2 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 Guidelines for Handling Medico Legal Cases Vinay M Raj1, Vasudeva D S2, Gagan S3 edicolegal knowledge is an es-sence for a medical professional, irrespective of their specialty. Law is common to all. Knowledge about Medico legal is-sues is not optional for a treating Doctor but a mandatory social re-sponsibility. Proper knowledge of the roles and responsibilities of a health care provider is of im-mense importance while han-dling these cases to facilitate so-cial and legal justice. A health care provider along with the medical records called to the court as an expert witness is of pivotal importance for the pro-ceedings of the trial and any in-competence by the health care provider can result in grave con-sequences for both the Institution and self.The health care provider must therefore exercise vigilance and proper documentation while treating a Medico Legal Case. It is advisable to follow the legal as-pects to avoid embarrassment in the court of law due to the lack of knowledge or awareness regard-ing MLC’s and their practices.Hence, this effort is done to compile a set of basic guidelines to be practiced in a hospital when dealing with MLCs. The follow-ing is a non-exhaustive list of guidelines compiled to effectively handle MLCs in a hospital.Role of Doctor in CasualtyRemain calm, do not panic, and treat as a regular case.Lives saving measures are always FIRST in priority.MLC workup is done SOON after it.Casualty services are 24×7 CMOs are supposed to reg-ister MLC by entering the follow-ing in the MLC register. Preliminary data:Name –Full name should be taken with ini-tials,Age Sex Address –local and permanent. Identification marks:Two reliable identifi-cation marks have to be noted preferably from the peripheral parts of the body,If not found then it could be from private parts Mole/scar/birth mark/ deformity/ any other peculiar mark can becon-sidered. Consent of the patient / relative has to be taken:Signature/ thumb impression of the patient.Signature of the rela-tive / guardian. Brief history of the inci-dent –time/ place/nature of in-cident. Examination findings:Injuries must be noted in the order of Head to toe or major to minor injuries.

Treatment given:Immediate treat-ment givenReferral to the concerned department. If referred outside –Place where it is referred should be mentioned. Information given to police –Name of the Police Station.Deciding a case as Medico-Legal or not, is based solely on the treating DoctorMLC can be registered at any time after the patient has come to the hospital –arrival/ later –based on the time of suspi-cionAny Doctor at any point of their treatment should inform the CMO regarding any suspicion about any foul play suggestive of unnatural means in the case.It is better to register as MLC and later easy to convert into non MLC than vice versa if the Doctor is in dilemma about the case.Once MLC done –either in our hospital or outside is suffi-cient –no need to repeat the same.

Dept. Of Forensic Medicine,2Principal, 3Dept. Of Community Medicine,S N Medical College &Research Centre. Address for Correspondence: Dr Vinay M Raj, Assistant Professor, Dept. Of Fo-rensic Medicine, Akash Institute of Medical Sciences &Research Centre, Deva-nahalli –
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 copy of the same should be at-tached to the file.If patient is referred from our hospital after registering un-der MLC, the same has to be men-tioned in the referring letter and inform the same to the police.History told by the patient or the relatives has to be entered in the same words preferably, if any doubt regarding the history has to be asked specifically. Avoid guessing, assumptions about the facts. All the information written should be legible, understandable and simple in nature. Try to avoid scientific and medical terminolo-gies as much as possible.To document, use ball point pen preferably. Avoid use of ink or gel pen. Avoid over writing, scrib-bling, etc. and any corrections made must be initialed along with the date.Saving the life of the pa-tient is a priority, irrespective of availability of attendees/ relatives for consent. However only lives saving procedures are allowed. Anything other than life saving procedures has to be with the con-sent.Life saving procedures Stabilizing the patient –Airway, Breathing, Circula-tion.oCPR. Based on knowledge/skill/experience, the treating Doctor will decide the most appropriate life sav-ing procedures needed for the patient at that specific time.Eg: Medical emer-gencies –Patient with chest pain with ECG changes suggestive of myocardial infarction should be treated with aspirin & clopidogrel Patient in Hypovo-lemic shock –need fluid re-placement.

CMO can take the ad-vice from the concerned de-partment if needed any time. Concerned specialist will decide the specific treat-ment required and the same can be done under their guid-ance during their physical ab-sence.Delay in payment should never be the reason to deny the treatment. ‘FIRST SAVE THE LIFE THEN TAKE THE PAYMENT’.MLC register & Police Inti-mation Register has to be kept in a locker and the Doctor at casualty is in charge of the key. At the time of change of duty, the concerned doctor has to handover the key to the reporting Doctor along with the instructions.If anybody found safe guarding of the patient from legal circumstances either the treating Doctor or any other person in-volved is punished asper the sec-tion IPC 201.Cases to be Regis-tered as MLCThe following is an in-exhaus-tive list of cases to be registered as MLC

Alleged history of assault

Road traffic accident –Ve-hicle collision / pedestrian injury.

Firearm injuries4.Self fallinjuries not con-sistent with the history

Poisoning / drug over dos-age6.

Alcohol intoxication & drunkenness Anaphylaxis due to thera-peutically injected drugs Victims of Animal ferocity

Snake Bite/ scorpion sting; however Bee sting or other insect sting being an exception

.Attempted Suicide –self in-flicting injuries/ poisoning / any means.

.Attempted Homicide -Hanging / strangulation / poison-ing

Burns except for minor do-mestic nonfatal accidental burn injuries

Electrocution/ Lightning.14.Any patient with uncon-sciousness/ unexplained coma.15.Death occurring within 24hrs of hospitalization without establishment of a diagnosis.16

Alleged Criminal abortion Any brought dead/ Death on arrival, without any corrobora-tive history supports death.Case of AssaultAll cases ofassault have to be registered as MLC and MUST be informed to the police without fail.Injuries have to noted down from oHead to toe or major to minor oThey have to be num-beredoDescription of the injury –size, site, shape, position from bony landmark should be noted, preferably take the measurement using measur-ing tape.oAging of the injury has to be mentioned.Fresh / dark brown/ brown/ black/scar  Type of weapon in-flicted can be assessed and cor-related with the type of injuryInjury certificate has to be issued only with the patient’s or police request.