Dr MC Gupta, a veteran physician and a practising medico-legal consultant answers doctor's queries posed by M3 India members.

QUESTION-1: A person from an area/district/state outside the place of work of a doctor comes to him for the purpose of getting First Aid / treatment and for getting a medico-legal report as well.

Can the doctor refuse his services?

ANSWER:

1. The doctor should not refuse services to the injured in any situation, even if he belongs to an area/district/state outside the place of work of a doctor.

2. If the doctor refuses services, this will be in contravention of the Code of Ethics for doctors, which can be viewed at— https://old.mciindia.org/RulesandRegulations/CodeofMedicalEthicsRegulations2002.aspx

Contravention of the Code of Ethics amounts to professional misconduct for which the medical council can punish the doctor.

3. Refusing services to the injured would also be in contravention of the Supreme Court judgment in Pt. Parmanand Katara Vs Union of India and Others, Supreme Court, decided on 28.08.1989, 1989 AIR 2039, 1989 SCR (3) 997, which can be viewed at-- https://indiankanoon.org/doc/498126/

4. As regards medico-legal report, it is the initial doctor to whom the [patient reports for treatment / First Aid who has to prepare it. It is an important document. A copy should be kept and preserved carefully by the doctor concerned. Besides clinical details, it should also include the address and identification details of the person examined.

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QUESTION-2: A registrar on duty in a hospital does not have any other doctor to help him. A violent patient is brought to him. Can he deny treatment to the violent patient?

ANSWER:

1. The doctor should not deny treatment to a violent patient.

2. It is assumed that the violence on the part of the patient is not knowingly voluntary but is a part of some disease process. The doctor would be guilty of dereliction of duty if he refuses treatment.

3. The lack of availability of another doctor is no ground for denying treatment to a patient. If help from another person is needed to physically control the violent patient, such help can be taken from any hospital staff, not necessarily a doctor, and even from anybody else who might, for example, be the relative of a patient.

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QUESTION-3: Are there any clear cut guidelines as to which cases are medico- legal cases?

ANSWER:

1. DEFINITION OF MEDICO-LEGAL CASE

There is no specific or legal definition of a medico-legal case. The meaning of the term is inherent in the word medico-legal. A medico-legal case would be one which concerns both medicine and law. One can say that a medico-legal case is the case of a patient treated by a doctor where there may be a possibility that the case may have legal connotations. Examples of such connotations are as follows:

i) When the cause of injury /disease may be unnatural or in violation of law (poisoning; suffocation; drowning; gunshot or hatchet wound; rape; child molestation, etc.)

ii) When there may be clear cut possibility of claim /compensation under some law—such as road accidents involving motor vehicles.[All such injured persons can claim compensation under the Motor Vehicles Act, 1988, and also under various insurance policies.]

iii)--When the person is a fugitive from law. [Even if a person seeks treatment for common cold and the doctor knows him or suspects him to be a murderer or rapist avoiding the clutches of law, he may have to consider whether to inform the police, especially in case he is admitted to the nursing home / hospital. This is not a case of injury / disease caused through violation of law and is not strictly a medico-legal case. However, every citizen has a legal duty to report a crime or criminal or evidence of crime to the police and a doctor who provides safe cover to a fugitive may be hauled up by the police for shielding a criminal. To repeat—reporting such a case to police is obligatory not as a doctor’s duty in a medico-legal case but as an ordinary citizen’s duty to society. This is a gray area where the doctor must exercise his own judgment and discretion. When a doctor is faced with the dilemma of choosing between saving life or fulfilling legal formalities, he should give preference to the former. The legal formalities can be attended to later on after the life-saving treatment has been given. This is the letter and spirit of the judgment in Pt. Parmanand Katara Vs Union of India and Others, decided by Supreme Court on 28.08.1989.

2. The following is reproduced from “Haryana Medico Legal Manual, 2012” prepared by Health Department, Haryana:

“2. Medical Officers should prepare the MLR in all cases brought in the emergency by the police, those coming of their own for medico legal examination or any other case in which foul play is suspected. Further, the Medical Officer on duty shall himself/herself write the medico-legal report (MLR).

The following category of cases admitted in the hospital are to be treated amongst others as medico legal cases:

2.1. Cases of grievous injuries (See definition under 320 IPC), drowning, hanging, sexual offences, attempted suicide etc.

2.2. Cases of poisoning even if accidental.

2.3. Cases of injuries due to traffic accidents even when an accident had occurred due to patient‟s mistake and no body else is to be blamed.

2.4. Burns even, if accidental.

2.5. Cases of grievous injuries (See definition under Section 320 IPC) even if accidental including fall from a height, burial under earth mound etc.

2.6. Cases of grievous injuries caused by electric shock or lightening, natural disaster etc.

2.7. Cases of attempted abortion by unauthorized person.

2.8. Cases of bites/injuries caused by animals.

2.9. All unconscious patients with injury of any nature.

2.10. All patients brought to the hospital in suspicious circumstances.

2.11. Person under police custody or judicial custody.”

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QUESTION-4: Do I have a right to refuse a patient for treatment under me?

ANSWER:

Situation one—“When the patient is not already under your treatment and you want to know whether you can refuse to take a new patient under your treatment”.

>>> In such a case, you may choose not to provide your services under certain circumstances, such as:

i)When the refusal is not on grounds of religion, nationality, race, party politics or social standing. [This is as per Appendix 1 of the Code of Medical Ethics.]

ii)When the refusal is not in case of an emergency patient needing urgent attention.

[NOTE—The basic principle is that nobody can force you to provide services.]

Situation two—“When the patient is already under your treatment and you want to withdraw from his treatment”.

>>> In this situation, you should work in accordance with Regulation 2.4 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, commonly referred, in short, as “Code of Ethics Regulations, 2002”,

“2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.”

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.