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| MEDICOLEGAL CORNER |
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| Year : 2015 | Volume
: 1
| Issue : 1 | Page : 45-51 |
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Salient Features Regarding Medicolegal Certificate
Anil Aggrawal
Director Professor, Forensic Medicine, MAMC, New Delhi, India
| Date of Web Publication | 27-Jan-2015 |
Correspondence Address:
Prof. Anil Aggrawal
Director Professor, Forensic Medicine, MAMC, New Delhi - 110 002
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2394-7438.150068
General duty doctors in all major hospitals -Govt and Private-are often unclear regarding when to label a case as medicolegal. This paper attempts to give general guidelines to doctors regarding this problem. Keywords: Emergency documentation, injury report, Medicolegal, poisoning, trauma
How to cite this article:
Aggrawal A. Salient Features Regarding Medicolegal Certificate. MAMC J Med Sci 2015;1:45-51 |
Almost on a daily basis the author gets from casualty requesting for advice whether a given case should be labeled as a medicolegal case or not. Through this introductory article in the MAMC journal, I wish to take up this most important and vital issue.
But first - what is an injury report? An injury report (wound certificate, medicolegal certificate, medicolegal case [MLC]) is a document prepared by the doctor in all medicolegal cases. Injury report is a kind of medicolegal report. A medicolegal case is a case of injury or ailment where attending doctor after taking history and clinical examination of the patient thinks that some investigations by law enforcing agencies are essential so as to fix the responsibility regarding the case [Table 1].
- Medicolegal case has not been explicitly defined anywhere in the law. It depends more or less upon the judgment of the doctors. In doubtful cases, it is better to inform the police than not informing. This will save the doctor from unnecessary and needless allegations later on.
- Some specialists talk about non-MLC police information in doubtful cases (doctor merely informs the police, but does not make an MLC). If, after police investigation, it turns out that some crime has been committed, an MLC is prepared. This is not desirable as evidence collection is best done at the time of examination. Valuable evidence may be lost if the police investigation is delayed.
- Medicolegal casess have to be attended round the clock without delay.
- Consent of the patient/relatives - is not required for labeling the case as MLC. In fact, even if the patient is stressing that he does not want an MLC, it should still be made.
Example: Consider a case of suicidal poisoning. Suicide is an offence u/s 309 Indian Penal Code (IPC). Patient insists he does not want an MLC. If the doctor agrees to the patient's request, it is like agreeing to a criminal requesting him not to give evidence regarding his crime to the police. Doctor's MLC with relevant history from the patient is a piece of evidence that a crime u/s 309 IPC has been committed. If the doctor does not inform the police, and does not hand over the MLC to the police, he may be sued u/s 201 IPC (causing disappearance of evidence of an offence). However, consent for examination would still be required because the patient is not arrested at that point in time.
Thus a possibility exists, when a person reports to a doctor after, say, failing in an attempt to commit suicide → insists that he does not want an MLC → the doctor however proceeds to inform the police → Patient begins to leave → Doctor cannot legally stop him → Since in this situation, the doctor has not treated him, nor has he collected any evidence from his person, he is now a member of general public and must act in accordance with s39CrPC, and may not inform the police. If, however, the patient stays on and the doctor collects evidence from his person (gastric lavage etc.), it becomes his duty to pass on this evidence to the police (s201 IPC).
- Delay-If delay has occurred initially in labeling a case as MLC, it can be so labeled at any later date and time - even after the patient has been admitted in the ward (but not after death of patient; please see below). For guidelines for making MLCs in wards, please see below.
- Private practitioners (PPs) - can make an MLC. The practice by PPs of sending patients to Government hospitals for getting registered as MLC cases is wrong. If the patient is serious, and dies on the way to Government hospital, the PP can be sued u/s304A IPC.
- Treatment in serious cases must take precedence over completion of the injury report. Injury report can be completed after patient has stabilized.
- Referral to a second hospital - If a case has been labeled as medicolegal, and has been referred to another hospital, it is in second doctor's interest to make a fresh MLC (second MLC), so as to record meticulously his own findings. It is because when he is summoned in the court, he has to go by his own findings.
- Dead on arrival ("brought dead" cases) - All cases which are pronounced dead on arrival at hospital must be labeled as MLC and police be informed.
| Case Study | |  |
The author was once contacted by a casualty medical officer (CMO) regarding the case of a 70-year-old man who was brought dead to the hospital and sent to the mortuary with a request merely to keep the body for 1 day, because his son had to arrive from the US. The family also produced a death certificate made by a private practitioner (PP), who last saw the patient. The certificate stated the cause of death (COD) as myocardial infarction (MI). The CMO wanted to know if the police needed to be informed or not. It was advised that all cases "brought dead" must be informed to the police, even if they had a death certificate. A postmortem was conducted, and the cause of death was determined to be strangulation. The old man had changed his will, and because of that, his son had strangled him. After strangling him, he called the PP and informed him that his father had a sudden chest pain and had become motionless soon after. The PP without examining the patient and in good faith made out a death certificate. Had the police not been informed, this murder would have gone undetected. The son was charged u/s 302 IPC. The police refrained from charging the PP for issuing a false certificate, although he was certainly guilty u/s 197 IPC.
- Patient admitted as non-MLC; suspicion raised by relatives after death - Such cases keep occurring in hospitals, especially when death is allegedly due to medical negligence. MLCs are not made in such cases as a routine. Instead, the patient lodges a complaint with the police. Police arrives in the hospital, seizes the body and if after inquest thinks that there is a necessity of postmortem, sends the body to autopsy surgeon.
- Medicolegal case after death - (i) Principle-Legally doctor-patient relationship starts when the doctor agrees to treat a patient (Point A) and ends when the patient dies and a death certificate has been issued (Point B). Legally, the patient is in doctor's custody during the period AB and in police custody during BC (Point C being the point when the body is buried). From Point C onward (if the body is buried), the law is silent on the custody of the body.
| Salient Features of Medicolegal Case | | |
Consent for examination
(1) Patient arrested by the police - (i) If the patient has been arrested and brought by the police, no consent need be taken. The doctor can proceed with examination u/s 53CrPC.
(ii) The doctor must still first try to take consent upholding the principle of human rights. If the consent is not given, examination must then be proceeded u/s 53CrPC.
(iii) Essential components of examination u/s 53CrPC - (a) Person should be arrested. (b) Request should be from a police officer not below the rank of sub-inspector or any person acting in good faith in his aid and under his direction. (c) If person resists, reasonable force can be used to restrain him. (d) If the arrested person is a female, her examination can be performed only by or under the supervision of a female doctor (s53 (2) CrPC). (e) What must be examined - "examination" shall include the examination of blood, blood stains, semen, swabs in case of sexual offences, sputum and sweat, hair samples, and fingernail clippings by the use of modern and scientific techniques including DNA profiling and such other tests which the registered medical practitioner thinks necessary in a particular case (s53(2)[a] CrPC). (2) If the patient reported directly to the doctor, and the doctor suspecting some foul play informed the police, he would still need patient's consent for examination until and unless the police official has arrested him. Remember: For labeling a case as medicolegal, the doctor does not need patient's consent (even if he is a victim, and does not want a police case), but for examination he would still need his consent, if the police official has not arrested him.
Case studies
(i) Examination of an arrested person u/s 53CrPC - The author examined a case of a prisoner who escaped from a Uttar Pradesh (UP) jail. The UP police chased him and shot at him, due to which his right leg received a bullet wound. He however managed to board a running Delhi-bound train. Reaching Delhi, he reported to Lok Nayak hospital with a history that he had received an accidental bullet wound while cleaning his gun. However, the wound was on the posterior aspect of the leg, and also it did not show any near discharge phenomenon. The author labeled the case as medicolegal and informed the police. Before proceeding with an examination, the author explained the patient his legal rights that he could refuse an examination. Quite predictably he refused to consent, so the examination could not be carried out. When the police arrived, the author advised the police to arrest him, and after his arrest proceeded with examination u/s 53 CrPC. The patient later revealed the entire story, and he was handed over to the UP police. (ii) Consent of the victim is not necessary for informing the police. In another case, a 54-year-old male (M) presented to the casualty with his 52-year-old wife (W). The latter had 3 rd degree patchy burns over both her hands. The story was that there was some fight between the two and the husband - in a fit of anger - burnt his wife. Both W (victim) and M (perpetrator) did not want a police case. An advice was sought by the CMO from the author, who advised them to report the matter to the police. During police investigation, it turned out that both of them had burnt their daughter-in-law (D) over a dowry dispute and had secretly disposed of her body. In the process, W had sustained burns, which needed medical attention immediately. A plan was hatched between M and W. It was planned that W would present herself as victim and M as perpetrator, and both would request they did not want a police case. Had the matter not been reported to police, it is doubtful if this crime would have been uncovered with such convincing evidence (both hands burnt). The doctor must always keep in mind that the so-called "victim" who is not wanting a police case, may be a "perpetrator" posing as a "victim".
Identification marks
- Two identification marks must be taken. (2) They are necessary to identify the person in court One identification mark is more likely to lead to mistaken identification, as it can be duplicated in another person. Two identification marks are less likely to lead to errors. Three would cause still less errors, but it is not practical to take more than two. (3) They should be on exposed parts, and not on hidden parts, so patient faces no embarrassment in court where these marks may be tallied.
General condition of the patient
- Whether the patient is conscious or unconscious. (2) If conscious, whether anxious, tense, afraid, agitated, subdued. (3) Bleeding from nostrils, ears, mouth, other natural orifices (vagina in case of sexual assault, anus in the case of buggery). (4) Pulse rate, blood pressure, temperature, whether in a state of shock, paralyzed or not. (5) If the police wants a statement from the victim, the doctor must first certify that the patient is compos mentis.
Type of each injury
(1) All injuries, however insignificant they may appear, should be recorded. Proper, adequate, and complete documentation is very necessary for all medicolegal work. Remember the maxim: Legally, only those injuries are present that have been recorded. Whatever has not been recorded was not present. Similarly, whatever procedures have been recorded were performed; whatever was not recorded was not performed. If necessary, photographic documentation should be performed. Although this is a common practice in the West, it has not yet caught on in India. (2) Even old injuries should be recorded. (3) Type of each injury (e.g. whether it is an abrasion, contusion, laceration, incised wound, stab, burn, scald, fracture, dislocation of tooth etc.) should be noted. (4) Systematic entries - In order not to miss any injury, a systematic plan should be adopted. The best is to go round the patient in this manner; start with head and neck → right upper limb → right lower limb → left lower limb → left upper limb → front of the chest and abdomen → genitalia → back of chest and abdomen. (5) Lens must be used in order to be able to differentiate between incised and incised looking lacerated wounds, or for noting other minute details such as singeing of hairs around firearm entry wounds. (6) Presence of any foreign material - (i) Note presence on the body or within the wound e.g. broken off point of a knife, bullets, coal, dirt, dust, fibers, glass, grass, gravel, grease, hair, metal, mud, oil, paint, pellets, powder, sand, shots, splinter of wood, synthetic materials, wads etc., These can often help identify the weapon, and indicate the manner in which injury was inflicted (e.g. Tip of a stabbing weapon may sometimes break when it strikes a bone [sternum, rib, skull, or when it gets lodged in a vertebra]. A recovered piece of broken knife tip can be matched to a knife with a missing tip. If the police official presents a knife with an intact tip, one can safely exclude that weapon. Similarly, recovered bullet can be matched to the suspect firearm). (ii) Detection by optical methods - magnifying glass, stereo microscope. [1] (a) Limitations - (I) Transparent materials (e.g. glass) are difficult to detect especially when they are masked by fluid, tissues, crusted blood and by the infiltration of particles in folds of tissues etc., (II) Material washed away during washing and cleaning of wound or during copious loss of blood. (iii) Detection by specialized methods - (a) Direct X-ray magnification, (b) Low energy X-ray imaging (syn, microradiography, X-ray microscopy) - Low-energy (0.1-10 keV) X-rays are used (In medical radiography voltage from 20 kV in mammography up to 150 kV for chest radiography are used for diagnostics. Energy goes up to 250 kV for radiotherapy applications). The magnification is obtained by optical or electronic means, or by a combination of both processes. (c) Nuclear magnetic resonance. [1]
(iv) All recovered foreign material should be preserved, sealed, and handed over to the police official for further examination by the forensic scientist (e.g. if the woman was pinned to the ground and sexually assaulted, dust, mud, sand, or grass may be sticking to her wounds, clothing, hair etc., Since dust and sand of all places has a different composition, these can be matched with that found at the alleged scene of the crime. DNA of grass, leaves, pollens, seeds, etc., has even been matched with that found at the scene, which can pinpoint the place of occurrence).
Size, shape and direction of each injury
(1) Size of each injury should be noted, after measuring them with a ruler. No reliance should be made on guesswork. (2) Shape of injuries - whether linear, triangular, circular, elliptical, oval, irregular or any peculiar shape. (3) Direction of wounds - Whether horizontal, vertical, oblique or in any particular direction. Relationship with an organ is desirable (e.g. directed toward the heart, or away from the heart). Beveling of edges is particularly helpful in determining this. (4) Labeled sketches of all injuries should be made. This helps lay persons like judges and lawyers to understand the injuries better.
On what part of the body inflicted
(1) Exact location of the injury in relation to important landmarks (e.g. midline, navel, nipple, outer canthus of the eye, a joint, a bony structure [e.g. knuckle]) should be noted. Distance from landmarks should be noted.
(2) Avoid technical terms as far as possible (e.g. instead of writing "medial malleolus", write "inner bony prominence of the ankle"). There is nothing wrong in writing technical terms, and if the doctor cannot think of a suitable common name, he can use technical terms too. Writing in layman's language makes it more comprehensible to laymen like judges and lawyers. A good alternative is to use the technical term and then common name within brackets, e.g. "Right anterior superior iliac spine (bony prominence on the right side of the waist)". (3) Concealed wounds - If the patient is unconscious (i.e. can't point to areas of pain), a careful search must be made for wounds in areas such as ears, nostrils, vagina, rectum, etc.
Age of each injury
Age of each injury should be noted after noting gross changes in the wounds (e.g. color of a bruise, condition of scab in abrasions, infection etc.).
Routine histological, histochemical and immunohistochemical examinations (please see below under the heading "Age of wounds" for details) are not possible in casualty setup, and should be undertaken only in extremely sensitive cases. If necessary, help of a pathologist may be taken. Age of injury confirms or refutes the allegations of the victim. For instance, he may be alleging that he was attacked in the morning and showing some old injuries to corroborate his statement. In the case of battered baby syndrome, since the injuries occur at different time periods, all injuries will be of different ages. The step-parent may falsely allege that the child fell down the stairs. If that be the truth, all injuries must be of the same duration.
Nature of each injury
(1) Against each injury, its nature should be noted (e.g. simple, grievous or dangerous) (2) If nature of injury is not immediately apparent, patient must be kept under observation and following entry made in the relevant column "patient under observation." Similarly, if X-rays or other investigations have been ordered and their reports awaited, following entry should be made "Awaiting X-ray report."
Patient may have to be kept under observation in obscure head or abdominal injuries. After observation period is over, or when the lab reports and X-reports have come, and the doctor is ready to opine on nature of injuries, they could be given on a separate piece of paper. This is called "subsequent opinion." Many hospitals have dedicated forms for giving such opinion. All precautions must be made as in the original injury report, e.g. making in duplicate, taking police official's signatures, etc., Serial number should be same as in the original MLC.
By what weapon inflicted
- Examination of wounds and clothes can indicate the nature of the weapon - whether sharp edged or blunt; or if sharp-edged, whether single-edged or double-edged.
Blunt and sharp weapons - A weapon which when used with some force can cause fractures, is loosely referred to as a "heavy blunt weapon". In the case of cranial trauma, once the author was shown a cricket bat in court and asked if it was a "heavy blunt weapon"? The answer was "yes". The lawyer asked, "if I take off 100 g from it, would it still remain a heavy weapon"? Answer - Yes. Q - If I take off another 100 g would it still remain a heavy weapon? Answer - You can remove as much as you want. The answer does not lie in weight. Rather if that weapon when used with force can cause a fracture or not. Show me such a weapon, and I will opine if it is a "heavy blunt weapon."
In another case, a lawyer showed the author a single piece of paper and asked if it's edge was sharp. Answer - Yes. Qu. So, this means it is as deadly as a blade or dagger because they are also sharp? Ans - No. The answer does not lie in the sharpness of the edge but whether it can produce an incised wound. Since the edge of the paper cannot produce an incised wound, we cannot classify it as a "sharp weapon". - Wounds caused by glass - (i) Are incised but may show some irregularities at the edges. They should not be confused with lacerated wounds. (ii) Finding of broken pieces of glass in the wound confirms causation by glass.
- Wounds caused by teeth - lacerated.
- Incised looking lacerated wounds must be differentiated from true incised wounds, with the help of a lens. (5) If suspect weapon is presented by the police official, the doctor should examine the weapon in detail before giving any opinion.
Examination of weapon - (i) If weapon is produced at the time of examination, the opinion regarding weapon is given on the MLC itself; if weapon is recovered and produced after some days, the opinion should be given on a separate weapon examination form. (ii) Doctor should enquire from the police official if the weapon has already been sent to fingerprint examiner and serologist (to determine blood group and DNA profile of the blood over it). If the reply is in the affirmative, the doctor must accept the parcel, otherwise it must be advised to have them examined first by a fingerprint official and then by serologist and finally submit it to him. (iii) In case opinion is given separately, note the reference no. and the date of the request letter from the police official, his name, and number. (iv) Description of parcel - The weapon is always sealed in a parcel by the police official after recovery from the crime scene or suspect. The doctor should describe the parcel with number of seals. The seals bear the mark of police station. These marks must be mentioned. (v) Items recovered and examined - (a) The contents of the parcel should be described in detail. There can be more than one weapon. (b) Extraneous material - the weapon should be examined for the presence or absence of extraneous material, such as hair, fibers, pieces of cloth, etc., These can be matched with those found on the victim. However, if the weapon had already been submitted to a forensic scientist, quite possibly, such material would already have been removed by him for examination. (c) A tracing of each weapon must be made on the "weapon examination form" and various dimensions mentioned, e.g. length and width of the blade, presence or absence of hilt, condition of the tip (whether pinpoint or rounded), condition of the edges (whether serrated or not). (d) In the case of heavy blunt weapon, weight of the weapon must be recorded. (e) Opinion - After complete and thorough examination of the weapon, the doctor must give opinion on whether the given injuries could have been produced by the said weapon or not. (f) Affixing doctor's signatures on the weapon - After examination is over, the doctor must affix his signature and date over some suitable spot on the weapon with an indelible ink (e.g. wooden handle in case of knife, dagger or hammer). This is necessary as the doctor would be asked to identify the weapon in the court. Summons regarding a particular offence are issued some months or even years later by the court. By that time, the doctor is likely to have forgotten the case completely. Signature on the weapon will help him in identification (g) Resealing of weapon and handing over to the police official - The weapon must then be resealed in doctor's own seal (in some places, hospital seal is used), and the parcel returned to the police official along with the opinion. The doctor must take police official's signature on his own copy stating that an opinion as well as a weapon has been returned to the police official.
Whether the weapon was dangerous or not?
Dangerous weapons have been defined legally in s324 IPC and s326 IPC (please see above for details). An entry must be made regarding the nature of the weapon.
Remarks
This would include entries not covered elsewhere, e.g. condition of clothes (whether they are blood stained or stained by other body fluids like semen, saliva etc., torn, buttons missing, burnt etc., or not). Whether wet, dry or show corrosion (if hot fluid was thrown on the body [as in scalds], they would be wet. In case of vitriolage, they would show corrosive marks). If blood stained, or if showing associated defects due to firearms, they must be sent to the forensic science lab for examination of gunshot residues (to enable estimation of distance of fire). The doctor must encircle each cut/defect he wants an opinion on, number it, and then seal the clothes in a packet with a hospital seal. The sealed packet is to be handed over to the accompanying police official, and an entry should be made in the MLC regarding it. Signatures of the police official to this effect must be taken. Doctor should try to associate each cut with the injuries (a typical entry is like this- "cut no. 1 on the shirt corresponds to injury no. 3"). More than one cut can be corresponded to a single injury.
Information to police
All MLCs should be informed to the police, irrespective of the patient's wish. If the doctor does not inform the police, and does not hand over relevant pieces of evidence (injury report, blood stained clothes, weapon, recovered bullets, pellets etc.), he may be charged for causing disappearance of evidence (s201 IPC).
How to communicate with police
(1) Government doctors - All government hospitals and large nursing homes have a police official posted there. Information is given to that police official, who passes it on to the respective police station (of the area where crime was committed). (2) PPs - Must ring up the local police station, or better still police control room (100) because all calls made to police control room are recorded. The doctor should ask the police official on the phone the daily diary number (DD no), and should record it in his injury report to save himself from harassment later. The date and time of making a call, as also the name and number of the police official informed should be noted.
Special situations
(1) If the death occurs during treatment, the police must be informed, and body handed over to him. It should never be handed over to the relatives. (2) In case dead body has been brought for initial examination, and the doctor finds some injuries, he must inform the police, and hand over the body to him.
Making medicolegal cases in wards
(1) Forensic specialist would many times receive calls from wards to examine a suspected MLC case. (2) All these cases are admitted cases because immediate medical attention was required. However, on detailed history taking and closer examination, doctor suspects foul play and sends a call to the forensic specialist. (3) These cases are different from cases which come straight to casualty and are designated as MLC cases right from the beginning. (4) Differences (i) Involves labeling the case as an MLC and informing the police from the ward. Author has personally examined many cases, where the cases had already been labeled as MLC, and even police had been informed, but no specific directions were given to police to visit the scene of the crime and collect evidence. Author then sent additional notice to the police through ward book, asking him to visit the scene of the crime and collect specific pieces of evidence e.g. partially cut chunni hanging from the fan etc., as told by relatives. (ii) Collection of evidence may be required; wards may not have enough infrastructure to collect and preserve evidence. Doctor should preferably carry a basic medicolegal examination kit with him. (iii) Forensic doctor is usually called after many days (often even after operative intervention). Findings are thus very much obscured.
(5) Some cases in which author has been personally involved are (i) Gunshot wound - (a) suspected to be self-inflicted to implicate an adversary, (b) inflicted during police firing as the suspect escape from prison. Reported as occurring during gun cleaning (ii) Stab wound - suspected to be self-inflicted; reported as being caused by some adversary (iii) Hanging - (a) suspected attempted suicidal or homicidal hanging (iv) Starvation - suspected to be cases of child neglect (v) Child abuse - suspected, while parents alleged fall from stairs etc.
| Following Guidelines must be Followed | | |
Guidelines
- Consent - (i) Intensive Care Unit (ICU) - If the patient is in ICU and there is no relative, do not proceed with an examination. While treatment can be done without consent in emergency (s92IPC), medicolegal examination cannot, certainly when treatment has already been started, and medicolegal examination has no bearing on treatment. (ii) Minor - If the patient is minor, insist on consent from parents only. If they are not present in hospital, doctor must insist that they be called. Doctrine of loco parentis applies in emergency treatment only and not in medicolegal examination; thus aunt, uncle, etc., present in the ward cannot give consent for medicolegal examination. (iii) Witness - If consent is available, ask a ward sister to act as a witness to the consent.
In author's experience, ward sisters are always reluctant to sign as witness as they fear court appearance later. They can be politely explained that this is a medicolegal duty of all medical and paramedical staff. If still she insists on not signing, a resident doctor from ward may be asked to be a witness. They never have a problem in signing as witnesses, especially as they get to learn the methodology of medicolegal examination. - Marks of identification - Generally not necessary because the patient is already identified and admitted. But it is preferable to note two identification marks.
- Always write in duplicate with carbon paper - (i) There is generally no MLC register in wards as one has in casualty. All history, observation, notes, etc., should be written on loose papers. (ii) Make a request to sister-in-charge to give several papers with carbon papers. (iii) The papers should not be blank A4 sheets, but official hospital papers with its names, etc., on the top. Blank A4 sheets can be challenged later in court as having been made outside.
- Numbering of pages - (i) Ask sister-in-charge for case sheet. See if all pages in the case sheet are numbered. If not, ask sister-in-charge to number all pages. (ii) The numbering should be at top right and signed by sister-in-charge below the numbering. (iii) Forensic doctor's observations would start next to the last numbered page. If, for example, the case sheet has 36 pages, your own notes should start from page 37 in duplicate. (iv) Original copy should be affixed to the case sheet. Carbon copy should be brought back to the department for filing. This will be useful for a later appearance in court.
- Sign all pages - to prevent anyone adding pages later.
- Examination - Make a complete body examination, even if you have been specifically called only for local examination.
Author was once called to the ear, nose, and throat (ENT) ward to opine upon whether a given ligature mark was causing by hanging or not. Patient was married since 1 year and was accompanied by his wife, father-in-law, mother, and sisters. Tracheostomy had been performed so he could communicate only through writing. His wife said that he had hanged himself while the patient wrote saying that his mother-in-law had tried to forcibly hang him. On examination, the ligature mark was discontinuous and oblique. There were neither any injury marks on exposed portions of the body, nor did anyone (including the patient himself) mention about any beating, nor had any doctor in the ENT ward mentioned about any other injury, although the patient had been admitted for 2 days. The patient was fully clothed, was unable to move about easily and there was a tracheostomy tube in-situ, which made unclothing very difficult. It was very tempting in such a situation to be just satisfied with local examination only. Author however insisted on patient taking off the clothes. On the back and buttocks there were innumerable railroad bruises and scratches. On enquiring about those injuries, the patient immediately started weeping inconsolably. It turned out that as he was living with his wife in his in-law's house, one day there was some fight between him on one side and his wife and her relatives on the other, and he was severely thrashed. Taking all factors into account, the author opined that a possibility of attempted homicidal hanging could not be ruled out. Without the examination of the back, the opinion would have been undoubtedly in favor of suicidal hanging. - Diagrams - Labeled diagrams indicating location, size, and shape must be made.
- Take photographs - For better recall during court hearings, etc.
- Information to Police - This will almost always be required. Sister-in-charge usually has a ward book/call book, etc., through which doctors are called to visit wards. On the same book, an entry can be made for police. The ward boy can take it to the casualty outside which policeman is normally posted. He signs the register and keeps a copy of doctor's request.
- Be polite - Many staff members grudge nitty-gritty's of medicolegal examination and frequent requests made by doctor for papers, scale, etc., Being polite can solve the matters a great deal.
| References | | |
| 1. | Bajanowski T, Hüttenbrink KB, Brinkmann B. Detection of foreign particles in traumatized skin. Int J Legal Med 1991;104:161-6.  |
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