Law > Medical Jurisprudence > Law and Medicine > Medico-Legal Aspect of Road Accidents
A Medico-Legal Case (MLC) can be defined as a case of injury or ailment, etc., in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment. It may be a legal case requiring medical expertise when brought by the police for examination. In this article we shall discuss medico-legal aspect of road accidents
List of Medico-Legal Cases:
- All cases of injuries and burns -the circumstances of which suggest commission of an offense by somebody. (Irrespective of suspicion of foul play)
- All vehicular, factory or other unnatural accident cases specially when there is a likelihood of patient’s death or grievous hurt.
- Cases of suspected or evident sexual assault.
- Cases of suspected or evident criminal abortion.
- Cases of unconsciousness where its cause is not natural or not clear.
- All cases of suspected or evident poisoning or intoxication.
- Cases referred from a court or otherwise for age estimation.
- Cases brought dead with improper history creating suspicion of an offense.
- Cases of suspected self-infliction of injuries or attempted suicide.
- Any other case not falling under the above categories but has legal implications
Medical professionals are often unsure of the course of action in medico-legal cases. Thus, they are rather reluctant to attend to cases of accident for fear of being involved in unnecessary litigation later on. Even in cases of serious accidents, medical professionals hesitate to offer help, sometimes resulting in patient’s death. The first question that arises in such cases is whether any medical man can be forced to accept an accident victim. The answer to this till some time back was very clear. The doctor could choose patients according to his own will.
In Parmananda Katara Vs Union of India, AIR 1989 SC 2039 case, the apex court held that every doctor is bound to provide medical aid to the victims irrespective of the cause of injury; he cannot take any excuse of allowing law to take its course. Hence, if now a doctor refuses treatment, in case of emergency, he/she could be sued under the law. Once the doctor accepts the case and starts treatment, then the doctor-patient relationship is established.
Medico-Legal Aspect of Road Accidents:
Immediate Treatment:
Some key factors that doctors need to keep in mind while receiving an road accident victim are:
- Inject TT Immediately: The doctor may forget to inject TT, and in such cases, if the patient develops tetanus, the doctors can face trial for negligence.
- Take X-rays: Taking X-rays of all possible parts to exclude fractures is crucial.
- Bleeding Points: Internal or external bleeding points should be examined, and should not be missed.
- Ophthalmoscopic Examination: Ophthalmoscopy is an examination of the back part of the eye (fundus), which includes the retina, optic disc, choroid, and blood vessels.
Procedure For Registering a Medico Legal Case:
- Treatment: Treatment should start immediately. All legal formalities to be suspended till the patient is resuscitated.
- Identification: When the patient is resuscitated , the medical practitioner must find whether the said case falls under Medico Legal Case or not.
- Intimation to Police: if the case does fall in Medico Legal category, then he must register the case as an MLC and/ or intimate the same to the nearest police station, either by telephone or in writing.
- Acknowledgement Receipt : He shall obtain from the police, the acknowledgement receipt for future reference.
Preparation for Medico Legal Case Report:
- The attending doctor should record all the findings and prepare a proper MLC report.
- He/she must record the preliminary particulars including full name, age, sex, occupation, date, and time, brought by whom and history of dying declaration whether necessary or not.
- Identification marks of the patient (details of minimum 2) should also be recorded.
- Date, time, finding, and description of injury (accurate measurements), whether the simple, grievous, or dangerous need to be recorded.
- The record of investigations performed on the patient like X-ray, USG, CT scan, and MRI must be maintained.
- Details of the injuries should be issued to the police or court on demand in the form of certificates. In the case of grievous injury, the details can be issued to the police even without a demand.
- The medical practitioner should fill a “wound certificate” and obtain a “written consent” from bystanders. The matter should be intimated to the police.
- Each page of the MLC report should bear the signature of the doctor and the patient, or a thumb impression of the latter.
- The report must be written meticulously, expending thought on language and content. This report should demonstrate competence as MLC reports involve litigation, insurance claims, medical negligence claims, and worker compensation issues.
Investigation of Road Accident as MLC:
The Investigation of the accident must be done as soon as possible after it occurs because it helps in observing the conditions as they were at the time of the accident. Investigation officer may take help from an automobile expert and a medical expert. Establishment of facts includes visiting site of accident, examination of mechanical damages. If the driver of the vehicle is survived, his medical examination is mandatory. It should be ascertained if he was under the influence of alcohol or drugs at the time of accident. Medical examination of the victims must be conducted immediately. Medical examination includes noting of injuries suffered, place, angle, extent, and depth of injury. It also includes noting of blood stains on body, tears, grease marks, mud and soil stains, etc.
Generally, there are multiple causes. The investigation officer must consider all possibilities. He should also consider contributing factors which include environmental factors, design factors, human behaviour (carelessness, rushing, and fatigue, etc.). When determining negligence of one of the drivers, the contributory negligence of the other person has also to be taken into account.
In case of accidental death, an autopsy (post mortem) is often performed to ascertain the cause of death. An autopsy or post-mortem is a surgical procedure involving a thorough examination of the corpse by dissection to determine the cause and manner of death. The procedure is performed by specialist pathologists.
Punishment to Offender:
Where offence is committed, the offender must be punished. Rash and negligent driving, drunken driving, over-speeding, red light jumping, etc. are punishable offences. The punishment has dual purpose. It warns the offender that he should take care in future and it also deters other persons from rash and negligent driving.
Compensation to Victim:
Under the law, compensation is recoverable by the victim of the accident, and if he is dead, by his next-of-kin. It is mandatory for all vehicles to be properly insured at all the times.
According to Section 1A of the Fatal Accident Act, 1855 “Whenever the death of a person shall be caused by wrongful act, neglect or default, and the act, neglect or default is such as would (if death had not ensured) have entitled the party injured to maintain an action and recover damages in respect thereof, the party who would have been liable if death had not ensued shall be liable to an action or suit for damages, notwithstanding the death of the person injured, and although the death shall have been caused under such circumstances as amount in law to felony or other crime. Every such action or suit shall be for the benefit of the wife, husband, parent and child, if any, of the person whose death shall have been so caused, and shall be brought by and in the name of the executor, administrator or representative of the person deceased.
Concept of Golden Hour:
The ‘Golden Hour’ is the first hour after the Trauma. However, Golden hour is not always a predefined time period. Sometimes, according to the severity of the situation the golden hour can range from a few minutes to several hours. It is a concept that emphasises the urgency of care required by major trauma patients to prevent ‘early deaths’ predominantly from haemorrhage.
R. Adams Cowley, founder of Shock Trauma Institute, Baltimore came up with the term ‘Golden Hour’ in the year 1975. He called this time as the time between life and death. According to him, if a person is critically injured, rather than dying right away, that person might have less than sixty minutes for any chance of survival. The concept of golden hour plays an important role even in the current situation as these spreads the importance of seeking urgent medical treatments in cases of traumas. The validity of this concept remains controversial
If proper and timely first aid is given, road accident victims have a higher chance of survival. Prompt action may also reduce the severity of the injuries. Many deaths and impact of injuries can be prevented with First Aid if causalities are treated immediately. One of the misconceptions about road accidents death is that most of them happen due to sever injury and loss of blood. But reality is that most common cause of death in road accidents due to loss of oxygen supply. Normally it takes less than four minutes for a blocked airway to cause death. It is said that these four minutes are crucial. It is not always possible that proper medical care reaches the victim within an hour. In that case the passer-by, onlookers and other people involved can provide the first aid to serious victims.
Good Samaritan Law:
According to the World Health Organisation (WHO), in the absence of established emergency medical services, bystanders can play a game changing role in saving lives. They can call for help, provide first-aid to the injured and even rush them to the nearest hospital, if an ambulance does not arrive in time.
A good Samaritan is a person who is good in faith, and without any expectation of any reward or payment, voluntarily comes forward to help and give immediate assistance and emergency care to a person injured in the accident or other mishap. Such person contacts the police and other authorities, provide first-aid to the injured person, and sometimes even take the person to a hospital if ambulance does not come in time.
In Save Life Foundation v. Union of India, AIR 2016 SC 1617 case, the Supreme Court gave following guidelines.
- A good Samaritan will not be liable for any civil or criminal action for any injury to the victim, or even his death.
- When such a person informs the police authorities or emergency services, he cannot be compelled to give his personal details.
- Such persons cannot also be forced to make the initial payments for the treatment of injured person.
- A good Samaritan cannot be compelled to appear as a witness in the court. But he may do it voluntarily.
Conclusion:
A Medico-Legal Case (MLC) is a case, in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment. It is the legal duty of the treating doctor to report it to the nearest police station immediately after completing primary lifesaving medical care of the victim. Quick action by the police also helps to avoid the destruction of evidence by the treating physician.