This document provides an overview of handling medico-legal cases. It discusses what constitutes a medico-legal case, common types of cases, relevant laws, and the process of managing a case which includes identification, registration, examination, investigation, treatment, preparing a final opinion. Specific issues like consent, injuries, autopsy, poisoning, and transport accidents are also covered. The presentation was made by 11 students providing information on approaching medico-legal cases.
This session was done in 2 nd EMS and Industrial Emergency Medicine conference in Ahammadabad in Feb 2020. The presentation explores how to asses the Key Performance in EMS and Ambulance Scenario.
Medico Legal implication of medical records-IndiaSrishti Bhardwaj
Medico legal liabilities related to patient records,
Medical Record committee and role of committee Hospital Utilization
Bed turnover ratio,
Average length of stay,
Death rate,
Bed occupancy rate
Unit 4- BVUCHMSR Portion (Sem-3)
This session was done in 2 nd EMS and Industrial Emergency Medicine conference in Ahammadabad in Feb 2020. The presentation explores how to asses the Key Performance in EMS and Ambulance Scenario.
Medico Legal implication of medical records-IndiaSrishti Bhardwaj
Medico legal liabilities related to patient records,
Medical Record committee and role of committee Hospital Utilization
Bed turnover ratio,
Average length of stay,
Death rate,
Bed occupancy rate
Unit 4- BVUCHMSR Portion (Sem-3)
The objective of this presentation is to make you aware of issues which are generally confronted during medical practice.
SOURCES OF LAWS:
PRIMARY SOURCES
Laws passed by the Parliament or the State Legislative
Ordinances passed by the President and the Governor
Subordinate legislation: Rules and regulations made by the executive through the power delegated to them by the Acts.
SECONDARY SOURCES:
Judgments of the Supreme Court, High Court and Tribunals (The ratio decedendi is a binding precedent)
Judicial legislation
Judgment of Foreign Courts
International Treaty
Medico Legal Responsibilities of Doctors
Registered medical practitioner (RMP) i.e. Emergency Medical Officer (EMO)/ Assistant Emergency Medical Officer (Asst. EMO) at Emergency should decide whether the case is to be registered as MLC or not.
Consent of family members NOT required for registration of a case as MLC.
Opinion Should be Crisp and to the Point. Articles Preserved and Should be Enumerated.Prepare Three Copies of The Document, One Copy is Kept at Emergency Room, other as Hospital Record.Original is Given to The Police.
If a MLC, recorded elsewhere (in other hospital) is referred, it should be treated as MLC but NO NEW MLC number should be issued. Treatment should continue in old MLC number. Neither a new MLR should be prepared nor is it needed to inform the police.
If a case is brought several days after the incident, it should be reported and findings to be noted regarding the present condition of the patient.
MLC can be written and signed by (EMO)/Asst. EMO /Faculty. Wherever possible, Faculty member should sign along with SR/JR if the report is prepared by them.
"whenever any medico-legal case comes to the hospital, the medical officer on duty should inform the Duty Constable, giving the name, age, sex of the patient and the place of occurrence of the incident and should start the treatment of the patient.
It will be the duty of the said Constable to inform the nearest concerned police station or higher police functionaries for further action.
In the presentation efforts have been made to guide the medical professionals how to deal with a MLC case in a step by step manner and certain issues relating to medical case records.
The objective of this presentation is to make you aware of issues which are generally confronted during medical practice.
SOURCES OF LAWS:
PRIMARY SOURCES
Laws passed by the Parliament or the State Legislative
Ordinances passed by the President and the Governor
Subordinate legislation: Rules and regulations made by the executive through the power delegated to them by the Acts.
SECONDARY SOURCES:
Judgments of the Supreme Court, High Court and Tribunals (The ratio decedendi is a binding precedent)
Judicial legislation
Judgment of Foreign Courts
International Treaty
Medico Legal Responsibilities of Doctors
Registered medical practitioner (RMP) i.e. Emergency Medical Officer (EMO)/ Assistant Emergency Medical Officer (Asst. EMO) at Emergency should decide whether the case is to be registered as MLC or not.
Consent of family members NOT required for registration of a case as MLC.
Opinion Should be Crisp and to the Point. Articles Preserved and Should be Enumerated.Prepare Three Copies of The Document, One Copy is Kept at Emergency Room, other as Hospital Record.Original is Given to The Police.
If a MLC, recorded elsewhere (in other hospital) is referred, it should be treated as MLC but NO NEW MLC number should be issued. Treatment should continue in old MLC number. Neither a new MLR should be prepared nor is it needed to inform the police.
If a case is brought several days after the incident, it should be reported and findings to be noted regarding the present condition of the patient.
MLC can be written and signed by (EMO)/Asst. EMO /Faculty. Wherever possible, Faculty member should sign along with SR/JR if the report is prepared by them.
"whenever any medico-legal case comes to the hospital, the medical officer on duty should inform the Duty Constable, giving the name, age, sex of the patient and the place of occurrence of the incident and should start the treatment of the patient.
It will be the duty of the said Constable to inform the nearest concerned police station or higher police functionaries for further action.
In the presentation efforts have been made to guide the medical professionals how to deal with a MLC case in a step by step manner and certain issues relating to medical case records.
detail knowledge of medico-legal cases, introduction,types, reports, consent,death certificate, patient right. it will help you to understand the concept of medico-legal cases
“Juris”- Law “Prudentia”- Knowledge . Therefore, Knowledge of Law
-In relation to practice of Medicine
-In relation with legal consequences
Medical Jurisprudence is also known as legal medicine.
Medical jurisprudence or legal medicine is the branch of science and medicine involving the study and application of scientific and medical knowledge to legal problems, such as inquests and in the field of law.
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judisprudence
legal medicine
dentistry
mbbs doctors
ethics
rules in medicine
medical practise
consents
autopsy
doctor patient state relation
medical negligence
biomedical
medical devices
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medico legal cases
dental course
dr. swostik devkota
bright line dental care
Medical records means and includes the record pertaining to the admission, diagnosis, treatment, investigation, daily progress, operations, consultations
A brief presentation on the Medicolegal aspects of healthcare initially intended for the students - Post Graduate Diploma in Hosp. Management (Medvarsity)
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Multi-source connectivity as the driver of solar wind variability in the heli...Sérgio Sacani
The ambient solar wind that flls the heliosphere originates from multiple
sources in the solar corona and is highly structured. It is often described
as high-speed, relatively homogeneous, plasma streams from coronal
holes and slow-speed, highly variable, streams whose source regions are
under debate. A key goal of ESA/NASA’s Solar Orbiter mission is to identify
solar wind sources and understand what drives the complexity seen in the
heliosphere. By combining magnetic feld modelling and spectroscopic
techniques with high-resolution observations and measurements, we show
that the solar wind variability detected in situ by Solar Orbiter in March
2022 is driven by spatio-temporal changes in the magnetic connectivity to
multiple sources in the solar atmosphere. The magnetic feld footpoints
connected to the spacecraft moved from the boundaries of a coronal hole
to one active region (12961) and then across to another region (12957). This
is refected in the in situ measurements, which show the transition from fast
to highly Alfvénic then to slow solar wind that is disrupted by the arrival of
a coronal mass ejection. Our results describe solar wind variability at 0.5 au
but are applicable to near-Earth observatories.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Richard's entangled aventures in wonderlandRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
THE IMPORTANCE OF MARTIAN ATMOSPHERE SAMPLE RETURN.Sérgio Sacani
The return of a sample of near-surface atmosphere from Mars would facilitate answers to several first-order science questions surrounding the formation and evolution of the planet. One of the important aspects of terrestrial planet formation in general is the role that primary atmospheres played in influencing the chemistry and structure of the planets and their antecedents. Studies of the martian atmosphere can be used to investigate the role of a primary atmosphere in its history. Atmosphere samples would also inform our understanding of the near-surface chemistry of the planet, and ultimately the prospects for life. High-precision isotopic analyses of constituent gases are needed to address these questions, requiring that the analyses are made on returned samples rather than in situ.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
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Thanks...!
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
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)
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
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
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.
29.
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.
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.
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
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.
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.
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.
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.