If an attending doctor (in casualty or OPD) after taking history and examining the patient suspects foul play or has doubts about the case and/or thinks that some investigations by law enforcing agencies are essential so as to fix responsibility regard­ing the case, the case is regarded as medico-legal case (MLC). It is left to the doctor’s judgment to label the case as MLC, whether patient agrees or not. A government as well as a pri­vate practitioner can make MLC. Common Medicolegal cases include  injury cases, poisoning, burns, sexual assault, brought dead cases, brought unconscious, road traffic accidents (RTA), fall from height, factory accidents, death in OT during MTP, criminal abortion, delivery or other surgical procedures, suspected homicide or suicide, etc.[1] .The mortalities and morbidities from all medico legal causes have been increasing at an alarming rate in our country. Despite the revolutionary advancement in medical technology and facilities, we are unable to successfully stop this preventable mortality and morbidity. Knowledge of types of medico-legal cases brought to casualty / emergency department is of paramount importance to make corresponding arrangements to deal with them. This is also important for law enforcement agencies as they can take preventive and corrective measures to reduce the number of such medico-legal cases.Hence, this study was conducted to know the pattern of medico-legal cases reported to the casualty / emergency department and preventive measures could be formulated to reduce morbidity and mortality.

The present study “Pattern of Medicolegal Cases in a Tertiary Care Hospital in North India” is a retrospective study conducted on 751 medico-legal cases which were reported to Emergency department of Career Institute of Medical Sciences and Hospital (CIMSH), Lucknow, Uttar Pradesh for a period of 4.5 years from 1st January 2017 to 30th June 2021. Individuals from both genders and all age groups were included and those with no medico-legal perspective were excluded from the study. The information required for the study was collected from the medico-legal register maintained by the Emergency department for which prior permission was taken from the Chief Medical Superintendent, CIMSH, Lucknow. A predesigned proforma was used to collect the information like the age, gender and type of medico-legal cases. Ethical clearance for the present study was obtained from the institutional ethical committee, CIMSH, Lucknow.

Total 751 cases were reported from Jan 2017 to June 2021. Out of these, 597 (79.49%) were males and 154 (20.50%) were females. (Table 1) 

Table 1:Gender-wise distribution of Medico-legal cases

Majority of medico-legal cases (32.75%) belong to age group 21 – 30 years followed by cases from age group 11 – 20 years (22.23%) and 31 – 40 years (19.70%). (Table 2)

Table 2: Age-wise distribution of Medico-legal cases

Out of all 751 cases, majority of cases were of road traffic accidents (70.03%) followed by cases of fall (12.91%) and physical assault (6.52%). Other cases such as trauma and poisoning contributed to 2.92% and 2.13% cases respectively. (Table 3)

Table 3: Pattern of Medico-legal cases

In our study, there was predominance of males (79.49%) over females (20.50%) with a ratio of 3.88:1. Our findings are consistent with the studies conducted [2-7]. The predominance of males over females may be attributed to the significant involvement of males in outdoor activities (occupational or recreational) compared with women. Majority of males are the financial provider. Another cause may be propensity of males to engage in high-risk behaviors, including drunk driving, drug use, not using seatbelts/helmets, speeding and dangerous physical activities. 

In our study, the maximum number of medico-legal cases belonged to the age group of 21-30 years (32.75%) which was followed by the age groups 11-20 years (22.23%) and 31-40 (19.70%). This shows that 74.70% (~75%) of the total cases were located in the 11 to 40 years age group, indicating that victims of injuries are mostly the young portion of the population. Similar results were observed [5,8]in their studies. In the studies conducted [2,4,6], majority of the cases however belonged to the age group 21-30 years, but the age group 31-40 years was more commonly involved than the age group 11-20 years.

In the present study, it has been well demonstrated that the road traffic accidents (RTAs) were responsible for the majority of medico-legal cases (70.03%). The findings of our study are consistent with the studies conducted [7,5,2,3,6]where road traffic accidents constituted majority of medico-legal cases. Major reason for such a great number of cases of RTAs being reported to our institution may be the location of our hospital alongside highway where RTAs are very common. Other common cause of road-traffic accidents in this region is unsafe traffic-related behaviors like not using helmets/seatbelts, drunk driving, not obeying the driving rules, uncontrolled high speed, sleeping when driving, etc. 

In our study, fall (12.91%) also accounted for a major portion of medico-legal cases. Similar proportion of cases of fall was reported by [5,2] in their studies. The cases of fall were mostly due to accidental slip and fall as a result of lack of attention. 

Medico-legal knowledge is an essence for a medical professional irrespective of his/her specialty, as one or the other time during the practice of his/her profession will come across certain medico-legal cases. A health care provider dealing with a MLC case can be called to the court anytime to come with the medical records as an expert witness as the judges are not trained in medical science and they rely on expert’s opinion in many cases. This is of pivotal importance for the proceedings of the trial and any incompetence by the health care provider can result in grave consequences for the doctor/hospital and may also turn the case in wrong direction. Thus, doctors dealing with MLC cases must be well trained in carrying out medico-legal works. This study not only shows the load of medico-legal cases in a tertiary care hospital but also emphasizes the need of training all the medical officers in medico-legal works like proper examination, documentation and certification of medico-legal cases. This saves the doctor from unnecessary and needless allegations later and also avoids embarrassment in the court and legal complications. It will be of immense help if a medico-legal expert is available for training medical officers to carry out medico-legal works and for consultation regarding medico-legal cases. 

It has been well demonstrated that road traffic accidents accounted for the majority of Medicolegal cases, especially in productive age groups. Though, several traffic-related regulations have already been in place in India for a long time, yet an effort may be made to decrease the incidence of RTAs by strict implementation of road safety measures and by increasing the awareness of road users to safety-oriented road behavior. As per WHO, falls tend to be the second leading cause of unintentional injury death, after road traffic injuries (https://www.who.int). Such incidences of falls can be reduced by educating people in fall prevention and encouraging them to secure their homes to reduce fall risk. Attempt should be made to provide counseling to people on the harms of substance abuse. People should be encouraged to use appropriate safety devices on the workplace, especially in factories or on the construction site. These preventive measures may have significant outcome in reducing morbidity and mortality in this population.

Ethical Clearance was obtained from Institutional Ethics Committee, Career Institute of Medical Sciences and Hospital (CIMSH), Lucknow prior to the study. Confidentiality was maintained.

NIL

Self

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