MLC introduction and basics

Medicolegal cases (MLCs)

(Part 1:Introduction and basics)

This is the most annoying and dangerous part of doctors especially new ones working in peripheries.It starts from RHC level to above.

This is a very vast topic.I will try to explain it in sections by multiple posts in coming day (at Doctors Republic group) and then we can move to Sexual assault and Postmortems.

Unfortunately new MOs and WMOs are thrown directly into declaring MLCs without any training within few days of their joining.I myself worked as Medicolegal officer for almost 4 month before i had the chance to go to PFSA(Punjab Forensic Science agency) for training and that was by luck.This is one of the most dangerous flaw in our medical system.I will try to explain point but bcaz its very diverse so feel free to ask question.i will try to explain it on what was taught to us during training (jitna yad rha hy mujhy)

1.First of all you should know that issuing MLC is legally binding on doctor issuing it.That can b challenged in medical board (district board that can b appealed in provincial medical board).But it can only b challanged after FIR is written.The police docket is not FIR.

2.  If your are found with professional misconduct or fake MLC issuing then you can b punished both by PMDC and court of law depending on the verdict by boards and their recommendation.

3.Only you will b charged as dispenser is not involve anywhere in conducting MLC.By law u have to b alone with the patient in a private room with no one else around you not even dispensar.You have to bring the register by yourself from locked cupboard, write it by urself and place the register back in lock by urself.You have to examine the patient first hand before anyone else is able to manipulate the wound (expand wound with fingers to expose bone etc).I am telling you this because in every hospital dispensors try to pose that its their job and u do not know what is true.During an investigation against you you cannot say that its dispensar's fault.

4.The patient usually comes to you with a police docket which is what police noticed when patient came to them and they note injuries in layman terms .You should know that a docket is not required to issue an mlc but try not to issue it without one.ask patient to got police for docket after u note their injuries in simple paper for ur remembrance.You are not bound to write only those injuries written in docket.if u find additional injury then add it to docket with ur initials and write on docket that this injury is in addition .If u find an injury not present but written on police docket the write on original docket and on copy that u haven't found that injury.U r medical officer.its upon u.

5.  Dispensars usually try to delay the procedure of issuing MLC.They wait for opponent party and try to bargain.Do not let them wait.Issue MLC as soon as possible otherwise people will start to gather and sifarishi and threats will become a headache.

6.During issuing MLC do not talk to patient much.Do not respond to any threats pleadings.Do not be friendly.I used to tell patient that i do not take any money for MLC and i have issued what is there so if anyone outside ask for money on my behalf do not give them anything(tell them after u completed the MLC)

7.Remember that once an MLC is issued no one can change it.Not even health minister.Not even you.So issue it as soon as possible and be done with it.pressure will b off u.Refuse any request to change it by anyone (MS and EDO included).That is against law.

8.  Do not overwrite,scratch or cut anything while filling the MLC form.if some cutting happens then put a signature on it.Because when u have to give court evidence and there they reproduce ur original MLC

u should know if it was you who make that correction or if someone else did it to trap u.alway sign on any edit or scratchs u do.

9.Stamp any signatures u did on that MLC or docket.Use stamp of ur own so that no one else can use it and keep ur stamp to urself.

10.Never Ever give any favor to anyone no matter what.Do not hesitate to simply telling anyone that u do not like being told in MLC.If u give a single favor than u will b blackmailed for it for the rest of your life.The same person asking u to give favor will threat u or give application against u later on in court for the same MLC u give favor in if u refuse to do that in future.So this is most important that u do not give favor to anyone.tell them u will write what u see.

Medicolegal cases (MLCs)

(Part 2: Filling the MLC form basics)

After seeing so many people having trouble with MLC ,i am forced to quickly complete the MLC section after so many requests.In case you haven't read the Part 1 ,its is there at "Doctors republic" group. This will be a little long post as so many things to cover so bear with me.

I am posting table containing all legal sections obtained from PFSA officially.The only change in the said table is that now all teeth injuries falls under section 336 instead of 337.I am unable to obtain empty MLC form as i no longer work as medicolegal officer so it is no longer available to me in short time.But u will know what i m talking about when u see it.Lets begin.

1.You fill MLC forum by keeping two things in mind.First is that you may have to give evidence regarding your MLC in court of law where you will b cross examined by opponents lawyer.Second is that your MLC may be challenged in a medical board so they will read what u wrote there and may ask you questions.In both situation original MLC report will be given to you because you may not remember the patients as so many MLC comes every day.If not provided then u can demand court to give u the MLC beforehand so that u can read it before evidence.That is why we avoid any cuttings,overwriting etc so that it may not confuse us.If u hav to correct or overwrite anything then sign above it so that you can remember that it was you who did that and no one else has tempered with ur MLC.

2.  Never leave any portion or part of MLC report blank.either fill it or cross it so that no one else can fill it afterwords.

3.The lawyers and non medical persons are usually interested in non medical part of the MLC as they cannot grasp the medical portion where u describe the injuries.And medical board is more interested in what u actually wrote in describing the injuries.we fill this form keeping that in mind.

4.First u check that a police docket is with the patient.If no docket is there than ask them to bring the docket from related police station after u note their injuries in blank page for remembrance.A hospital can only issue MLC for the incidents occurred in their police station jurisdiction.For example DHQ Faisalabad can entertain MLC which happened in the boundaries of Tehsil faisalabad.It cannot issue MLC of an incidence in Jaranwala (Tehsil of faisalabad) or incidence happened in boundary of an RHC.

5.Fill in the name,fathers name, cast ,address according to the docket or as in ID card. Put ID card number if available. if patient do not hav an ID card then write N/A (not available).

6.In "accompanied by" section you write who brought the patient to u.It may be police, relatives or he himself came.U r not required to say that it is brought by police if no police came with them.its not

necessary for police to accompany the patient.

7.Two identification marks are very important because sometime they change the person in court.that is why u yourself find identification marks like moles, scars and write their position so that u can compare it later whenever he came back or in court .So do not ask dispensar to find those marks for you.

8.Another important portion is time of arrival and examination.Write actual times.Try not to delay the MLC as it may create pressure on u by sifarish and etc.

9.Fill in the constable name ,peti number from the docket.fill in if u have admitted the patient or discharged it immediately.

10.Always fill in the consent section.and this completes ur information section.

11.Now in brief history ask the patient the time of fight,number of persons who assaulted him and the weapon they used.these questions are important.time and date of fight may not correlate with his wound(wound may b fresh or older).If patient give u the history of a blunt weapon use and u find sharp wounds than this will help ur case of fabrication etc.

12.Always write what clothes he is wearing at the time of examination.where is the blood or any stain present.or any torn portion.this again helps you determining fabrication.for example if wound is at back of skull but blood is in front of shirt...or if there is lacerated wound at upper arm but no tear or stain in the shirt..If patients tells u he has changed the clothes(this will the 1st inquiry about clothes) than simply write changed clothes and that is it.

13.Now we come to writing injuries.u write injuries from head to foot.it is easy way.Remember u want to involve more and more experties in ur MLC so do not hesitate to write investigation like x-ray or expert opinions of surgery ,dentistry etc in it.If there is a blunt trauma anywhere on bony part and there is a swelling or bruise, always write an xray.its for ur own safety bcaz without xray u cant b sure if there is a hairline fracture.sometimes u write L-2 and patient goes straight to dispensar and get a fabricated fracture and challenge ur MLC.u cannot justify that fracture without a Xray.The more people u involve ,the less u will b accused of bribery .

14.I m writing these two injuries as in MLC so that u can get the idea how to describe an injury properly

"Injury No.1 : A lacerated wound 2x2 cm on right side of forehead 2 cm above right eyebrow and 2.5 cm lateral to root of nose.Bone exposed.spindle shaped with rough edges .skin seems chopped .fresh bleed at the time of examination.painful to touch.Xray skull and CT head advised.expert opinion of radiologist needed"

"Injury No.2: A contusion 3x3 cm at right side of abdomen 4cm above pubic symphysis and 3 cm right from umbilicus.Dark blue in colour ith induration.skin intact.Painfull to touch.USG(ultrasound) abdomen and expert opinion of radiologist advised"

"Injury NO.1 and No.2 are KUO (kept under observation)"

15.Never ever declare an injury unless all of the investigation's results are back and available to you.Never Ever declare the fabrication yes or no unless all of investigation and expert opinions are back.KUO the fabrication.

16.Fill any investigation u ordered.

17.In filling the age of wound be carefull here. if ur age of wound differs from the actual time of injury patient told u in his history than it will fall under fabrication.Write what feels right to u.

18.there are many ways to declare a wound fabricated.You can either directly declare all injuries fabricate or not fabricated.U cant declare individual injuries fabricated or not fabricated.like in the back

u can write that injury no 1 is fabricated but injury no 2 is not.

19.You can say that possibility of fabrication cannot b completely ruled out and subject to police for further investigation.your concern is whether medically the wound is fabricated or not.its the responsibility of police to find out that a knife is held by his father of his enemy.its not ur headache.he may fall from a tree or he may b thrown from a roof.injuries will b the same so its work of police to find out what is what.In weapon section write blunt or sharp.

20.Encircle the wounds on diagrams exactly where u describes and write total number of injuries there.

21.  Lastly always give the MLC to the police officer after getting his thumb and put ur "by name" stamp on every signature u did on MLC or docket.*Its not ur job to listen to witnesses and try to figure out what really happened. u will b seeing if time, date, wound age, weapon and investigation matched or not.