POLICY FOR HANDLING MEDICAL LEGAL CASES

                                          

                                  POLICY FOR HANDLING MEDICAL LEGAL CASES

Purpose: To define the standard operating procedure for the hospital staff to deal with Medico Legal Cases as & when patients arrive.

 

MEDICO LEGAL CASES: - All those cases who fulfils following criteria can be termed as MLC

 

•      All victims of violence (spouse, child or elder abuse)

•      Physical or Sexual assault

•      Domestic accidents

•      Drug /alcohol addiction

•      Suicidal attempts

•      Road traffic accidents

•      Occupational related injuries like factory accidents

•      Medical malpractices

•      Food and drug tampering like all cases of suspected acute poisoning or intoxication

•      Environmental hazards like storm

•      Burns

•      Gun-shot injury

•      Brought dead cases with improper history or doubtful integrity creating suspicion of an offence & the death is not natural

 

But a case in which any harm or injury is caused by animal is not taken as medico legal case.

 

1.    POLICY: It is the policy of the hospital to provide immediate medical attention to any patient who comes to the Emergency Ward of the hospital. Even if the patient is a medico legal case, the treatment protocol should not be delayed pending legal formalities.

 

2.PROCEDURE

 

a.       When the patient comes to the emergency ward, initially the staff must deal first with the emergency. The primary treatment of the patient must not be delayed due to the legal formalities.

b.      It is essentially the responsibility of the ER Medical Officer (ERMO)* to decide or debate as when to label a case as “Medico legal”. The attending doctor has to base his decision on the nature of the injury of the patient & the relevant circumstances.

c.       Proper history of patient must be taken by the ERMO*, in which he must enquire the patient about the accident, time, location & injury.

d.      The ERMO* or the sister-in-charge must call the nearest police station & inform about the patient’s case.

e.       Sister-in-charge* must also take down the police station’s address, police officer’s name & buckle number for future reference.

f.       Above details must also be documented in the MLC register.

g.      It is the legal duty of the police official to initiate further necessary protocols.

h.      All MLC shall be recorded in the Emergency Room Record and submitted to the Medical Record department for safekeeping and a copy of records must be kept in the ER department.

i.        MLC details form must be completed at the time of discharge.

j.        The MLC (medico legal certificate)* certificate must be handover to the police not to the patient or patient’s relatives at the time of discharge.

 

FOR AMBULATORY CARE

 

For such cases, the routine procedure must be carried out without delay.

•      POLICE REPORTING: If the ERMO doesn’t suspect it to be anyway related to MLC than he may give an option to the patient whether to report the case to the police station or not.

•      If the patient & his relatives don’t want to report the case in the police station then a written consent is taken from them stating the accident & patient’s details & their unwillingness to report the incident to police station hence taking the whole responsibility of the consequences.

•      If the patient & his relatives agree to report the case as MLC at the police station then the appropriate MLC charges must be posted to his account.

•      REGISTRATION: If the ERMO assesses the patient to be in a stable condition & to be treated on ambulatory basis than he sends a note of the same to the ER Billing/ Registration Counter along with the patient’s relatives. The patient is registered & OPD number is generated (if the patient is new to the hospital). The patient’s file is generated according hospital policy. All charges for MLC reporting & procedures must be posted in patient’s account.

•      CHARGES: The charges for MLC case inside the limits of Ahmedabad city & outside the City are different & hence must be posted separately as per the management’s decision.

•      Also if the case has already been reported in any of the police stations in or outside Ahmedabad by the relatives or by the prior hospital than the procedure for police reporting can be absconded, but the details of the police station must be taken for future reference.

•      Before the patient is discharged all his bills must be cleared.

 

FOR INDOOR MLC

 

•      POLICE REPORTING: Once the consulting doctor in the ER prescribes the patient to be admitted in any of the ICUs or wards, the sister-in-charge* should make sure to mandatory report all the indoor MLC to the nearest police station.

•      It is the legal duty of the police official to initiate further necessary protocols.

•      REGISTRATION: When the consulting doctor or ERMO decides to shift the patient to ICU then the relative is sent to the ER registration counter & if the patient is to be admitted in the ward then he is sent the registration & admission dept. for patient’s registration & admission.

•      At the registration counter the patient if new to the hospital is registered & admitted to the ward or ICU & patient’s file is generated according to the hospital policy.

•      VALUABLES: Also the unit nurse must take off all the valuables the patient is wearing including all his clothes (undergarments also) & hand it over to patient’s relative. The nurse must also document the list of valuables in two valuables form. Take due signature of the receiving relative with other details. One of the

·         forms must be filed in the patients file & other form must be filed in the valuables file.

•      CHARGES: MLC charges must be appropriately posted in the patient’s bill.

•      The charges for MLC case inside the limits of Ahmedabad city & outside the City must be posted separately as per the management’s decision.

•      Also if the case has already been reported in any of the police stations in or outside Ahmedabad by the relatives or by the prior hospital than the procedure for police reporting can be absconded, but the details of the police station must be taken for future reference.

•      DISCHARGE: If the patient expires or is discharged than the earlier referred police station must be informed by the sister-in-charge. Sister-in-charge must also take down police officer’s name & buckle number to whom she passed the information.

•      If the patient is discharged against medical advice (DAMA) or discharged on request (DOR) than the earlier referred police station must be immediately informed by the sister-in-charge. Sister-in-charge must also take down police officer’s name & buckle number to whom she passed the information.

 

BROUGHT DEAD CASES

 

•      Cases of unnatural death like accident, burns, sexual assault etc to be assessed, and history obtained from the relatives or police accompanying to be labeled as MLC.

•      If any patient of MLC was brought dead to the hospital in the hospital’s own ICU ambulance, than that MLC case will be reported by the anesthetist who accompanied the ICU ambulance to bring the patient to the hospital.

•      The case report must be prepared with the title dead on arrival.

•      All brought dead cases should not be handed over to the relatives but to be sent to the mortuary

•      Death certificate forms & dead body should only be handed over to relatives after informing the police authorities.

•      If the death appears to be natural, the case may not be labeled as medico legal.

 

The case report must be prepared & the cause of death must be written as not known.

 

 

 

 

 

 

MLC PATIENT’S FILE

•      A red Colour tag or strip or sticker shall paste in all MLC file.

•      The MLC file must have the MLC sticker or stamp on each page of the file & also on the front cover of the file

•      The file must contain the medico legal form filled up by the ER registrar

•      The file must also contain Medico Legal Certificate

•      The file when the treatment is finished must contain all the relevant & necessary documents

•      The MLC file is never given to the patient or his relatives. The patient is only given the discharge summary & if requested the copy of his diagnostic reports. The patient file is preserved by the medical records dept. for future reference.

 

Identification marks

1.      Two identification marks must be taken.

2.      They are necessary to identify the person in court One identification mark is more likely to lead to mistaken identification, as it can be duplicated in another person. Two identification marks are less likely to lead to errors. Three would cause still less errors, but it is not practical to take more than two.

3.      They should be on exposed parts, and not on hidden parts, so patient faces no embarrassment in court where these marks may be tallied.

 General condition of the patient

1.      Whether the patient is conscious or unconscious.

2.      If conscious, whether anxious, tense, afraid, agitated, subdued.

3.      Bleeding from nostrils, ears, mouth, other natural orifices (vagina in case of sexual assault, anus in the case of buggery).

4.      Pulse rate, blood pressure, temperature, whether in a state of shock, paralyzed or not.

5.       If the police want a statement from the victim, the doctor must first certify that the patient is compos mentis.

Annexure

 

SN	Task	Responsibility	Timings
	ERMO/RMO	To decide or debate as when to label a case “Medico legal”.	8 am to 2 pm (Duty ERMO) 2 pm to 10 pm (RMO-)10 pm to 8 am ( Duty ERMO in consultation with Sr Doctor posted)
	Sister Incharge-ER	To inform police & note down the police station’s address, police officer’s name & buckle number for future reference	9 am to 6 pm (Sister Incharge)   6 pm to 9 am (Staff Nurse-R)
	Sister Incharge- Ward/ICU	To mandatory report all the indoor MLC to the nearest police station.	9 am to 6 pm ( Sister Incharge -Ward/ICU)   6 pm to 9 am ( Staff Nurse-Ward/ICU)