FORENSIC SCIENCE

MEDICO LEGAL REPORTS

B.Com LLB (H), 9th Semester, U.I.L.S P.U

Submitted to: Submitted By:

Dr. Ajay Ranga Daanish Singh
131/12, section C

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 ACKNOWLEDGEMENT

I take this opportunity to express my profound gratitude and

deep regards to my guide Dr. Ajay Ranga for his exemplary
guidance, monitoring and constant encouragement throughout
the course of my project. I would like to thank my dear friends
for helping me in this project. Without their help I wouldn't be
able to make it.

THANK YOU

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 TABLE OF CONTENTS

1. Introduction 4
2. The agreement between lawyer and physician 5
3. Direction and Disclosure 6
4. Consent 9
5. Guidelines 10
6. Contents .. 11
7. Medico Legal Case . 13
8. Conclusion .. 16
9. Bibliography 17

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INTRODUCTION

Medico Legal reports are essential to the legal process of assessing and resolving
claims for compensation after personal injury. A full, frank and clearly written
medico-legal report will contribute significantly to the proper and just resolution of
a claim for personal injuries. It will expedite the process, reduce costs, and
frequently preclude the need for a court appearance by a physician. A good
medico-legal report is more likely to result when members of the legal and medical
professions communicate and co-operate.

Physicians and lawyers share responsibility to see that full, frank and effective
medico-legal reports are made available as required for the benefit of a
patient/client and for the administration of justice. Unfortunately, poor
communication between lawyers and physicians regarding medico-legal reports
can lead to misunderstanding and lack of co-operation.1

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.

1
http://www.jkscience.org/archive/volume91/jk8.pdf

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The Agreement Between Lawyer And
Physician

The lawyer and physician should arrive at an understanding as to the terms upon
which the physician is to provide a medico-legal report. These terms should be
discussed in advance. This is especially important in complex matters. There
should be a clear understanding between lawyer and physician as to the nature of
the medico-legal report, its purpose and the issues in the proceeding. It is the
responsibility of the lawyer to ensure that specific instructions are given to the
physician to enable the physician to identify the issues to be addressed in the
medico-legal report. The other essential elements which should be discussed and
agreed upon in advance are the amount of the fee and the time for payment (this is
discussed in more detail under the heading The Physicians Fee). The Ontario
Medical Association recommends that physicians seek agreement regarding their
fees in writing, whenever possible. The physician or the lawyer may wish to
confirm some of the more important terms of their discussions in a letter, to ensure
that the terms have been mutually understood.2 The section, entitled Elements of
an Agreement Between Lawyer and Physician for MedicoLegal Reports, lists in
more detail some of the topics which should be discussed in advance, including:

a) what is needed by the lawyer

b) reasonable time lines for completion of various steps, including the completion
of the medico-legal report

c) the obligation of the lawyer to pay for the physicians services, unless the
physician is notified in advance, and in writing, that someone else will be
responsible for the physicians fee (see The Obligation to Pay")

d) the amount of the payment, or the method of calculating the fee e) the time
frame for payment by the lawyer for the medico-legal report

2
https://www.freedomfromtorture.org/what-we-do/10/5132

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f) the obligation of the lawyer to show a copy of the medico-legal report to the
client if the client insists on seeing the medico-legal report.

Direction and Disclosure to the Physician

The lack of sufficient direction and disclosure by a lawyer when first requesting a
medico-legal report is a principal source of difficulty between the professions.

(a) Direction
The lawyer should provide the physician with clear, written directions as to the
matters to be addressed by the latter in the medico-legal report. The directions that
are appropriate will vary with the particular circumstances in each case, and with
the function of the physician from whom a medico-legal report is requested. For
example, in the case of a treating physician who is a general practitioner and has
not continued to treat the patient, all that may be required is a description of the
injuries observed on examination, diagnosis, treatment and the patient's response to
treatment. The treating physician who happens to be familiar with the patient's
medical history and continues to be involved in treatment may be asked to provide
an opinion on the effect of injuries on the patient having regard to the patient's
previous medical history, occupation, hobbies and general lifestyle as known to the
physician. The lawyer may also wish a full opinion on the prognosis and the effect
of the injuries on the patient and, in particular, the effect on certain aspects of the
patient's activities. If the physician is not a treating physician, but is asked to
provide an opinion, the need for specific direction is even greater. The physician in
such a case should be apprised of the issues to be addressed concerning the injuries
in the medico-legal report. Good practice requires that the lawyer understand the
limits of the physicians expertise. The lawyer should be careful to formulate the
specific questions on which the physicians opinion is sought without trying to
suggest the answer that the physician ought to give. The lawyer must also take care

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to ensure that the physicians opinion is based on foundation facts that can be
proved by admissible evidence to be given at trial or at the hearing. 3

(b) Full Disclosure

The physician asked to provide a prognosis or opinion in a medico-legal report
should be informed fully by the lawyer of all the available medical information
concerning the injuries. The lawyer should not withhold relevant medical
information because the information is perceived to be unfavourable to the interest
the lawyer represents. The physician asked for a prognosis or opinion should be
informed fully of allegations, specific issues, and pertinent particular
circumstances of the patient. The physician should be provided with all relevant
medical information available, such as previous medical history, hospital records,
original Xrays (original X-rays are preferred over X-ray reports or copies), ECGs,
EEG's, laboratory reports, histology, and other material if required. If the lawyer
has difficulty deciding what information is relevant, then the lawyer should discuss
with the physician what information should be sent for review. The lawyer should
be aware that clinical notes and records may not be the only documents available
regarding the patients health history. For example, pathology slides, radiological
films, etc. should be requested to describe the complete history. As medical
technology advances and becomes more sophisticated, information may be stored
in electronic databases, digitalized records, etc.

The prudent lawyer should make inquiries about these other forms of data storage,
in addition to clinical notes and records, to ensure that the physician is provided
with all important information. It can be most disconcerting, when a physician is
under cross-examination in court, to first learn of relevant medical information that
was available when the medico-legal report was requested but not provided to the
physician. The opinion previously expressed by the physician, based on incomplete
medical information, may be undermined. Relevant medical information is as
important to the physician's opinion as relevant facts are to the lawyer's opinion.
One might question the wisdom and judgment of a lawyer who withholds relevant
medical information. This creates a risk that such strategy or tactic will backfire
3
http://www.tla-medicolegal.com/

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should all relevant medical information subsequently become known. The lawyer
should bear in mind that the instructions and information conveyed to the
physician may be disclosed during the course of a trial. There may be cases in
which the lawyer deems it appropriate not to disclose a previous medical opinion
to a physician asked to provide a second opinion until after the second opinion is
received. In some cases the physician from whom a second opinion is sought may
prefer not to be made aware of the previous opinion until after the second has been
given. Whether or not a second opinion is sought, and whether or not the previous
opinion is disclosed in advance or sometime after receipt of the second opinion, are
matters which a lawyer must decide based on the particular circumstances in each
case and upon consultation with the physician. These remarks should not be
interpreted as an endorsement of the practice, engaged in by some lawyers, of
shopping around for a favourable opinion and disregarding all other opinions
received. Such practice is to be discouraged. 4

(c) Surveillance
Surveillance is often used in an effort to obtain objective evidence as to the extent
of injuries sustained by a patient and the effect of these injuries on that patients
activities. This evidence may be in the form of videotapes (the most common
form), photographs, film or oral testimony of the person who conducted the
surveillance.

In civil actions, the admissibility of and the weight to be attached to any evidence
obtained by surveillance ultimately will be determined by the court that hears the
case. The court (judge and/or jury) will consider this type of evidence in
conjunction with all other evidence presented. A treating physician or an
independent expert may be asked to review the results of surveillance and consider
it as part of the information made available to the physician in arriving at an
opinion. The physician will have to assess the extent to which the results of the
surveillance are of assistance in formulating an opinion. If the physician is asked to
formulate an opinion based solely on the results of the surveillance, the physician

4
http://www.wma.net/en/30publications/10policies/c18/

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will have to assess the extent to which he or she is able to do so. If the results of
surveillance have not been reviewed and taken into account by the physician in
formulating an opinion, the physician may be cross-examined by an opposing
lawyer. The lawyer will attempt to discredit or minimize the weight of that
opinion, given without taking into account the evidence obtained by surveillance.
A treating physician has a relationship of utmost trust and a duty of fidelity to his
or her patient. The treating physician who has been asked to review surveillance
evidence and comment or express an opinion on it should ask the person presenting
the surveillance to obtain the patients specific consent to have the treating
physician review the surveillance evidence with a view to commenting or
expressing an opinion on it. The use of and disclosure of surveillance evidence in
claims for personal injuries remains an issue of controversy. Lawyers who intend
to use such evidence are well advised to consider carefully the risks of withholding
disclosure of such evidence until the last possible moment. Physicians who are
asked to conduct medical examinations should not be placed in a position where
they are expected to assess issues of credibility based on surveillance evidence
produced late in the legal process. The trend of the law is towards early disclosure
and early resolution of claims. Lawyers who consider that the surprise use of
surveillance evidence is a helpful tactic may find that this does not yield the results
intended.5

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;

5
http://www.rch.org.au/clinicalguide/guideline_index/Writing_a_good_medical_report/

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 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;

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

GUIDELINES FOR WRITING A MEDICO

LEGAL REPORT
1. If possible, type the report on headed paper, sign and date it. If you are using
your employers 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 GMCs Good Medical Practice.

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CONTENTS OF A MEDICO LEGAL
REPORTS

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 baic 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 experts
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

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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 themselves . 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 experts 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.6

6
http://www.ohchr.org/en/ProfessionalInterest/pages/cat.

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MEDICO LEGAL CASE

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 ParmanandKatara v.
Union of India (Supreme Court, 1989). 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
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 authorized to
handle medico-legal cases, which was situated 20 kilometers away. Here is a look
at what has changed over the years, and what to expect to when you register a
medico legal case.7

What is a 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 offense. 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.
7
http://www.thehealthsite.com/diseases-conditions/medico-legal-cases-top-facts-you-should-know/

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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.8
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.

Procedure for filing a medico legal case:

On visiting a hospital for a medico legal case, once you or your loved one has
received treatment, your doctor or hospital will inform the police about your case,
8
http://www.india.com/topic/medico-legal-cases/

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an acknowledgement of receipt is taken for future reference. If the intimation is
given orally or via the phone, a docket number is provided which can be used as
proof of intimation and is documented in the patients records.
Once the patient is stabilised you will be directed to the medico legal desk. Here
you will be asked to fill out a form and sign it . Your signature is required to
authenticate the information you have provided. At this point your case sheet will
be kept in the hospital and you will be visited by the police. They will take down
your statement, and confirm if you want to file a case. The treating physician will
fill out the medical details in the form. Your doctor is responsible to give accurate
information to the police which will assist them in their investigation. After your
case is filed you will get a receipt stating your file number and case number. If
required you will need to employ a lawyer to take the case forward.9

9
http://www.legalserviceindia.com/medicolegal/medico.htm

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CONCLUSION

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.

The correct format allows for completeness, uniformity, and consistency in the
preparation of expert opinions given in medicolegal 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.

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BIBLIOGRAPHY

Websites Referred
* http://www.jkscience.org/archive/volume91/jk8.pdf

* http://www.wma.net/en/30publications/10policies/c18/MEDICO
CASE//

* http://www.ohchr.org/en/ProfessionalInterest/pages/cat.aspx *

* https://en.wikipedia.org/wiki/medicolegal *
https://www.hrw.org/topic/torture

* http://www.irct.org/medicolegalrepoerts/defining.aspx

* http://www.legalserviceindia.com/medicolegal/medico.html
* http://medicolegalindia.org/latest_judgement.html

Books Referred
* Modi, J.P., Medical Jurisprudence and Toxicology, 23rd edition,
LexisNexis, New Delhi

* Sharma B.R., Forensic Science in Criminal Investigation & Trials,

5th Edition, 2006

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