What is Medico-Legal work? What is the procedure to be followed?

Aashima Kakkar

Despite popular belief that medical negligence cases against doctors and hospitals are increasing every year, it has been discovered that the number of medical negligence cases filed in India has decreased in 2019. In India, 3241 cases of medical negligence were filed in 2018, but only 2638 cases of medical negligence were filed in 2019, representing an 18.61 percent decrease.^[1]

Only two cases increased at the National Consumer Commission level, with 435 medical negligence cases filed in 2019 compared to 433 medical negligence cases filed in 2018.

In 2019, 566 medical negligence cases were filed in all State Commissions, compared to 861 medical negligence cases in 2018, a decrease of 34.26% in 2019.

Similarly, only 1637 medical negligence cases were filed in all District commissions in 2019, compared to 1946 medical negligence cases in 2018. In the year 2019, there were 309 (15.88%) fewer cases at the district commission level than in 2018.

Even though the numbers are decreasing, that does not mean that doctors have no obligation towards their patients. During current times when the Pandemic is at full swing, Doctors are the ones who are the only ones who can help everyone, if they conduct themselves in a manner that harms their patients, where will this world go?

Medicolegal is a term that combines the fundamentals of two sister professions, medicine and law. Everyone talks about the law, but few people, aside from lawyers, judges, and law professors, have a firm grasp on what constitutes law. The average layperson often knows about the law about as well as he knows about medicine or life on Venus.

In this article we delve into the intertwined nature of legal and medical profession and how they both help people strive towards the betterment of the country.

Relationship of Medical and Legal Profession

The medical profession has its own set of ethical guidelines and code of ethics. Doctors’ negligence, on the other hand, must be determined by judges who are not medically trained. They rely on the advice of experts and make decisions based on reasonableness and prudence. The line between the three levels of negligence, lata culpa (gross neglect), levis culpa (ordinary neglect), and levissima culpa (slight neglect), is frequently blurred.^[2]

The degree of negligence is determined by the overall context, which includes the location, time, people involved, and the degree of complications. The distinction between medical negligence and medical error is well-established, and the principles are well-founded, having been clearly laid out by the Supreme Court in numerous cases.^[3] As a result, there is a need for society to recognize this distinction so that doctors are not prosecuted for impractical reasons.

A doctor owes his patients a duty of care in deciding whether or not to take on the case, a duty of care in determining what treatment to give, and a duty of care in administering that treatment.^[4]

A breach of any of these responsibilities gives the patient the right to sue for negligence. A doctor should be aware that in order to establish negligence, the plaintiff or patient must show that the damage would not have occurred if the defendant’s or doctor’s negligence had not occurred; or that the defendant’s negligence materially contributed to or increased the risk of injury; or, if the claim is for negligent nondisclosure, had he/she been adequately informed, he/she would not have been injured.^[5]

Any of the following actions can be taken by a victim against a negligent medical professional:^[6]

• Compensation: Obtaining monetary compensation through the civil courts, high court, or consumer dispute redressal forum in accordance with constitutional law, tort law/contract law, and the Consumer Protection Act. Filing a criminal complaint against the doctor under the Indian Penal Code as a form of retaliation.
• Disciplinary Action: requesting disciplinary action against the health-care provider in question from professional bodies such as the Indian Medical Council and the State Medical Council.
• Recommendation: File a complaint with the National/State Human Rights Commission to seek redress.

Unfortunately, two professional groups suffer from far more ignorance of law and medicine than is healthy, such as lawyers who do not regularly deal with medical issues in their legal practice and thus know very little about the medical profession and its problems; and lawyers who do not regularly deal with medical issues in their legal practice and thus know very little about the medical profession and its problems. Physicians frequently have a poor understanding of the law and how it affects their professional practice.

Medicolegal experts can serve as a bridge between these two professions, allowing them to work together smoothly and effectively in a scientific manner. Every step of the way, the doctor complies with the law. He faces it when a narcotic addict, a man with a gunshot wound, or a young couple seeking a blood test is subpoenaed as a witness in a personal injury lawsuit; he faces it when his assistance is sought as an expert in connection with a claim that another member of his profession has been negligent; and when he is confronted in his office or clinic by a narcotic addict, a man with a gunshot wound, or a young couple seeking a blood test.

When he is required to submit a bewildering array of governmental reports or to preserve physical evidence for the benefit of a law enforcement agency, he comes face to face with the law. In fact, the physician finds much of the law to be extremely irritating, often because he is unsure of its purpose.

List of Medico-Legal cases

• All cases of injuries and burns -the circumstances of which suggest commission of an offense by somebody. (irrespective of suspicion of foul play)
• All vehicular, factory or other unnatural accident cases specially when there is a likelihood of patient’s death or grievous hurt.
• Cases of suspected or evident sexual assault.
• Cases of suspected or evident criminal abortion.
• Cases of unconsciousness where its cause is not natural or not clear.
• All cases of suspected or evident poisoning or intoxication.
• Cases referred from a court or otherwise for age estimation.
• Cases brought dead with improper history creating suspicion of an offense.
• Cases of suspected self-infliction of injuries or attempted suicide.
• Any other case not falling under the above categories but has legal implications.

Registration of a Medico-Legal case

• Treatment – All legal formalities to be suspended till the patient is resuscitated
• Identification – Whether the said case falls under Medico Legal Case or not
• Intimation to police – if it does fall in this category, then he must register the case as an MLC and/ or intimate the same to the nearest police station, either by telephone or in writing.
• Acknowledgement receipt – From the police should be received for future reference.^[7]

Postmortem

Section 174 of the Criminal Procedure Code, 1973 (hereinafter as CrP.C) authorizes police to investigate and report on suicide, among other things. The purpose of this section, according to the Supreme Court in Pedda Satya Narayana v. State of Andhra Pradesh^[8], is to determine:

• Whether a person died under suspicious circumstances.
• If that is the case, what was the cause of death?

The body is handed over to the relatives for disposal if no foul play is suspected. Private medical institutions can perform medico-legal examinations and treatments on the living, but autopsies can only be performed with the state government’s permission.^[9]

In India, different states have different rules for conducting post-mortems. Post-mortem examinations should be done as much as possible in natural light rather than artificial light. Several state governments, however, have recently issued orders mandating the use of night post-mortems. As a result, forensic medicine experts have raised concerns about the verification of color matching in different injuries, which is more accurate in natural light than in artificial light.^[10]

The Ministry of Home Affairs’ Medico-Legal Advisory Committee has recommended that the current practice of performing post-mortems during the day be continued, based on the opinion of the Bureau of Police Research and Development’s standing committee of Forensic Medicine.^[11]

• In the state of Haryana, post-mortem examinations are permitted from sunrise to sunset on all days of the week, but they must be completed in one sitting once they begin.^[12]
• The Gujarat government permits post-mortem at night if it is not a case of poisoning or suspected poisoning, if it is not a case of a woman under thirty years of age, if it is not a case of a woman dying in her husband’s or in-home, law’s if the body is not distorted, and if adequate light resembling day light is provided.^[13]
• The Kerala State Government allows post-mortems only between the hours of 8 a.m. and 5 p.m.
• In Tamil Nadu, post-mortems were allowed to be performed at all government hospitals during the night in 1996 if the body’s claimant insisted and the cause of death was due to accidents. Because the cause of death is already known, the post-mortem can be performed at night, according to Tamil Nadu’s order. It is self-evident that if the cause of death can be determined by clinical examination and other relevant factors, the post-mortem procedure can be avoided entirely. Otherwise, post-mortems are permitted from 6 a.m. to 6 p.m. on all days, and autopsy requisitions are accepted until 4 p.m.^[14]

Postmortem in Delhi High Court Rules

Part A of Chapter XVIII of the Delhi High Court Rules deal with the provisions related to postmortem.

Rule 1 states that the effect of decomposition is to be determined and that is the main purpose of conducting a postmortem on the deceased.

Rule 2 states that it is the duty of the medical officer to conduct postmortem examination when there is no information about the cause of death and that the postmortem should be conducted as soon as possible.

Rule 3 states that the body can be exhumated or dug up if the Magistrate orders the examination of the body. Whenever there is doubt regarding digging up the body, the Magistrate can consult a Medical Officer.

Following are authorized to appointed as Medical officers:^[15]

• All Civil Surgeons
• All medical officers holding collateral Civil charges
• All staff surgeons
• All Assistant surgeons

Case Law relating to Postmortem

Amit v. State of Maharashtra^[16]

The postmortem report in the rape and murder case revealed that the girl had been sexually assaulted prior to her death. The court stated that the accused was free to criticize the report’s recitals without giving the doctor an opportunity to explain his or her criticisms.

State of Karnataka v. Papanaika^[17]

The doctor who treated the injured when he was taken to the hospital in this case did not mention all of the injuries. All injuries discovered on his person were detailed in the postmortem report after his death. The injury statement was also consistent with the testimony of prosecution witnesses. According to the court, there was no reason to doubt the post-mortem report.

Boraiah @ Shekhar v. State^[18]

The authenticity of the document postmortem report is not contested by the defence in this case. There was no objection from the defence counsel to marking the document in evidence, and thus no prohibition for the Court, which had admitted the document in evidence, to use it to find corroboration or contradiction to the other evidence on record. As a result, we believe that where a post-mortem report is signed with consent and its authenticity is uncontested, it is clearly admissible evidence. Regardless of whether or not the author of the post-mortem report is called to testify in court, especially if the defence has chosen not to cross-examine the post-mortem doctor.

References to the Chemical Examiner

Generally, a chemical examiner can be defined as the officer of the Government who has the power to chemically examine the articles relating to a case on the order of the Magistrate. A medical officer has to be consulted by the Chemical Examiner regarding the articles that can be chemically analyzed.^[19]

The officer appointed by the Government as a chemical examiner to the Excise Control Laboratory, the Delhi Forensic Science Laboratory, the Central Revenues Control Laboratory, or the Central Forensic Science Laboratory, as well as the deputy chemical examiners of the above laboratories or any other laboratory approved by the Excise Commissioner, is referred to as a chemical examiner.^[20]

Rules regarding Chemical Examiner in Delhi High Court Rules

Rule 1 states the articles that can be sent for examination by the Medical officer to the Chemical Examiner. In cases where humans were not harmed, police can directly send the articles to the Chemical Examiner. All Magistrates can send the articles for chemical examination after consultation with the medical officer, and the results should be forwarded back to the Magistrate within one day.

Rule 3 states that when an article is sent to the Chemical Officer for examination it must be accompanies by a statement by the Magistrate that can help the officer to conduct his analysis. Not only this the article must be sent in separate bottles, for instance, the stomach in one and the liver in another, but also be immersed in methylated spirits of wine which should cover 1/3^rd of the article, as given in Rule 4. This rule also states that the bottles need to be tightly shut with a corkscrew and should be numbered and weighed at the time of handing over to the officer in front of the forwarding officer and give an invoice regarding it as is given in Rule 5, 8 and 7.

Rule 6 talks about the precautions to be taken while packing of bottles:

• Several bottles should be sent in a tin or wooden box
• The tin or wooden box should have enough space to allow raw cotton on top of the bottles, at least 3/4^th of an inch thick.
• The box is to wax sealed shut.
• The box must be made of tin in cases where any of the contents of the bottles might be offensive, and MacDougall’s powder^[21] or charcoal should be dusted between the box and the wax-cloth.

When a homicidal case is being referred, then the identity of the body needs to be proved before the examination, thus the family of the deceased should identify the body and establish before the Magistrate. (Rule 10)

Conclusion

Medico legal work done in India is not that developed as of yet when compared to the world. India still needs new equipment to be on par with the world. If doctors practice medicine with due care, sincerity, efficiency, and skill, it is capable of providing significant benefits to society. The cordial relationship between doctor and patient has changed dramatically as a result of the medical profession’s corporatization, which has resulted in the commercialization of the noble profession, which goes against the letter and spirit of the Hippocratic Oath.

Despite the fact that rapid advances in medical science and technology have proven to be effective tools for doctors in better diagnosing and treating patients, they have also become tools for the commercial exploitation of patients.

Medical law is undergoing a significant transformation. Professional misconduct and negligence law has not progressed to a satisfactory level. The laws are insufficient and do not cover all aspects of medical malpractice.

By taking steps to keep patients satisfied, adhering to policies and procedures, developing patient-centered care, and knowing how to defend against malpractice judgments, medical malpractice lawsuits can be minimized or avoided. In today’s litigious society, having comprehensive professional liability insurance is a must.

A Medico-Legal Case is a case of injury or illness, for example, in which investigations by law enforcement agencies are required to determine who is responsible for the injury or illness’s cause. It is a medical case with legal ramifications for the attending doctor, in which the attending doctor believes that some kind of investigation by law enforcement agencies is necessary after gathering information and examining the patient. When the police bring you in for an examination, it could be a legal case that requires medical expertise.

1. Mukesh Yadav, Pooja Rastogi, Amit Kumar Study of medical negligence cases decide by Consumer Court (NCDRC/SCDRC/DCDRC) in India avaialbale at: Researchgate ↑
2. Smt. Madhubala v. Government of NCT of Delhi and Ors. 118 (2005) DLT 515; 2005 (82) DRJ 92 ↑
3. Ins. Malhotra v. Kirplani and Ors. 2009 (4) SCC 705 ↑
4. Lakshman Balakrishnan Joshi v. Trimbak Bapu Godbole and Anr. 1969 AIR 128; 1969 SCR (1) 206 ↑
5. Balachandran MK. Consumer Protection Act and Medical Profession, Department of Consumer Affairs, Govt. of India in association with I.I.P.A. New Delhi: 2008 ↑
6. Rao CK, editor. Corpus juris secundum. Law of Negligence. 2nd ed. Allahabad: The Law Book Company; 1991. p. 14.p. 322 ↑
7. Saovik Dhar, Medico Legal Case – An overview available at: iilsindia ↑
8. Pedda Satya Narayana v. State of Andhra Pradesh AIR 1975 SC 1252 ↑
9. Forensic Medicine and Indian Criminal Laws: A Study of relevancy with legal provisions, Roshini Duhan, Innovare Journal of Medical Sciences Vol 4, 2016 ↑
10. Critics and Sceptics of Medico-legal Autopsy Guidelines In Indian Context, Basant Lal Sirohiwal, Luv Sharma, P.K. Paliwal J Indian Acad Forensic Med. October-December 2013, Vol. 35, No. 4.p.376 ↑
11. Ministry of Home Affairs, Government of India, letter no. 4/4/72- DD/CPA-1, dated 11 June 1987 ↑
12. Haryana Medico Legal Manual 2012 ↑
13. Critics and Sceptics of Medico-legal Autopsy Guidelines In Indian Context, Basant Lal Sirohiwal, Luv Sharma, P.K. Paliwal J Indian Acad Forensic Med. October-December 2013, Vol. 35, No. 4.p.376 ↑
14. Analysis of Provisions related to post mortem in accordance with the Criminal Procedure Code, 1973  ↑
15. Punjab Government Notification no. 332 dated 3^rd April, 1905 ↑
16. Amit. State of Maharashtra AIR 2003 SC 3131 ↑
17. State of Karnataka v. Papanaika AIR 2004 SC 4967 ↑
18. Boraiah @Shekhar v. State 2003 CriLJ 1031 ↑
19. Rule 1 of Part B of Chapter XVII of Delhi High Court Rules ↑
20. Definition available at: lawinsider ↑
21. It is a baking powder used to remove the stench in medical procedures. ↑