What is Medico legal and What are the law and cases in India
“Medicolegal” is the term, which incorporates the basics of two sister professions i.e. Medicine and Law, as when medical testing or examination is undertaken for a legal purpose.
- Medical jurisprudence, a branch of medicine (Forensic Medicine, it deals with medical aspects of law and medico-legal case management)
- Medical law, a branch of law
What is a Medico-Legal Case(MLC)?
A doctor has ethical and legal obligations, and he needs to abide by the laws of the land while discharging his duties. In medical practice, most of the doctors would come across which at the time or subsequently, would be called a “Medico-Legal Case” (MLC).
An MLC 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 responsibility for the case in accordance with the law of the land. It can also be defined as a case of injury or ailment, etc., in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment.
Difference Between MLC & Non-MLC
|Medico-Legal Case||Non-Medico-Legal Case|
|Information to police must be sent||No such information to police|
|A report must be made in duplicate, one copy of which is handed over to the police, and his signatures taken on doctor’s copy. The other copy is retained by the doctor, which he may have to produce before the court. This copy is retained in a register called a “Medicolegal Register.” This register is a confidential record and should be in the safe custody of the doctor only.||A report made as a single copy only|
|Both copies of the report must be marked “Medicolegal Case” in bold. In X-ray requisition slips and other lab report slips, similar markings should be made.||No such mark made|
|The report, X-rays etc., not to be handed over to the patient. They are handed over to the police.||The report, X-rays etc., handed over to the patient|
|Detailed personal entries must be made. Please see below under the column “Entries to be made in an injury report”||Not required|
|Example: Stab wounds, lacerated wounds, fractures, bruises, abrasions, etc.||Example: Asthmatic attack, Myocardial Infection, status epilepticus etc.|
Cases that are to be treated as medicolegal are:
- All cases of injuries and burns – the circumstances of which suggest commission of an offense by somebody (irrespective of suspicion of foul play);
- All vehicular, factory, or other unnatural accident cases especially when there is a likelihood of a patient’s death or grievous hurt;
- Cases of suspected or evident sexual assault;
- Cases of suspected or evident criminal abortion;
- Cases of unconsciousness where its cause is not natural or not clear;
- All cases of suspected or evident poisoning or intoxication;
- Cases referred from the court or otherwise for age estimation;
- Cases brought dead with improper history creating suspicion of an offense;
- Cases of suspected self-infliction of injuries or attempted suicide;
- Any other case not falling under the above categories but has legal implications.
- Patients dying suddenly after parenteral administration of a drug or medication.
- Patient falling down or any mishap in the Hospital, sustaining an injury in the Hospital.
- Death on the Operation table.
- Unexplained death after surgery or Interventional procedure.
- Unexplained ICU death.
- Patient treated and then referred from a private hospital or another Government hospital with complications of surgery or delivery or bleeding, where the cause of death is unexplained.
- Relatives of the patient assault the treating doctor or other staff of the hospital.
- Relatives of the patient create a law and order problem in the hospital.
Sadly, doctors are usually apprehensive in dealing with these “MLCs.” The usual impression is that MLC implies a lot of disputes, unwanted burden, rough speaking police officials, inordinate hours in the court, unrelenting defense counsels, etc. Because of this fear-factor, they either try to avoid the cases or try to get rid of them as soon as possible.
Further, after examination of a medicolegal case, a medico-legal report should be issued. The reports must be handed over to the police officials after getting them duly received on the duplicate copy of the same. The records should be kept under lock and key, in the custody of the doctor concerned or may be kept in the record room of hospitals, where such facility is available. There is no specified time limit after which the medico-legal reports can be destroyed; hence, they have to be preserved. In view of the multitude of cases against the doctors under the Consumer Protection Act, it is advisable to preserve all the inpatient records for a period of at least 5 years and outpatient department records for 3 years.
Laws Relating to MLC
Section 44 of IPC: Definition of Injury Any harm whatever illegally caused to any person in body, mind, reputation or property.
Section 319 IPC: Hurt Hurt means bodily pain, disease or infirmity caused to any person.
Section 321 IPC: Defines “Voluntarily Causing Hurt”
Section 322 IPC Defines “Voluntarily Causing Grievous Hurt”
Section 323 IPC: Describes Punishment for Voluntarily Causing Hurt. Shall be imprisonment which may extend for one year with or without fine which may be Rs 1000/-.
Section 324 IPC: Describes Punishment for Voluntarily Causing Hurt by dangerous weapon shall be imprisonment for up to 3 years with or without fine.
Section 325 IPC: Describes Punishment for Voluntarily Causing Grievous Hurt. Shall be imprisonment which may extend for 7 years with or without fine.
Section 299 IPC: Defines “Culpable Homicide”
Whoever causing death by doing an act with the intention of causing death, or with the intention of causing such bodily injury that likely to cause death or with the knowledge that he is likely by such act to cause death, commits the offense of culpable homicide.
Section 300 IPC: Culpable Homicide is Murder
- If the act by which the death is caused is done with the intention of causing death or,
- If it is done with the intention of causing such bodily injury as the offender knows to be likely to cause death or,
- If it is done with the intention of causing such bodily injury which is sufficient in the ordinary course of nature to cause death or,
- If the person committing the act knows that it is so imminently dangerous, that it must in all probability cause death or such bodily injury as is likely to cause death and commits such act without any excuse.
Example of a Medico-Legal Case:
Consider a case of suicidal poisoning. Suicide is an offense u/s 309 Indian Penal Code (IPC). Patient insists he does not want an MLC. If the doctor agrees to the patient’s request, it is like agreeing to a criminal requesting him not to give evidence regarding his crime to the police. Doctor’s MLC with relevant history from the patient is a piece of evidence that a crime u/s 309 IPC has been committed. If the doctor does not inform the police and does not hand over the MLC to the police, he may be sued u/s 201 IPC (causing the disappearance of evidence of an offense). However, consent for examination would still be required because the patient is not arrested at that point in time.
The author was once contacted by a casualty medical officer (CMO) regarding the case of a 70-year-old man who was brought dead to the hospital and sent to the mortuary with a request merely to keep the body for 1 day because his son had to arrive from the US. The family also produced a death certificate made by a private practitioner (PP), who last saw the patient. The certificate stated the cause of death (COD) as a myocardial infarction (MI). The CMO wanted to know if the police needed to be informed or not. It was advised that all cases “brought dead” must be informed to the police, even if they had a death certificate. A postmortem was conducted, and the cause of death was determined to be strangulation. The old man had changed his will, and because of that, his son had strangled him. After strangling him, he called the PP and informed him that his father had a sudden chest pain and had become motionless soon after. The PP without examining the patient and in good faith made out a death certificate. Had the police not been informed, this murder would have gone undetected. The son was charged u/s 302 IPC. The police refrained from charging the PP for issuing a false certificate, although he was certainly guilty u/s 197 IPC.
October 20, 2018