The legal system is integrated with various strata of the societal systems, including the healthcare system. Medical practitioners often encounter serious cases with legal implications (MLC cases). The occurrence of MLC has been on the rise in the civil and the Armed Forces.

Appropriate handling of such cases is important. The Law and Order of different states vary, hence the variations in medio-legal procedures.

MLC involves any case of physical injury, trauma, or violence/abuse. This includes occupational injuries, poisoning, suicide, and patient harm in the hospital/death on the operation table.

Labeling a case as MLC is based on sound professional judgment, detailed history-taking, and thorough clinical examination. 

• Injury is defined by Section 44 – any harm caused to a person, physical or mental.
• Simple hurt is defined in Section 319 – as bodily pain, disease, or infirmity.
• Grievous hurt is defined in Section 320 – as permanent impairment, disfiguration, fracture, dislocation, or severe bodily pain, life-threatening, debilitating condition.
• Culpable homicide is defined under Section 299 – intention to cause bodily injury, death, or an act likely to cause death.
• Murder is defined under Section 300 – Death of a person caused by an act that is intended to cause death or due to a deliberate act that is likely to cause death.

Work Flow for MLC Brought to the Emergency Department

All patients are first provided with a hospital registration number. If it is a suspected MLC case – an MLC number is allotted. If the patient is unstable – preliminary support and patient stabilization are warranted before MLC documentation. If the patient is stable, MLC documentation can be initiated immediately in the Emergency department. Thereafter, a medico-legal report is prepared, and the information is sent to the Police in charge.

General Guidelines for Dealing with Medico-Legal Cases

• Only one MLC number should be allotted to a case. 
• The findings should be noted based on the presenting condition of the patient.
• MLC can be written and signed by the EMO/Assistant EMO. The faculty may be required to provide evidence in a court of law.
• All documents should be appropriately labeled. Records must be maintained for future referrals.
• Corresponding entry should be made in the MLC register in the ED.
• The documents should be handed over to the Police in charge, and appropriate receipts should be obtained.
• Even though the patient was not admitted to the hospital, MLC register entry is warranted.
• Consent for emergency surgery can be provided by the Medical Superintendent.
• If the EMO/Assistant EMO does not register the case as MLC, but the duty doctor deems it as MLC, the required MLC entry can be made at a later juncture as well.
• The Police in charge should be informed immediately if the patient is extradicated from the medical facility without the doctor’s consent.
• All investigational data should be labeled as MLC.
• Hospital record keeping is essential. These records should be stored as confidential documents.
• In case of a Death – the Police in charge must be informed. Death certificate should be issued by the medical officer who has attended within seven days. 
• The body can be sent to the Mortuary after informing the Police in charge. 
• In case of an impending death in an MLC case – the medical officer must inform the Police in charge, who should call a magistrate to record the dying declaration. 

Precautions for Medico-Legal Cases

• The Death Certificate should not state the cause of death.
• The body should be handed over to the Police, who will hand it over to the next of kin.
• The death of a service person on a military aircraft is not considered an MLC.
• Death of a veteran of a Navy, Army, Air Force, or Para-military is not reported as MLC.

Special Precautions for Case of An In-hospital Death in Medico-Legal Cases

• Proper packing for mortuary transfer is important.
• The mortuary staff will note down two identification marks of the deceased.

Consent 

Consent is very important while examining MLC cases. All survivors should be examined after appropriate consent is obtained. The Doctrine of Informed Consent should be followed. 

Consent is not mandatory in cases of medical emergencies. Under Section 53, a patient can be examined by force at the Police’s request. However, females must be examined under this section only by a female doctor. 

Consent can be obtained from a legal guardian or next-of-kin when the patient is a minor, mentally impaired, or unconscious.

Medical Negligence

Medical negligence implies medical malpractice. This includes criminal negligence. 

Patient Missing from the Hospital

The Police station and Civil authorities must be informed, along with the patient’s family.

Bio-Medical Waste Management

Bio-medical waste should be treated, handled, and disposed of according to Schedule I and in compliance with Schedule V.

Transplantation 

All hospitals conducting or storing human transplant organs must be registered under the Transplantation of Human Organs Act 1994, amended in 2003. No human organ transplantation is permitted without such registration.

The Drugs Control and Cosmetics Act

The Drugs Control and Cosmetics Act prevents substandard quality drugs and cosmetics. The act also encompasses intoxicating liquors. Blood banks are exempted from the act.

Prenatal Diagnostic Tests

Prenatal tests should not be misused for fetal sex determination. Apt regulations must be followed for pregnancy termination. 

Right To Information Act (RTI) 2005

RTI promotes transparency and accountability and applies to army veterans as well. 

Penal Provisions Against Medical Practice

A doctor cannot refuse to treat a patient just because it is an MLC case – this is deemed a violation of Article 21 of the Indian Constitution.