Role of clinical forensic medicine unit in quality and standardization of medico-legal reports

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Abstract

Introduction

Incomplete and inaccurate medico-legal report (MLR) often slow down the court trials and lead to incorrect judgments. Identification of such mistakes and shortcomings in the report can help in preventing litigations against doctors, unbiased court judgments, and injustice. Clinical Forensic Medicine Unit (CFMU) deals with all medico-legal cases (MLC) brought to the institution. It prepares MLR's, collect evidence, and supervises medicolegal issues of the institute.

Material & method

Pre-CFMU included 50 poisoning and 50 non-poisoning reports, selected randomly among 504 cases. Post-CFMU also included 50 poisoning and 50 non-poisoning reports, which were chosen randomly among total 588 cases.

Result

Comparing the pre and post CFMU non-poisoning reports, the following parameters were statistically significant; date and time of examination, address of the patient, details of accompanied police, details of attendant, identification marks, history of incidence, consent, description, dimension, location and age of injuries, pictorial presentation, general condition of the patient on arrival, and final opinion. Comparing the pre and post CFMU poisoning reports, statistically significant results were obtained for the following parameters; address of the patient, identification marks, history of incidence, consent, general condition of the patient on arrival, details of evidence collected, preservative used, seal status, and final opinion.

Conclusion

The present study concludes that the errors were significantly reduced in medico-legal reports prepared by forensic experts. It is, therefore, necessary to employ forensic experts at every healthcare facility not only to prevent lawsuits but also to strengthen the judiciary. Additionally, we recommend regular training of non-forensic professionals to acquaint them with medico-legal work.

Introduction

Medico-legal cases (MLC) are those medical cases in which legal investigation by the police is essential, both in living patients and in dead. Whenever a case presents to the emergency department with injuries inflicted in accidental/suicidal/homicidal manner or when medical practitioner finds any discrepancy between the narrated history and examination findings, then he quotes those cases as MLC and immediately informs the police.1,2 The type of MLC frequently encountered in the emergency department of All India Institute of Medical Sciences (AIIMS) Rishikesh are road traffic accidents, fall from height, physical assault, sexual violence, poisoning, burns, firearm injury, suicidal attempt. Doctor of any specialty while attending such cases is duty-bound to inform the police under section 39 of Criminal Procedure Code (CrPC), failing which he may be sued under section 176 Indian Penal Code (IPC), 201 IPC, and 202 IPC.

When an MLC comes, doctor on duty after intimating the police prepares a medico-legal report (MLR) based on the physical examination of the patient, collects and preserves medical evidence if required, and frames final opinion. These MLR's serve as essential evidence in the court of law which aid in framing judgments and imparting justice.1

In most of the government hospitals of India, due to shortage of forensic doctors, MLR's are prepared by MBBS graduates or non-forensic post-graduates; therefore, they have limited exposure to the medico-legal work. MLR's are often found incomplete and inconclusive in many aspects like incomplete details of the patient, improper history, improper description of injuries, pending opinion, and failure to collect sample evidence, which in few cases are the only proofs that establish a crime. Such incomplete and inaccurate MLR's often slow down the court trials and lead to incorrect judgments. Identifying such mistakes and shortcomings in the report can help prevent litigations against doctors, unbiased court judgments and injustice.3

AIIMS Rishikesh is an institute of national importance, tertiary healthcare center and research institute in Uttarakhand state, established by the Government of India. Clinical Forensic Medicine Unit (CFMU) is a sub-division of the Department of Forensic Medicine & Toxicology at AIIMS Rishikesh. This unit deals with all MLC brought to the institution. It prepares MLR's, collect evidence, and supervises medico-legal issues of the institute. CFMU also serves as a “one-stop center” for the victims of sexual assault. The present study highlights the errors and shortcomings of MLR's prepared by non-forensic doctors. It also compares the quality of reports prepared before and after the participation of CFMU in medico-legal works.

Section snippets

Study design

Retrospective, observational, and non-interventional.

Data collection

The current study was conducted by CFMU and planned in May 2019. It included 200 MLR's that were shortlisted among the reports prepared from June 2018 to December 2018. CFMU was established in September 2018, non-forensic doctors prepared MLR's before September 2018 and afterward by forensic doctors. MLR's of June, July, and August 2018 (before setup of CFMU) were categorized as pre-CFMU reports and October, November, December 2018 (after

Non-poisoning MLR's

(Table 1, Graph-1) Comparing the pre and post CFMU non-poisoning reports, statistically significant results were obtained for the following parameters. Date and time of patient examination were incomplete in 14% (n = 7) pre-CFMU reports, while there was no error in post-CFMU reports. Address of the patient was incomplete in 28% (n = 14) pre-CFMU reports, whereas 6% (n = 3) post-CFMU reports had incomplete addresses. In 26% (n = 13) pre-CFMU reports, details of accompanied police and attendants

Discussion

The present study emphasizes the necessity of accurate documentation of medico-legal reports by doctors of all specialties. The present study compares the medico-legal reports prepared by forensic and non-forensic doctors. The quality and accuracy of medico-legal reports were greatly enhanced due to the involvement of forensic specialists. The reports were more detailed, simple, and understandable to any non-medical individual like lawyers and judges. Injuries were better described covering all

Conclusion

The most common mistakes found in MLR's prepared by non-forensic professionals were incomplete documentation of the following parameters, identification marks, history of incidence, consent for examination, location & age of injury, general condition of the patient, details of sample evidence and final opinion. The present study concludes that the errors were significantly reduced in medico-legal reports prepared by forensic experts. Therefore, it is necessary to employ forensic experts at

Funding

No funding received.

Declaration of competing interest

None.

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