MEDICOLEGAL CASES - PowerPoint PPT Presentation

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  1. MEDICOLEGAL CASES DR KSH MANGLEM SINGH Chief Medical Officer/Director, District Health Mission, Imphal East Cum Senior Medico-legal Specialist Government of Manipur

  2. Accidental injury cases Alleged cases of assault Cases of burns Cases of alcoholic intoxication Victim to animal ferocity Snake and insect bite/stinging cases Unconscious/Comatose patients Alleged criminal abortion Drug overdose/anaphylaxis reactions Dead on arrival to hospital Brought dead to hospital Sudden unexpected death cases Surgical death Anaesthetic death Common Medico legal Cases

  3. Cannot refuse to examine MLC Never delay examination Patient may be hospitalized or referred, preparing injury report A referred case and already registered fresh report not necessary Always obtain informed consent prior to giving treatment Note at least 2 identification marks from exposed parts of the body If death is inevitable arrange to take dying declaration In case of poisoning perform gastric lavage and administer specific antidote and admit the patient,collect necessary samples Don’t make un-necessary delay in issuing MLReports In case of discharge or death of a MLC in the hospital;inform the police,in case of death don’t issue death certificate If a MLC is discharged against medical advice,inform police. Points to be remembered in handling Medicolegal Cases

  4. Injury/Wound Report • Record details of the injuries found in the Accident Register cum Injury or Wound Report/Certificate. • The original is the Injury or WoundReport/Certificate,which is to be detached and issued to the Police Officer,the carbon copy will remain in the register and serve as a permanent record for the Medical Officer

  5. Referring a MLC to second hospital • MO who examined first should give necessary first aid • Copy of accident/wound certificate which is sent to IO should invariably accompany the patient to next institution along with discharge certificate.This when produced before the MO in the second hospital,can allow him to continue treatment for the injures

  6. Drunkenness • Consumption of alcohol in any form is an offence in an area where there Prohibition Act is in force • In case of assault,rape or homicide • The victim and the driver have to be examined in traffic accident cases • Person who has intoxicated himself is responsible for his acts,but not at all if another person forces it on him • Intoxicated person cannot give valid consent

  7. Drunkenness(contd) Blood for chemical examination : Collect 2 to 3 ml by venepuncture.Use soap and water for disinfection.The container is stopped tightly and mouth sealed with paraffin or candle wax.Put name of the person,date,time of collection along with signature of MO.Sample duly sealed and delivered to IO.Get a receipt

  8. Drunkenness(contd) Opinion: 1 Consumed alcohol and is under its influence 2 Consumed alcohol but is not under its influence 3 Not consumed alcohol

  9. Documents of ML nature • Consent in medical practice • Birth/Death certificate • Medical/Sick leave certificate • Fitness Certificate • Court attendance exemption certificate • Dying declaration • Mental illness certificate

  10. Consent in medical practice • Examination of a patient without consent amounts to assault • Expressed consent is to be obtained wherever an invasive procedural techniques to be adopted for treating • In emergency treatment cases,a patient can be examined and life saving emergency procedures carried out in good faith even without consent (IPC 92).Age for consent for operation is 18 yrs • In a MLC simply because a person is brought by police implied consent cannot be taken for granted

  11. Consent(contd) • Accused can be examined by MO at the request of police officer,not below the rank of SI,without consent and even by use of force -Cr PC 53(i) • When examination of female person,examination shall be made only by or under the supervision of a female MO -Cr PC 53(ii) • Consent of legal guardian if person is below 12 yrs/18 yrs for undergoing operation

  12. Death Certificate Issued only : • If cause of death is known beyond all doubts • A person is admitted in hospital,clinical diagnosis is made based on signs,symptoms and diagnostic procedures • Death occurs due to natural consequences after diagnosis is made

  13. Death certificate (contd) Don’t certify death in the following conditions: • Person brought death/dead on arrival to casualty • Persons dying after admission and before making a diagnosis • In all alleged cases of unnatural death(accident/suicide/homicide) • Anaesthetic deaths • Snakebites • Death of a woman in her husband’s house within 7 yrs of marriage

  14. Dying Declaration Statement of a dying person, relating to the cause and circumstances of his death • Magistrate having jurisdiction should be called to record the declaration • Before recording doctor should certify that person and his/her mental faculties are normal • If situation demands the doctor himself can record in the presence of two witnesses • The declaration is then sent to the magistrate in a sealed envelope with a letter

  15. Medical Negligence • “the ommission to do something which a reasonable man guided by those ordinary considerations which ordinarily regulate human affairs,would do,or the doing of something which a reasonable and prudent man would not do”

  16. Classification of negligence • Civilnegligence-breach of duty to use reasonable skill and care,resulting in damage.Burden of proof is on the patient or his relatives • Criminalnegligence-negligence of such a degree that it amounts to a criminal offence,whereby the medical practitioner may have caused the death of his patient • Contributorynegligence-damage to the patient is caused partly by his own and partly by the doctor’s negligence

  17. Failure to obtain informed consent for diagnostic and therapeutic procedures to employ necessary and recognised diagnostic procedures to attend a patient who is under the doctor’s active clinical care to inform the patient about toxic or harmful side effects of drugs to inquire,test for and precautions against anaphylactic reactions to drugs to sterilize instruments like needles,syringes etc to remove foreign body like instruments,gauze etc Instances amounting to negligence

  18. Instances of negligence(contd) Failure • to discover the disease,delay in treatment of which may be harmful and even dangerous to the life of the patient • to obtain consent of both partners in case of operation leading to sterility of either of them • to exercise care in selecting assistants and delegating duties to them • to assume responsibility of post operative care

  19. withdraw active clinical care without giving adequate notice or providing alternative care to the patient misdiagnosing non existing conditions operative procedures,except in emergency,expressedly not authorised by the patient anaesthetic mishaps,and accompanying ancillary responsibilities-transfusion,intravenous injection,catheterisation,diathermy,hot water burns Instances of negligence(contd)

  20. Defence against negligence • Actual denial of negligence taken place • Delegation of duty to the subordinate • Contributory negligence by the patient • Assumption of risk by the patient • Emergency of the situation • release of tortfeasor-settlement wth third party and release • Res judicata (”the thing has been decided”) • Statutes of limitation • Immunity to charitable and ggovernment institutions

  21. Prevention against negligence • Do not criticise another doctor • Employ qualify staff & associate with good partners • Udate your knowledge • Keep accurate and complete records • Obtain valid consent • Establish good professional relationship • Take reasonable skill and care • Guard against therapeutic hazards

  22. Prevention against negligence(contd) • Good conduct of the doctor • Maintain professional secrecy • Relationship with legal profession • Medical Indemnity Insurance • Countersuit against patients

  23. Thank You