This article was written by Adhila Muhammed Arif, a student of Government Law College, Thiruvananthapuram. This article seeks to explain what a medico-legal case is, some important laws related to it, and what medical practitioners must keep in mind while dealing with a medico-legal cases. 

It has been published by Rachit Garg.

Introduction

The legal system of the modern world is undoubtedly closely integrated with every sector or industry of society, and the healthcare sector is no different. As a result of such integration, medical practitioners often deal with medical cases which have serious legal implications. Such cases are called medico-legal cases (MLCs). Every doctor at some point in their life encounters a medico-legal case. Most of them are apprehensive about having to deal with medico-legal cases as they imagine that they would be summoned by the courts and the police. The fear of being entangled in court cases leads them to avoid medico-legal cases or mislabel them. This article attempts to clear out certain misconceptions regarding medico-legal cases and provide awareness to medical practitioners on dealing with the same. 

What is a medico-legal case

A medico-legal case is essentially a medical case with legal implications. A medical case becomes a medico-legal case when the attending doctor clinically examines the patient and their history and forms the opinion that an investigation by law enforcement is needed. A medical examination conducted for patients brought by the police or the court also falls within this category. The following are some examples of cases that fall under the category of medico-legal cases: 

  • Injuries due to battery;
  • Injuries that have a likelihood of death;
  • Injuries due to accidents, which can be industrial, vehicular, or other causes;
  • Injuries due to firearms;
  • Suspected or evident suicides or homicides, which also include attempts;
  • Suspected or evident poisoning or intoxication;
  • Cases referred from courts or otherwise in order to determine the age;
  • Burns;
  • Electrical or chemical injuries; 
  • Death by an animal bite;
  • Unnatural deaths; 
  • Patient is a person in judicial or police custody;
  • A patient who is unconscious or in a coma where the cause has not been found;
  • Asphyxia due to hanging strangling, drowning or suffocation;
  • Suspected or evident sexual assault;
  • Suspected or evident criminal abortion; 
  • Domestic violence and child abuse;
  • The sudden death of a patient on the operation table or after parenteral administration of a drug or medication;
  • Person brought dead where there is improper history. 

It is to be noted that the list given above is not exhaustive. Any case that does not fall into any category in the list yet still has legal implications is a medico-legal case. The doctor must use professional judgement to recognise whether a case has legal implications or not. 

Legal terms relevant to medico-legal cases

The following are some of the legal terms in the Indian Penal Code that every medical practitioner should be aware of while dealing with a medico-legal case: 

  • Injury: Section 44 of the Indian Penal Code, 1860 defines injury as any harm caused to a person’s mind, body, reputation, or property in a manner that is illegal. Hence, the term “injury” includes any kind of bodily harm that is inflicted on a person illegally. 
  • Simple hurt: The term ‘simple hurt,’ also called ‘hurt,’ is defined in Section 319 of the Indian Penal Code. It includes any bodily pain, disease, or infirmity caused to a person. 
  • Grievous hurt: The term ‘grievous hurt’ is defined in Section 320 of the Indian Penal Code. It includes the following things:
  1. Permanent deprivation of an eye or an ear,
  2. Deprivation or destruction or permanent impairing of a member or a joint,
  3. Permanent disfiguration in the face or head, 
  4. Fracture or dislocation of a bone or a tooth,
  5. Hurt that causes the person to be in severe body pain for a period of twenty days,
  6. Hurt that is life-threatening,
  7. Hurt that renders the person incapable of doing his daily chores and activities. 
  • Culpable homicide: It is defined in Section 299 of the Indian Penal Code. It refers to the death of a person caused by an act done – 
  1. with the intention of causing bodily injury that has the likelihood of causing death, or 
  2. with the knowledge that the act is likely to cause death. 
  • Murder: The legal definition of murder is provided in Section 300 of the Indian Penal Code. As per this Section, a culpable homicide becomes a murder if it was caused by an act which was done – 
  1. with the intention of causing death, or
  2. with the intention of causing bodily injury that has the likelihood of causing death, or 
  3. with the intention of causing bodily injury that is enough to cause death in the ordinary course of nature, or
  4. With the knowledge that the act is so dangerous that it can cause death or bodily injury that is very likely to cause death in all probability. 

Duties of doctors with respect to medico-legal cases

Duty to not refuse treatment

  • Every doctor is bound by their duty to treat any patient. When doctors enter their profession, they make an oath to perform their duties with utmost dignity and integrity, promising to always put the patient’s needs first. They cannot give any reason to refuse treatment, particularly for patients requiring emergency medical services. 
  • This was upheld in the landmark judgement of Parmananda Katara v. Union of India (1989), where the Supreme Court of India held that healthcare workers cannot decide whether or not to provide immediate medical assistance based on innocence or guilt of the patient. The right to seek medical assistance is an integral part of Article 21 of the Indian Constitution.  
  • In the case of Poonam Sharma v. Union of India (2002), the Delhi High Court reiterated that doctors, as well as, police officers have a duty to ensure and provide medical aid to persons involved in medico-legal cases. 
  • Additionally, the Supreme Court laid down the following guidelines: 
  1. A patient who needs emergency medical assistance must be admitted by the doctor.
  2. Even when there is no vacant bed available, the doctor must ensure that the patient gets due care. 
  3. In case a patient cannot be admitted to the hospital, the doctor must also take the necessary steps required to transfer the patient to another hospital via an ambulance. The doctor must ensure that the receiving hospital has space and qualified doctors for treatment. The doctor must send the necessary medical reports as well with the transfer. 

Disclosure of crimes 

  • As per Section 39 of the Code of Criminal Procedure (CrPC), 1973, a person who becomes aware of the commission of an offence must provide the information to the nearest Magistrate or a police officer. The same shall apply to a doctor, who on examining or treating a patient, forms an opinion that an offence was committed or attempted. The following are some of the offences of the Indian Penal Code that a doctor must report: 
  1. Offences that affect life (Sections 302, 303 and 304),
  2. Offences against public tranquillity (Sections 143, 144, 145, 147 and 148),
  3. Offences relating to adulteration of food and drugs (Sections 272 to 278),
  4. theft after preparation made to cause death, hurt or restraint (Section 382),
  5. Robbery and dacoity (Sections 392 to 399). 
  • A doctor should consider whether a case is a medico-legal case or not on the basis of the facts. The doctor must inform the police on receiving a medico-legal case. It is to be noted that a doctor does not need consent from the patient or his relatives for the labelling and informing the police. 

Collection of samples and information 

  • Every doctor must collect necessary information and samples and properly record them while examining or treating a patient. This ensures that in case legal complications arise, the doctor will have sufficient evidence to provide for investigation. It is also to be noted that the disappearance of evidence is a punishable offence under Section 201 of the Indian Penal Code. 

Management of medico-legal cases 

  1. Identification 
  • The first step is the identification of a medico-legal case. 
  • After assessing the injuries, history, and circumstances, the doctor or medical practitioner must exercise his professional judgement to label a case as medico-legal or as non-medico-legal. The doctor must be careful while labelling. He must avoid mislabelling a case as non-medico-legal merely due to pressure from the patient or his relatives. 
  • In the case of Smt.Reshma W/O Ramesh Sutar v. Shri.Amool Laxman Ukirde  (2020), it was held that if a doctor, after noting his history and clinically examining him, thinks that investigation by law enforcement is necessary, then he shall identify the case as a medico-legal case.
  1. Preliminary treatment 
  • In case of the medico-legal case being an emergency, the first thing the doctor should do is to ensure that the patient receives the preliminary treatment. As stated earlier, every doctor is bound by their oath to put the patient’s needs first before any procedural requirements. This was also affirmed in the case of  Parmananda Katara v. Union of India (1989)
  1. Medico-legal report
  • A medico-legal report contains three parts: preliminary details, findings from the examination, and an opinion. 
  • Preliminary details to be filled: 
  1. The report of a medico-legal case must contain all the necessary details.
  2. It must contain details of the person such as age, sex, address, name of the patient’s father, the person who brought him to the hospital, the date and time of reporting, the time of the incident, and all such 
  3. The use of abbreviations must be avoided. 
  4. It must contain identification marks and fingerprints of the patient. 
  5. The time and date of the examination should be included as well.
  6. The history of the patient must be recorded as well. 
  7. Everything in the report must be written in legible handwriting. 
  • Consent for examination: 
  1. Obtaining the consent of the patient on the report is essential. 
  2. The consent obtained must be an informed one. 
  3. Consent is to be taken before starting the procedure. 
  4. The doctor must clearly explain to the patient that the examination is medico-legal and that a medico-legal injury report would be prepared. The patient must be informed that there would be an investigation conducted and its purpose. The patient must also be informed that if the findings and his history don’t match, it could have legal implications for him. 
  5. If it is not possible to obtain his consent due to unconsciousness, consent must be obtained from the guardian or the person accompanying him, which could be a police officer as well. 
  6. A conscious patient who is of the age of majority has the right to refuse. 
  7. Consent of the accused in a case: This is dealt with by Section 53 clause 1 of the CrPC. If the police have reasonable grounds to believe that the medical examination of the accused in a case can give evidence that suggests the commission of the offence, then they can request a registered medical practitioner for the medical examination of that person. The police officer directing the medical practitioner must have the rank of sub-inspector, or above. A female accused must be examined under the supervision of a female medical practitioner. 
  8. Consent of a minor: Generally in Indian hospitals, the minimum age to give consent to a medical examination or intervention is twelve. For any child below that age, consent must be given by a parent or guardian or any close relative. If it is found that the parents or guardians of the child do not care for his or her welfare, the Child Welfare Committee must be informed regarding the same. Under the Juvenile Justice (Care and Protection) Act, 2015, the Committee has the duty to ensure that children are protected, cared for, and rehabilitated. 
  9. There are instances where consent is not required. The following are such instances: 
  • Medical emergencies, 
  • Medico-legal post-mortem,
  • When there is a court order for examination and treatment, 
  • Members of the armed forces if there is a written request from a competent authority,
  • Patient is a person arrested for committing an offence of such a nature that a medical examination would give necessary evidence when requested by a police officer (Section 53 clause 1 of CrPC). 
  • Examination: 
  1. When the patient is female, either the doctor must be female, or the attending nurse must be female. 
  2. In case of transfer of medico-legal cases where there is already a report, the findings must be attached to the same report instead of a fresh one. 
  3. There must be a detailed examination of the pulse, heartbeat, respiration, blood pressure, alertness, etc. 
  4. All injuries must be described properly with details on their length, depth, and breadth, whether bleeding, dry, or lacerated. 
  5. The probable cause of the injury must be included as well.  
  6. The total number of wounds must be described.
  7. Colour changes in any part of the body must be noted.
  8. Fractured bone or tooth must be noted.
  9. Consciousness level must be checked. 
  • Opinion: 
  1. Finally, the doctor must write his opinion on the findings from the examination on the medico-legal report. 
  2. He must state the nature of the unity, whether it is simple hurt or grievous hurt. 
  3. He must also form an opinion on the nature of the weapon used, whether it was blunt or sharp. 
  4. He must also write down the estimated duration of the injuries. 
  5. The doctor may also be summoned by the court to produce his opinion as an expert witness. 
  6. The opinion given by the doctor is considered ‘expert evidence’ as per Section 45 of the Indian Evidence Act, 1872
  • Collection of samples and medico-legal evidence: 
  1. Some cases may also require the collection of samples such as saliva, blood, vomit, vaginal swab, etc. 
  2. The samples must be properly sealed and preserved and given to the authorities for investigation. 
  3. Medico-legal evidence such as a patient’s clothes with blood stains, bullet holes, stab marks, etc. must be preserved as well. 
  4. When a foreign object such as a bullet has entered the patient’s body, it is necessary to remove it and preserve it for evidence. 
  5. The possessions found with the patient at the time of examination must be preserved as well. 
  6. When such samples and medico-legal evidence are taken, the same must be mentioned in the report. 
  • The document must have the full name of the doctor with his signature. 
  • The documents must be copied and at least one of the copies must be kept with the hospital as evidence. 
  • The copies of important documents and reports must be kept safely at the hospital for at least 10 years, or at least till the case is disposed of. This protects the doctors from being sued by the patients. 
  • The report must be submitted to the authorities as soon as possible.
  1. Informing the police 
  • It is an important obligation of the doctor to register medico-legal cases and inform the police regarding the same, as per Section 39 of CrPC. He can do so by telephone or in writing. 
  • The registration or the information must be made as early as possible. 
  • A copy of the medico-legal report must be sent to the police. 
  1. Acknowledgement of receipt 
  • Once the police are informed, an acknowledgement receipt must be taken from them. This is useful for future reference. 
  • Keeping a register for medico-legal cases must be practised in every hospital. The register can be used to enter the facts of medico-legal cases. So, if at all a patient or the court or the police request a copy of the medico-legal report, the register makes it easier to provide such a copy. 

Recording of dying declaration 

  • If a patient is dying, it is important to inform the police to call the magistrate to record the dying declaration. 
  • As per Section 32 of the Indian Evidence Act, 1872, a dying declaration is essentially a statement made by a person about to die, regarding the causes or circumstances that led to his death. 
  • The patient must be mentally sound at the time of giving the statement. 
  • If there is no sufficient time to have the magistrate, the doctor must himself record the statement in the presence of the police officers or the presence of fellow doctors. 
  • After the statement is recorded, the signature or thumb impression of the patient shall also be obtained.
  • In the case of State of Karnataka v. Shariff (2003), the Karnataka High Court held that the history given by the patient regarding the incident that caused his death, which was properly recorded by the doctor in the report, can be considered a dying declaration under Section 32 of the Indian Evidence Act, 1872. 

Steps to be taken in a rape case

  • In the case of the State of Karnataka v. Manjanna (2000), the Karnataka High Court held that the examination of a rape victim is a medicolegal emergency. The Court held that since it is an emergency, the medical examination of the victim must be conducted first before informing the police in cases where the victim has come for the examination by herself. In some cases, the victims are brought by the police or the court. 
  • An examination of a female patient who has undergone sexual assault can be conducted only by, or at least under the supervision of a female doctor. This is mandated by Section 53(2) of the Criminal Procedure Code. This has also been reaffirmed by the Supreme Court in the case of State of Punjab v. Gurmit Singh, (1976).
  • In the case of the Delhi Commission of Women v. Delhi Police (2009), the Delhi High Court recommended that some measures must be taken by the authorities and health services to effectively and fairly deal with rape cases. The Court also held that doctors must use the SAFE (Sexual Assault Forensic Evidence collection) kit to collect evidence. 
  • Medical examination of victim: Section 164A of the CrPC lays down the procedure to be followed for the examination of a rape victim. It states the following: 
  1. Once a complaint of rape has been received, the victim shall be sent for medical examination within 24 hours. 
  2. The examination shall be conducted by a registered medical practitioner, who works at a hospital run by the Government or a local authority, and if such a medical practitioner is not available, then any registered medical practitioner. 
  3. It is essential to obtain the consent of the victim or the person accompanying her who is competent to give consent on her behalf. The consent obtained must be properly recorded in the medical report. 
  4. The medical report should contain details such as age, name, address, DNA material, description of injuries, mental state of the woman, etc. 
  5. The report shall also carry the time at which the examination started and concluded. 
  6. The conclusion and the reasoning behind it must be properly stated in the report. 
  1. The history of the incident must be noted and recorded by the attending doctor. It shall be recorded in the victim’s own words. If not, the name of the person who testifies to it shall be noted in the record. This is an important piece of evidence. 
  2. Details of clothing shall be recorded as well.  
  3. The responses and state of mind of the victim shall be noted. The doctor should take note of the victim’s pupils, pulse rate, blood pressure, stains, and semen marks. 
  4. Stains, injuries, and swellings from the oral cavity and anal openings must be examined and recorded as well. 
  5. Injuries, whether they are in the nature of fractures, nail marks, teeth marks, weapon infection, etc., must be recorded. 
  6. The external genital area must be examined and injuries, foreign objects, semen stains, and stray pubic hair, must be recorded or preserved. 
  7. The vagina must be examined to find out whether there are internal injuries in cases where there is penetration. It is done by lubricating it with warm or sterile water. 
  8. Doctors are forbidden from performing the two-finger test to determine whether sexual assault has been committed or not on the basis of the laxity of the muscles, which is essentially a virginity test. In the case of Lillu & Anr v. State Of Haryana (2013), the Supreme Court held that the two-finger test is unconstitutional as it violates the right to privacy of the victim. 
  • Medical examination of accused: Section 53 of the CrPC provides for the medical examination of an accused in any case. Section 53A specifically deals with accused persons in a rape case. The provision states the following: 
  1. An accused in a rape or rape attempt case can be examined by a registered medical practitioner on the request made by the police officer who is not of a rank below that of a sub-inspector. 
  2. The examination must be conducted properly as soon as possible. 
  3. The medical report should contain details such as name, age, injury marks, DNA material taken, and other such information obtained from the medical examination. 
  4. The report shall have an opinion and its reasoning. 
  5. The date and timing of the examination must be included in the report as well. 
  6. The report must be sent to the concerned police officer and the police officer in turn will send it to the magistrate as per Section 173 of CrPC. 

Medical examination of a person in police custody

  • Persons in police custody are often subjected to violence and torture, which sometimes even lead to their death. There are several provisions and guidelines that ensure some level of protection from custodial violence. Medical examination of such persons is one of such protective measures. 
  • Arrested or detained persons may access medical intervention in the following ways: 
  1. Through the police,  
  2. Through a court directive,
  3. To a prison doctor if the person is in judicial custody,
  4. Visit the hospital on their own after being released from jail. 
  • As per Section 54 of CrPC, it is mandatory for arrested or detained persons to get medically examined. 
  1. As soon as a person is arrested, it is required for a medical examination to be conducted by a government medical practitioner, or a private practitioner in case of unavailability. 
  2. A female arrested person shall be examined by a female doctor only. 
  3. The doctor shall prepare a report containing important details such as injuries or other marks that suggest violence. 
  4. The report may also carry the approximate time when the injury must have been inflicted. 
  5. A copy of the medico-legal report shall be provided to the arrested person or his nominee. 
  • It is crucial to examine the mental state of the patient and provide adequate psychological support. 
  • If the patient was brought by the police officer, the details of the police officer must be noted down as well. 
  • The doctor must not allow himself to be influenced by the police officer’s interests and his version of the facts. The doctor must ensure that the examination and the opinion formed in the medico-legal report must be objective and unbiased. 

Conclusion

A medical practitioner may encounter several cases which could point to the commission of a certain offence. The attending medical practitioner must label such a case as a medico-legal case and inform the authorities regarding the same. In some scenarios, such cases are sent to doctors by the court or by the police themselves. The doctor must ensure that the medical examination is properly carried out and that all the medico-legal evidence obtained is properly preserved. Most importantly, when the patient is in need of urgent treatment, the doctor must provide the preliminary treatment first before fulfiling the formalities of a medico-legal case. Fortunately, doctors do not have to worry as most hospitals now have a medico-legal manual that provides detailed instructions to medical practitioners on the management of medico-legal cases. 

To sum up, doctors must be aware of the medico-legal guidelines that are recommended by their respective hospitals. Attending doctors must remain diligent and attentive while examining and treating the patient. They must also take due care while filling up the medical records. They must ensure that on death under suspicious circumstances, the body undergoes postmortem examination and the police must be informed before handing the body to relatives. All hospitals must ensure that their medical practitioners get adequate training to handle medico-legal cases. 

Frequently Asked Questions

Can a doctor be punished for not reporting a medico-legal case? 

Yes, if a medical practitioner does not report a medico-legal case to the police intentionally, he will be subject to either imprisonment of 6 months or a fine or both, as per Section 202 of the Indian Penal Code. 

What are the consequences of giving false information to the police by a medical practitioner attending a medico-legal case? 

Section 177 of the Indian Penal Code states that any person who is legally bound to disclose information to a public servant regarding the commission of an offence and provides false information will be subject to imprisonment of 2 years or a fine or both. Hence, a medical practitioner that attends a medico-legal case can be punished for providing false information. 

Can a doctor refuse to treat a patient solely because it is suspected to be a medico-legal case? 

No, a doctor cannot refuse to treat a patient solely because of the fact that it is a medico-legal case. It is a violation of Article 21 of the Indian Constitution as well as a violation of their contractual duties. 

References


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