APPROACH TO HANDLING OF MEDICO-LEGAL CASES

1. APPROACH TO HANDLING OF
MEDICO-LEGAL CASES

2. PRESENTED BY--
1. AKSHAT JINDAL ( Roll no 5)
2. PRATIKSHA BARUAH (Roll no 6)
3. BHAGYASRI MODI (Roll no 7)
4. SHUBHAM PAUL (Roll no 8)
5. BISMITA PATGIRI (Roll no 9)
6. ABHISHEK KUMAR DHANDH (Roll no 10)
7. WASHIM UL ISLAM (Roll no 11)
8. SUDESHNA CHANDA (Roll no 12)
9. UTTAM KUMAR NATH (Roll no 13)
10. ARINDOM RAJBONSHI (Roll no 14)
11. PRASANTA GHOSH (Roll no 15)

3. CONTENTS
 What is medico legal case?
 Laws related to MLC

4. MEDICO LEGAL CASE
It can be defined as a case of injury in which investigations by the
Law-enforcing agencies are essential to fix the responsibilities
regarding the causation of the said injury.

5. WHICH CASE IS TO BOOKED AS ML?
Any case which was registered as Normal case may become
medicolegal case due to delayed allegations and suspicion of foul
play.

6. COMMON CASES
1. Accidental injury.
2. Alleged cases of assault.
3. Cases of burns.
4. Cases of alcoholic intoxication.
5. Unconscious/comatose patients.
6. Alleged criminal abortion.
7. Drug overdose/poisoning cases

7. LAWS RELATING TO MLC
1. INDIAN PENAL CODE (I.P.C), 1860:
It deals with substantive criminal law of India
 It defines offences and prescribes punishments.
2. CRIMINAL PROCEDURE CODE (Cr.P.C.), 1973
It provides mechanism for punishment of offences against the substantive
criminal law.

8. 3. INDIAN EVIDENCE ACT (I.E.A.), 1872
It deals with law of evidence and applies to all judicial proceedings in any
court.
4. CRIMINAL LAW
5. CIVIL LAW OR CASE LAW
6. COMMON LAW

9. Section 44 of IPC: Definition of Injury.
Section 319 IPC: Hurt.
321 IPC: Defines "Voluntarily Causing Hurt“
322 IPC: Defines "Voluntarily Causing Grievous Hurt“
323 IPC: Describes Punishment for Voluntarily Causing Hurt.
324 IPC: Describes Punishment for Voluntarily Causing Hurt by dangerous weapon
325 IPC: Describes Punishment for Voluntarily Causing Grievous Hurt.

10. DOCTOR AND MLC
Apart from his routine and usual "clinical" cases, a doctor will come across
certain 'Medico-legal‘ problems at one time or the other during the practice
of his profession.
Medico legal case (MLC) examination and reporting is one of the legal
responsibility of all doctors working in a hospital.

11. RECEIVING A MLC
A doctor can receive a medico-legal case in any of the four situations:-
1. A case is brought by the police for examination and reporting, or order
of the court for medical examination.
2. The person in question was already attended to by a doctor and a
medico-legal case was registered in the previous hospital, and the
person is now referred for expert management/ advice.
3. When patient himself expressing his intention to register a case against
the alleged accused.
4. After eliciting history and examining the patient, the attending doctor
feels that some investigation by law enforcement agencies is essential to
establish and fix responsibility for the case in accordance with the law of
the land.

12. MEDICO LEGAL CASE MANAGEMENT
1. IDENTIFICATION
2. REGISTRATION AND REPORTING
3. CASE EXAMINATION AND GIVING
OPINION
4. PREPARATION OF RECORD
5. INVESTIGATION AND TREATMENT
6. FINAL OPINION

13. IDENTIFICATION OF MLC

14. DEFINATION OF INJURY AND HURT

15. GRIEVOUS HURT
(SECTION 320 OF IPC)
1. Emasculation.
2. Permanent privation of the sight of either eye.
3. Permanent privation of the hearing of either ear.
4. Privation of any member or joint.
5. Destruction or permanent impairing of the powers of
any member or joint.
6. Permanent disfiguration of the head or face.
7. Fracture or dislocation of a bone or tooth.
8. Any hurt which endangers life or which causes the
sufferer to be during the space of twenty days in
severe bodily pain or unable to follow his ordinary
pursuits.

16.  The responsibility to label any case as an MLC rests solely
with the attending medical practitioner, and his first
priority must be to save the life of the patient.
 By the order of the Hon’ble Supreme Court of India, all
legal formalities to be suspended till the patient is
resuscitated .
 MLC should be registered as soon as the doctor suspects
foul play or feels its necessary to inform the police.
REGISTRATION AND REPORTING

17. REGISTRATION AND REPORTING

18. REPORTING OF MEDICO-LEGAL CASE

19. DYING DECLARATION
(Section 32 of The Indian Evidence Act)

20. EXAMINATION OF MLC

21. CONSENT
It means voluntary agreement, compliance or permission.
Consent signifies acceptance by a person of the
consequences of an act that is being carried out.

22. RULES OF CONSENT
 Consent is necessary for every medical examination.
 Oral consent should be obtained in presence of a disinterested
third party.
 Written consent should refer to one specific procedure & not
blanket permission on admission to hospital.
 The wordings in the consent form should include a phrase to
confirm that the patient has been informed of the nature of
procedure.
 In criminal cases, the victim cannot be examined without his/her
consent.
 In cases of drunkenness, consent is required but the person may be
examined without consent if requested by the sub-inspector of
police.

23. RULES OF CONSENT
 A person above 12 yrs can give consent for medical examination but for
consenting to procedures which are life threatening the age is 18years.
 In emergency cases where there is a threat to the life of patient any
procedure which is life saving can be adopted by the doctor without
consent if no one is available.
 The nature of illness of a patient should not be disclosed to any third
party without consent of the patient.
 For contraceptive sterilization consent of both husband & wife is
required.
 It is unlawful to detain an adult patient in hospital against his will. If he
demands discharge against medical advice, this should be recorded &
his signature obtained.

24. INFORMED CONSENT
 Benefits of treatment
 Risks of treatment
 Alternatives (other treatment options)
 No treatment (risks of)
 Documentation + signature(patient,
doctor, independent witness)

25. EXAMINATION OF PATIENT
 There should be detailed examination of the patient
including BP, Pulse, Consciousness, Respiration, Alertness.
 All injuries are to be properly described with the dimensions
and details of the margins of the wound, whether the wound
is bleeding or dried, etc.
 Colour change in any part of the body is to be clearly
mentioned along with the total number of wounds.
 Any injury to the sense organs should be noted.
 The examining doctor should give opinion on whether the
injury is simple or grievous and impression of the cause of
death if needed.

26. PREPERATION OF MLC REPORT
 These are reports prepared by a doctor on the request of the
investigating officer, usually in criminal cases, e.g., assault,
rape, murder, etc . when there is a requisition from a police
officer or Magistrate.
 These reports consists of two parts----
1. The facts observed on examination
2. The opinion drawn from the facts
 These reports will be attached to the file relating to the case
and will be produced in the court.

27.  It will not be admitted as evidence, unless the
doctor attends the Court and testifies to the facts
under oath.
 The opinion should be based on the facts observed
by himself, and not on information obtained from
other sources.
 It should be clear, concise, complete, legible and it
should avoid technical terms.
 Relevant negative information should also be given.
 The report should be given in duplicate using carbon
paper.

28. DESCRIPTION OF INJURIES AND
INVESTIGATION
 Type of weapon used i.e. blunt or sharp.
 Nature of injury either simple or grievous giving size, shape,
depth and margin.
 Probable cause of injury / condition.
 All MLC X-rays should be kept in department as evidence for
Court of Law.
 If special investigation is needed, samples like vomitus, vaginal
swab and DNA are collected, preserved with patient particulars
and a signed receipt has to be exchanged between the doctor
and the investigating officer.

30. TREATMENT AND TRANSFER OF MLC
 The patient should immediately be given treatment
without waiting for the medicolegal formalities of
reporting.
 Treatment to be started after examination and recording
of findings.
 For the transfer of patient under MLC, the Emergency
Medical Treatment and Active Labor Act 1986(EMTALA) Is
to be followed.

31. ADMISSION AND DISCHARGE
 Whenever a MLC is admitted or discharged, the same
should be informed to the nearest police station at the
earliest and this is done through the casualty
department of the concerned hospital.
 While discharging or referring the patient, care should
be taken to see that he receives the Discharge Card/
Referral letter , complete summary of admission, the
treatment given in the hospital and the instructions to
the patient to be followed after discharge.
 Police has to be informed before any said MLC patient
leaves the hospital.

32. ABSCOND/DEATH OF MLC

33. FINAL OPINION

34. POISIONING

35. POISON
POISON IS ANY SUBSTANCE (SOLID, LIQUID OR GASS),
WHICH when INTRODUCED IN a LIVING BODY by any
route, OR BROUGHT INTO CONTACT WITH ANY PART,
WILL PRODUCE ILL HEALTH OR DEATH, BY ITS
CONSTITUTIONAL OR LOCAL EFFECTS OR BOTH.

36. CLASSIFICATION POISON
CORROSIVES
STRONG ACIDS
STRONG
ALKALIS
METALLIC SALTS
IRRITANTS
AGRICULTURAL
INORGANIC
ORGANIC
SYSTEMIC
CEREBRAL
SPINAL
PERIPHERAL
CVS
ASPHYXIANTS
MISCELLANEOUS

37. Medicolegal HANDLINGof Poisoning
MEDICAL DUTIES
i. Assessment of condition of the patient
ii. Diagnosis, resuscitate and treatment (Emetics, Diuretics, Gastric lavage &
Specific antidote)
iii.Psychological counselling
LEGAL DUTIES
i. Note the patient particulars
ii. In suicidal or accidental poisoning, Doctors in private set up is not bound to
inform police
iii.In all cases of definite or suspected homicidal poisoning, Doctors in both
private and government sector must have to inform the nearby police station
under SEC 39 CrPC . Assist the police to determine the manner of death.
iv. If the patient’s condition is serious – Dying declaration is to be obtained.

38. v. PM Lividity
vi. Maintain details of written records of treatment in all cases of
poisoning
vii. In every case of poisoning, Doctor must preserve all the samples
which will helpful to the doctor in the court. If the Doctor fails to do the
same or deliberately omits any information, it will lead to sanction
under SEC 201 IPC for disappearance of evidence
viii. In case of death, don’t issue death certificate, instead advise
autopsy and inform police for further investigations.
ix. If the public eateries are sourced in case of food poisoning, PUBLIC
HEALTH AUTHORITIES should notified.

39. LAWS in india related
to POISON
 THE DRUGS AND COSMETICS ACT 1940
 THE DRUGS AND COSMETICS RULE 1945
 THE PHARMACY ACT 1948
 THE DRUGS CONTROL ACT 1950
 THE DRUGS AND MAGIC REMEDIES ACT 1954
 NARCOTIC DRUGS AND PSYCHOTROPIC
SUBSTANCES (NDPS) ACT 1985
 PREVENTION OF ILLICIT TRAFFIC IN
NARCOTIC DRUGS AND PSYCHOTROPIC
SUBSTANCES ACT 1988
SECTIONS RELATED TO
POISON
• IPC = 176, 177, 193, 201, 202,
284, 299, 300, 304A, 309, 320,
324, 326, 328
• CrPC = 39, 40, 175

40. MEDICOLEGAL HANDLING OF TRANSPORT
ACCIDENTS

41. INTRODUCTION
 Transport accident is any accident (or incident)
that occurs during any type of transportation,
including accidents occurring during road
transport, rail transport, and air transport. It can
refer to:
 A road traffic accident
 Railroad accidents (including train wreck)
 An aviation accident and incident.

42. ROAD TRAFFIC ACCIDENTS
 WHO defines RTA as “ an event occuring on a street , road or highway,in which atleast one motor
vehicle in motion is involved by collision or losing control and which causes physical injury or damage to
property.
 The road traffic accidents , injuries may be sustained to
 Pedestrians
 Cyclist/motorcyclist
 Occupants of a vehicle

 INJURIES TO PEDESTRIANS
 3 patterns of injuries are seen.
 Impact injuries – when the vehicle strikes the victim.
 Primary impact injuries – caused when the pedestrian is hit by projecting objects of the vehicle
 Secondary impact injuries – occurs due to a later impact with the same vehicle such as being lifted onto the
vehicle after primary impact or being run over.
 Secondary injuries – due to victim falling on the ground or striking any other stationary object.
 Runover injuries – due to vehicle running over some part of victim.

43.  INJURIES TO CYCLISTS AND MOTORCYCLISTS
 Primary injuries are mostly open fracture of the tibia and fibula.
 Secondary injuries are mostly fracture of the skull, ribs , cervical spine as well as
contusions of the brain.
 There may be graze abrasions due to sliding across the road.
 INJURIES TO OCCUPANTS OF VEHICLES
 In vehicular accidents ,the injuries that can occur are – head injuries like fracture
of skull , whiplash neck injury , steering wheel impact injury , fracture of knees and
pelvis etc.

44. INVESTIGATIONS IN RTA
 Examination of the accident scene
 Mechanical and engineering examination of the involved vehicles and of each
component whose failure could affect safety in motion
 Complete autopsy of all dead victims
 Physical and psychiatric examination of surviving drivers
 Personal and social histories of surviving person

45. AUTOPSY
 For the autopsy of road traffic accidents , the main objectives are--
 To construct the accident to determine its cause
 To find out the cause of death
 To find out the manner of death
 To establish identity of victims
 To identify the driver and reconstruct the position of the victims prior to accident
 To differentiate injuries caused by being hit from those caused by being run over.
 To identify the automobile in cases of hit and run
 To determine the significance of previous injuries in cases of delayed death.
 Severe blunt force injuries alone or in combination with minor natural disease will point to a traumatic cause
of death.
 The pattern of injuries and their circumstances of death will indicate whether the death is accidental ,
suicidal or homicidal .
 Sometimes minor trauma may be sufficient to cause death either by affecting diseased organs in a diseased
person or by affecting vital areas. E.g. Nervous center of brain or conduction system of heart.

46. CAUSES OF DEATH
Disease and accidents
Drugs and accidents
Psychology and accidents

47. MURDER BY MOTOR VEHICLE
 A crime may be committed with the help of an automobile in the following ways:
 Pre-meditated murder of a pedestrian with an automobile.
 HIT AND RUN
 Accident faked to conceal crime

48. Medicolegal Case Report in Road Traffic
Accidents
 The following details should be included :
 Full name, age, sex, occupation, date, and time, brought by whom and history of dying declaration whether
necessary or not.
 Mode of accident
 Time of accident
 Date of accident
 Condition of the patient after accident
 Condition of the patient at the time of admission
 3 identification marks preferable ( 2 identification marks must)
 Date, time, finding, and description of injury (accurate measurements), whether simple, grievous, or dangerous
, need to be recorded.
 The record of investigations performed on the patient like X-ray, USG, CT scan, and MRI must be maintained.
 Each page of the MLC report should bear the signature of the doctor and the patient, or a thumb impression of
the latter

49. IPC RELATED TO ROAD TRAFFIC
ACCIDENTS
 Sections 279, 304A, and 338 of IPC are imposed on the victims of hit-and-run incidents.
 Any person who drives vehicles rashly on the public road can be guilty of making an offense under Section
279. Imprisonment for 6 months, a fine of Rs 1000 or both can be imposed on a driver for rash driving or
injuring another person on the road. The offense committed under section 279 is bailable and is
cognizable by the district magistrate.
 If a driver who is not under the influence of alcohol leads to the death of a person in an accident, the
crime is reported under section 304A. The rider may face imprisonment for a year which may be
extended up to 2 years with a fine of more than Rs 1000 or both. 304A is a non-bailable offense, and an
individual can be convicted by lifetime imprisonment.
 In extreme cases, the police may also report a hit and drive case under 302, which is a section related to
the murder. A driver booked under Section 302, may face a death sentence or life imprisonment.

50. RAILWAY INJURIES
 Accidental Injuries:
 When the person walks on the track, primary injuries are seen on the front or the back, due to contact with the
protruding parts of the engine.
 Secondary injuries are produced due to being thrown or run over which are soiled with oil and dust.
 When the person is crossing the line, primary injuries are seen on the side of the head and shoulders.
 If the person is bending down, the primary injuries are seen on the back and the buttocks and secondary injuries on
the face and front of the body.
 When the person walks at the side of the line, the shoulder or head may be hit by some protruding part of the
train.
 When a person falls from the train, multiple injuries are produced.
 When a person leans out of the window, head injuries are produced due to railway fixtures, bridge abutments or
tunnel sides, etc., and the person may be found in the carriage or on the side of the track.
 Suicidal Injuries :
 The injuries are extensive and due to primary impact. If a person lies down on the track, extrusion of organs,
traumatic amputations of the limbs or trunk or decapitation may occur. Wheel marks and dirt and grease
contamination may be found on the body.
 Sometimes, a person is killed and the body placed on the railway track to simulate suicide or accident.

51. AIRCRAFT INJURIES
 Most of the aircraft accidents occur on landing (35%), or take-off (35%)
 CRASH ACCIDENT : Many types of injuries are seen, in the relatively intact bodies.
 a. Fracture spine, especially thoracic spine are very common.
 b. There may be fracture of the base of the skull, especially ring fracture.
 c. Fracture of the lower legs due to seat displacement is typical of the landing time accident, while
fracture of the femur and internal injuries due to vertical declaration indicates a deep still type of
accident.
 d. Intrathoracic injuries occur due to squeezing of chest by pressure against sternum.
 e. Rupture of other organs may occur.
 FLIGHT ACCIDENTS
 The cabins are pressurized to prevent anoxia while in flight.
 If a door or window breaks, cabin pressure falls and anoxia may produce death. The rush of air out of the
cabin is sufficient to blow a standing or even seated man out with it.
 The injuries vary from total disintegration of the body to relatively minor injuries.

52. ANAESTHETIC AND OPERATIVES DEATHS
 The deaths occurring inside the operation theatre often evoke
considerable distress to relatives of the patient and the subsequent
misgivings to the whole team involved in the operation comprising
of surgeons, anesthesiologists, nursing staff etc.

53. ASA CLASSIFICATION
 ASA -1 : Healthy individual
 ASA -2 : Patient with mild systemic disease.
 ASA -3 : Patient with severe systemic disease but not
incapacitating.
 ASA -4 : Patient with incapacitating severe systemic
disease with constant threat to life.
 ASA- 5 : A dying patient who is not expected to survive for
more than 24 hrs with/without anesthesia.

54. Causes of death
I. Vagal stimulation while intubation.
II. Faulty use of relaxants & hypotensive drugs.
III. Accidents causing airway obstruction.
IV. Effect of the drug.
V. Hypotension.
VI. Anaphylactic reaction.
VII. Using of hypoxic mixture of gases.

55. Deaths during administration of anaesthesia
but not due to anaesthesia
A. Deaths d/t injury or disease which
necessitated the procedure.
B. Deaths due to a disease other than for which
the operation was done & diagnosed before
operation.
C. Deaths due to a disease other than for which
the operation was done & not diagnosed
before operation.

56. Deaths due to administration of
anaesthesia
A. Respiratory failure.
B. Airway obstruction.
C. Pneumothorax.
D. Aspiration of gastric contents.
E. Equipment failure.
F. Cardiovascular failure.
G. Hypovolemia.

57. Investigation & autopsy of operative or
anaesthetic deaths
 History.
 Conditions requring surgery.
 Preexisting coronary artery disease.
 Preanaesthetic medications.
 Anaesthetic agents.
 Blood transfusion.
 Equipments used.

58. Autopsy:
1. External examination: For natural diseases,
evidence of therapy, odour of anaesthetic
agents.
2. Internal examination: Hypoxic changes.
3. Histological examination: Samples from heart,
liver, kidney, brain.
4. Toxicological investigations

59. Medicolegal Aspects
In order to minimize malpractice following should be
done:
1. Establish proper physician patient relationship.
2. Informed consent.
3. Maintenence of documentated records.
4. Application of reasonable care & skill prior to use of
new technologies.

60. ABORTION
 It can be defined as an expulsion of the products of
conception before the age of viability, i.e. 28 weeks of
pregnancy. For international credence, the limit of
viability is brought down to either 20 weeks or fetus
weighing 500 g.
 Abortion is a procedure to end a pregnancy. Legally, the
procedure is done by a licensed physician or someone
acting under the supervision of a licensed physician.

61. INCIDENCE
 > An estimated 44 million abortions are performed
globally each year, with slightly under half of those
performed unsafely.
 > However, unsafe abortions result in
approximately 70,000 maternal deaths and five million
disabilities per year globally.

62. The Medical Termination of Pregnancy Act passed in 1971 legalizes
abortions on the following grounds:
 Therapeutic
 Eugenic
 Humanitarian
 Social.

63. Therapeutic grounds
 When continuation of pregnancy endangers life of woman/ may cause severe
injury to her mental or physical health.
Eugenic grounds
 When there is risk of child being born with serious physical or mental
abnormality.
Humanitarian grounds
 Pregnancy caused by rape.
Social grounds
These relate to the conditions:
 When pregnancy in married women is the result of contraceptive failure
 When social or economic environment can injure mother health.

64. Rules for Doing MTP
 It can be done in hospitals maintained or established by government.
 Consent of the women/guardian(in case of minor or insane) is required
before abortion.
 Documentation and record should be maintained.

65. Method for Induction of MTP:
 Medical abortion
 Surgical abortion
 Criminal abortion

66. Legal Status of Criminal Abortion
 i. IPC 312: For causing miscarriage
 ii. IPC 313: For causing miscarriage without women's
consent
 iii. IPC 314: Death caused by an act done with intent to
cause miscarriage
 iv. IPC 315: Act done with intent to prevent child being
born alive or to cause it to die after birth
 v. IPC 316: Causing death of quick unborn child by act
amounting to culpable homicide

67. MEDICO LEGAL ASPECTS IN OPTHALMOLOGY
 Every ophthalmologist must be aware of the legal aspects of
practicing medicine and vice-versa.
 Lawsuits usually address medical negligence, inappropriate
diagnosis, and treatment.

68.  In various countries
including India,
cataract and corneal
surgeries account for
majority of the claims
filed in courts.
 The proportion of
retina related
malpractice claims is
less even though
retinal diseases may
have a poor prognosis
and outcomes.

69. Different laws
 Previously, the Transplantation of Human Organs Act
1994 mandated that cornea retrieval was to be done
by a registered medical practitioner.
 Recent amendment in 2014 states cornea to be a tissue
and not to be treated as an organ, which has
authorized trained technicians to harvest it
 Permanent privation of sight of either eye has been
termed as grievous injury, which makes it a punishable
offence under IPC SECTION 320

70. Prevention
 The present article has comprehensively described the various
medico legal issues faced by ophthalmologists in India. Potential
areas of vigilance include appropriate patient workup, OT
sterilization, anesthesia, and emergency resuscitation setup.
 Preventive steps can be taken at four levels to avoid
professional liability cases.

71. Medicolegal Decision making in noise
induced hearing loss related tinnitus
 In clinical practice, tinnitus is fairly
common symptom in patients with
chronic acoustic trauma and noise
induced hearing loss.
 However in some cases, tinnitus may
cause devastating effect on one's life
style and ability to work, it may
attract levels of compensation higher
than those for hearing loss

72. Levels and Decisions
 The method is proposed on the basis of ranked progression in decision
making. At each of 4 step, a fairly large number of elementary decision,
easily made and reproducible among different experts, leads to a higher
decision level.
 The 4 levels are worked through in progression from level 1 to level 4.
The 4 decision levels are structured as follows:
Level 4: Consists of 1 decision
Level 3: Consists of 4 decisions
Level 2: Consists of 12 decisions
Level 1: Consists of 65 decisions

73. Materials and methods
 1. From subjectivity to objectivity
Medicolegal decision making obviously must rely on maximal objectivity
Reports or indications about existence of tinnitus prior to any compensation
claim support reliability. Similarly, documents proving that the patient has sought
relief of tinnitus before making any claim for compensation are highly relevant in
this context.
 2. Interrater Reliability
To check for agreement among different experts of first level decisions and for
concordance in higher level decisions, we selected 10 exemplary files from
among the patient material of the institute of occupational disorders.

74.  Tinnitus is frequently associate with occupational
hearing loss and can be an additional item of claim
in countries applying a specific insurance system
for occupational disorder.

75. CONCLUSION

76. REMEMBER
Life saving is the foremost duty of a doctor and a hospital in
Medicolegal Cases.
Patient treatment is the first priority.
Medicolegal aspect is always secondary to life saving
treatment.