Medico-Legal Aspects of
Toxicology
Dr. Somnath Das
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.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Duty to exercise reasonable degree of skill and knowledge.
Duties in regard to attendance and examination.
Duty to furnish proper and suitable medicines.
Duty to give instructions.
Consultation with a specialist.
Duties in regard to psychiatric patients.
Duties in regard to poisoning.
Duty to notify certain diseases.
Duties in regard to operative procedures.
Professional Secrecy.
DUTIES OF REGISTERED MEDICAL PRACTITIONER
TOWARDS STATE
1.
2.
3.
4.
5.
Consent
Confidentiality
Maintenance Of Records
Collection And Preservation Of Samples
Dying Declaration
OVERVIEW
•
•
•
•
•
WHAT
WHO
WHERE
WHEN
HOW
WHAT IS A MEDICOLEGAL CASE?
No legal definition
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/SMC
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
preferably done by female doctors.
Where?
No specified area is defined for ML case
Emergency Department is the area where majority
of ML reports are prepared
but
sometimes may be in wards after detection of
new findings
When?
•
•
•
•
•
•
•
•
•
•
•
Some of the Pre-labeled MLC (as per BPRD)
[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
How?
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.
REMEMBER
• 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
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
DOCUMENTATION OF A MEDICOLEGAL CASE contd..
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 with registration number
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.
OPINION REGARDING INJURIES
•SIMPLE
•UNDER OBSERVATION AND REFERENCE FOR A
SPECIALIST OPINION
•GREVIOUS (AFTER CONSIDERATION OF ALL FINDINGS/XRay etc)
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.
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.
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.
COLLECTION AND PRESERVATION OF SAMPLES
•
•
•
•
•
•
•
•
•
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
All the collected samples are handed
over to the Police Personnel
Special Comments in cases of
poisoning
• If working in a government hospital, a doctor is
bound to inform the legal authorities of all the
cases of poisoning regardless of their manner,
either suicidal/accidental/homicidal.
• A private medical practitioner, on the other hand,
is not legally bound to inform the legal
authorities of all the cases of poisoning. He only
has a legal obligation to inform in homicidal cases
of poisoning as per Section 39 CrPC. He is not
bound to inform the legal authorities if he is sure
the case is suicidal/ accidental in nature.
Finally
• It must remembered that he is protected
against any harm done in good faith to a
patient in an emergency situation ethically as
well as legally as per Section 92 IPC
Thank you