1. PREPARATION OF MLC REPORTS
Department of A&E
GTB Hospital
Dilshad Garden,Delhi
MEDICOLEGAL TRAINING PROGRAMME for TRAINEE JUDICIAL OFFICERS
GURU TEG BAHADUR HOSPITAL AND UCMS DELHI 25 NOVEMBER 2009

2. DISCLAIMER/CAUTION
THIS PRESENTATION BRIEFLY OUTLINES THE PROTOCOL FOR PREPARATION OF MEDICOLEGAL REPORTS.THESE GUIDELINES ARE NOT THE FINAL AND COMPLETE DOCUMENT OF THE MEDICOLEGAL SYSTEM. THE GUIDELINES ARE SUBJECT TO REVISION FROM TIME TO TIME AS PER CENTRAL GOVT/STATE GOVT OR COURT DIRECTIVE AS THE CASE MAY BE. THE GUIDELINES ARE BEST UTILIZED IF THE MEDICAL PROFESSIONAL USES KNOWLEDGE AND SKILL TO THE BEST OF HIS/HER CAPABILITIES FOR PATIENT CARE AND MEDICOLEGAL DOCUMENTATION AS PER PROVISIONS OF THE LAW OF THE STATE. THE HEALTH CARE PROFESSIONALS ARE ALSO ADVISED TO CONSULT STANDARD REFERENCES IN SUCH MATTERS WHENEVER NECCESSARY.

3. 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

4. DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS PATIENT
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.
Duties towards children and adults.
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.
Duties under Geneva convention.
Duties in convention with X-rays.
Professional Secrecy.

5. DUTIES OF REGISTERED MEDICAL PRACTITIONER TOWARDS STATE
Consent
Confidentiality
Maintenance Of Records
Collection And Preservation Of Samples
Dying Declaration

6. OVERVIEW
WHAT
WHO
WHERE
WHEN
HOW
RELATED LAWS

7. WHAT IS A MEDICOLEGAL CASE?
No legal definition
Pre-labeled case: 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 (BPRD).

8. 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.

9. Who? Any doctor who Possess permanent registration with MCI/SMC
Some experience (preferable)
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 done by female doctors.

10. sometimes may be in wards after detection of new findings
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

11. 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

12. 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.

13. 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

14. TREATMENT is PRIORITY THE PRIME RESPONSIBILITY OF
DOCTOR IS THE INSTITUTION OF
PROPER TREATMENT TO THE PATIENT PROMPTLY

15. 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

16. 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

17. 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
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.

20. GENERAL DEATAILS REGISTRATION NUMBER MLC NO NAME S/D/W OF AGE SEX
RELIGION
OCCUPATION
RESIDENTIAL ADDRESS
BROUGHT BY …….
DATE AND TIME OF EXAMINATION
NAME OF POLCE STATION

21. DETAILS OF EXAMINATION
ALLEGED HISTORY
TO BE PRECICISE AND TO THE POINT
LEGIBALY/CLEARLY WRITTEN
DESCRIPTION OF INJURIES
ABBREVIATIONS AVOIDED
WHEN IN DOUBT CONSULTATION OBTAINED
MINOR INJURIES ALSO NOTED IN CASE OF
POLYTRAUMA/MULTIPLE INJURIES
MARKS OF IDENTIFICATION ARE NOTED AND DOCUMENTED

22. CERTIFY FITNESS
and
OPINION

23. CERTIFYING FITNESS
As a part of documentation of ML Case report or whenever the I.O requests the doctor for certifying fitness of the patient to make a statement the examining doctor will certify the same on the original MLC sheet. He/she will mention date and time clearly with signature, name in full with designation below the certification.

24. OPINION REGARDING INJURIES
SIMPLE
UNDEROBSERVATION AND REFERENCE FOR
A SPECIALIST OPINION
GREVIOUS (AFTER CONSIDERATION OF
ALL FINDINGS/X-Ray etc)
CAUSED BY SHARP/BLUNT OBJECTS

25. 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.

26. 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.

27. Discharged after initial treatment Admitted as in patient
ML CASE
Discharged after initial treatment
Admitted as in patient
Referred to other hospital after providing First Aid / stabilization for expert management after completion of all necessary documentation

28. If the case brought is a referred case and is already registered as medico legal case FRESH REPORT is NOT REQUIRED

29. 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.

30. How? First aim is to preserve life Registration at designated area
Specified Register
Cases already registered and referred
Duty of referring doctor
Duty of receiving doctor
Entertaining requests of patient/relative

31. 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

32. DOCTORS MAINTAIN CONFIDENTIALITY IN ALL MLC CSES
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

33. 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.

34. 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

35. COLLECTION AND PRESERVATION OF SAMPLES
Urine for pregnancy test in rape cases
Undergarments
Swabs from glans penis in rape/unnatural sexual offences
Swab from bite marks for blood/DNA test
Nails and hair in chronic poisoning of heavy metals
Any other material which may be useful in investigation
Any other exhibit e.g. bottle of poison or tablet or weapon if recovered should be properly labeled and sealed. It is essential to give sample of seal on separate cloth/paper putting initials. The endorsement of sample of seal should also be made in MLR.

36. AGE DETERMINATION GENERAL PHYSICAL EXAMINATION Generally
DEV. OF SECONDARY SEXUAL CHARACTERS
DEVELOPMENT AND ERUPTION OF TEETH
OSSIFICATION OF BONES
Generally
X-ray of
Wrist
Elbow
Shoulder
is advised for age determination- juvenile or not
VICTIM
ACCUSED
It is necessary that to estimate age all precautions to be taken so that
range of estimation should not be more than ± 6 months up to 16 years
of age and ± 1 year up to 21 years.

37. RELEVANCE OF AGE DETERMINATION
CRIMINAL CULPABILITY Section 82 IPC child < 7 years
Section 83 IPC child 7 years -12 years
CONSENT FOR MEDICAL EXAMINATION
CONSENT for any harm not intended to cause death or grievous hurt can be given by a person> 18 years age Section 87 IPC
IMPRISONMENT –Juvenile < 18 years not to be kept in prison
CASES OF SEXUAL ASSAULT/RAPE

38. Issues regarding MLC Dying declaration Dying deposition
Custody of ML Records
Attending court of Law

39. Admission and Discharge of MLC
Whenever a medico-legal case is admitted the same is documented in admission papers and hospital records
When discharged, the same should be intimated to the police authorities of the hospital
Police is informed if a MLC is taking discharge against medical advice
At the time of discharge, detailed instructions to the patient regarding treatment, follow up general care, diet, exercise etc are given in writing.

40. Death of a person admitted as a medico-legal case
The following are the do's and don'ts in case a person admitted as a medico-legal case expires.
Police Informed immediately.
Body sent to the hospital mortuary for preservation, till the legal formalities are completed and the police releases the body to the lawful heirs.
Death certificate not issued – even if the patient was admitted.
Dead body never released to the relatives directly

41. BROUGHT IN DEAD PATIENTS
POLICE TO BE INFORMED IF NOT ALREADY DONE
NO INJURIES NOTED IN MLC RECORD
ARTICLES IN POSSESSION DOCUMENTED AND HANDED
OVER TO RELATIVES/POLICE
DEAD BODY TO BE SENT TO HOSPITAL MORTUARY

42. MEDICAL EXAMINATION OF VICTIMS OF SEXUAL ASSAULT
Section 164A of CrPC
Examination only by female registered medical practitioner
Without delay
Consent -documented
Note down particulars
Complete history
Examination – Genital examination and injuries:
Standard protocols and guidelines
Preserve samples-DNA profiling
Emergency Contraception if required
Treatment /prophylaxis as required
Opinion

43. EXAMINATION OF PERSON ACCUSED OF SEXUAL ASSAULT
Section 53A CrPC
Brought by police written and signed request
Details of examination findings
Sample preservation –Clothing/Blood/Semen sample/Pubic hairs
for DNA profiling
Opinion
Age determination
Consent not required

44. CHILD ABUSE/ SUSPECTED VICTIMS OF SEXUAL ASSAULT/ABANDONED CHILDREN
Guidelines laid down by hon’ble court
A detailed description of assault/abuse history be mentioned
In case of girl victim medical examination preferably by a female doctor
As far as practical –psychiatrist help be made available to victim
Report to be prepared as early as possible
Parents/ guardian whom child should trust should be allowed to be present
In case of results of examination are likely to be delayed the same should be mentioned
Emergency medical treatment/prophylaxis against STD to be provided when necessary
After examination child permitted to wash up and provide fresh clothing if clothing is taken as evidence
Preserve samples according to guidelines –SAFE [Sexual abuse Forensic Evidence] Kit provided in Govt. hospitals

45. LEGAL PROVISIONS Section 191 IPC (Giving false evidence)
Section 192 IPC (Fabricating false evidence)
Section 193 IPC (Punishment for false evidence)-Imprisonment up-to 7 years+ fine
Section 201 IPC (Causing disappearance of evidence of offence, or giving false information to screen offender)

46. LEGAL PROVISIONS (cont.)
Section 202 IPC (Intentional omission to give information of offence by person bound to inform)
Section 203 IPC (Giving false information respecting an offence committed)-Under Sections 201 and 202 and in this section the word “offence”, includes any act committed underSection302,304,382,393,394,395,396,397,398,402,435,436,449,450,457,458,459 and 460 46

47. LEGAL PROVISIONS (cont.)
Section 204 IPC (Destruction of document or electronic record to prevent its production as evidence) Imprisonment up-to 2 years or fine or both
Section 88 IPC (Act not intended to cause death, done by consent in good faith for person’s benefit)
Section 89 IPC (Act done in good faith for the benefit of child or insane person, by or by consent of guardian) 47

48. LEGAL PROVISIONS (cont.)
Section 92 IPC (Act done in good faith for benefit of a person with out consent)
Section 93 IPC (Communication made in good faith)
Section 39 CrPC (Public to give information of certain offences-Section ) 48

49. LEGAL PROVISIONS (cont.)
Section 53 CrPC (Examination of accused by medical practitioner at the request of police officer)
Section 53A CrPC (Examination of person accused of rape by medical practitioner)
Section 54 CrPC (Examination of arrested person by medical practitioner at the request of the arrested person) 49

50. THE ONUS OF FIXING RESPOSIBILITY OF GUILTY IS FOR THE COURT
SUMMARY
MLC REPORTS FILLED LEGIBALY
AVOID SUPERLATIVES,ABBREVATIONS, TECHNICAL JARGON
ALL RELEVANT DETAILS NOTED
SIGNATURE / NAME IN FULL CAPITAL LETTERS BELOW
ALL RELATED FORMS ARE LEGAL DOCUMENTS FILLED IN DUPLICATE
WITH MLC NUMBER AND DETAILS
ALL COULUMS COMPLETED
CONFIDENTIALITY MAINTAINED
NONJUDGEMENTAL ABOUT ANY CASE –DUTY IS TO EXAMINE THE PATIENT AND DOCUMENT THE FINDINGS AND PATIENT MANAGEMENT.
THE ONUS OF FIXING RESPOSIBILITY OF GUILTY IS FOR THE COURT

51. THANK YOU