MEDICOLEGAL ISSUES : GUIDELINES TO MEDICAL OFFICERS ...

1 MEDICOLEGAL ISSUES : GUIDELINES TO MEDICAL (MLC)are an integral part of MEDICAL practicethatisfrequentlyencountered by MEDICAL OFFICERS (MO).The occurrence ofMLCsis on theincrease, bothin the Civil as well as in the Armed Forces. Properhandlingandaccurate documentation of these cases is of prime importance to avoid legalcomplicationsand to ensurethatthe Next of Kin (NOK)receive theentitled MEDICAL OFFICERS workingin hospitals/field MEDICAL units/ non medicalunitsencountermedicolegalissues which should behandledin accordance with thelaw of the land anddirectives issued by service of this memorandum is to provide general guidelinesfor MedicalOfficersof the Armed Forces MEDICAL Services(AFMS)

2 While dealing withcommonlyencountered situationswhich fall within law and order is a state subject,there are differences in the legalprocedures being followed by different states. MEDICAL OFFICERS should acquaintthemselves withmedicolegalproceduresthat arein vogue in the statein which MEDICAL MLC is defined as anycase of injury or ailment where,the attendingdoctor after history taking and clinical examination,considers that investigations bylaw enforcement agencies(and also superior military authorities) are warranted toascertain circumstances andfix responsibility regarding the said injury or ailmentaccording to the law.

3 Case asMLC.(a)RMO /Casualtymedical officer / MOin chargeofMI Room / DutyMedical Officer(DMO)/MO In chargewardwho is attending to the case, maylabel a case as a MLC.(b)Thedecisiontolabel acase asMLCshould be based on soundprofessional judgement,afteradetailed history taking and thorough following are some of the examples of MLCs andmedical officersshould use their professional judgement to decide any other casesnot enumerated in the list:(a)Assaultand battery,including domestic violence and child abuse(b)Accidents likeRoad Traffic Accidents (RTA), industrial accidents etc.

4 (c)Cases of trauma with suspicion of foul play(d)Electrical injuries(e)Poisoning,Alcohol Intoxication3(f)Undiagnosed coma(g)Chemical injuries(h)Burns and Scalds(j)Sexual Offences(k)Criminal abortions(l)Attempted suicide(m)Cases ofasphyxiaas a result ofhanging,strangulation, drowning,suffocationetc.(n)Custodial deaths(o)Death in the operation theatre(p)Unnatural deaths(q)Death due to Snake Bite or Animal Bite(r)Fire Arm injuries(s)Drug overdose(t)Drug abuse(u)Dead brought to the Accident and Emergency Dept / MI Room (Founddead) and deaths occurring within 24 hours of hospitalization withoutestablishment of a GUIDELINES for dealing withMedicolegalcases(a)In emergencies, resuscitation and stabilization of the patient willbecarried out first andmedicolegalformalities may be completed for treatment is implied in all (b)

5 Emergency MEDICAL care will be administered to all cases brought toany AFMSH ealth Care Establishment irrespective of their entitlement. Innon-entitled cases, after the initial stabilization, thepatientmaybe transferredtothenearest Government hospital,andif necessary by service ambulance.(c)Cases of trauma will be labeled asMLCs,ifthere isasuspicion of foulplay,even if the incident is cases of injury to servicepersonnel should be reported on IAFY 2006 (Injury Report) withtheappropriate classification viz.,trivial, moderately severe or severe.

6 (d)All MI Rooms and hospitals will maintain a MLC registerand theMLCwill beinitiated and documented in particulars,identification marks, finger printsof the individualwill be noted. Particulars ofthe person accompanying the patient will also be noted.(e)Medicolegaldocuments should be prepared in duplicate, with utmostcare giving all necessary details,preferablywrittenwith a ball-pointpenandavoiding overwriting. If any overwritingor correction is made,it should beauthenticated withthefull signatureandstampof the be avoided.(f)The Commanding Officer (CO)/Commandant and Senior Registrarand equivalent in other hospitalsshould beimmediatelyinformed as andwhen aMLCis registered or of the patient andashort summary of the case will be mentioned in the DMO report (g)The patient will be placed on SIL / DIL,when required.

7 (h)NOK will be informed ifthe addressis available.(j)The police should be informed. Under Section ,the attendingMO is legally bound to informthe police aboutthearrival ofa failure to report the occurrence ofaMLCmay inviteprosecution under Sections 176and/ or202 , theinformation should be given to ADH, Station Headquarters (HQ), Corps ofMilitaryPolice (CMP)and to the unit concerned (bytelephone). The verbalcommunication should invariably be followed by communication in writingsubsequently.(k)In case of discharge /transfer /death of such a case in the hospital,the policeshould beinformed.

8 (l)Medicolegaldocuments should be considered as confidential recordsand should be stored under safe custody to avoid recordsmust be thorough, complete and should document each and every significantevent in the course of care ofthepatient. All the documents includingcasesheets, X-rays and investigation reports will be preserved meticulously in themedical record section indefinitely and handed over to the concernedauthorities (Police Investigating Officer/ Court / Court of Inquiry) as and (m)Prompt attention, correct triage and safe transfer of a patient from onefacility to anotheras required shouldbe carried out in all casesand notdelayed because of themedicolegalnature of the case.

9 (n)Opinion on severity of injuries should be given afterthe X-rayreportsare received in cases of injury to bones / joints.(o)Samples and specimens collected formedicolegalpurposes will beproperly sealed, labeled and handed over to theinvestigatingofficer detailedby thepolice. Commandant/CO of thehospital willensure thatthe documentsare keptinthecustodyof an appropriate officertill the caseisfinally decidedorcleared by the policeandjudicial authorities.(p)Dying cases where the patient wishes to make a dyingdeclaration,themagistrate will be theMagistrate is unable tocome and record a statement or where the MO feels that he mightnot be ableto reach the patient in time,theMOmay record the dying declaration himselfin presence of two independent witnesses whose signatures are alsoaffixedin the document.

10 The MO will certifythe soundness of mind of the personmaking thedyingdeclaration.(q)Battle Casualties(BC)andBattle Accidents(BA)are not to be MEDICAL cause of deathin these casesmayhoweverbecertified must obtain the certification of BC/BA from theunit,duly signed by the CO,before mentioning the same in the 20/2001/ DVdeals with details ondeclaration of (r)Where civil police cover is not available, amilitary inquest will be heldby the military administrative authority to decide cause and other factspertaining to death. Normally, the service pathologist carries , medico - legal autopsies may be carriedout by theservice pathologist (RMSAF para 58refers).