patient then hisname should be written in the form.name should be written in the form.
  50. 50. RAPE/SEXUAL ASSAULTRAPE/SEXUAL ASSAULT• The victims and accused should be examined as perThe victims and accused should be examined as perwritten prayer or/and order from Honorable Magistratewritten prayer or/and order from Honorable Magistrate(S.D.J.M.).(S.D.J.M.).• The written consent of victim and accused must beThe written consent of victim and accused must betaken in form.taken in form.According to the Bureau of Police research andAccording to the Bureau of Police research andDevelopment the number of rape cases per lakhDevelopment the number of rape cases per lakhpopulation has risen continuously in India over the year,population has risen continuously in India over the year,• the highest volume of rape cases was registered in Sikkimthe highest volume of rape cases was registered in Sikkimfollowed by Jammu and Kashmir, Madhya Pradesh, Assamfollowed by Jammu and Kashmir, Madhya Pradesh, Assamand West Bengal.and West Bengal.• Among the major cities in India Delhi has shown theAmong the major cities in India Delhi has shown thehighest number of rape cases in one year followed byhighest number of rape cases in one year followed byBombay compared to other metropolitan cities in theBombay compared to other metropolitan cities in theworld.world.
  51. 51. What is Rape?What is Rape?• Rape is defined as an unlawful carnal knowledgeRape is defined as an unlawful carnal knowledgeof a female for and against her will.of a female for and against her will.• Carnal knowledge is defined as penetration ofCarnal knowledge is defined as penetration ofgenitalia no matter how slight by the penisgenitalia no matter how slight by the penisoccurs while the female is sleeping unconsciousoccurs while the female is sleeping unconsciousor under the influence of alcohol or drugs.or under the influence of alcohol or drugs.• A male who is sexually assaulted is sodomized.A male who is sexually assaulted is sodomized.• Sodomy is oral or anal penetration.Sodomy is oral or anal penetration.
  52. 52. Nursing AlertNursing Alert :-:-• The management of the sexual assault isThe management of the sexual assault isimportant but immediate physical health shouldimportant but immediate physical health shouldbe ensured first.be ensured first.• A complete primary and focused assessmentA complete primary and focused assessmentshould take place being alert for signs of internalshould take place being alert for signs of internalhaemorrhage, shock or respiratory distress buthaemorrhage, shock or respiratory distress butvictim is suffering from trauma in the form ofvictim is suffering from trauma in the form ofphysical assault the trauma should be managedphysical assault the trauma should be managedin the order of established priorities.in the order of established priorities.• Most emergency department have commerciallyMost emergency department have commerciallyprepared rape evidence collection kits as well asprepared rape evidence collection kits as well aswritten protocols for the treatment of injuries,written protocols for the treatment of injuries,legal documentation and sexually transmittedlegal documentation and sexually transmitteddisease and pregnancy prevention.disease and pregnancy prevention.
  53. 53. Interviewing the patient :-Interviewing the patient :-• Consent should be obtained for the examinationConsent should be obtained for the examinationof collecting of swab/evidence for release ofof collecting of swab/evidence for release ofinformation to law enforcement agencies.information to law enforcement agencies.• Record history of event in the patient’s ownRecord history of event in the patient’s ownwords.words.• Ask the patient has bathed, gargled or brushedAsk the patient has bathed, gargled or brushedteeth changed clothes or urinated defaecatedteeth changed clothes or urinated defaecatedsince attack – may alter interpretation ofsince attack – may alter interpretation ofsubsequent findings.subsequent findings.• Examine rectum for signs of trauma, blood andExamine rectum for signs of trauma, blood andsemen stains.semen stains.
  54. 54. Interviewing the patient :-Interviewing the patient :-• Record time of admission, time of examination,Record time of admission, time of examination,date and time of sexual assault and thedate and time of sexual assault and theappearance of the patient.appearance of the patient.• Document any evidence of trauma –Document any evidence of trauma –dislocation, bruises, laceration, secretion, torndislocation, bruises, laceration, secretion, tornand bloody clothing.and bloody clothing.• Record emotional state.Record emotional state.• All collected samples & records to beAll collected samples & records to beenveloped by sealed.enveloped by sealed.
  55. 55. Intervention : Preparing forIntervention : Preparing forphysical examinationphysical examination– Assist the patient to undress over a sheet large pieceAssist the patient to undress over a sheet large pieceof paper to obtain debris.of paper to obtain debris.– Protect patient against sexually transmitted diseasesProtect patient against sexually transmitted diseasessuch as gonorrhoea, H.I.V. etc.such as gonorrhoea, H.I.V. etc.– Immediately obtained (positive swab taken in theImmediately obtained (positive swab taken in theimmediate post rate period will only reflect existingimmediate post rate period will only reflect existingdisease).disease).– Place each item of clothing in a separate paper bagPlace each item of clothing in a separate paper bag(plastic bags promote moisture retention which may(plastic bags promote moisture retention which maylead to formation of mold and mildew which canlead to formation of mold and mildew which candestroy evidence).destroy evidence).• Label bags appropriately : give to appropriate lawLabel bags appropriately : give to appropriate lawenforcement authorities and has to be sealedenforcement authorities and has to be sealed
  56. 56. Physical ExaminationPhysical Examination..• Examine the patient ( from head to toe) for injuryExamine the patient ( from head to toe) for injuryespecially to the head, neck, breasts, thigh, back andespecially to the head, neck, breasts, thigh, back andbuttocks.buttocks.• Assess for external evidence of trauma (bruises,Assess for external evidence of trauma (bruises,laceration, stab wounds).laceration, stab wounds).• Inspect fingers for broken nails and tissue and foreignInspect fingers for broken nails and tissue and foreignmaterials under nails.materials under nails.• Document evidence of trauma with body diagrams orDocument evidence of trauma with body diagrams orphotographs.photographs.• Assist in conducting oral examination to determineAssist in conducting oral examination to determinesecretion status of patient compared with that ofsecretion status of patient compared with that ofassailant.assailant.• obtain a saliva specimenobtain a saliva specimen• take prescribed cultures of gum and tooth areas.take prescribed cultures of gum and tooth areas.
  57. 57. Providing follow-up services.Providing follow-up services.• Make an appointment for follow up surveillanceMake an appointment for follow up surveillancefor pregnancy, sexually transmitted disease andfor pregnancy, sexually transmitted disease andHIV counseling.HIV counseling.• The patient should be accompanied by familyThe patient should be accompanied by familymember or friend when leaving the health caremember or friend when leaving the health carefacility.facility.• Inform the patient for counseling services toInform the patient for counseling services toprevent long term psychological effects.prevent long term psychological effects.Counseling services should be made available toCounseling services should be made available tothe family.the family.
  58. 58. Obtaining LaboratoryObtaining LaboratorySpecimenSpecimen• Collect vaginal aspiration which is examine forCollect vaginal aspiration which is examine forpresence or absence motile/non-motile sperm.presence or absence motile/non-motile sperm.• Use sterile swab to draw from vaginal pool forUse sterile swab to draw from vaginal pool foracid phosphatase, blood group, antigen ofacid phosphatase, blood group, antigen ofsemen and precipitation test against humansemen and precipitation test against humansperm and blood.sperm and blood.• label all specimens with name of patient, date,label all specimens with name of patient, date,time of collection, body area from whichtime of collection, body area from whichspecimen was obtained and names of personnelspecimen was obtained and names of personnelcollecting specimens to preserve chain ofcollecting specimens to preserve chain ofevidence, give to designated person (crimeevidence, give to designated person (crimelaboratory) etc. and obtain an itemized receipt.laboratory) etc. and obtain an itemized receipt.
  59. 59. • Examination of the VictimExamination of the Victim ::• It must be remembered that the police or courtIt must be remembered that the police or courthas no power of compelling a women to showhas no power of compelling a women to showthe private parts of her person for examinationthe private parts of her person for examinationof medical practitioner, male or female.of medical practitioner, male or female.• Conclusion :Conclusion :• Rape has been described as :-Rape has been described as :-• ““ not an act of sex but an act of violence withnot an act of sex but an act of violence withsex as the primary weapon”. It may lead to asex as the primary weapon”. It may lead to awide variety of physical and psychologicalwide variety of physical and psychologicalreactions.reactions.
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