Medico-Legal Aspects of Toxicology

1. Medico-Legal Aspects of Toxicology Dr. Somnath Das

2. 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

3. 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. • 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. • Professional Secrecy.

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

5. OVERVIEW • WHAT • WHO • WHERE • WHEN • HOW

6. WHAT IS A MEDICOLEGAL CASE? No legal definition 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.

7. 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.

8. Who? Any doctor who Possess permanent registration with MCI/SMC 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 preferably done by female doctors.

9. 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

10. 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

11. How? 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.

12. 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

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

14. MLC should be registered as early as possible • There is no time limitfor 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

15. 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

16. 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 with registration number • 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.

17. OPINION REGARDING INJURIES • SIMPLE • UNDER OBSERVATION AND REFERENCE FOR A SPECIALIST OPINION • GREVIOUS (AFTER CONSIDERATION OF ALL FINDINGS/X-Ray etc)

18. 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.

19. 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.

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

21. 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.

22. Whenever there is doubt, doctorstake second opinion/consult specialists All reports and documents of a medico legal case are labeled as MLC with the number assigned

23. 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

24. 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.

25. 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

26. All the collected samples are handed over to the Police Personnel

27. Special Comments in cases of poisoning • If working in a government hospital, a doctor is bound to inform the legal authorities of all the cases of poisoning regardless of their manner, either suicidal/accidental/homicidal. • A private medical practitioner, on the other hand, is not legally bound to inform the legal authorities of all the cases of poisoning. He only has a legal obligation to inform in homicidal cases of poisoning as per Section 39 CrPC. He is not bound to inform the legal authorities if he is sure the case is suicidal/ accidental in nature.

28. Finally • It must remembered that he is protected against any harm done in good faith to a patient in an emergency situation ethically as well as legally as per Section 92 IPC

29. Thank you