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A record based study of frequency and pattern of medico-legal cases reported at a tertiary care hospital in Miraj

Medico-legal case (MLC) can be defined as a case of injury or ailment, etc. in which investigations by the lawenforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment. In simple language it is a medical case with legal implications for the attending doctor where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential. 1,2 All the medico-legal cases are registered in casualty. Casualty department is very crucial for any hospital as all the medical and surgical emergencies first report there. Further it serves as an outpatient department after the routine outpatient department hours.


INTRODUCTION
Medico-legal case (MLC) can be defined as a case of injury or ailment, etc. in which investigations by the lawenforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment. In simple language it is a medical case with legal implications for the attending doctor where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential. 1,2 All the medico-legal cases are registered in casualty. Casualty department is very crucial for any hospital as all the medical and surgical emergencies first report there. Further it serves as an outpatient department after the routine outpatient department hours.
Medico-legal case is an integral part of medical practice that is frequently encountered by medical officers working in emergency department. For such patients, not only treatment, but exhaustive documentation is also mandatory. The on-duty doctor in the casualty department has to first stabilize the patient of any emergency. He is also duty bound to register a particular case as a medico-legal case whenever indicated and has to examine the same. In the present study an attempt is made to know the workload of medico-legal cases and their pattern.
The objectives of the study was to assess the frequency and pattern of medico-legal cases reported at a tertiary care hospital and to highlight the vulnerable gender, age, residence and the cause.

METHODS
It is a record based cross-sectional study. It is carried out in the casualty department of a tertiary care hospital in Miraj during the month of September 2013. All the reported MLC cases in the medico-legal case record book for first 6 months (1 st January -30 th June) of the year 2013 were included. Cases found as non-medicolegal and those with incomplete entry were excluded. Data was collected in various parameters from medico-legal case register like age, gender, residence, and indication for medico-legal cases.

Inclusion criteria
All the medicolegal cases registered during 1 st January 2013 to 30 th June 2013 in the medicolegal case record book were included.

Exclusion criteria
Cases found non-medicolegal and those with incomplete entry were excluded.

RESULTS
Total number of medico-legal cases included in the study were 2350 from the record of medico-legal cases from 1 st January 2013 to 30 th June 2013. Out of 2350 cases, 1866 (79.4%) were males and 484 (20.6%) were females. In the present study, maximum number of cases (828, 35.2%) were from the age group of 21-30 years followed by 23.7% from the age group of 31-40 years. The individuals of geriatric age group were also involved in the medico-legal cases. For both males and females, maximum cases were from the age group of 21-30 years followed by 31-40 years. It is observed from Table 1 that, the number of males is more than the number of females in each age group. Difference in the percentages of males and females was less in the age group of 1-10 years as compared to other age groups (Table 1).
Maximum (1440, 61.27%) cases were from urban area and rest of the cases i.e. 910 (38.73%) were from rural areas. Most of the cases were registered in the month of May (32 %) & minimum in February (10%). Maximum cases (70 %) were reported during 4 pm to 9 pm.
We observed that the commonly used weapon for assault was hard and blunt type object (608, 95.0%) followed by sharp edged objects (32, 5.0%). Around 87% cases of the road traffic accidents were on two-wheeler while 4.3% were pedestrians. Out of the total 162 fall cases, 24 (14.8%) were alcoholic. 86.3% of the Poisoning cases were suicidal type ( Table 2). Among females, majority (36.8%) were assault cases, followed by RTA (30.5%).
Most common cause of MLC in the age group of 1-10 years was poisoning followed by fall. In the age group of 11-20 years most common indication of MLC was RTA. In all other groups, assault was the most common cause.   [3][4][5][6][7] This is because males are more exposed to outdoor activities as well as disputes in family matters.
Like other studies, present study had also shown the age group of 21-30 years as most commonly involved age group in medico-legal cases, followed by the age group of 31-40 years which is economically productive and also involved in outdoor household activities. [3][4][5][6][7] In the present study we observed that most of the medicolegal cases were due to assault and the age group 21-30 years was most commonly involved. Similar results were observed by Haridas et al, Bhullar et al and Aggarwal et al. 3,8,9 However, in the study by Malhotra et al "Poisoning" was the most common cause of MLC. 10 Commonly used weapon for assault was hard and blunt type object followed by sharp edged objects in the present study which is in accordance to the study by Haridas et al. 3 After "assault", "medical check-up of the prisoners and accused for fitness" was the most common cause of MLC followed by "RTA". Similar findings were found in the study by Haridas et al. 3 10% of the RTA cases were found to be alcoholic which could be the cause of RTA.  3,9,11,13 All the cases of poisoning in the age group of 21-30 years were of suicidal type whereas all the poisoning cases in the age group of 1-10 years were of accidental type.
Among females, 36.8% were assault cases. This may be due to domestic violence. "Abandoned persons" was a new group found in this study of which 65% were above 60 years.
Most common causes of MLC in the age groups of 1-10 years and 11-20 years were poisoning and RTA respectively. In all other groups, assault was the most common cause.

CONCLUSION
Majority of the victims were young adult males, urban residents with the most common cause being assault. 33% cases needed multidisciplinary care.

Recommendations
Proper counseling for developing positive attitude and controlling the aggression in youth have to be promoted. Strategies for alcohol control should be stringent. Caring shelters for elderly should be promoted. MBBS curriculum should give proper emphasis on emergency care and management of poly-trauma cases.