POISONING - MEDICOLEGAL CONSIDERATIONS
Dr. Pankaj N. Murkey*, Dr. I. L. Khandekar**
Reader, MGIMS, Sewagram *, Resident, Dept. of Forensic Medicine & Toxicology MGIMS, Sewagram.**
Virtually every case of poisoning, whether acute or chronic has medicolegal overtones. Basically, there are three categories of medicolegal cases:
  1. Accidental
  2. Suicidal
  3. Homicidal

The vast majority constitutes either accidental or suicidal poisoning while homicidal cases are quite rare.

Whatever the nature of case, every hospital (Government-run or privately-owned) is under a legal obligation to treat to best possible extent and no case can be turned away on the pretext that the hospital concerned is not authorized to handle medico legal case. (As per the Supreme court judgment passed in 1989, in response to a Public Interest Litigation petition).

If adequate facilities don't 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 poisoning are:
  1. The foremost duty of the doctor is to treat the patient.
  2. If a case of poisoning is undoubtedly 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.
  3. But if the patient dies, the police have to be informed. Death certificate must not be issued and send body for post-mortem examination.(2)
  4. Doctors working in government hospital are required to report every case of poisoning regardless of the nature to the police.(3)
  5. All cases of homicidal poisoning (definite or suspected) must be compulsorily reported to the police as per section 39 of Criminal Procedure Code (CrPC)⁴. Failure to do so will make him culpable under section 176 and 202 of the Indian Code (IPC).(4,5)
  6. If the police require information on any case of poisoning, which is suicidal, accidental 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 withheld or false information is provided, the doctor becomes culpable under section 202 or 197 and 193 IPC, respectively.(1,5)
  7. The attending doctor must make every effort to collect and preserve evidence suggestive of poisoning. Deliberate omission to do so can attract punishment under section 201 of IPC 1,5. Failure to preserve samples may render him liable to be charged u/s 201 IPC for causing disappearance of evidence.(1,5,6)
  8. It is legally obligatory for the treating doctor to send sealed samples of gastric lavage, blood, urine, stool, vomitus, incriminating substances, etc. (whatever available) for chemical analysis to the nearest forensic Science Laboratory.(1,6)
  9. If the patient dies, Death Certificate should not be issued. Inform the police and the body should be sent for post-mortem examination.
  10. If suspected, food, drink, drugs, utensil, bottles and soiled clothes, if brought, should be sent for chemical analysis. (It is corroborative evidence).
  11. If a patient who has consumed poison is conscious, but on the verge of death, arrange for dying declaration. 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 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 a Magistrate, 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 judgment or wherein, which is sometimes encountered in the final moment before death1.
  12. If a patient was brought dead to the hospital, the duty doctor must notify the case to the police, who will in all probability order for an autopsy. Death certificate must not be issued.(2)
  13. Detailed written records should be made with respect to every case of poisoning and to be kept in safe custody.
  14. 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.
References :
  1. V.V.Pillay, Comprehensive Medical Toxicology, 1st edition, 2003;41-42.
  2. V.V.Pillay, Poisoning and the physician : An update practitioner's forum, 1990;5:112-119.
  3. N.G. Rao, Textbook of Forensic Medicine & Toxicology, 1st edition, Jaypee brothers 2000;355.
  4. Ratanlal & Dhirajlal. The code of criminal procedure, 15th edition, 2002, Wadgava & Co., Nagapur.
  5. Rantanlal & Dgurajla. The Indian Penal Code 28th edition, 2002, Wadhava & Co., Nagpur
  6. S.K. Singhal. The Doctor & Law 1st edition. The National Book Depot, 1999:204-205
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