1. MEDICOLEGAL CASES DR KSH MANGLEM SINGH Chief Medical Officer/Director,
District Health Mission, Imphal East
Cum Senior Medico-legal Specialist
Government of Manipur

2. Common Medico legal Cases
Accidental injury cases
Alleged cases of assault
Cases of burns
Cases of alcoholic intoxication
Victim to animal ferocity
Snake and insect bite/stinging cases
Unconscious/Comatose patients
Alleged criminal abortion
Drug overdose/anaphylaxis reactions
Dead on arrival to hospital
Brought dead to hospital
Sudden unexpected death cases
Surgical death
Anaesthetic death

3. Points to be remembered in handling Medicolegal Cases
Cannot refuse to examine MLC
Never delay examination
Patient may be hospitalized or referred, preparing injury report
A referred case and already registered fresh report not necessary
Always obtain informed consent prior to giving treatment
Note at least 2 identification marks from exposed parts of the body
If death is inevitable arrange to take dying declaration
In case of poisoning perform gastric lavage and administer specific antidote and admit the patient,collect necessary samples
Don’t make un-necessary delay in issuing MLReports
In case of discharge or death of a MLC in the hospital;inform the police,in case of death don’t issue death certificate
If a MLC is discharged against medical advice,inform police.

4. Injury/Wound Report
Record details of the injuries found in the Accident Register cum Injury or Wound Report/Certificate.
The original is the Injury or Wound Report/Certificate,which is to be detached and issued to the Police Officer,the carbon copy will remain in the register and serve as a permanent record for the Medical Officer

5. Referring a MLC to second hospital
MO who examined first should give necessary first aid
Copy of accident/wound certificate which is sent to IO should invariably accompany the patient to next institution along with discharge certificate.This when produced before the MO in the second hospital,can allow him to continue treatment for the injures

6. Drunkenness
Consumption of alcohol in any form is an offence in an area where there Prohibition Act is in force
In case of assault,rape or homicide
The victim and the driver have to be examined in traffic accident cases
Person who has intoxicated himself is responsible for his acts,but not at all if another person forces it on him
Intoxicated person cannot give valid consent

7. Drunkenness(contd) Blood for chemical examination :
Collect 2 to 3 ml by venepuncture.Use soap and water for disinfection.The container is stopped tightly and mouth sealed with paraffin or candle wax.Put name of the person,date,time of collection along with signature of MO.Sample duly sealed and delivered to IO.Get a receipt

8. Drunkenness(contd) Opinion:
1 Consumed alcohol and is under its influence
2 Consumed alcohol but is not under its influence
3 Not consumed alcohol

9. Documents of ML nature Consent in medical practice
Birth/Death certificate
Medical/Sick leave certificate
Fitness Certificate
Court attendance exemption certificate
Dying declaration
Mental illness certificate

10. Consent in medical practice
Examination of a patient without consent amounts to assault
Expressed consent is to be obtained wherever an invasive procedural techniques to be adopted for treating
In emergency treatment cases,a patient can be examined and life saving emergency procedures carried out in good faith even without consent (IPC 92).Age for consent for operation is 18 yrs
In a MLC simply because a person is brought by police implied consent cannot be taken for granted

11. Consent(contd)
Accused can be examined by MO at the request of police officer,not below the rank of SI,without consent and even by use of force -Cr PC 53(i)
When examination of female person,examination shall be made only by or under the supervision of a female MO -Cr PC 53(ii)
Consent of legal guardian if person is below 12 yrs/18 yrs for undergoing operation

12. Death Certificate Issued only :
If cause of death is known beyond all doubts
A person is admitted in hospital,clinical diagnosis is made based on signs,symptoms and diagnostic procedures
Death occurs due to natural consequences after diagnosis is made

13. Death certificate (contd)
Don’t certify death in the following conditions:
Person brought death/dead on arrival to casualty
Persons dying after admission and before making a diagnosis
In all alleged cases of unnatural death(accident/suicide/homicide)
Anaesthetic deaths
Snakebites
Death of a woman in her husband’s house within 7 yrs of marriage

14. Dying Declaration
Statement of a dying person, relating to the cause and circumstances of his death
Magistrate having jurisdiction should be called to record the declaration
Before recording doctor should certify that person and his/her mental faculties are normal
If situation demands the doctor himself can record in the presence of two witnesses
The declaration is then sent to the magistrate in a sealed envelope with a letter

15. Medical Negligence
“the ommission to do something which a reasonable man guided by those ordinary considerations which ordinarily regulate human affairs,would do,or the doing of something which a reasonable and prudent man would not do”

16. Classification of negligence
Civil negligence-breach of duty to use reasonable skill and care,resulting in damage.Burden of proof is on the patient or his relatives
Criminal negligence-negligence of such a degree that it amounts to a criminal offence,whereby the medical practitioner may have caused the death of his patient
Contributory negligence-damage to the patient is caused partly by his own and partly by the doctor’s negligence

17. Instances amounting to negligence
Failure
to obtain informed consent for diagnostic and therapeutic procedures
to employ necessary and recognised diagnostic procedures
to attend a patient who is under the doctor’s active clinical care
to inform the patient about toxic or harmful side effects of drugs
to inquire,test for and precautions against anaphylactic reactions to drugs
to sterilize instruments like needles,syringes etc
to remove foreign body like instruments,gauze etc

18. Instances of negligence(contd)
Failure
to discover the disease,delay in treatment of which may be harmful and even dangerous to the life of the patient
to obtain consent of both partners in case of operation leading to sterility of either of them
to exercise care in selecting assistants and delegating duties to them
to assume responsibility of post operative care

19. Instances of negligence(contd)
withdraw active clinical care without giving adequate notice or providing alternative care to the patient
misdiagnosing non existing conditions
operative procedures,except in emergency,expressedly not authorised by the patient
anaesthetic mishaps,and accompanying ancillary responsibilities-transfusion,intravenous injection,catheterisation,diathermy,hot water burns

20. Defence against negligence
Actual denial of negligence taken place
Delegation of duty to the subordinate
Contributory negligence by the patient
Assumption of risk by the patient
Emergency of the situation
release of tortfeasor-settlement wth third party and release
Res judicata (”the thing has been decided”)
Statutes of limitation
Immunity to charitable and ggovernment institutions

21. Prevention against negligence
Do not criticise another doctor
Employ qualify staff & associate with good partners
Udate your knowledge
Keep accurate and complete records
Obtain valid consent
Establish good professional relationship
Take reasonable skill and care
Guard against therapeutic hazards

22. Prevention against negligence(contd)
Good conduct of the doctor
Maintain professional secrecy
Relationship with legal profession
Medical Indemnity Insurance
Countersuit against patients

23. Thank You