Medicolegal Cases
What role does the medical system play or should play in ensuring that the voices of those in abusive environments are heard?

A photograph of the woman’s back shows in graphic detail some of the “minor” wounds she sustained after being abused severely by her husband and his parents. Doctors tending to the woman stated in their report that she had scratch marks all over her chest and abrasions on other parts of her body. She also had bruises on her right forearm and over her right shoulder.

Noting the nature of her injuries, the doctors at the hospital, where 30-year-old Sindhu Sharma was treated at, had encouraged her to go to the police and file a complaint against her husband, her father-in-law, retired High Court judge Nooty Ramamohana Rao, and her mother-in-law.

This case brings to the forefront a significant question: What role does the medical system play or should play in ensuring that the voices of those in abusive environments are heard?

What is supposed to happen in practice

“With or without a patient’s consent, a medicolegal case (MLC) can be filed, but if the investigation is taken up further, it will be difficult if the patient isn’t willing to disclose the history of abuse,” explains Dr Vignesh, an associate consultant in the casualty department at Sundaram Medical Foundation (SMF) and Hospital in Chennai.

A medicolegal case is one in which the doctor tending to the patient thinks there may be legal implications based on the events leading to the individual's injuries. This includes road traffic accidents (especially if an individual is suspected to have been under the influence of alcohol), instances where the history reveals the person may be the victim of abuse, sexual assault cases, among others.

“It’s usually when their story doesn’t match their injuries, that we get a red flag. At that point, the doctor should spend some time alone with the patient and speak to them to find out what has happened,” Dr Vignesh adds.

The doctor, who has practised in the UK before working in Chennai, notes that while there are more rigid protocols in place abroad, India has yet to develop such measures.

“If a doctor even suspects that there is a history of abuse being inflicted, they can raise a query. They can inform a social worker who probes into the incident more and steps in to take over,” he states. “In India, we do see this happen in instances where a child might be a victim of abuse, but in the case of adults, especially women who might be dealing with abuse, we don’t see that happen much.”

In India, in the event of a ‘grievous injury,’ doctors are well within their rights to notify the police. These injuries are defined as those which may chronically or permanently impair an individual: fractures, deformities, and impairments to hearing, vision or speech.

“It is compulsory that in the event that a grievous injury has occurred that a doctor files the MLC. They should inform the patient, but do not need their consent to file the case,” states Dr Vignesh.

The events leading to the injury and the nature of the injury, along with all medical certificates, must be submitted along with the complaint when the doctor files the MLC.

However, in practice, not all doctors encourage women who face domestic abuse to seek help and take legal action.

“The medical system is hostile to women. They just are not responsive to these women,” states one individual from Vimochana, a Bengaluru-based Womens’ Rights Forum.

She notes that many women who the group has helped were put off by the delays in the medical system or with the number of times doctors have shrugged off their patient’s injuries. Several women end up dropping all charges and choose to stay silent rather than report instances of abuse.

“We’ve known of some women may who have gone to the hospital only a day or two after they have gotten hurt, and the doctor tells them that these are ‘simple injuries’ and doesn’t take note of the gravity of the situation,” she adds. “When they are victimized further at the hands of the system, their burden increases. You would think that female doctors would be more supportive, but they too end up becoming a part of the problem.”

“This must change,'' she adds.