ORIGINAL PAPER AN APPROACH TO MEDICO-LEGAL CASES IN INDIAN GOVERNMENT HOSPITAL “DO'S AND DON'TS”. Dr Omna Shaki Medical Officer (MBBS, DFH, PGDMLS, LLB(Hons), Medical Officer In- charge, Accident & Emergency Services, INHS Asvini - Corresponding Author Dr SK Rai Orthopaedics surgeon & Associate professor, INHS Asvini ABSTRACT Medicolegal cases (MLC) are an integral part of medical practice that is frequently encountered by Medical Officers working in any government or private hospitals across the country. The occurrence of MLCs is on the increase, both in the Civil as well as in the Indian Armed Forces because of fast growing economy, increasing expectation from doctors , life style, crime and road traffic accidents. Proper handling and details and accurate documentation of these cases is of prime importance to avoid legal complications and to ensure that the Next of Kin (NOK) receive the entitled benefits per as exiting rules and provisions. All medical officers working in government or in private hospitals, encounter medicolegal issues which should be handled in accordance with the law of the land existing SOPs (standing order procedure) and directives issued by higher formation or service headquarters. The rule of thumb is to register the case as MLC when you are in doubt about the nature of injury or death of the person, never ever come under pressure not to initiate /register MLC. KEYWORDS Medicolegal cases (MLC), medical officer, hospital emergency Introduction: Medical officer or medical practitioner working either in government or in private hospital across the country at any time during the practice of his profession will encounter/ would have encountered certain cases, which at that given time or subsequently, would be labeled as "medico-legal". Many of us as medical officer are usually apprehensive in dealing with these type of cases, because according to them, a MLC (Medico-legal Case) implies-'rough speaking' police officials, trapped in the case, 'inordinate hours' in the court, 'unrelenting' defense counsels, etc. Because of this "fear-factor", medical officer either try to avoid the cases or try to 'get away with' them as soon as possible. In both ways, because they do not properly understand the implications of the case, they may make mistakes, which may land them in trouble. The best way to deal all medico legal cases is to understand them properly, analyze them thoroughly, and then act accordingly. Since law and order is a state subject, there are differences in the legal procedures being followed by different states. Medical Officers should acquaint themselves with medicolegal procedures that are in vogue in that state in which they are serving or practicing. RMO / Casualty medical officer /medical officer in charge of emergency room / Duty Medical Officer (DMO) / MO In charge ward who is attending to the case, may label a case as MLC. What is a medico-legal case or whom should a doctor register as MLC? A medico-legal case is a case of injury/ illness where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land [1]. It can also be defined as a case of injury or ailment, etc., in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment [2]. In a simple way,it is a medical case with legal implications or a legal case requiring medical expertise. Accordingly, a medico- legal report is one, which is prepared for the purpose of litigation - imminent or prospective. The responsibility to label any case as an MLC rests solely with the attending medical officer. Receiving a MLC A doctor can receive a medico-legal case in any of the three ways - 1. A case is brought by the police for examination and reporting, 2. The person in question was already attended to by a doctor and a medico-legal case was registered in the previous hospital, and the person is now referred for expert management/ advice. 3. If any patients transferred in from previous station and MCL has been raised at previous station , being admitted at new station for further management, the DMO/MO should not initiate MLC again at new station rather he should enter preamble of patient ( patient details) in his MLC register and in the injury column he should write previous MLC nunber only (stating as per MCL no: dated & place). The written information has to be given to local police station as well.(As per AIIMS New Delhi hospital management board) [13]. 4. In the other situation, after history taking and thorough examination, if the doctor feels that the circumstances/ findings of the case are such that registration of the case as an MLC is warranted, he should immediately inform the patient of the same and take his consent for converting the case into MLC. At that given time, the patient may refuse consent, withdraw the consent already given or may even leave the hospital. The doctor has no right to force anything on the patient. The best way is to carefully document all the findings, note the exact moment at which the consent was withdrawn and inform the nearest police station regarding the same, giving reasons for his actions. At times, the decision may be made easier by the patient himself expressing his intention to register a case against the alleged accused. The medical officer has to use his judgment when the person comes on his own and the history is not corroborative to clinical finding or injury sustained and not completely revealed, either by the patient or his relatives/ friends, due to some motive. When a person has been referred from another hospital, which has already registered as a medico-legal case, the same may be informed to the nearest police station, however, a fresh medico-legal case need not be registered. However only preamble portion has to be mentioned in medicolegal register and present condition of injury, wound has to be entered. When a patient is to be referred to another hospital for further management, he should be issued a referral letter detailing the treatment given and whether the case was registered as an MLC or not. Request made by the patient or the persons accompanying, not to register a medico-legal case, should not be acceded to, by the medical practitioner and the medical officer should not come under any pressure whatsoever. He should use his judgment and experience. If doctor thinks that the case needs to be reported to the police, he should do so without fail and without any delay. When medical officer is in doubt whether to register as MLC or non MLC it is better to register as MLC. Remember not informing the police of such cases may invite trouble to the doctor u/s 39 CrPC [Criminal Procedure Code (cases wherein public is duty-bound to inform the police)] and S.177 & 201, IPC [Indian Penal Code (giving false information & causing disappearance of evidence)]. In no condition/ circumstances MLC to be register in back date. Procedure of registering a medico-legal case In the casualty, while attending to an emergency, the doctor should understand that his first priority is to save the life of the patient. He should do everything possible to resuscitate the patient and ensure that he is out of danger. All legal formalities stand suspended till this is achieved. This has been clearly exemplified by the Hon'ble Supreme Court of India in Parmananda Katara Vs Union of India [3]. "Every doctor is bound to provide medical aid to the victims irrespective of the cause of injury; he cannot take any excuse of allowing law to take its course". In the same case, the MCI (Medical Council of India) INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Orthopaedics Volume-6 | Issue-9 | September-2017 | ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 78.46 53 International Journal of Scientific Research