Health is a vital indicator of human development and human development is the basic ingredient of economic and social development. According to the World Health Organization (WHO), health is a state of complete physical, mental and social well-being and not merely the absence of disease. The right to health for all people means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship. No one should get sick and die just because they are poor, or because they cannot access the health services they need. Good health is also clearly determined by other basic human rights including access to safe drinking water and sanitation, nutritious foods, adequate housing, education and safe working conditions. Everyone has the right to privacy and to be treated with respect and dignity. Nobody should be subjected to medical experimentation, forced medical examination, or given treatment without informed consent. The Indian Constitution has granted certain fundamental rights to its citizen under part III of it these rights play an important role with reference to the health and health care.

In CESC Ltd. v. Subash Chandra Bose, AIR 1992 SC 573 case, the Supreme Court relied on international instruments and concluded that right to health is a fundamental right. It went further and observed that health is not merely absence of sickness: “The term health implies more than an absence of sickness. Medical care and health facilities not only protect against sickness but also ensure stable manpower for economic development. Facilities of health and medical care generate devotion and dedication to give the workers’ best, physically as well as mentally, in productivity. It enables the worker to enjoy the fruit of his labour, to keep him physically fit and mentally alert for leading a successful economic, social and cultural life. The medical facilities are, therefore, part of social security and like gilt edged security, it would yield immediate return in the increased production or at any rate reduce absenteeism on grounds of sickness, etc. Health is thus a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Constitutional Provisions:

There is no direct mention of the “Right of Health” in the Constitution. But Article 21 refers to right to life which includes living with a good Health. In a leading case, the Supreme Court held that the right to life implies the right to live healthy life. The Constitution of India not only provides for the health care of the people but also directs the state to take necessary measures to improve the condition of health of the people. Though the provisions enshrined under this part have no direct link with the healthcare, however from various judicial interpretations it has been established that the intention of the legislature were there to cover the health as a right of the citizens.

Fundamental Rights:

Article 14:

Article 14 speaks about equality before law where the State shall not deny to any person equality before the law or the equal protection of the laws within the territory of India.

Article 15:

Article 15 contains provisions for a particular application of the general principle of ‘equality of treatment’ embodied in Article 14. It prohibits discrimination against citizens on the grounds only of religion, race, caste, sex, place of birth or any of them. Even nothing in this Article shall prevent the State from making any special provision for women and children for their betterment of life.

Article 19(1)(g):

According to Article 19 (1) (g) all citizens shall have the right to practice any profession, or carry on any occupation, trade or business subject to restrictions imposed in the interest of general public under clause (6) of Article 19. 

In Burrabazar Fire Works Dealers Association v. Commissioner of Police, Calcutta, AIR 1998 Cal 121 case, the Supreme Court held that Article 19 (1) (g) does not guarantee the freedom which takes away that community’s safety, health and peace.

Article 21:

According to Article 21 of the Constitution of India “no person shall be deprived of his/her life or personal liberty except according to the procedure established by law. Right to life under Article 21 of the Constitution has been generously deciphered to mean something more than only human presence and incorporates the right to live with nobility and conventionality. The use of word ‘Life’ in Article 21 of the Constitution has a lot more extensive importance which includes human nobility, the right to livelihood, right to health, right to pollution free air, and so forth.

In Bandhua Mukti Morcha v. Union of India, AIR 1984 SC 802 case, Bhagwati, J. observed: “This right to live with human dignity enshrined in Article 21 derives its life breath from the Directive Principles of State Policy and Particularly clauses (e) and (f) of Article 39 and Article 41 and 42.” Since the Directive Principles of State Policy are not enforceable in a Court of law, it may not be possible to compel the State through judicial process to make provision by statutory enactment or executive fiat for ensuring these basic essentials which go on to ensure a life of human dignity.

In Paschim Banga Khet Mazdoor Samity v. State of West Bengal, (1996) 4 SCC 37  case, while widening the scope of Article 21 and the government’s responsibility to provide medical aid to every person in the country, the Apex Court held that in a welfare state, the primary duty of the government is to secure the welfare of the people. Providing adequate medical facilities for the people is an obligation undertaken by the government in a welfare state. The government discharges this obligation by providing medical care to the persons seeking to avail of those facilities.

In Unnikrishnan, J.P. v. State of Andhra Pradesh, AIR 1993 SC 2178 case, the Court held that the maintenance and improvement of public health is the duty of the State to fulfill its constitutional obligations cast on it under Article 21 of the Constitution.

In the State of Punjab v. M.S. Chawla, AIR 1997 SC1225 case, the Court held that-the right to life ensured under Article 21 incorporates inside its ambit the right to health and clinical consideration. 

in Consumer Education and Research Center v. Union of India, AIR 1995 SC 922 case, the Supreme Court held that right to health, medical aid to protect the health and vigour of a worker while in service or postretirement is a fundamental right under Article 21. 

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. The Court further stated that preservation of health is of paramount importance. Once life is lost it cannot be restored. Hence, it is the duty of doctors to preserve life without any kind of discrimination.

Article 32:

Under Article 32 of the Constitution, any person whose fundamental rights are violated can approach the Supreme Court for restoration of his fundamental right. Similarly, under Article 226 of the Constitution, any person whose fundamental rights are violated can approach High Court of respective State for restoration of his fundamental right.

Directive Principles:

The Directive Principles of State Policy (DPSP), enshrined in Chapter IV of the Constitution of India, require the state to, among other duties.

Article 38:

Article 38 provides that, “the State shall strive to promote the welfare of the people by securing and protecting, as effectively as it may, a social order in which justice– — social, economic and political, shall inform all the institution of the national life”. Thus, a constitutional liability is imposed on state that the State will secure a social order for the promotion of welfare of the people including public health because without public health welfare of people is practically meaningless.

Article 39:

Article 39 enjoins upon the State that (i) that the health and strength of workers and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength and (ii) that children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood and youth are protected against exploitation and against moral and material abandonment.

In Lakshami Kant Pandey v. Union of India, 1987 AIR 232 case, Bhagawati, J. while delivering the opinion of the court observed that: “It is obvious that in civilized society the importance of child welfare cannot be overemphasized because the welfare of the entire community, its growth and development depends upon the health and well-being of its children. Children are a „supremely important national asset and the future well-being of the nation depends on how its children grow and develop.”

 In Sheela Barse v. Union of India, 1986 SCALE (2) 230 case, the Supreme Court held that “A child is a national asset and therefore, it is the duty of the State to look after the child with a view to ensuring full development of its Personality.”

Article 41:

Article 41 deals with right to work, education and public assistance in certain cases and thus imposed duty on the State to public assistance basically for those who are old, sick and disable. This Article specifically says that “the state shall within the limits of its economic capacity and development, make effective provisions for securing the right to work, to education and to public assistance in case of unemployment, old age, sickness and disablement, and in other cases of undeserved want”. Their implications in relation to health are obvious.

In Mahendra Pratap Singh v. State of Orissa, AIR 1997 Ori 37 case, the Court held that in a country like ours, it may not be possible to have sophisticated hospitals but definitely villagers within their limitations can aspire to have a Primary Health Centre. The government is required to assist people, get treatment and lead a healthy life. Thereby, there is an implication that the enforcing of the right to life is a duty of the state and that this duty covers the providing of right to primary health care.

Article 42:

Article 42 provides for just and humane conditions of work and maternity relief and gives the power to the State for making provisions in this regard, which implies that this Article is intended to protect the health of infants and mothers by providing maternity benefit.

In U.P.S.E. Board v. Harishankar, AIR 1980 SC 65 case, the Supreme Court held that Article 42 provides the basis of the larger body of labour law in India. Further referring to Article 42 and 43, the Supreme Court has emphasized that the Constitution expresses a deep concern for the welfare of the workers. The Court may not enforce the Directive Principles as such, but they must interpret law so as to further and not hinder the goal set out in the Directive Principles. 

In P Sivaswamy v. State of Andhra Pradesh, AIR 1988 SC 1863 case, the Supreme Court held that Article 42 of the Constitution makes it the obligation of the State to make provisions for securing just and humane conditions of work. There are several Articles in Part IV of the Constitution which indicate that it is the State’s obligation to create a social atmosphere befitting human dignity for citizens to live in.

Article 43:

Article 43 lays down that alia that the State must endeavour to secure a decent standard of life to all workers.

Article 45:

Article 45 lays down that the State must endeavour to provide any childhood care and education to all children under the age of six years.

Article 47:

Article 47 imposes duty on the State to raise the level of nutrition and the standard of living and to improve public health. It categorically provides that “the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and, in particular, the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health.”

In Vincent Panikurlangara v. Union of India, AIR 1987 SC 994 case, the Court stated that “maintenance and improvement of public health have to rank high as these are indispensable to the very physical existence of the community and on the betterment of these depends, the building of the society of which the Constitution makers envisaged. Attending to public health, in our opinion, therefore is of high priority perhaps the one at the top”. The Supreme Court while interpreting Article 47 has rightly stated that public health is to be protected for the betterment of the society. Further it has been held that, in this welfare era raising the level of nutrition and improvement in standard of living of the people are primary duties of the State.

Article 48A:

Article 48A ensures that State shall endeavour to protect and impose the pollution free environment for good health.

In M.C. Mehta v. Union of India, Writ Petition (civil) 13029 of 1985 Case, the Court held that, “Art 39 (a), 47 and 48-A by themselves and collectively cast a duty on the State to secure the health of the people, improve public health and protect and improve the environment”

In Virender Gaur v. State of Haryana, 1995 (2) SCC 577 case, the Supreme Court held that environmental, ecological, air and water pollution, etc., should be regarded as amounting to violation of right to health guaranteed by Article 21 of the Constitution.

Fundamental Duties:

Article 51A:

Article 51 A (g) under Part IV – A of the Constitution says that “it shall be the duties of every individual to protect and improve the natural environment including forests, lakes, rivers and wild life, and to have compassion for living creatures.”

Euthanasia:

Euthanasia is described as the deliberate and intentional killing of a person for the benefit of that person in order to relieve him from pain and suffering. The term ‘Euthanasia’ is derived from the Greek words which literally means “good death” (Eu= Good; Thanatos=Death). Euthanasia is defined as the act of bringing the death of a person (patient) for the purpose of relieving the patient’s intolerable and incurable suffering. Typically, the physician’s motive is merciful and intended to end suffering. In voluntary euthanasia, a consent from the patient is taken. In non-voluntary euthanasia, the consent of patient is unavailable due to some reason.

In active euthanasia, the death of patient is brought directly by giving him a lethal dose of poisonous drug. In passive euthanasia, the life supporting system to the patient is discontinued and ultimately patient dies. In Aruna Shanbaug v. Union of India, the Supreme Court opposed active euthanasia but has given nod to passive euthanasia.

Conclusion:

From the above discussion, it is evident that right to life also includes right to health and therefore the state and its instruments, are duty bound to provide health care facilities and services to all its citizens without any discrimination. The Constitution also stipulates certain duties for the citizens towards contributing to the promotion of health in the country.

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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 sexual assault.

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.

The doctor or hospital is required to examine a victim of rape if she reports to the hospital directly, and voluntarily, without a police requisition.

In State of Karnataka v. Manjanna, 2000 (3) SCR 1007 case, the Supreme Court recognized that the rape victim’s need for a medical examination constituted a “medicolegal emergency”. Second, it was also the right of the victim of rape to approach medical services first before legally registering a complaint in a police station. The hospital was obliged to examine her right away; they could always subsequently initiate a police complaint on the request of the victim. The judgment also recognizes the three ways by which a hospital may receive a victim of rape: voluntary reporting by the victim; reporting on requisition by the police, and reporting on requisition by the Court.

Medico-Legal Aspect of Sexual Assault:

Section 375 of the Indian Penal Code defines the term “Rape” as follows:

A man is said to commit “rape” who, except in the case hereinafter excepted, has sexual intercourse with a woman under circumstances falling under any of the six following descriptions:

(First) — Against her will.

(Secondly) —Without her consent.

(Thirdly) — With her consent, when her consent has been obtained by putting her or any person in whom she is interested in fear of death or of hurt.

(Fourthly) —With her consent, when the man knows that he is not her husband, and that her consent is given because she believes that he is another man to whom she is or believes herself to be law¬fully married.

(Fifthly) — With her consent, when, at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration by him personally or through another of any stupe¬fying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent.

(Sixthly) — With or without her consent, when she is under sixteen years of age.

Explanation: Penetration is sufficient to constitute the sexual intercourse necessary to the offence of rape.

Exception: Sexual intercourse by a man with his own wife, the wife not being under fifteen years of age, is not rape.

Object of Rape Evaluation Test:

Victims of alleged Sexual offences like rape may be brought for the medical examination by police, or by order of a court, or the victim may come on their own. In the event the victim comes directly, the police will be informed and necessary action will be taken to register a case. The objects of medical examination are as follows:

1. Medical assessment and treatment of injuries and assessment, treatment, and prevention of pregnancy and Sexually transmitted diseases (STDs)
2. Collection of forensic evidence;
3. Psychological evaluation;
4. Psychological support;
5. Prepare reports required under the law.

The principal features of the examination are:

1. Primary data;
2. Physical Examination and mental condition;
3. Signs of struggle on clothes and body;
4. Local examination of the genitals.

Medico Legal Aspect of Sexual Assault with Reference to Victim:

Section 53(5) of the CrPC talks about examination of a female victim, which should be done by or under the supervision of a female doctor.
Section 164(A) CrPC explains the legal requirements for medical examination of a victim of rape. One of the main elements of this is that the consent of the victim is mandatory and should be part of the report.

The Section provides for a medical examination of the victim of rape by a registered medical practitioner. It also provides that when no woman doctor is available, there is no bar against a male doctor carrying out the examination, if the victim consents. Though getting the examination done by a woman doctor is ideal, the law does not mandate it, keeping in mind that a medical examination should not be postponed because of an extreme situation such as the want of a female doctor.

The same section mandates that a medical examination must be carried out within 24 hours of the police receiving information, thus recognizing this as a medico legal emergency and putting a timeframe for the investigating officer.

The report shall state precisely the reasons for each conclusion arrived at. The exact time of commencement and completion of the examination shall also be noted in the report. The registered medical practitioner shall, without delay, forward the report to the investigating officer, who shall forward it to the Magistrate referred to in section 173 of Cr. P. C. as part of the documents referred to in clause (a) of sub-section (5) of that section.

Medico Legal Aspect of Sexual Assault with Reference to Accused:

Section 53A of the CrPC provides for a detailed medical examination of a person accused of an offence of rape or an attempt to commit rape. A detailed medical examination is to be carried out by a registered medical practitioner (only allopathic doctors registered under the MCI) employed in a hospital run by government or local authority – and in the absence of such a practitioner within the radius of 16 km from the place where the offence has been committed, by any registered medical practitioner acting on the request of a police officer not below the rank of a sub inspector.

The medical examination should be carried out without any delay and a “reasoned” report be prepared recording the name and address of the accused, the person by whom he was brought, the age of the accused, marks of injury if any, a description of materials collected from the accused for DNA profiling, other material particulars in reasonable detail, and the exact time of commencement and completion of examination. The report should be forwarded without any delay to the investigating officer who in turn shall forward it to the magistrate concerned.

The report shall state precisely the reasons for each conclusion arrived at. The exact time of commencement and completion of the examination shall also be noted in the report. The registered medical practitioner shall, without delay, forward the report to the investigating officer, who shall forward it to the Magistrate referred to in section 173 of Cr. P. C. as part of the documents referred to in clause (a) of sub-section (5) of that section.

Where the accused in a case of sexual offence in police custody is brought for medical examination, consent is not required. Samples may be collected and handed over to the police for forensic examination.

SAFE Kit:

The kit was developed in Chicago in the mid-1970s by Louis Vittulo, in order to provide a more uniform protocol for evidence collection after sexual assaults. For years, the standardized tool was referred to as a Vitullo kit. Today it is colloquially referred to as a rape test kit or a rape kit, which is used interchangeably to refer to the specific evidence that is obtained through the use of the rape kit. Other terms and abbreviations used are sexual assault kit (SAK), a sexual assault forensic evidence kit (SAFE), sexual assault evidence collection kit (SAECK) and PERK (Physical Examination Recovery Kit).

A SAFE kit consists of small boxes, swabs, microscope slides, sterile containers, and plastic bags for collecting and storing evidence such as clothing fibers, hairs, saliva, blood, semen or body fluid from lips, cheeks, thighs, and vagina.

The kit is useful for investigations conducted after an alleged sexual assault, and can be used in evidence to punish the assailant. It is equally useful to exonerate persons who have been falsely accused of sexual assault.

In Delhi Commission of Women v. Delhi Police, W.P. (CRL) 696/2008 case, the Court mandated certain changes in the police system, health services, child welfare committees, legal services and support services in order to give justice to victims of rape. The court pronounced that a SAFE Kit (Sexual Assault Forensic Evidence collection kit) be used by all medical personnel for gathering and preserving physical evidence following sexual assault. Court issued guidelines to police, medical examiners, courts, and prosecution. Click here for guidelines

Guidelines for attending alleged victim of sexual offence

1. The date and time of arrival of the victim must be mentioned, both in the case sheet and the MLC Register. The duplicate copy of case sheet and Medicolegal Report shall be preserved for future reference.
2. The date and time of examination will be mentioned in the case sheet.
3. Case sheet will be initiated, noting personal particulars of the victim, along with date and the time of reporting.
4. MLC will be initiated after filling the MLC Register available at examination facility.
5. The alleged victim will be admitted if the medical condition is serious.
6. The police will be informed telephonically followed by in writing after filling up the MLC Register.
7. The Senior Registrar / Station HQ will be informed.
8. At least two identification marks of the victim will be mentioned in the case sheet as well as in MLC register.
9. Report to the police will be given by name of the victim or as an unknown case (If name of the victim is not known). Care must be taken to preserve the confidentiality of the victim from others not related with the case.
10. Police will register a case under the relevant section of the IPC.
11. The police may take the victim and the accused for medical examination at a hospital which is authorized to carry out medicolegal work.
12. Neither the victim nor accused in cases of sexual offences should be permitted to wash or take a bath till the medical examination is completed.
13. The proforma for recording medical examination of alleged rape victim and the accused are enclosed as in prescribed format respectively.
14. Consent of the victim must be obtained before starting the examination. The steps of examination and their purpose should be explained to the victim in a language she understands. The examination is to be carried out in the presence of a female attendant.
15. All injuries present on the body will be recorded. Line diagrams depicting the front and back of the body may be used for a better description of location of the injuries.
16. If the clothes are the same as those worn during the occurrence of alleged sexual offence, they should be carefully examined for the presence of blood, seminal stains, mud etc.
17. If there are any marks of suspicious stains, the clothes should be preserved with a view to forwarding them to forensic laboratory in prescribed format.
18. If there are foreign hairs, fibres, debris under the nails etc, they must be carefully preserved and sent to experts of forensic laboratory for comparison with those found on the accused. Specimens should include vaginal swab, preferably from the posterior fornix.
19. Care must be taken to preserve various samples of medicolegal importance for their submission to respective police authority.
20. In case the victim reports herself directly to the hospital after the alleged crime, she should not be sent to the police station for legal formalities; instead the police will be called to the hospital for the necessary requirements.

Other Legal provisions Associated with Sexual Assault:

• U/s 228A of Indian Penal Code, no person can disclose the name of the rape victim and if anybody discloses the name, he shall be punished with either description for a term which may extend to two years and shall also be liable for fine.
• U/s 114-A of Indian Evidence Act, presumption can be made as to the absence of consent in certain prosecutions for rape. Whenever the person of a female victim is to be examined under section 53 [5] of Criminal Procedure Code (Cr. P. C), the examination shall be made only by, or under the supervision of, a female registered medical practitioner.
• U/s 327(2) of Code of Criminal Procedure, there should be in camera trial for all rape victims.

Conclusion:

Medico legal evidence has been considered an important component in the prosecution of crimes, especially those related to sexual violence. The courts heavily rely upon it. However, it is important to understand that forensic science itself is a new and emerging discipline. No forensic method has rigorously been able to demonstrate a definitive connection between a specific individual and a sample or source. So special precaution should be taken and care, emphasis should be laid on section 53 CrPC and 164A CrPC.

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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:

1. Treatment: Treatment should start immediately. All legal formalities to be suspended till the patient is resuscitated.
2. Identification: When the patient is resuscitated , the medical practitioner must find whether the said case falls under Medico Legal Case or not.
3. 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.
4. 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.

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