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Chapter: Modern Medical Toxicology: General Principles: Medicolegal Aspects of Poisoning

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Medicolegal Duties of a Doctor in Suspected/Actual Poisoning

Virtually every case of poisoning, whether acute or chronic, has medicolegal overtones. Basically there are three categories of medicolegal cases: accidental, suicidal, and homicidal.

Medicolegal Aspects of Poisoning

Virtually every case of poisoning, whether acute or chronic, has medicolegal overtones. Basically there are three categories of medicolegal cases: accidental, suicidal, and homicidal. The vast majority constitute either accidental or suicidal poisoning, while homicidal cases are quite rare. Whatever the nature, every hospital (Government run or privately owned) is under a legal obligation to treat to the best possible extent, and no case can be turned away on the pretext that the hospital concerned is not “authorised” to handle medicolegal cases.* If adequate facilities do not exist for proper treatment, the victim should be administered first-aid and such other medical or surgical help that is possible under the circumstances before referring him to the nearest hospital where required facilities exist.

MEDICOLEGAL DUTIES OF A DOCTOR IN SUSPECTED/ACTUAL POISONING

·              If a case of poisoning is indubitably accidental or suicidal in nature, the attending doctor is under no legal obligation to notify the police in case he is working in a private hospital. But if the patient dies, the police has to be informed. Death certificate must not be issued.

·              Doctors working in government hospitals are required to report every case of poisoning regardless of the nature, to the police.

·              All cases of homicidal poisoning (definite or suspected) must be compulsorily reported to the police as per section 39 of the Criminal Procedure Code (CrPC). Failure todo so will make him culpable under section 176 of the Indian Penal Code (IPC).

·              If the police require information on any case of poisoning which is either suicidal or homicidal in nature, the attending doctor has to divulge it. There is no scope for professional secrecy in such matters (175 CrPC). If information is witheld or wrong information is provided, the doctor becomes culpable under section 202 and 193IPC respectively.

·              Every effort must be made by the attending doctor to collect and preserve evidence suggestive of poisoning.

·              Deliberate omission to do so can attract punishment under section 201 IPC.

·            Collect vomitus, faeces, stomach washings, contami-nated food, incriminating substance, etc., and despatch the same for chemical analysis to the nearest ForensicScience Laboratory.

·            If a poisoned patient is conscious but on the verge of death, record a dying declaration relating to the circum-stances. It is preferable to call a magistrate for this purpose, but if death appears imminent, or if there is likelihood of delay in the arrival of the magistrate, the attending doctor must himself record the declaration as per section 32, clause 1, of the Indian Evidence Act(IEA). Even when a declaration is taken down by amagistrate, the presence of a doctor is desirable to certify that the dying victim was in possession of his senses, and there was no clouding of judgement or coherence which is sometimes encountered in the final moments before death.

·            If a patient dies before the exact diagnosis could be made out, or he was brought dead to the hospital, the duty doctor must notify the police who will in all probability order an autopsy to be done. Death certificate must not be issued.

·            Detailed written records should be made with respect to every case of poisoning and kept in safe custody.

·            If a doctor comes across a case of food poisoning from a public eatery (canteen, café, restaurant, etc.), he must notify the public health authority concerned.

 

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