common mistakes in preparation of medicolegal cases

2. MEDICO-LEGAL CASE
 ~ is a case of injury/illness where the
attending doctor, after eliciting history
and examining the patient, thinks that
some investigation by law enforcement
agencies is essential to establish and fix
responsibilities for the case in
accordance with the law of the land.

3.  Medical Officers may commit some mistakes
on account of lack of
 Judgement,
 Knowledge & result in disastrous consequences
 Experience.
One must be very vigilant and cautious to avoid
any such mistakes which may lead on to
 ‘injustice’ to any of the parties, the injured or the
alleged accused and
 serious problems for the examining doctor.

4.  The present discussion on “Common mistakes in
dealing with medico-legal cases” has been derived
primarily from two sources.
 1. The mistakes committed by ME during my
earlier days in the field.
 2. The FEEDBACK obtained from my fellow
colleagues and Medical Officers working at
Primary Health Centres/Community Health
Centres/District hospitals;
 which I came across/learnt during my more than
24 years’ experience.

5. COMMON MISTAKES IN DEALING WITH MEDICO-
LEGAL CASE
1. Mistake of not being aware of the primary duty
2. Failure/negligence in providing no information
and/or delayed information to Police
3. Failure to report to Police certain medico-legal
cases
4. Acceding to request by the patient or the
accompanying relatives, not to register a MLC.
5. Refusing to attend a medico-legal case citing
jurisdiction problem
6. Examination without consent/inadequate
consent

6. COMMON MISTAKES IN DEALING WITH
MEDICO-LEGAL CASE (Cont.)
7. Failure to maintain professional secrecy
8. Examination of a female patient without the
presence of a female attendant
9. Unnecessary delay in documentation of a medico-
legal case
10. Clerical/Typing/Typographical mistakes in the
medico-legal reports
11. Use of short forms/abbreviations of various terms
such as LW, CLW, IW, ILW etc.
12. Failure to complete all details in the Medico-legal
reports
13. Cutting/overwriting in medico-legal reports

7. COMMON MISTAKES IN DEALING WITH MEDICO-
LEGAL CASE(Cont.)
14. Failure to note identification marks
15. Inadequate history
16. Inadequate and improper description regarding
General condition of the patient
17. Inadequate and improper examination of
clothes worn by the patient
18. Failure to preserve the clothes and necessary
samples
19. Inadequate and improper description of injuries
sustained by the patient

8. COMMON MISTAKES IN DEALING WITH
MEDICO-LEGAL CASE(cont.)
20. Influenced opinion regarding the kind of
weapon used, duration and nature of injuries
21. Issuing false, misleading, exaggerated or
inaccurate medico-legal reports
22. Failure to arrange for recording of dying
declaration of the patient
23. Failure to provide discharge card/referral letter
to the patient
24. Allowing taking away of body of a medico-legal
case dying in hospital or that of a brought in
dead case by relatives

9. 1. Mistake of not being aware of the
primary duty
a doctor owes the following duties in medico legal
cases: -
 1. Medical care and
 2. Legal responsibility.
Medical care gets priority especially when patient is
serious as the first and the foremost duty of the doctor
is to save the life of a patient and give necessary urgent
treatment.
All legal formalities stand suspended till the patient’s
life is out of danger. The duty of the doctor to provide
medical aid, even in medico-legal cases, has been
extended to the private doctors also as exemplified by
the High Court of Andhra Pradesh in Pattipati
Venkaiah Vs State of AP.

10. 1. Mistake of not being aware of the primary
duty(Cont.)
As per the Supreme Court Ruling (Parmananda
Katara Vs Union of India),
 no doctor shall refuse to treat a patient in
emergency. In the same case, the MCI filed an
affidavit stating “the MCI expects that all
registered medical practitioners must attend to
the sick and the injured immediately and it is the
duty of the medical practitioner to make
immediate and timely medical care available to
every injured person, whether he is injured in an
accident or otherwise…..Life of a person is far
more important than the legal formalities.”

11. 2. Failure/negligence in providing no information
and/or delayed information to Police
 Not informing the police of a medico-legal case
may invite trouble to the doctor u/s :-
 39 Cr.P.C.-- cases wherein public is duty-bound to
inform the police
 177 and 201 IPC---giving false information &
causing disappearance of evidence.
 Failure to do so is punishable u/s 176 IPC.
 Sec. 175 Cr.P.C.If police require information, the
doctor is bound to supply the information, failure
to do so is punishable.
 Sec. 193 Cr.P.C. Whereas giving false information to
the investigating agency is punishable.

12. 3. Failure to report to Police certain
medico-legal cases
Inexperienced doctors omit reporting certain
medico-legal cases like---
 Cases of attempted suicide
 Bites/injuries caused by animals
 Accidental strangulation
 Poisoning of small children
 Pregnancy of an unmarried girl
 Criminal abortion conducted by dais, quacks or
registered medical practitioners

13. 3. Failure to report to Police certain medico-legal
cases (Cont.)
 Electrical shock or lightening
 Natural disaster
 Unknown unconscious patients
 Trauma brought to the hospital in suspicious
circumstances,
 Drug overdose and drug abuse
 Industrial/factory accidents
 Accidental injuries like fall from a height, burial
under earth mound
It is advisable to inform the Police in all the above
cases even when an accident has occurred due to
patient’s mistake and nobody else is to be blamed.

14. 4. Acceding to request by the patient or
the accompanying relatives, not to register
a MLC.
 A doctor should never accede to the request by the
patient or the accompanying relatives of not
registering a medico-legal case.
 He should use his own judgment and experience.
If he thinks that the case needs to be reported to
the police, he should do so without any delay.

15. 5. Refusing to attend a medico-legal
case citing jurisdiction problem
 A Govt. Serving Doctor is duty bound to attend all
cases brought to him and he is supposed to
prepare the medico-legal report in all medico-
legal cases.
 A Private Practitioner cannot refuse to attend an
emergency case and he must provide emergency
treatment/first aid to any such patient. He cannot
refuse to attend a medico-legal case on the basis
of being a private practitioner or citing a
jurisdiction problem.

16. 6. Examination without
consent/inadequate consent
 Sometimes full informed consent is not obtained
from the patient or his/her legal guardians and
the doctors just get the thumb impression or
signatures of the injured or the accompanying
person without even knowing his exact
relationship with the patient.
 The accompanying person may sometimes be
offender i.e. responsible for causing injuries to
the patient, especially in cases where the patient
is drowsy, semiconscious or unconscious.

17. 6. Examination without
consent/inadequate consent (cont.)
 Consent taken from a drowsy or semiconscious
patient is not valid.
 Many a times, the purpose of the medico-legal
examination is not explained to the patient or his
relatives.
 It is advisable that the doctor should always take
informed written consent of the patient which
includes information that the examination to be
conducted would be a medico-legal one and
would culminate in the preparation of a medico-
legal injury report.

18. 7. Failure to maintain professional
secrecy
A doctor has a legal and ethical duty to keep
information about his patients confidential,
unless the following instances prevail (privileged
communication):
 Patient himself consents to the disclosure.
 Disclosure is required by law.
 Disclosure is necessary in the public interest.

19. 8. Examination of a female patient without
the presence of a female attendant
 A female patient, even if she is not a medico-legal
case, should not be examined without the
presence of a female relative of the patient or a
woman hospital attendant.

20. 9. Unnecessary delay in
documentation of a medico-legal case
 Medico-legal report (MLR) should be prepared by
the examining Medical Officer immediately/as
early as possible, after the examination is done.
 In no case the injury report form should be filled
by any person other than the doctor on duty (e.g.
an intern) in the Accident & Emergency
department.

21. 10. Clerical/Typing/Typographical mistakes
in the medico-legal reports
Common mistakes in the said reports could be in
form of --
 Incorrect particulars of the patient examined like
name of patient, father’s/husband’s name,
address etc.
 The date and time of arrival of patient in the
hospital as well as the time of examination are
wrongly mentioned as e.g. AM in place of PM and
vice-versa.
 One or other columns may be left unfilled/blank
in the preliminaries.

22. 11. Use of short forms/abbreviations of
various terms.
 Abbreviations/short cuts of all sorts must always
be avoided. (such as LW, CLW, IW, ILW etc)
 If multiple injuries of the same type are
apparent/present then it may be prudent to first
mention the full form along with short form of
that injury and then using the same short
form/abbreviation in the detailed report.

23. 12. Failure to complete all details in the
Medico-legal reports
 All the details are completed in the medico-legal
report then and there only, leaving nothing to be
completed later on.

24. 13. Cutting/overwriting in medico-
legal reports
 Cutting/overwriting etc. must be avoided as much
as possible and all corrections if done should be
properly initialled.

25. 14. Failure to note identification marks
 Two permanent identification marks, preferably
on the exposed parts of the body, should always
be recorded for comparing the same for
identification in the court while giving the
evidence.

26. 15. Inadequate history
Before examining the patient, brief history of the
incidence as stated by the injured/ accompanying
person regarding----
 time
 manner (accidental/ intentional)
 weapon/means caused
 place of event of injury/poisoning
 time sequence of symptoms/ incapacitation
developed etc.
should be recorded.

27. 16. Inadequate and improper description
regarding General condition of the patient
General condition of the patient like---
 level of consciousness,
 BP, Pulse, Respiration,
 Pupils,
 posture, gait,
 speech,
 bleeding through natural orifices like ear, nose,
mouth, rectum, vagina, etc.,
 paralysis, urinary/faecal retention/incontinence,
smell etc.
should always be be recorded in the injury report.

28. 17. Inadequate and improper examination
of clothes worn by the patient
The condition of the clothes be recorded
regarding their---
 disorder
 buttons (intact, undone, or torn)
 rents, tears, cuts whether coinciding with a
particular injury
 presence of stains like blood, mud/sand, weeds,
faecal, seminal, salivary etc.
 any foreign matter, stippling, burns, peculiar
colour and odour esp. in poisoning cases etc.

29. 18. Failure to preserve the clothes and
necessary samples
 All tears, cuts or holes etc. over the clothes should
be encircled and numbered with matching
description in the medico-legal report.
 Clothes in medico legal cases involved in rape,
stab injuries, firearm injuries, burns,
unidentified dead body etc. must be placed into
paper bags (no plastic/polythene bags should be
used), air dried if wet from fresh stains of any
kind, converted into a parcel, sealed and handed
over to the police for their evidentiary value.

30. 18. Failure to preserve the clothes and
necessary samples (Cont.)
 The required samples should be properly
preserved, packed and sealed under the doctor’s
supervision & then handed over to Police for
examination at Forensic Science Laboratory and
production as evidence in the court.
 Failure to collect, destruction or loss of such
evidence is punishable U/s 201 IPC.

31. 19. Inadequate and improper description
of injuries sustained by the patient
 All the injuries should be recorded in a systematic
way on the front as well as back aspects from head
to toe and they have to be numbered.
 The firearm injuries are preferably sequenced
alphabetically (a,b,c,d….etc) rather than
numbering them (1,2,3,4….etc.) as there have been
many instances where the numbering of gunshot
injuries has been correlated with the sequence of
shots.

32. 19. Inadequate and improper description
of injuries sustained by the patient (Cont.)
Every detail of each and every injury must be
recorded:
 type
 size (dimensions)
 shape
 situation/ exact location (distance from 2
anatomical/bony land marks)
 direction, along with any patterned injury like
tramline contusion, patterned ligature mark etc.
if present.

33. 20. Influenced opinion regarding the kind of
weapon used, duration and nature of injuries
The opinion should always be unbiased and scientific.
 The age/duration of injuries should always be based
on colour changes/changes due to healing and repair
in them.
 The nature of injuries should be based on
consideration of all the relevant investigations and
concerned specialist’s opinion.
Inexperienced doctor may sometimes give the opinion
regarding the kind of weapon used (blunt, sharp,
pointed, firearm etc.) and their duration as suggested
by the injured or police.

34. 21. Issuing false, misleading, exaggerated or
inaccurate medico-legal reports
A doctor can be booked under Sec. ---
 195 (giving or fabricating false evidence)
 196 (using evidence known to be false)
 197 (issuing or signing false certificate)
 467 (forgery of valuable security)
 468 (forgery for purpose of cheating)
 420 (cheating)
 120-B (criminal conspiracy) .
The doctor must be aware and look for the presence of
self-inflicted/fabricated injuries in all assault cases,
particularly when the history of assault is
incompatible with the injuries.

35. 22. Failure to arrange for recording of dying
declaration of the patient
 If a patient is likely to die as a result of injuries
(including burns) or an alleged criminal act,
immediate arrangement should be made to get
his/her dying declaration recorded.
 Police must be informed immediately in writing
to call a Magistrate for the needful.

36. 23. Failure to provide discharge
card/referral letter to the patient
 Failure to provide ‘discharge card/referral letter’
to the patient containing the summary of
admission, the treatment given in the hospital
and the instructions to the patient to be followed
after discharge, renders the doctor liable for
“negligence” and “deficiency of service” as ruled
by the Madhya Pradesh Consumer Disputes
Redressal Commission in the case of N. K. Kohli
Vs Bajaj Nursing Home (1999 (1) CLT 540).

37. 24. Allowing taking away of body of a medico-
legal case dying in hospital or that of a brought
in dead case by relatives
Whenever a patient registered as medico-legal
case dies, police must be informed immediately.
 The body should not be handed over to the next
of kin (relatives/lawful heirs).
 The body along with brief summary of the case
should be handed over to Police wanting to get
the autopsy done.
 Do not issue a death certificate even if the patient
was admitted.

38. Conclusion
 Medico-legal cases have to be dealt properly and
carefully, following the latest prevailing
guidelines as per ‘Medico-legal Manual’ of the
State.
 A doctor must be honest and trustworthy while
examining the patient and preparing medico-
legal documents in order to avoid any future
problems.
 Almost any mistake can be avoided if a doctor is
careful, vigilant, cautious and attentive while
dealing with a medico-legal case.


39. REFERENCES
 Haryana Medicolegal Manual, 2012.
 Dogra TD, Rudra A. Lyon’s Medical Jurisprudence and Toxicology. 11th ed.
Delhi Law House. 2005.
 Parmananda Katara Vs Union of India. AIR 1986 SC 2039.
 Aggrawal A. Salient features regarding medicolegal certificate. MAMC J
Med Sci 2015;1:45-51.
 Harish D, Chavali KH. The Medico-Legal case - Should we be afraid of
it? Anil Aggrawal's Internet J Forensic Med Toxicol [serial online], 2007;
Vol. 8, No. 1.
 Available from:
http://www.anilaggrawal.com/ij/vol_008_no_001/others/pg/pg001.html
 Pattipati Venkaiah Vs State of Andhra Pradesh. 1985(2) Crimes 746 at pp
749.
 Medicolegal Manual. AIIMS, New Delhi-1990.
 Vinay MR, Vasudeva DS, Gagan S. Guidelines for Handling Medico Legal
Cases. Internat J Health Information Med Res. 2014;1(1):2-6.
 Madhya Pradesh Consumer Disputes Redressal Commission in the case
of N. K. Kohli Vs Bajaj Nursing Home (1999 (1) CLT 540)