Facts about Medico Legal Case

A medico legal case is a legal case that centers on medical expertise rendered to a patient due to illness or injury and when the patients does not get proper care. It also helps in finding out who is responsible for causing the injury or infectivity, and a medical doctor will be needed to examine this injury or illness to decide what the effects of this will be on the injured party.

In India there are many sections and subsections of IPC dealing with the Medico Legal Cases. Currently about 10,000 – 15,000 cases are pending in various courts of India it has seen a sharp rise since past decade. The total number of criminal cases pending before D&S Courts is about 1.90 crore (190 lakh) cases, about 82¼ lakhs civil cases are pending. That means the number of criminal cases is about 2 ½ times more than civil cases. The main reason for the shoddy treatment of pending cases is lethargy and inaction on the part of the police in registering the FIRs and taking up the investigation in right earnest for various reasons. Police are either hesitant to proceed with the investigation against influential persons or they are under pressure not to act swiftly especially if the person accused is in power or an active member of the ruling party. They adopt a spineless attitude when the accused are such persons.

                                                     (AIIMS – All India Institute of Medical Sciences, New Delhi)

Forensic medicine deals with medical aspects of law and medico legal case management.

Every medical practitioner detests encountering a MLC. Many a practitioners are usually hesitant in dealing with these, for, according to them, a MLC involves unpleasant things such as talking to rough police officers, unwarranted hours in the court, insistent defense counsels etc. It is waste of time and energy for them. Because of these and many other unrecorded reasons the medical practitioners avoid the cases and try to ‘settle’ them or try to ‘get rid’ of them as soon as possible. Both ways it is not in a good taste, because they do not properly understand the implications of the case, they may make mistakes or land into some legal hassles. The best way is to deal with them is to understand the law clearly, analyze the circumstance and the case thoroughly, and then act.

Similarly, many patients and their relatives also avoid the route of filing a MLC as the law takes too long and it requires time, energy and money. Often you need a pull from the top officials to get the justice.  As the process takes too long in which whatever evidence is there, slowly vanishes or becomes obscure. Oral evidence which in most of the cases is vital to the prosecution, takes a deceitful or distorted course. Hostile witnesses with faded memories are summoned in the court; thus, with the long passage of time the case loses its grip. Heavy reliance on oral evidence has significant drawbacks. Lack of expertise and sustained effort in investigation and non-utilization of scientific methods of investigation does result in low rate of convictions and even implication of some innocent accused persons.

To change the scene, and make it a favorable in a country where more than 130,000 deaths occur annually due to road traffic accidents and more than 40 % women suffer from domestic violence leading to grave injuries, it is important that hospitals and the law work hand in hand to help the injured innocent lives. The legal environment in the nation has grown in leaps and bounds since 1989. Prior to that innumerable people would lose their lives waiting for treatment.  Year 1989 witnessed the formation of the ‘right to life’ act, which was formed after the monumental ruling in Parmanand Katara v. Union of India (Supreme Court, 1989). The case was filed by the family of a two wheeler (scooter) owner who was severely injured in a road accident. He was refused admission when taken to the nearest hospital, because the hospital claimed that it was not equipped well enough to handle a medico legal case. The scooterist succumbed to his injuries before he could be taken to the nearest hospital that was authorized to handle medico-legal cases, which was situated 20 kilometers away.

Please understand in which circumstances a medico legal case can be filed: when a person is injured or harmed in any way and needs medical attention for it and when it is not given the case is registered as Medico Legal Case (MLC). Cases such as Injury which suggest some criminal offense, burn injuries, vehicular accidents (includes railways and other modes of transport), suspected homicide/murder, poisoning, sexual assault and criminal abortion are classified as medico legal cases.  Patient who is unconscious due to unknown reasons, brought dead or die shortly after admission without proper medical documents to indicate cause of death also come under purview of MLC.  Hospital deaths where the patient dies suddenly due to administration of medication or a fall within the hospital, when he is in the ICU or during surgery can also be classified under medico legal cases. To see whether the case falls under MLC or not a medical autopsy has to be ordered under all the above circumstances.

In all these cases, it is the legal duty of the treating doctor to report the case to the nearest police station immediately after completing primary lifesaving medical care. This is in accordance with Section 39 of Criminal Procedure Code of India. The idea is to initiate legal proceeding at the earliest is so that maximum evidence can be collected by the police officer.  Quick action by the police also helps to avoid the eradication of evidence by the treating physician.

How does the law protect the victim in medico legal cases?

The law states that concerns like legal formalities, monetary considerations or even the infrastructural restraints of the institution should not prohibit the institution or hospital from providing basic and emergency medical treatment. Here are a few things everyone should know:

1. A hospital cannot deny emergency medical care to an accident victim under Article 21.
2. It cannot deny treatment on the alleged reason of lack of facilities. The hospital has to provide emergency care and then transfer the patient safely in their ambulance to the nearest facility. This includes government and private hospitals. It also includes private clinics and nursing homes.
3. The hospital cannot deny a patient emergent treatment on the basis that he/she is unable to pay the required fees or that there is no close relative to sign for consent. (Consent is overridden in an emergency)
4. In the case of a rape or criminal abortion the lady cannot be examined by a doctor without written consent from the victim.
5. In both cases – rape and criminal abortion the doctor is bound by law to keep the patients information including her name confidential.
6. In cases where a woman is being examined another woman must be present during the examination. In the case of males a male has to be present at all times.
7. In the case of suicide causing death, the doctor is obligated to report the matter to the police for further investigation.
8. If the patient is alive and suicide is suspected the doctor is not obligated to report the matter to the police.
9. Please remember, on visiting a hospital for a medico legal case, after the patient has received treatment, the doctor or hospital must inform the police about the case, it’s advised to take an acknowledgement of receipt for future reference. If the intimation is given orally or via the phone, a docket number is provided which can be used as proof of intimation and is documented in the patient’s records.
10. Once the patient is stabilized the patient and his relative will be directed to the medico legal desk. Here they are asked to fill out a form and sign it. The signature is required to authenticate the information that has been provided. At this point, the case sheet will be kept in the hospital and the victim/patient will be visited by the police. They will take down the statement of the victim, and confirm if a case needs to be filed or not. The treating physician will fill out the medical details in the form. The doctor is responsible to give accurate information to the police which will assist them in their investigation. After the case is filed the victim will get a receipt stating the file number and case number. If required the victim can employ a lawyer to take the case forward.

As citizens of this country, we all must know law of the land; our rights for our wellbeing. And clinicians and the medical fraternity must be able to justify their actions to patients, colleagues and the world around. Knowing the medical law and method will help both doctors and patients. Good doctors apply clinical knowledge in a way that is legally and ethically correct. They also know when to seek advice from senior colleagues and avoid working in a vacuum. Simple things like writing concise and accurate records, getting valid consent from patients and knowing when to seek advice can help them practice safely.