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MEDICO LEGAL CASES - FACTS
DR.V.SHYAM KUMAR
DISCLAIMER/CAUTION
THIS PRESENTATION BRIEFLY OUTLINES THE PROTOCOL FOR
PREPARATION OF MEDICOLEGAL REPORTS.THESE
GUIDELINES ARE NOT THE FINAL AND COMPLETE
DOCUMENT OF THE MEDICOLEGAL SYSTEM. THE
GUIDELINES ARE SUBJECT TO REVISION FROM TIME TO TIME
AS PER CENTRAL GOVT/STATE GOVT OR COURT DIRECTIVE
AS THE CASE MAY BE.
THE GUIDELINES ARE BEST UTILIZED IF THE MEDICAL
PROFESSIONAL USES KNOWLEDGE AND SKILL TO THE BEST
OF HIS/HER CAPABILITIES FOR PATIENT CARE AND
MEDICOLEGAL DOCUMENTATION AS PER PROVISIONS OF THE
LAW OF THE STATE. THE HEALTH CARE PROFESSIONALS ARE
ALSO ADVISED TO CONSULT STANDARD REFERENCES IN
SUCH MATTERS WHENEVER NECCESSARY.
Why to manage MLC
 ML Cases are just as Non MLC sick/injured patients and doctor
is duty bound to treat as well as document the details.
 Crucial piece of evidence
Communication to law enforcing agencies is required under section 39
of CrPC and failure to do so will attract legal penalty
Liable to be prosecuted under section 201 of IPC
DUTIES OF REGISTERED MEDICAL
PRACTITIONER TOWARDS PATIENT
1. Duty to exercise reasonable degree of skill and knowledge.
2. Duties in regard to attendance and examination.
3. Duty to furnish proper and suitable medicines.
4. Duty to give instructions.
5. Duties towards children and adults.
6. Consultation with a specialist.
7. Duties in regard to psychiatric patients.
8. Duties in regard to poisoning.
9. Duty to notify certain diseases.
10. Duties in regard to operative procedures.
11. Duties under Geneva convention.
12. Duties in convention with X-rays.
13. Professional Secrecy.
1. Consent
2. Confidentiality
3. Maintenance Of Records
4. Collection And Preservation Of Samples
5. Dying Declaration
DUTIES OF REGISTERED MEDICAL PRACTITIONER
TOWARDS STATE
OVERVIEW
• WHAT
• WHO
• WHERE
• WHEN
• HOW
• LEGAL PROVISIONS
WHAT IS A MEDICOLEGAL CASE?
No legal definition
Pre-labeled case: It is a case of injury or ailment
where an attending doctor after taking history and
clinical examination of the patient thinks that some
investigation by law enforcing agencies is essential,
so as to fix the responsibility regarding the case in
accordance with the law .
Receiving an MLC
A doctor can receive a medico-legal case–
• Brought by the police for examination and reporting.
• Already registered MLC referred from other health care system for
expert management/advice
• After history taking and thorough examination, if the doctor suspects
that the circumstances/ findings of the case are such that registration
of the case as an MLC is warranted
• Directive of court.
Who?
Any doctor who
 Possess permanent registration with MCI/State MC
 Some experience (preferable)
The doctor who has -First contact with patient should
prepare an ML case report
In rape victims by the examination and preparation of MLC is
done by female doctors.
Where?
 No specified area is defined for ML case
Emergency Department is the area where
majority of ML reports are prepare but sometimes
may be in wards after detection of new findings
When?
Some of the Pre-labeled MLC
[This list is not comprehensive]
 RTA’s, Rail accidents, factory accidents or any other
unnatural mishap
 Suspected or evident homicides or suicides
 Suspected or evident poisoning
 Burn injuries due to any cause
 Injury cases where foul play is suspected
 Injury cases where there is likelihood of death in near
future
 Sexual assault cases
 Suspected or evident criminal abortions
 Unconscious cases where cause of it is not clear
 Brought in dead cases where suspicion of foul play
 Cases referred from court
Consent in Medico legal cases
 Consent for medicolegal examination to be taken in
written in all cases
 Exception : Cases brought by police being arrested on
charge of committing an offence
 Person below 12 years/unsound mind- consent of
guardian is to be taken.
Life saving is the foremost duty of a doctor and a
hospital, in accident or medico-legal cases (MLC).
Patient treatment is priority
Doctor has to do is to COMPLETE the injury
sheet, which is a part of the assessment of the
patient.
 NO DELAY FOR PROVIDING FIRST AID
REMEMBER
TREATMENT is PRIORITY
THE PRIME RESPONSIBILITY
OF
DOCTOR IS THE INSTITUTION OF
PROPER TREATMENT TO THE PATIENT
PROMPTLY
MLC should be registered as early as possible
There is no time limit for preparing an MLR or registering a case as
MLC
 A case which otherwise qualifies to be an MLC was not registered
earlier is to be registered as MLC by the concerned doctor
 A case due to unraveling of new findings –history/clinical
examination etc. later on qualifies to be an MLC to be registered by
the concerned doctor
DOCUMENTATION OF A MEDICOLEGAL CASE
 Documentation is done in duplicate in a set Performa as per
hospital policy
 Separate performas may be available for medical
examination, examination of drunkenness etc.
All columns are filled up carefully and by the same doctor
who had examined the patient
Each MLC is given a fresh MLC number sequentially or
parallel series as per hospital policy
The details are completed then and there only, leaving
no provisions as to be completed later on.
After completion doctors sign and mention his/her
name in full below it with designation
Police constable on duty informed in each case.
After registration of a case as MLC , thereafter all
documents and requisition forms bear the same MLC
number including the discharge slip.
DOCUMENTATION OF A MEDICOLEGAL CASE contd..
1. REGISTRATION NUMBER
2. MLC NO
3. NAME
4. S/D/W OF
5. AGE
6. SEX
7. RELIGION
8. OCCUPATION
9. RESIDENTIAL ADDRESS
10.BROUGHT BY …….
11.DATE AND TIME OF EXAMINATION
12.NAME OF POLCE STATION
GENERAL DETAILS
DETAILS OF EXAMINATION
• ALLEGED HISTORY
• TO BE PRECICISE AND TO THE POINT
• LEGIBALY/CLEARLY WRITTEN
• DESCRIPTION OF INJURIES
• ABBREVIATIONS AVOIDED
• WHEN IN DOUBT CONSULTATION OBTAINED
•MINOR INJURIES ALSO NOTED IN CASE OF
POLYTRAUMA/MULTIPLE INJURIES
MARKS OF IDENTIFICATION ARE NOTED AND DOCUMENTED
CERTIFY FITNESS
and
OPINION
CERTIFYING FITNESS
As a part of documentation of ML Case report or whenever the
I.O requests the doctor for certifying fitness of the patient to
make a statement the examining doctor will certify the same on
the original MLC sheet. He/she will mention date and time
clearly with signature, name in full with designation below the
certification.
OPINION REGARDING INJURIES
Simple
Underobservation and reference for a specialist opinion
Grevious (after consideration of all findings/x-ray etc)
Caused by sharp/blunt objects
Time limit for registering a
Medico legal case
 A medico-legal case is registered as soon as a
doctor suspects foul play or feels it necessary to
inform the police, at any time after admission.
 A case is registered as an MLC even if it is brought
several days after the incident.
Can a doctor refuse to attend MLC
 NO
GOVT SERVICE DOCTORS -DUTY BOUND
ROLE OF PRIVATE PRACTITIONERS?
A doctor cannot refuse to examine medico legal case
on the basis of being a private practitioner or citing
a jurisdiction problem.
ML CASE
 Discharged after initial treatment
 Admitted as in patient
 Referred to other hospital after providing
First Aid / stabilization for expert
management after completion of all
necessary documentation
 If the case brought is a referred case and is
already registered as medico legal case
FRESH REPORT is NOT REQUIRED
• A case that is admitted and on treatment, later on
found out be MLC, is made MLC by the
concerned doctor.
• If death is inevitable, arrangement to take the
dying declaration is made.
• All the materials such as vomit, gastric lavage
sample, blood urine, etc. in poisoning cases,
vaginal swab and pubic hair in sexual offences,
foreign bodies found in the wounds, etc are
collected
• Samples are properly preserved, packed and
sealed then handed over to the police.
How?
First aim is to preserve life
Registration at designated area
1. Specified Register
2. Cases already registered and referred
i. Duty of referring doctor
ii. Duty of receiving doctor
Entertaining requests of patient/relative
Whenever there is doubt, doctors take second
opinion/consult specialists
 All reports and documents of a medico legal case are
labeled as MLC with the number assigned
 Information is given only to I.O. or any person
designated by I.O.
 If the I.O. gives requisition for any clarification
regarding certain points mentioned in the report
given, answer is given in writing.
DOCTORS MAINTAIN CONFIDENTIALITY
IN ALL MLC CSES
• If the I.O. demands an original document/
photocopy of the same, of a MLC, it is given
and a receipt obtained.
• If the court demands X-Ray films, P.M. report
etc. they are deposited in the court and a
receipt obtained.
• Gastric lavage/ vomitus in poisoning cases
• Blood in alcoholic/poisoning cases/drug abuse or
for DNA test
• Clothes in assault/injury/fire-arm/burn cases
• Nail clippings in assault/rape cases
• Pellets/bullet etc. if recovered
• Vaginal swabs/public hair in rape cases
• Swabs in un-natural sexual offence cases
• Swabs from fire-arm entry wounds
• Washing from hands in fire-arm suicide cases
COLLECTION AND PRESERVATION OF SAMPLES
• Urine for pregnancy test in rape cases
• Undergarments
• Swabs from glans penis in rape/unnatural sexual offences
• Swab from bite marks for blood/DNA test
• Nails and hair in chronic poisoning of heavy metals
• Any other material which may be useful in investigation
• Any other exhibit e.g. bottle of poison or tablet or weapon if
recovered should be properly labeled and sealed. It is
essential to give sample of seal on separate cloth/paper
putting initials. The endorsement of sample of seal should
also be made in MLR.
COLLECTION AND PRESERVATION OF SAMPLES
AGE DETERMINATION
• VICTIM
•ACCUSED
1. GENERAL PHYSICAL
EXAMINATION
2. DEV. OF SECONDARY
SEXUAL
CHARACTERS
3. DEVELOPMENT AND
ERUPTION OF TEETH
4. OSSIFICATION OF
BONES
It is necessary that to estimate age all precautions to be taken so that
range of estimation should not be more than ± 6 months up to 16 years
of age and ± 1 year up to 21 years.
Generally
X-ray of
•Wrist
•Elbow
•Shoulder
is advised for age
determination- juvenile or
not
RELEVANCE OF AGE DETERMINATION
1. CRIMINAL CULPABILITY Section 82 IPC child < 7 years
Section 83 IPC child 7 years -12 years
2. CONSENT FOR MEDICAL EXAMINATION
3. CONSENT for any harm not intended to cause death or grievous hurt can
be given by a person> 18 years age Section 87 IPC
4. IMPRISONMENT –Juvenile < 18 years not to be kept in prison
5. CASES OF SEXUAL ASSAULT/RAPE
Issues regarding MLC
 Dying declaration
 Dying deposition
 Custody of ML Records
 Attending court of Law
Admission and Discharge of MLC
o Whenever a medico-legal case is admitted the same is
documented in admission papers and hospital records
o When discharged, the same should be intimated to the
police authorities of the hospital
Police is informed if a MLC is taking discharge
against medical advice
At the time of discharge, detailed instructions to
the patient regarding treatment, follow up general
care, diet, exercise etc are given in writing.
Death of a person admitted as a medico-legal case
The following are the do's and don'ts in case a person
admitted as a medico-legal case expires.
• Police Informed immediately.
• Body sent to the hospital mortuary for
preservation, till the legal formalities are
completed and the police releases the body to the
lawful heirs.
• Death certificate not issued – even if the patient
was admitted.
• Dead body never released to the relatives directly
BROUGHT IN DEAD PATIENTS
• POLICE TO BE INFORMED IF NOT ALREADY DONE
• NO INJURIES NOTED IN MLC RECORD
• ARTICLES IN POSSESSION DOCUMENTED AND HANDED
OVER TO RELATIVES/POLICE
• DEAD BODY TO BE SENT TO HOSPITAL MORTUARY
MEDICAL EXAMINATION OF VICTIMS
OF SEXUAL ASSAULT
Section 164A of CrPC
•Examination only by female registered medical practitioner
•Without delay
•Consent -documented
•Note down particulars
•Complete history
•Examination – Genital examination and injuries:
Standard protocols and guidelines
•Preserve samples-DNA profiling
•Emergency Contraception if required
•Treatment /prophylaxis as required
•Opinion
EXAMINATION OF PERSON ACCUSED OF
SEXUAL ASSAULT
Section 53A CrPC
•Brought by police written and signed request
•Details of examination findings
•Sample preservation –Clothing/Blood/Semen sample/Pubic hairs for
DNA profiling
•Opinion
•Age determination
Consent not required
CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL
ASSAULT/ABANDONED CHILDREN
Guidelines laid down by hon’ble court
 A detailed description of assault/abuse history be mentioned
 In case of girl victim medical examination preferably by a female doctor
 As far as practical –psychiatrist help be made available to victim
 Report to be prepared as early as possible
 Parents/ guardian whom child should trust should be allowed to be present
 In case of results of examination are likely to be delayed the same should be
mentioned
 Emergency medical treatment/prophylaxis against STD to be provided when
necessary
 After examination child permitted to wash up and provide fresh clothing if
clothing is taken as evidence
 Preserve samples according to guidelines –SAFE [Sexual abuse Forensic
Evidence] Kit provided in Govt. hospitals
LEGAL PROVISIONS
• Section 191 IPC (Giving false evidence)
• Section 192 IPC (Fabricating false evidence)
• Section 193 IPC (Punishment for false evidence)-
Imprisonment up-to 7 years+ fine
• Section 201 IPC (Causing disappearance of evidence
of offence, or giving false information to screen
offender)
LEGAL PROVISIONS (cont.)
• Section 202 IPC (Intentional omission to give
information of offence by person bound to inform)
• Section 203 IPC (Giving false information respecting
an offence committed)-Under Sections 201 and 202
and in this section the word “offence”, includes any
act committed
underSection302,304,382,393,394,395,396,397,398,4
02,435,436,449,450,457,458,459 and 460
LEGAL PROVISIONS (cont.)
• Section 204 IPC (Destruction of document or
electronic record to prevent its production as
evidence) Imprisonment up-to 2 years or fine or both
• Section 88 IPC (Act not intended to cause death,
done by consent in good faith for person’s benefit)
• Section 89 IPC (Act done in good faith for the
benefit of child or insane person, by or by consent of
guardian)
LEGAL PROVISIONS (cont.)
• Section 92 IPC (Act done in good faith for
benefit of a person with out consent)
• Section 93 IPC (Communication made in good
faith)
• Section 39 CrPC (Public to give information of
certain offences-Section 302-304)
LEGAL PROVISIONS (cont.)
• Section 53 CrPC (Examination of accused by
medical practitioner at the request of police officer)
• Section 53A CrPC (Examination of person accused
of rape by medical practitioner)
• Section 54 CrPC (Examination of arrested person by
medical practitioner at the request of the arrested
person)
 MLC REPORTS FILLED LEGIBALY
 AVOID SUPERLATIVES,ABBREVATIONS Etc.,
 ALL RELEVANT DETAILS NOTED
 SIGNATURE / NAME IN FULL CAPITAL LETTERS BELOW
 ALL RELATED FORMS ARE LEGAL DOCUMENTS FILLED IN DUPLICATE
WITH MLC NUMBER AND DETAILS
 ALL COULUMS COMPLETED
 CONFIDENTIALITY MAINTAINED
 NONJUDGEMENTALABOUT ANY CASE –DUTY IS TO EXAMINE THE PATIENT
AND DOCUMENT THE FINDINGS AND PATIENT MANAGEMENT.
 THE ONUS OF FIXING RESPOSIBILITY OF GUILTY IS FOR THE COURT
SUMMARY
Dr.Shyam MLC .ppt

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Dr.Shyam MLC .ppt

  • 1. MEDICO LEGAL CASES - FACTS DR.V.SHYAM KUMAR
  • 2. DISCLAIMER/CAUTION THIS PRESENTATION BRIEFLY OUTLINES THE PROTOCOL FOR PREPARATION OF MEDICOLEGAL REPORTS.THESE GUIDELINES ARE NOT THE FINAL AND COMPLETE DOCUMENT OF THE MEDICOLEGAL SYSTEM. THE GUIDELINES ARE SUBJECT TO REVISION FROM TIME TO TIME AS PER CENTRAL GOVT/STATE GOVT OR COURT DIRECTIVE AS THE CASE MAY BE. THE GUIDELINES ARE BEST UTILIZED IF THE MEDICAL PROFESSIONAL USES KNOWLEDGE AND SKILL TO THE BEST OF HIS/HER CAPABILITIES FOR PATIENT CARE AND MEDICOLEGAL DOCUMENTATION AS PER PROVISIONS OF THE LAW OF THE STATE. THE HEALTH CARE PROFESSIONALS ARE ALSO ADVISED TO CONSULT STANDARD REFERENCES IN SUCH MATTERS WHENEVER NECCESSARY.
  • 3. Why to manage MLC  ML Cases are just as Non MLC sick/injured patients and doctor is duty bound to treat as well as document the details.  Crucial piece of evidence Communication to law enforcing agencies is required under section 39 of CrPC and failure to do so will attract legal penalty Liable to be prosecuted under section 201 of IPC
  • 4. DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS PATIENT 1. Duty to exercise reasonable degree of skill and knowledge. 2. Duties in regard to attendance and examination. 3. Duty to furnish proper and suitable medicines. 4. Duty to give instructions. 5. Duties towards children and adults. 6. Consultation with a specialist. 7. Duties in regard to psychiatric patients. 8. Duties in regard to poisoning. 9. Duty to notify certain diseases. 10. Duties in regard to operative procedures. 11. Duties under Geneva convention. 12. Duties in convention with X-rays. 13. Professional Secrecy.
  • 5. 1. Consent 2. Confidentiality 3. Maintenance Of Records 4. Collection And Preservation Of Samples 5. Dying Declaration DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS STATE
  • 6. OVERVIEW • WHAT • WHO • WHERE • WHEN • HOW • LEGAL PROVISIONS
  • 7. WHAT IS A MEDICOLEGAL CASE? No legal definition Pre-labeled case: It is a case of injury or ailment where an attending doctor after taking history and clinical examination of the patient thinks that some investigation by law enforcing agencies is essential, so as to fix the responsibility regarding the case in accordance with the law .
  • 8. Receiving an MLC A doctor can receive a medico-legal case– • Brought by the police for examination and reporting. • Already registered MLC referred from other health care system for expert management/advice • After history taking and thorough examination, if the doctor suspects that the circumstances/ findings of the case are such that registration of the case as an MLC is warranted • Directive of court.
  • 9. Who? Any doctor who  Possess permanent registration with MCI/State MC  Some experience (preferable) The doctor who has -First contact with patient should prepare an ML case report In rape victims by the examination and preparation of MLC is done by female doctors.
  • 10. Where?  No specified area is defined for ML case Emergency Department is the area where majority of ML reports are prepare but sometimes may be in wards after detection of new findings
  • 11. When? Some of the Pre-labeled MLC [This list is not comprehensive]  RTA’s, Rail accidents, factory accidents or any other unnatural mishap  Suspected or evident homicides or suicides  Suspected or evident poisoning  Burn injuries due to any cause  Injury cases where foul play is suspected  Injury cases where there is likelihood of death in near future  Sexual assault cases  Suspected or evident criminal abortions  Unconscious cases where cause of it is not clear  Brought in dead cases where suspicion of foul play  Cases referred from court
  • 12. Consent in Medico legal cases  Consent for medicolegal examination to be taken in written in all cases  Exception : Cases brought by police being arrested on charge of committing an offence  Person below 12 years/unsound mind- consent of guardian is to be taken.
  • 13. Life saving is the foremost duty of a doctor and a hospital, in accident or medico-legal cases (MLC). Patient treatment is priority Doctor has to do is to COMPLETE the injury sheet, which is a part of the assessment of the patient.  NO DELAY FOR PROVIDING FIRST AID REMEMBER
  • 14. TREATMENT is PRIORITY THE PRIME RESPONSIBILITY OF DOCTOR IS THE INSTITUTION OF PROPER TREATMENT TO THE PATIENT PROMPTLY
  • 15. MLC should be registered as early as possible There is no time limit for preparing an MLR or registering a case as MLC  A case which otherwise qualifies to be an MLC was not registered earlier is to be registered as MLC by the concerned doctor  A case due to unraveling of new findings –history/clinical examination etc. later on qualifies to be an MLC to be registered by the concerned doctor
  • 16. DOCUMENTATION OF A MEDICOLEGAL CASE  Documentation is done in duplicate in a set Performa as per hospital policy  Separate performas may be available for medical examination, examination of drunkenness etc. All columns are filled up carefully and by the same doctor who had examined the patient Each MLC is given a fresh MLC number sequentially or parallel series as per hospital policy
  • 17. The details are completed then and there only, leaving no provisions as to be completed later on. After completion doctors sign and mention his/her name in full below it with designation Police constable on duty informed in each case. After registration of a case as MLC , thereafter all documents and requisition forms bear the same MLC number including the discharge slip. DOCUMENTATION OF A MEDICOLEGAL CASE contd..
  • 18. 1. REGISTRATION NUMBER 2. MLC NO 3. NAME 4. S/D/W OF 5. AGE 6. SEX 7. RELIGION 8. OCCUPATION 9. RESIDENTIAL ADDRESS 10.BROUGHT BY ……. 11.DATE AND TIME OF EXAMINATION 12.NAME OF POLCE STATION GENERAL DETAILS
  • 19. DETAILS OF EXAMINATION • ALLEGED HISTORY • TO BE PRECICISE AND TO THE POINT • LEGIBALY/CLEARLY WRITTEN • DESCRIPTION OF INJURIES • ABBREVIATIONS AVOIDED • WHEN IN DOUBT CONSULTATION OBTAINED •MINOR INJURIES ALSO NOTED IN CASE OF POLYTRAUMA/MULTIPLE INJURIES MARKS OF IDENTIFICATION ARE NOTED AND DOCUMENTED
  • 21. CERTIFYING FITNESS As a part of documentation of ML Case report or whenever the I.O requests the doctor for certifying fitness of the patient to make a statement the examining doctor will certify the same on the original MLC sheet. He/she will mention date and time clearly with signature, name in full with designation below the certification.
  • 22. OPINION REGARDING INJURIES Simple Underobservation and reference for a specialist opinion Grevious (after consideration of all findings/x-ray etc) Caused by sharp/blunt objects
  • 23. Time limit for registering a Medico legal case  A medico-legal case is registered as soon as a doctor suspects foul play or feels it necessary to inform the police, at any time after admission.  A case is registered as an MLC even if it is brought several days after the incident.
  • 24. Can a doctor refuse to attend MLC  NO GOVT SERVICE DOCTORS -DUTY BOUND ROLE OF PRIVATE PRACTITIONERS? A doctor cannot refuse to examine medico legal case on the basis of being a private practitioner or citing a jurisdiction problem.
  • 25. ML CASE  Discharged after initial treatment  Admitted as in patient  Referred to other hospital after providing First Aid / stabilization for expert management after completion of all necessary documentation
  • 26.  If the case brought is a referred case and is already registered as medico legal case FRESH REPORT is NOT REQUIRED
  • 27. • A case that is admitted and on treatment, later on found out be MLC, is made MLC by the concerned doctor. • If death is inevitable, arrangement to take the dying declaration is made. • All the materials such as vomit, gastric lavage sample, blood urine, etc. in poisoning cases, vaginal swab and pubic hair in sexual offences, foreign bodies found in the wounds, etc are collected • Samples are properly preserved, packed and sealed then handed over to the police.
  • 28. How? First aim is to preserve life Registration at designated area 1. Specified Register 2. Cases already registered and referred i. Duty of referring doctor ii. Duty of receiving doctor Entertaining requests of patient/relative Whenever there is doubt, doctors take second opinion/consult specialists  All reports and documents of a medico legal case are labeled as MLC with the number assigned
  • 29.  Information is given only to I.O. or any person designated by I.O.  If the I.O. gives requisition for any clarification regarding certain points mentioned in the report given, answer is given in writing. DOCTORS MAINTAIN CONFIDENTIALITY IN ALL MLC CSES
  • 30. • If the I.O. demands an original document/ photocopy of the same, of a MLC, it is given and a receipt obtained. • If the court demands X-Ray films, P.M. report etc. they are deposited in the court and a receipt obtained.
  • 31. • Gastric lavage/ vomitus in poisoning cases • Blood in alcoholic/poisoning cases/drug abuse or for DNA test • Clothes in assault/injury/fire-arm/burn cases • Nail clippings in assault/rape cases • Pellets/bullet etc. if recovered • Vaginal swabs/public hair in rape cases • Swabs in un-natural sexual offence cases • Swabs from fire-arm entry wounds • Washing from hands in fire-arm suicide cases COLLECTION AND PRESERVATION OF SAMPLES
  • 32. • Urine for pregnancy test in rape cases • Undergarments • Swabs from glans penis in rape/unnatural sexual offences • Swab from bite marks for blood/DNA test • Nails and hair in chronic poisoning of heavy metals • Any other material which may be useful in investigation • Any other exhibit e.g. bottle of poison or tablet or weapon if recovered should be properly labeled and sealed. It is essential to give sample of seal on separate cloth/paper putting initials. The endorsement of sample of seal should also be made in MLR. COLLECTION AND PRESERVATION OF SAMPLES
  • 33. AGE DETERMINATION • VICTIM •ACCUSED 1. GENERAL PHYSICAL EXAMINATION 2. DEV. OF SECONDARY SEXUAL CHARACTERS 3. DEVELOPMENT AND ERUPTION OF TEETH 4. OSSIFICATION OF BONES It is necessary that to estimate age all precautions to be taken so that range of estimation should not be more than ± 6 months up to 16 years of age and ± 1 year up to 21 years. Generally X-ray of •Wrist •Elbow •Shoulder is advised for age determination- juvenile or not
  • 34. RELEVANCE OF AGE DETERMINATION 1. CRIMINAL CULPABILITY Section 82 IPC child < 7 years Section 83 IPC child 7 years -12 years 2. CONSENT FOR MEDICAL EXAMINATION 3. CONSENT for any harm not intended to cause death or grievous hurt can be given by a person> 18 years age Section 87 IPC 4. IMPRISONMENT –Juvenile < 18 years not to be kept in prison 5. CASES OF SEXUAL ASSAULT/RAPE
  • 35. Issues regarding MLC  Dying declaration  Dying deposition  Custody of ML Records  Attending court of Law
  • 36. Admission and Discharge of MLC o Whenever a medico-legal case is admitted the same is documented in admission papers and hospital records o When discharged, the same should be intimated to the police authorities of the hospital Police is informed if a MLC is taking discharge against medical advice At the time of discharge, detailed instructions to the patient regarding treatment, follow up general care, diet, exercise etc are given in writing.
  • 37. Death of a person admitted as a medico-legal case The following are the do's and don'ts in case a person admitted as a medico-legal case expires. • Police Informed immediately. • Body sent to the hospital mortuary for preservation, till the legal formalities are completed and the police releases the body to the lawful heirs. • Death certificate not issued – even if the patient was admitted. • Dead body never released to the relatives directly
  • 38. BROUGHT IN DEAD PATIENTS • POLICE TO BE INFORMED IF NOT ALREADY DONE • NO INJURIES NOTED IN MLC RECORD • ARTICLES IN POSSESSION DOCUMENTED AND HANDED OVER TO RELATIVES/POLICE • DEAD BODY TO BE SENT TO HOSPITAL MORTUARY
  • 39. MEDICAL EXAMINATION OF VICTIMS OF SEXUAL ASSAULT Section 164A of CrPC •Examination only by female registered medical practitioner •Without delay •Consent -documented •Note down particulars •Complete history •Examination – Genital examination and injuries: Standard protocols and guidelines •Preserve samples-DNA profiling •Emergency Contraception if required •Treatment /prophylaxis as required •Opinion
  • 40. EXAMINATION OF PERSON ACCUSED OF SEXUAL ASSAULT Section 53A CrPC •Brought by police written and signed request •Details of examination findings •Sample preservation –Clothing/Blood/Semen sample/Pubic hairs for DNA profiling •Opinion •Age determination Consent not required
  • 41. CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL ASSAULT/ABANDONED CHILDREN Guidelines laid down by hon’ble court  A detailed description of assault/abuse history be mentioned  In case of girl victim medical examination preferably by a female doctor  As far as practical –psychiatrist help be made available to victim  Report to be prepared as early as possible  Parents/ guardian whom child should trust should be allowed to be present  In case of results of examination are likely to be delayed the same should be mentioned  Emergency medical treatment/prophylaxis against STD to be provided when necessary  After examination child permitted to wash up and provide fresh clothing if clothing is taken as evidence  Preserve samples according to guidelines –SAFE [Sexual abuse Forensic Evidence] Kit provided in Govt. hospitals
  • 42. LEGAL PROVISIONS • Section 191 IPC (Giving false evidence) • Section 192 IPC (Fabricating false evidence) • Section 193 IPC (Punishment for false evidence)- Imprisonment up-to 7 years+ fine • Section 201 IPC (Causing disappearance of evidence of offence, or giving false information to screen offender)
  • 43. LEGAL PROVISIONS (cont.) • Section 202 IPC (Intentional omission to give information of offence by person bound to inform) • Section 203 IPC (Giving false information respecting an offence committed)-Under Sections 201 and 202 and in this section the word “offence”, includes any act committed underSection302,304,382,393,394,395,396,397,398,4 02,435,436,449,450,457,458,459 and 460
  • 44. LEGAL PROVISIONS (cont.) • Section 204 IPC (Destruction of document or electronic record to prevent its production as evidence) Imprisonment up-to 2 years or fine or both • Section 88 IPC (Act not intended to cause death, done by consent in good faith for person’s benefit) • Section 89 IPC (Act done in good faith for the benefit of child or insane person, by or by consent of guardian)
  • 45. LEGAL PROVISIONS (cont.) • Section 92 IPC (Act done in good faith for benefit of a person with out consent) • Section 93 IPC (Communication made in good faith) • Section 39 CrPC (Public to give information of certain offences-Section 302-304)
  • 46. LEGAL PROVISIONS (cont.) • Section 53 CrPC (Examination of accused by medical practitioner at the request of police officer) • Section 53A CrPC (Examination of person accused of rape by medical practitioner) • Section 54 CrPC (Examination of arrested person by medical practitioner at the request of the arrested person)
  • 47.  MLC REPORTS FILLED LEGIBALY  AVOID SUPERLATIVES,ABBREVATIONS Etc.,  ALL RELEVANT DETAILS NOTED  SIGNATURE / NAME IN FULL CAPITAL LETTERS BELOW  ALL RELATED FORMS ARE LEGAL DOCUMENTS FILLED IN DUPLICATE WITH MLC NUMBER AND DETAILS  ALL COULUMS COMPLETED  CONFIDENTIALITY MAINTAINED  NONJUDGEMENTALABOUT ANY CASE –DUTY IS TO EXAMINE THE PATIENT AND DOCUMENT THE FINDINGS AND PATIENT MANAGEMENT.  THE ONUS OF FIXING RESPOSIBILITY OF GUILTY IS FOR THE COURT SUMMARY