INTRODUCTION

The bondage of law and medicine is ancient one ,as old as Egyptian civilisation, The code
of Hammurabi [Babylon-2200 BC] is oldest code on medical-legal cases.The Forensic
medicine or legal medicine & Toxicology and medical jurisprudence gained lot of
importance in the modern world due to newer technology like Finger Printing and DNA.

It is prudent for young police officers, prosecuting officers, defence counsels and general
public to gain fundamental knowledge of medical jurisprudence, forensic medicine and
toxicology. The forensic medicine deals with the medical aspects of law viz. death, injuries,
sexual offences, infant deaths, poisoning ,accidents, homicide.The Medical jurisprudence
deals with the legal aspects of practice of medicine viz. medical negligence ,rights & duties
of doctor, professional misconduct. Both Forensic medicine and Medical Jurisprudence are
very important subjects in the Criminal Justice System.

The medical students will be familiar with 'Medical Jurisprudence’ & 'Forensic Medicine and
Toxicology’. The 'Forensic medicine & Toxicology' is a branch of 'Medical Sciences’, which
plays a crucial role in deciding medico-legal court cases.

The highly experienced forensic medicine professional act as expert witness and their
evidence [as per Indian Evidence Act under section 45 e.g doctor, firearms expert, finger
prints experts, handwriting experts etc are called expert witnesses] will be
considered crucial [or even clinching evidence] corroborative evidence in all court cases
viz. cause of the death [medico-legal death investigation], time of death, sexual offences,
paternity, fertility, determination of age etc.

In a country where 130,000 deaths occur annually due to road traffic accidents and 53%
women suffer from domestic violence leading to grave injuries, it is important that hospitals
and the law work hand in hand to help the injured. Our legal system has grown in leaps
and bounds from 1989 when people would lose their lives waiting for treatment.

This year saw the formation of the ‘right to life’ act, which was formed after the
monumental ruling in Parmanand Katara v. Union of India1. The case was filed by the
family of a scooterist who was severely injured in a road accident. He was refused
admission when taken to the nearest hospital, because the hospital claimed that it was not

1
AIR 1989 SC
equipped well enough to handle a medico legal cases. The scooterist succumbed to his
injuries before he could be taken to the nearest hospital that was authorised to handle
medico-legal cases, which was situated 20 kilometres away. Here is a look at what has
changed over the years, and what to expect to when you register a medico legal case.
 MEDICO LEGAL CASE

A medico legal case is where a person is injured or harmed in any way and needs medical
attention for it. Injury cases which suggest some criminal offence. Burn injuries, vehicular
accidents (includes railways and other modes of transport), suspected homicide/murder,
poisoning, sexual assault and criminal abortion are classified as medico legal cases. Patient who is
unconscious due to unknown reasons, brought dead or die shortly after admission without proper
medical documents to indicate cause of death also come under its purview. Hospital deaths
where the patient dies suddenly due to administration of medication or a fall within the hospital,
when he is in the ICU or during surgery can also be classified under medico legal cases. A medical
autopsy has to be ordered under all the above circumstances.

A medico legal case is where a person is injured or harmed in any way and needs medical
attention for it. Injury cases which suggest some criminal offence. Burn injuries,
vehicular accidents (includes railways and other modes of transport), suspected
homicide/murder, poisoning, sexual assault and criminal abortion are classified as
medico legal cases. Patient who is unconscious due to unknown reasons, brought dead
or die shortly after admission without proper medical documents to indicate cause of
death also come under its purview. Hospital deaths where the patient dies suddenly due
to administration of medication or a fall within the hospital, when he is in the ICU or during
surgery can also be classified under medico legal cases. A medical autopsy has to be
ordered under all the above circumstances.

In all these cases, it is the legal duty of the treating doctor to report it to the nearest
police station immediately after completing primary lifesaving medical care. This is in
accordance with Section 39 of Criminal Procedure Code of India. The idea is to initiate
legal proceeding at the earliest is so that maximum evidence can be collected by the
police officer. Quick action by the police also helps to avoid the destruction of evidence by
the treating physician.

In all these cases, it is the legal duty of the treating doctor to report it to the nearest police
station immediately after completing primary lifesaving medical care. This is in accordance with
Section 39 of Criminal Procedure Code of India. The idea is to initiate legal proceeding at the
earliest is so that maximum evidence can be collected by the police officer. Quick action by the
police also helps to avoid the destruction of evidence by the treating physician.
 WHAT DOES THE LAW SAY?
The law states that concerns like legal formalities, monetary considerations or even the
infrastructural restraints of the institution should not prohibit the institution or hospital from
providing basic and emergency medical treatment. Here are a few things you should know
:
• A hospital cannot deny emergency medical care to an accident victim under Article 21.
• It cannot deny treatment on the pretext of lack of facilities. They have to provide
emergency care and then transfer the patient safely (via their ambulance) to the nearest
facility. This includes government and private hospitals; it also includes private clinics and
nursing homes.
• They cannot deny a patient emergent treatment on the basis that he/she is unable to pay
the required fees or that there is no close relative to sign for consent (consent is overridden
in an emergency)
• In the case of a rape or criminal abortion the lady cannot be examined by a doctor without
written consent from the victim.
• In both cases the doctor is bound by law to keep the patients information including her
name confidential.
• In cases where a woman is being examined another woman must be present during the
examination. In the case of males a male has to be present at all times.
• In the case of suicide causing death the doctor is obligated to report the matter to the
police for further investigation.
• If the patient is alive and suicide is suspected the doctor is not obligated to report the
matter to the police.
 BASIC PRINCIPLES FOR DOCTORS
There are a few basic principles to follow when writing a report. Firstly patient confidentiality is an
important consideration even if a patient has died. In the case of coroner’s inquests, you have a
duty to assist, however in other circumstances you should make sure that informed consent has
been given to your writing the report. Secondly, as a medico-legal report will usually be requested
as part of formal proceedings, it is important that it is produced quickly to avoid causing delay. If
for any reason you believe that you will be delayed in producing your report, then it is important
to inform the appropriate person as soon as possible.

Advice on writing the report

The report should always provide a detailed but factual account of the situation, based on the
medical records and your knowledge of the patient. Ensure you have a full copy of the patient’s
medical records before writing your report.

All medico-legal reports will, to a certain extent, contain some of the same basic information. Your
full name and professional medical qualifications should be written out in full (e.g. Bachelor of
Medicine) with your job title also stated. This will allow the person receiving the report to easily
identify your level of expertise.

Start by stating who has requested the report and for what purpose. You may also want to list the
supporting documentation used to draft the report, such as medical records and drug charts. This
will allow the recipient to easily see what additional information you have used in preparing your
report and if necessary, ensure that they have it to hand when reading.

Ensure the report is easy to read by presenting information in a straightforward manner. Give a
description of events in chronological order, referring to clinical notes when possible and noting
each relevant contact with the patient, their family or other medical professionals. Include the
purpose of each contact (e.g. clinical or forensic) and whether it was carried out under the NHS or
privately, alongside any treatment options, diagnoses or referrals discussed. If there was another
person present at the time of the consultation, include their name and status in the report, so they
can be contacted if necessary. If medication was prescribed to the patient, its clinical name should
be stated, along with the dosage and what format it was administered in.

Stating the facts

Concentrate on your observations and understanding at the time of the event, rather reporting
exactly what the patient told you. A description of the patient’s presenting symptoms is important
as it can be used to put your observations and interpretation of the situation into context. State
what you looked for as well, even if it was not found as this demonstrates that you took the
appropriate steps to make an adequate assessment of the patient and will hopefully avoid your
evidence being challenged. If you are asked to provide an opinion then do so but be sure to only
comment within the limits of your knowledge and expertise.

If at any time, another clinician has been involved in the care of the patient, list their full name and
job title and state, to the best of your knowledge, what their role was in your patient’s care while
avoiding commenting on the adequacy of the care they provided. Avoid criticising another
clinician’s care of the patient.

Although it may be daunting when first asked to provide a medico-legal report, if the information
provided is accurate, factual and presented in a clear manner, writing a medico-legal report is not
something to be feared.

Before preparing the report

• Ensure that you have the permission of the patient to provide the report. Ideally, any
medico-legal report should be prepared in response to a written request,
accompanied by an appropriate signed authority and/or the express permission of
the patient. It may be appropriate to confirm directly with the patient that the
authority is valid by ensuring that the patient is aware of what has been requested
and that they agree to the release of this information.
• Know the nature and purpose of the report. Clarification from the requesting party
should be sought if the purpose of the report is not clear. Be wary of requests from
patients for reports addressed ‘to whom it may concern’.
• Use the medical records to prepare the report. Do not rely on your memory or the
information provided by the requesting party.
 WRITING A MEDICO-LEGAL REPORT
1. If possible, type the report on headed paper, sign and date it. If you are using your employer’s
notepaper, check they know you are writing the report before you send it in.

2. Do not make the assumption that the reader has any of the background information referred to
in your report. Always ensure that your report can stand alone as an independent document.

3. Write any medical terms in your report out in full.

4. Consider including the medical notes with your report. You may wish to provide a written
transcript with abbreviations written out in full and state the dates which the notes span, but
never change the original notes. Do not send original notes without the permission of your
employing trust.

5. Write your report in the first person – this should allow the reader to clearly see who did what
and when.

6. Make sure that everything you put in the report is honest, accurate and is not misleading,
before signing it off, in line with the GMC’s Good Medical Practice.

7. Keep a copy of the report for your own records, in case you are called to give evidence in person
about the incident.
 WHAT MAKES A GOOD REPORT?

“Conforms to the Rules of Admissibility”

In order for the MLR to be admitted as evidence, it must meet the requirements of the Civil Rules
in the jurisdiction where the case is being heard. It is important to confirm the specific
requirements. Generally, the basic Rules require the following:

• Name

The report must include the name of the person responsible for the report. This requirement is
aimed at group reporting, or where one person carries out part of the evaluation and a second
person carries out the balance resulting in different components of the report being authored by
different individuals. Multiple authors and / or evaluators should be avoided where ever possible
as it may become unnecessarily complicated as to whose opinion is whose. It may be that all
authors of the report (not just the first named or senior author) may be called to testify.

• Qualifications

The report must include the qualifications of the expert. The use of letter headed paper alone is
insufficient5 and neither is a Curriculum Vitae (CV) alone. It is best to provide the report on
letterhead, to include a statement of the expert’s qualifications within the body of the report, and
also attach a CV as an appendix. The statement of qualifications should include the nature of
practice, recognized specialist and sub-specialist qualifications and length of experience in the
area of practice relevant to the opinion. The qualifications and experience of the expert is likely
one of the most persuasive variables considered by the court when determining whose opinion in
favours.

• Facts and Assumptions

The MLR needs to include a list of Facts and Assumptions upon which the opinion is based. This
criterion gives rise to the most challenges. A skilled expert will list all relevant facts and
assumptions relied upon in giving their opinion, while avoiding the inclusion of excessive or
irrelevant information. The expert should not attempt to give a final determination of the facts
themselves6 . It is not the role of the expert to convince the court to accept or reject the facts and
assumptions. Rather, the facts and assumptions must be clearly stated in the report, and it is left
to the court to assess whether all the facts and assumptions have been (a) proved and (b) carry
weight in supporting the opinion.

• Duty to Court

The report must include a statement confirming the expert’s duty to the court to act as an
unbiased expert and not an advocate for any party. The expert is expected to not only formally
state this duty in their report, but to also comply with the duty of objectivity and impartiality
throughout the body of the report and during any court testimony. If an expert is found to be an
advocate for one side or the other, the report will be given little weight or may be inadmissible

• Documents Reviewed

The report needs to include a list of documents reviewed, including all documents referred to
within the body of the report.

TYPES OF MEDICO-LEGAL REPORTS

A request for a treating doctor to prepare a report for legal purposes may be received from:

 a patient

 a solicitor

 an insurer

 a statutory authority (eg WorkCover)

 an employer

 the police

 a court.
 EXPERT OPINION

The required particulars for providing an expert opinion are as follows-:

 The experts should identify themselves as a physician in good standing and are
registered practitioners. The year of certification in their specialty with the Medical
Council of India should be stated; identify any additional subspecialty interest and
qualification.

 The experts should state what their type of practice is at the time when the
particular case under review occurred and what it is at present.

 The experts should state the number of years of experience in field of their
expertise.

 The experts should state their affiliation to the hospitals and universities.

 The experts should state that their clinical practices are relevant with the elemental
facts under review of a particular case.

 The committee should itemize the information provided to them to be reviewed.

 The committee or the expert should provide a synopsis of the facts contained in the
documentation using objective, non-slated language.

 The experts should identify the issues pertaining to the standard of care of possible
relevance to the clinical outcome.

 For each issue identified in the report, the committee should opine whether
standard of care was met.

 If certain facts are missing or required any other additional information at the time of
drafting the report and if the expert opinion is subject to change if other facts under
query are provided, they should state clearly in the report.

 The experts should provide reason for the basis of opinion with appropriate
reference: a standard textbook, specific review article, and guidelines, widespread
clinical practice in the expert’s jurisdiction or personal experience.
 The experts should not stray beyond their expertise to provide an opinion on
matters about which they are unable to demonstrate special qualification or
experience.

 The expert should provide the opinion in an unbiased manner.

 The report should be comprehensive without being unnecessarily wordy and over-
inconclusive. Its length should be dictated by the complexity of the matter under
consideration. It is important to be clear at the outset what the issues in a particular
case are. If the report has been requested from an outside agent, read the
requesting letter from time to time to ensure that the issues are well in mind while
writing the report and to check that they have been clearly addressed.

 The expert giving opinion in a medico legal case should be ready to be cross-
examined by the defence lawyer in the court of law. Calling the expert to the court
to give evidence on the opinion provided by him/her is a matter to be decided by the
judge.

 Once the report is ready, the experts should sign mentioning his/her designation,
seal the cover, and it has to be sent to the requesting party at the earliest. The
confidentiality of the report has to be maintained by the authority signing the
opinion.
 CONSENT

Consent for the release of medical information to a third party must be obtained prior to a
medico-legal report being dispatched. It is recommended that consent is obtained prior to a
report being prepared to prevent inadvertent release without consent.

The following criteria must be met for consent to be valid:

1. The subject (or their legal guardian) must be competent to provide it;

2. It must be informed. That is, the subject must have a clear understanding of the
implications of the release of the information;

3. It must be specific;

4. It must be freely given. Release of privileged medical information in a medico-legal

report without valid consent is unethical and may be illegal. In situations where a
medico-legal report is requested but consent is withheld, the requesting agency
may apply for a court order for release of the material.

CONCLUSION

The correct format allows for completeness, uniformity, and consistency in the preparation of
expert opinions given in medico-legal cases. The proper drafting of the opinion outlines the
different elements that should enable lawyers and the court to assess the weight of the opinion,
its factual basis, and the reasons for opinions expressed.

The preparation of a medico-legal report is an essential part of the service provided by hospital
doctors. It is a task that should be approached with a desire to accurately communicate the clinical
situation encountered. A structured format and objective opinion will enhance both the
readability and accuracy of the report.
 REFERENCES

Web Links -

1. http://www.thehealthsite.com/diseases-conditions/medico-legal-cases-top-facts-you-should-
know/

2.
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0
ahUKEwjFyLWA9-
LWAhVFKZQKHU1PAGwQFggrMAE&url=https%3A%2F%2Flegalgensis.blogspot.com%2F2012%2F0
1%2Fimportance-of-medical-forensic-medicine.html&usg=AOvVaw2051BNpRx2MHrDE6fUd_ub

3.
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0
ahUKEwjFyLWA9-LWAhVFKZQKHU1PAGwQFgg8MAQ&url=http%3A%2F%2Fvips.edu%2Fwp-
content%2Fuploads%2F2017%2F07%2FForensic-Science.pdf&usg=AOvVaw3SZ5k0do-
VwHCE3tRtZCUS

4.
https://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=18&cad=rja&uact=8&ved=
0ahUKEwjFyLWA9-
LWAhVFKZQKHU1PAGwQFghjMBE&url=https%3A%2F%2Fwww.researchgate.net%2Fpublication%
2F308802523_Medicolegal_Investigation_of_Medical_Negligence_in_India_A_Report_of_Forensic
_Autopsy_Case&usg=AOvVaw2EnKXqsPi-BUB3dVIxzZxU

E-Books -

1. Fundamentals Of Forensic Science, Book by Max M Houck & Jay A Siegel, Third Edition.

2. Medical Jurisprudence and Toxicology (Law, Practice and Procedure), Book by K S Narayan
Reddy, ALT Publications, 2006.

3. Ethics and the Practice of Forensic Science, Book by Robert T Bowen, CRC Press Taylor and
Francis Group Publication, Second Edition.