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Guidelines for Handling Medico Legal Cases
Vinay M Raj1, Vasudeva D S2, Gagan S3
M
edico legal
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
1Dept. 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 – 562110.
email: drvinaraj84@gmail.com
2 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
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 ar-
ealways FIRST in priority.
 MLC workup is done
SOON after it.
 Casualty services are 24x7
 CMOs are supposed to reg-
ister MLC by entering the follow-
ing in the MLC register.
o Preliminary data:
 Name – Full name
should be taken with ini-
tials,
 Age
 Sex
 Address – local and
permanent.
o 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 be con-
sidered.
o Consent of the patient /
relative has to be taken:
 Signature/ thumb
impression of the patient.
 Signature of the rela-
tive / guardian.
o Brief history of the inci-
dent – time/ place/nature of in-
cident.
o Examination findings:
 Injuries must be
noted in the order of
Head to toe or
major to minor injuries.
o Treatment given:
 Immediate treat-
ment given
 Referral to the
concerned department.
o If referred outside –
Place where it is referred
should be mentioned.
o 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.
A 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:
o Stabilizing the patient –
Airway, Breathing, Circula-
tion.
o CPR.
o 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
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
 Patient in Hypovo-
lemic shock – need fluid re-
placement.
o CMO can take the ad-
vice from the concerned de-
partment if needed any time.
o 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 fromlegal
circumstances either the treating
Doctor or any other person in-
volved is punished as per the sec-
tion IPC 201.
Cases to be Regis-
tered as MLC
The following is an in-exhaus-
tive list of cases to be registered as
MLC
1. Alleged history of assault
2. Road traffic accident – Ve-
hicle collision / pedestrian injury
3. Firearm injuries
4. Self fall injuries not con-
sistent with the history
5. Poisoning / drug over dos-
age
6. Alcohol intoxication &
drunkenness
7. Anaphylaxis due to thera-
peutically injected drugs
8. Victims of Animal ferocity
9. Snake Bite/ scorpion sting;
however Bee sting or other insect
sting being an exception.
10. Attempted Suicide – self in-
flicting injuries/ poisoning / any
means.
11. Attempted Homicide -
Hanging / strangulation / poison-
ing
12. Burns except for minor do-
mestic nonfatal accidental burn
injuries
13. 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
17. Any brought dead/ Death
on arrival, without any corrobora-
tive history supports death.
Case of Assault
 All cases of assault have to
be registered as MLC and MUST
be informed to the police without
fail.
 Injuries have to noted
down from
o Head to toe or major to
minor
o They have to be num-
bered
o Description of the injury
– size, site, shape, position
from bony landmark should
be noted, preferably take the
measurement using measur-
ing tape.
o Aging of the injury has
to be mentioned.
 Fresh / dark brown/
brown/ black/scar.
o Type of weapon in-
flicted can be assessed and cor-
related with the type of injury
 Injury certificate has to be
issuedonly with the patient’s or
police request.
3
Case of Sexual As-
sault
 Consent :
o Written informed Con-
sent of the patient >18 years is
a must
o If minor, consent has to
be taken from the guardian.
 Examination
o Examination of the Case
has to be done at casualty in a
private room.
o Make the patient calm –
build the confidence in the vic-
tim
o Third person as a female
witness is a must in case of a
male Doctor.
o Immediate life saving
measures to be taken if re-
quired should be given as soon
as possible
o Detailed medico-legal
examination will be done by
the faculty of Forensic Medi-
cine.
o Counseling, Treatment
and Post-Exposure Prophy-
laxis are part of the case man-
agement – Gynecologist Opin-
ion should be taken.
 NO Doctor/ Hospital can
refuse the patient since it is a case
of sexual assault. Such Doc-
tor/hospital will be punished un-
der the court of law.
 All cases have to be in-
formed to the police.
 In case of minor (<18 yrs) –
mandatory to inform to the police
even it is a consensual sexual act.
Otherwise treating doctor is held
guilty and punished.(Prevention
of Sexual & Child Abuse Act)
Case of Poisoning
 All cases should be regis-
tered as MLC
4 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
 Following Samples are to
be collected – no preservatives
should be added.
o stomach wash (if done)/
vomitus~ 30 ml
o Urine -10 ml
o Blood – 5 ml
o Unused tablet or con-
tainer brought along with the
patient has to be preserved
carefully
 Labels has to be made cor-
rectly containing details of the pa-
tient, MLC no, and should be
handed over to the police.
Case of Drug Abuse
 If suspicion found about
any narcotic drug abuse - opium,
ganja, charas and others must be
brought to the notice of police.
 Therapeutically used drugs
(barbiturates and benzodiaze-
pam) have to be under the guid-
ance of a treating doctor. Any ir-
rational use should be informed
to the police.
Case of Alcohol In-
toxication (Inebriant
state)
If the patient is unconscious;
 Smell of alcohol has to be
mentioned.
 Fresh Blood sample has to
be collected and preserved as
soon as possible from the time of
arrival of the patient.
 Blood (5 ml) has to be pre-
served in potassium oxalate and
sodium fluoride (2:1)
 The time of blood collected
has to be noted without fail.
If a case of drunken and driv-
ing – met with RTA or self fall;
 MLC should be made and
police is informed.
 Blood should be collected
after obtaining the consent.
 If the patient refuses to give
blood for examination of alcohol
content – it has to be entered in
the register.
Case of Snake
Bite/Scorpion Sting.
 Case has to be registered as
MLC
 Life saving treatment first
 Try to locate the fang/sting
marks
o Number, size, position
from a bony landmark
o Skin color surrounding
the bite mark – any signs of re-
actions to be noted.
 Clinical signs suggestive of
type of snake bite should be
noted.
Case of Animal fe-
rocity
 Case should be registered
as MLC
 Preliminary data has to be
collected
 Type of injury should be
described
 The history matching with
the injury found on the body has
to be correlated.
Case of Electrocu-
tion/Lightning
 Life saving procedures are
first
 Case should be registered
as MLC
 History
o Time of incident
o Position of the victim at
the time electrocution/ light-
ning.
o Place of occurrence –
domestic / working should be
mentioned.
 Examination
 o Points of entry and exit
wounds should be located and
described
o Path of electricity trav-
elled in body has to be noted.
o Any other secondary in-
juries should be noted.
Case of Attempted
Hanging
 Life saving procedures are
first
 Case has to be registered as
MLC
 History and other prelimi-
nary data should be noted.
 Describe the injury
Ligature mark
o Position of the ligature
mark
o Dimension – length /
Width / position from bony
land mark
o Skin color
o Is ligature material di-
mension comparable with the
marks found on the body
should be correlated.
Case of Alleged
criminal abortion
 Doctor must be aware of
MTP act 1971 protocols and the
case should be treated as a Med-
ico-Legal Case.
 All the records must be pre-
served.
 MLC registration & police
intimation should be made.
Case of Brought
Dead
 If PROPER HISTORY avail-
able –
o If the patient was suffer-
ing from any chronic ailment
has been treated in our hospi-
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
tal, the concerned Doctor/De-
partment can issue the death
certificate.
o The previous illness and
other details can be taken from
the MRD of our hospital. How-
ever if the previous illness is
not supportive of the death of
the patient, then it should be
subjected to PM examination.
o If no such details are
available, it is the relatives to
decide whether they want the
Cause of Death (COD) or not.
o If the relatives want the
COD, then it is subjected for
post-mortem examination and
protocol is followed.
 If PROPER HISTORY NOT
AVAILABLE
o Mandatory to make it
MLC and inform the police –
body should NOT be released
from the hospital without
making the protocols.
Dying Declaration
 In case the patient wishes
to make a dying declaration, the
magistrate needs to be intimated.
 If magistrate is unavailable,
CMO can record by himself in the
presence of two independent wit-
nesses whose signature are also
affixed in the document.
Police Intimation
 Police has to be intimated
as soon as the MLC registration is
done.
 Police intimation has to be
made in writing and countersig-
nature should be taken from the
concerned police authority.
 If the Doctor feels the need
to be kept it confidential as in cer-
tain cases, need not be informed
to the police.
Eg - A case of suicidal con-
sumption of drug (drug over
dosage)/ poisoning, the patient
is safe from deranging compli-
cations, No need to inform the
police; however, it has to be
kept confidential. If the patient
dies, then it must be informed
to the police and protocol has
to be followed.
 In a case of simple nonfatal
domestic injuries, where a young
recently married female being a
victim, it is better to inform to the
police as it might come under
dowry harassment sections.
Do Remember
 There is no role of patient in
deciding whether a case is Med-
ico-legal or not, even if the patient
refuses to get treated.
 Practice of making MLC
OR NOT based on patient’s wish
is not entertained in the court of
law. Taking signature for the
same is again not explained in any
of the Indian laws.
Documentation in
MLC
 All cases come under MLC
– OPD / IPD has to be mentioned
on the case sheet. The Medico-le-
gal registration number and the
date of registration should be en-
tered.
 MLC seal has to be entered
in all the papers of the case sheet
including lab investigations/ radi-
ological investigations/ consent
forms/ OT & other papers/ billing
or activity charts. The seal should
not be placed over any of the val-
ues/ findings. (Ideal to place over
the corner of the page)
 All the reports along with
case papers are hospital’s prop-
erty.
5
  The case sheet along with
all the investigation reports en-
closed should be handed over to
the MRD with acknowledgement.
 Never allow the patient or
the attendees to handle the case
sheet nor the investigation re-
ports.
 At the time of discharge of
the patient, neither the reports nor
the films can be issued to the pa-
tient. If the patients request/ de-
mands for the reports, can be
given a photocopy of the same
from MRD.
 In discharge summery all
the finding should be entered and
handed over to the patient. A
copy of the same has to be kept in
the case file.
 MLC case sheet should not
be taken outside the hospital un-
der any circumstances without
6 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014
the knowledge of the MRD in-
charge or the Medical Superin-
tendant.
 MRD guidelines for archiv-
ing the document should be fol-
lowed.
Housekeeping staff
 Do not discard any of the
samples collected in the hospital
without the knowledge of the
Doctor especially in MLC cases.
 Purposeful disposal or de-
struction of the sample or evi-
dence is a punishable offence.
Security
 Always strict vigilance has
to be made over the visitors of the
MLC patient especially if the pa-
tient is in ICU.
~~*~~
 Only ONE responsible
guardian has to be identified as a
patient attendant
 Visitor should be accompa-
nied by a security staff at the time
of visiting the patient.
 Only one visitor can visit
the patient at a time.
Acknowledgement
We sincerely thank Dr Var-
ghese P S, Dr Manju Prakash for
valuable guidance and Dr Satish
Babu, Dr Govindraju, Dr Brijesh
for support and encouragement.