Legal Aspects in Nursing
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In law a man is guilty when he
violates the rights of others. In
ethics he is guilty if he only thinks
of doing so. -Immanuel Kant
Prof.Dr. RS Mehta

Medico-legal Issues are those in which victim who are seeking medical
help but are related to legal issues.
Medico-legal is something that involves both medical and legal aspects.
Medico Legal Issues
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TERMINOLOGIES
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BILL
• Drafts or temporary outline of what the act will be.
• VIDEYAK in Nepali
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• A written document which has been formally passed
by Government.
• Ain In Nepali
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LAW
• Defined as the sum total of rules and regulations by
which a society is governed. As such, law is created
by people and exists to regulate all persons.
• Kanun
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Constitution
• It is a system of laws and principles according to
which a state or other organization is governed.
• It indicates how the government is created and
given authority.
• It states the principles and provisions for
establishing specific laws i.e. constitutional laws.
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• It involves all those cases where there is involvement of law
enforcement agencies like police, lawyer and court of law besides the
health care providers including nurse to provide treatment and justice to
victim and punishment to the culprit.
Cont.….Medico Legal Issues
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• Legal event generally occur already out side the hospital area.
• Victim will come to hospital for the purpose of investigation and
treatment.
• They should provide special attention while caring and documentation.
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Laws and Acts applicable in nursing practice
• Nepal Health Service Act 2053 with second amendment in 2058
• Muluki Ain (Civil Code)
• Drugs Administration Act
• Nepal Nursing Council Act
• ICN & NAN – code for Nurses
• Consumers Protection Act
• Abortion Law
• Organ Transplant Act
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1. Deliberate self harm
2. Accidents
3. Criminal cases
Common Medico Legal cases
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Deliberate self harm
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Accidents
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Criminal cases
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1. All cases of injuries.
2. All cases of burn.
3. Alleged cases of assault.
4. All cases of suspected or evident of poisoning or intoxication.
5. Case referred from court.
6. Victims of Animal ferocity
6. Suspected or evident criminal abortion.
7. Unconscious or comatose where the cause is not natural or clear.
8. Brought dead/ dead on arrival/ sudden unexpected death
9. Cases of suspected self-inflicted injuries or attempted suicides.
Common Medico Legal Cases in Emergency
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Common Medico Legal cases in BPKIHS
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7
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Rape RTA Physical Assault Fall injury Hanging Burn Injury Poisioning 0thers
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1. Rape cases- 5-7 years of imprisonment.
2. Attempt to rape- 2-3 years of imprisonment.
3. Murder- 10-12 years of imprisonment.
4. Attempt to murder- 5-8 years of imprisonment.
5. Accident- if one possess driving license – 35 days of imprisonment, if
not- 11 years of imprisonment.
LEGAL PROVISION IN NEPAL
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TERMINOLOGIES
Informed consent
Liability
Tort
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A legal wrong committed against a person, his/her rights or property,
intentionally or willfully committed without just cause.
The person who commits a tort is liable for damage in civil.
TORT
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Unintentional
•Negligence:
•Malpractice
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Omitting an action expected of a sensible person in a particular
circumstances is considered negligence.
There are four elements to negligence:
1. There must be a known duty (responsibility).
2. The nurse must fail to meet this duty.
3. There had to be a foreseeable harm.
4. An injury must have occurred.
Negligence
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Failure to maintain accepted ethical standard.
 Any unreasonable lack of skills in professional duties or illegal or
immoral conduct that result in injury.
E.g.: Untrained nurse conducting abortion.
Malpractice
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1. Assault
2. Battery
3. Crime
4. Defamation libel
5. Defamation slander
6. Crime
7. Euthanasia
8. Invasion of privacy
Intentional Tort
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Assault: Assault occurs when a person puts another person in fear of
harm or offensive contact. The victim fears and believes that harm
will be caused as a result of threat.
Battery: An intentional touching of another’s body without other’s
consent.
Cont.…Intentional Tort.
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Defamation slander: Something untrue was said to ruin the reputation
of a person.
Defamation liable: Something untrue was written to ruin the reputation
of a person.
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Invasion of privacy:
It is the release of a patient’s medical information to an unauthorized
person such as a member of press, the patients employer, or the patient’s
family.
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Provides a frame work for establishing which nursing actions in the care
of client are legal.
Differentiates the nurse’s responsibility from those of other health
professionals.
FUNCTION OF LAW IN NURSING
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Establish the boundaries of independent nursing actions.
Assists in maintaining a standard of nursing practice by making nurses
accountable under the law.
Cont.….Function of Law in Nursing
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1. Overlooked sponges, instruments and needles during surgery.
2. Burn with hot water bag.
3. Fall from bed.
4. Assault/ battery.
5. Failure to report and negligence.
6. Failure in close monitoring such as B.P., FHS.
7. Forced to do abortion.
8. Exchange of new born babies. (tags, m/f).
9. Handing over of dead body without postmortem.
10. Discharging MLC without informing police.
SOME LEGAL ISSUE IN NURSING PRACTICE
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11. Failure to maintain
records of MLC.
12. Poor recording and
reporting ( GCS, DEATH).
13. Identification of patient
and parts.
14. Loss of client property.
15. Medication error or
wrong medication

1. Overflow of patients.
2. Poor information system
3. Poor lab report
4. Inadequate supplies
5. Poor security and inadequate knowledge of MLC.
REASON FOR LEGAL PROBLEMS
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LEGAL SAFEGUARD IN NURSING PRACTICE
1.Informed consent
2. Communication
3. Competence in practice
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LEGAL SAFEGUARD……
4. Licensure
5. Patient education
6. Executing physician’s order
7. Documentation
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LEGAL SAFEGUARD……
8. Professional liability insurance
9. Good Samaritan law
10. Adequate staffing
11. Patient’s bill of rights
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LEGAL SAFEGUARD……
12. Licensure
13. Good rapport
14. Standards of care
15. Standing order
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LEGAL SAFEGUARD……
16. Don’t accept gifts
17. Don’t give legal advice
1.Correct identity
1.Maintenance of drugs
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Legal aspects
• Consent
• Medico-legal case
• Medical documentation
• Use of restraints
• Decisions regarding life sustaining treatment
• CPR decisions
• Do not resuscitate
• Withholding and withdrawing treatment
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BASIC GUIDELINES FOR HANDLING OF MLCS
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DETAILS TO BE ENTERED IN MLC REGISTER
1. Preliminary data
2. Identification Marks
3. Consent of the patient /relative has to be taken.
4. Brief history of the incident
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DETAILS TO BE ENTERED IN MLC REGISTER…
5. Time/ place/nature of incident
6. History told by the patient or the relatives has to be entered
in the same words preferably.
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DETAILS TO BE ENTERED IN MLC REGISTER…
7. All the information written should be legible,
understandable and simple in nature.
8. Avoid over writing, scribbling, etc. and any corrections
made must be initialed along with the date.
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DETAILS TO BE ENTERED IN MLC REGISTER…
9. Saving the life of the patient is a priority, irrespective of availability of
attendees/ relatives for consent.
10. Anything other than life saving procedures has to be with the
consent.
11. Delay in payment should never be the reason to deny the
treatment. ‘FIRST SAVE THE LIFE THEN TAKE THE PAYMENT’.
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DETAILS TO BE ENTERED IN MLC REGISTER…
12.MLC register & Police Intimation Register has to be kept in
a locker and the Doctor at casualty is in charge of the key. At
the time of change of duty, the concerned doctor has to
handover the key to the reporting Doctor along with the
instructions.
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INJURY REPORT FORM OF BPKIHS
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INJURY REPORT FORM OF BPKIHS
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POLICE INTIMATION LETTER
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CONTENTS OF MLC REGISTER
1. Date
2. ID No
3. Patient name
4. MLC No
5. Age/sex
6. Address
7. Case of
8. Seen by
9. Signature of the doctor
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LEGAL PROCEEDING FOR MLC CASES IN BPKIHS
1. Registration in MLC record book as well as in admission book.
2. Put stamp of MLC in the document
3. Injury form filled in ER
4. Inform to the police.
5. Maintain confidentiality
6. Collection of samples.
7. 2-3 reports collected.
8. After forensic examination, report collected and sent to court.
9. Identified as accident or intention.
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• 10. If accident, no further
proceeding.
• 11. If intention, proceeding as per
the law.
• 12. Sent for postmortem if dead.
• 13. Inform police during discharge

FOR ABANDONED OR LAWARIS DEAD BODY
1. Dead body is kept in mortuary for 35 days
2. In that period police in that area is reported and information
disseminated via media
3. If no one claims for that duration, the body is handed over to
municipality office for funeral.
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IN CASE OF DISCHARGE OF MLC CASES
1. The culprit as well as victim may be MLC cases.
2. In culprit – taken under the control of the police and submitted to
district police for further proceeding.
3. If victim- victim report of events taken.
4. MLC cases if dead- sent for post mortem
5. All MLC cases registered in MLC book
6. Accidental cases is open for 2 years for investigation then the case is
closed.
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RECENT TRENDS IN MEDICO-LEGAL ASPECTS
1. Age estimation.
2. Dental identification.
3. Bite marks.
4. Photography
5. DNA analysis :- hair/ blood.
6. Crime evidence.
7. Forensic medicine/nursing.
8. Finger prints.
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