INTRODUCTION: A medico-legal case is one where besides the medical treatment; investigations by law enforcing agencies,

are essential to fix the responsibility regarding the present condition of the patient. The case therefore has both medical and legal
implications. Registering MLC is a MUST.
DEFINITION: A medico-legal case can be defined as a case of injury or ailment etc, in which investigations by the law-
enforcing agencies are essential to fix the responsibility regarding the causation of the injury or ailment .
A. LEGAL ISSUES SPECIFIC TO NURSING: Nurses face legal issues daily. Those issues may be in connection to
negligence, administering medication and advocating for the patient. The Nurse Practice Act lists all of the duties and role of a
nurse, except the legal and ethical issues. If these duties and regulations are not followed, the nurse is at risk of losing his license
and facing a malpractice suit.
 Duty to seek Medical Care for the patient
It is the legal duty of the nurse to ensure that every patient receives safe and competent care. The nurse cannot guarantee the
patient will receive medical care that the nurse be a strong advocate for the patient and use every resource to ensure medical care
is received. If you determine that a patient in any setting needs medical care and you do not do everything within your power to
obtain that care for the patient, you have breached your duty as a nurse.
 Confidentiality
 It is a privilege to care for other people. At times, your patients will relate to you in a personal way. One of the outcomes of
your relationship is that you may be told information of a personal nature in addition to what a patient may share with you,
you have access to the person‘s hospital records.
 Permission to treat
 When people are admitted to hospitals, nursing homes and home health services, they sign a document that gives the
personnel in the organization permission to treat them. Every time the nurse provides nursing care to person, however,
permission must be obtained.
 Informed consent
 The concept of permission to treat is closely tied to the concept of informed consent. The law
states the persons receiving health care must give permission to treat based on informed consent.
The principle of informed consent states that the person receiving the treatment fully understands
the possible outcomes, alternatives to treatment and all possible consequences.
 The physician is responsible for obtaining informed consent for medical procedures, such as
surgery, whereas the nurse is responsible for obtaining informed consent for nursing procedures.
Each institution has forms for informed consent for complex or serious procedures, such as
surgery, chemotherapy, electroconvulsive therapy.
 Advance Directives
 Although the Patient Self – Determination Act was passed by the U.S. Congress in 1990, it was not implemented until 1992.
The act states that all the health care institutions are required to give clients or patients an opportunity to determine what
lifesaving measures or life-prolonging actions they want implemented.
 This requirement applies to all hospitals, long term care facilities, and home health agencies and is to be done at the time of
admission. The institution is required to give adequate information to the person and assist in completing any forms.
 Negligence
 The law requires nurses to provide safe and competent care. The measure of safe and competent care is the standards of care.
A standard of care is the level of care that would be given by a comparable nurse in a similar situation.
 Negligence occurs when a person fails to perform according to the standards of care or as a reasonably prudent person would
perform in the same situation. It is the responsibility of the nurse to monitor the patient.
Requirements to establish Negligence
There are four legal requirements that must be met for negligence to be proved:-
 A standard of care exists.
 A breach of duty or failure to meet the standard of care has occurred.
 Damages or injury has resulted from the breach of duty. (This could be commission of an inappropriate action or omission of a
necessary or appropriate act).
 The injury or damage must result from the nurse‘s negligence. I have never met a nurse whose goal was to be negligent, but it
doesn‘t happen.
Examples of negligent acts are:-
 Malpractice
Malpractice is a term used for negligence. Malpractice specifically refers to negligence by a professional person with a license.
You can be sued for malpractice once you have your LPN license. If you are a nursing assistant right now, you may be negligent,
but it wouldn‘t be malpractice because you are not licensed.
 Fraud
Few cases of fraud exist in nursing, but it does need to be mentioned. Fraud is a deliberate deception for the purpose of personal
gain and usually is prosecuted as a crime. Most courts are harder on cases of fraud compared with cases of negligence or
malpractice because fraud is deliberate and results in personal gain.
 Assault and Battery
 It is found that most nurses do not understand the definitions for assault and battery. It is important to your practice that you
do understand them.
 Assault is the threat of unlawful touching of another, the willful attempt to harm someone.
 Battery is the unlawful touching of another without consent, justification, or exercise. In legal medicine battery occurs if a
medical or surgical procedure is performed without patient consent.
 False Imprisonment
 Preventing movement or making a person stay in a place without obtaining consent is false imprisonment. This can be done
through physical or non physical means.
 Physical means include using restraints or locking a person in a room.Insome unique situations, restraints and locking
patients in a room are acceptable behaviours.This is the case when a prisoner comes to the hospital for treatment or when a
patient is a danger to self or others.
 Invasion of privacy
Clients have claims for invasion of privacy‘, e.g. their private affairs, with which the public has no concern, have been publicized.
Clients are entitled to confidential health care. All aspects of care should be free from unwanted publicity or exposure to public
scrutiny. The precaution should be taken sometimes an individual right to privacy may conflict with public‘s right to information
for e.g. in case of poison case.
 Nurse Practice Act
 Each state has what is called a Nurse Practice Act. The guidelines and laws outlined in the act pertain to all nurses who are
licensed in that particular state. Nurse limitation is one of those laws. Each nurse has a limitation on what he is allowed and
trained to do.
 He must follow the chain of command, especially with the care of a patient. If he does not have the authority or knowledge
to give a prescription, analyze a lab report, or advise the patient on treatment, he may not legally do so.
 Any wrong information or practice he commits is punishable by the law and the patient or family may file a suit against him
and the health agency or hospital he works for.
 Patient's Advocate
A nurse has a legal obligation to act as the patient's advocate in case of emergency. The nurse is to act as the liaison between the
patient and the health care provider, such as a physician. The nurse will monitor the patient, ensuring that if any complications or
abnormalities arise, a physician notified immediately. The nurse is legally obligated to keep the personal data and information of
the patient private; not doing so is a violation of the code of ethics for nurses.
 Administering Medication
Nurses are responsible for administering the correct doses and medications to patients. If the nurse gives a fatal dosage amount,
she may face legal malpractice suits. It is also the responsibility to research the patient's records, or ask the patient and family
members if there are any allergies or complications that may pose a risk if a certain medication is administered.
 Report It or Tort It
Allegations of abuse are serious matters. It is the duty of the nurse to report to the proper authority when any allegations are made
in regards to abuse (emotional, sexual, physical, and mental) towards a vulnerable population (children, elderly, ). If no report is
made, the nurse is liable for negligence or wrongdoing towards the victimized patient.
Examples of legal torts
 Invasion of Privacy example: a nursing student observing a procedure without the client's
consent or taking photos of the client.
 False imprisonment example is telling the client that he/she may not leave the hospital or the use of restraints.
 Battery example: performing procedure without consent such as resuscitation.
 Rights to Privacy
The nurse is responsible for keeping all patient records and personal information private and only accessible to the immediate care
providers, according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If records get out or a patient's
privacy is breached, the liability usually lies on the nurse because the nurse has immediate access to the chart.
 Document
It is the nurse's responsibility to make sure everything that is done in regards to a patient's care (vital signs, specimen collections,
medication administration, etc.), is documented in the chart. If it is not documented with the proper time and what was done, the
nurse can be held liable for negative outcomes. A note of caution: if there was an error made on the chart, cross it out with one
line (so it is still legible) and note the correction and the cause of the error.
B. LEGAL ISSUES IN SPECIALITY AND PRACTICE AREA
MATERNAL AND INFANT NURSING
Many legal issues are involved in the care of mother and her infant. Generally the causes of lawsuits for malpractice in this area
may be divided into two categories who handling the mother and child. Lawsuits brought against physicians/ doctors and nurses
differ, reflecting the wellrecognized differences between these professions and their responsibilities. A likely against a doctor who
is in charge of looking after mother and infant might be one of the following:-
 Failure to diagnose a high risk pregnancy.
 Delay in performing a caesarean section.
 Improper vaginal delivery or failure to perform a caesarean section.
The common causes for lawsuits against nurses will include the following:-
 Problems of medication
Nurses are authorized to administration of medication. So many allegations against nurses with regard to medication dosage, route
or time, and failure to monitor side effects, for e.g. nurses are often involved in the administration of oxytocin for the
augmentation of labour.
 Failure in adequate client monitoring.
Nurses are expected to monitor their clients at appropriate time intervals that depend upon the client‘s condition. Labour and
delivery pose a unique monitoring challenge, in that there are two clients to monitor, the mother and baby. The delivering mother
must be adequately monitored to prevent any maternal complications during prenatal period. Nurses have legal responsibilities
regarding fetal monitoring during labour. And prompt monitoring will be continued during natal period, postnatal period to
prevent complication related to mother and child in respective periods.
 Failure to adequately assess the client.
Every nurse regardless of the area of practice is expected by virtue of his or her licensure to be capable of performing assessment.
The nurse is an important member of the health care team who is the client constantly, and responsible for the minute by minute
evaluation of the client progress. Nurses in all specialty areas must maintain the higher level of assessment skills.
 Failure to report changes in the patient
 Whenever the nurses‘ assessment indicates that the client‘s condition has changed, the nurse must notify the concerned
physician. For example the nurses failure in reporting changes in the child, denied the physician the opportunity to intervene
and possibly save the child‘s life.
 When a nurse reports a client‘s changed condition to the physician, the nurse feels that the physician has not responded in a
manner that is in the client‘s best interest, the nurse must proceed up the chain of command until proper medical care is
given to the client.
 As a patient advocate, nurses must understand that failing to notify a doctor of a problem often leads to a delay in appropriate
medical care being implemented. This in turn can lead to an injury to the client and a lawsuit.
 Abortions
Abortion is one of the emotionally charged issues confronting nurses. Nurses cannot be forced to participate in procedures they
find morally offensive. Nurses have right to refuse to assist with abortions. However, nurses cannot attempt to stop an abortion
being performed. She can assist with abortion if it is performed under Medical Treatment of pregnancy Act.
 Nursing care of new born.
There are certain legal requirements in providing nursing care for newborns, such as properly identifying the infant- mother pair
as soon as possible with finger prints, foot prints and wrist bands. Standards of practice include providing a clear airway, clamping
the umbilical cord, applying antibiotics or silver nitrate to the edges and keeping infant warm. Resuscitation equipment must be in
the delivery room. When a still born infant is delivered, the nurse must record all events about the delivery. Although the
atmosphere in a delivery room is disquieting, the nurse must complete legal requirement by careful documentation .
 Informed Consent
 Before treatment, diagnostic procedures, or experimental therapy, a patient must be informed of the reasons for the treatment as
well as possible adverse effects and alternative treatments.
 The physician must obtain signed consent.
 The nurse must ensure that signed consent is in the patient‘s chart before the procedure is performed.
 Prenatal Screening
 Can detect inherited and congenital abnormalities long before birth.
 Early diagnosis may allow repair of an abnormality in utero.
 May force a patient to choose between having an abortion and assuming the emotional and financial burden of raising a severly
disabled child.
 Helps the patient fully understand the procedure.
 Pretest and post test counseling are essential parts of an ethical prenatal- screening program.
 In vitro fertilization (IVF)
 With IVF, the ovum is fertilized outside the body and then implanted into the uterus. Between 15 and 20 embryos may result
from a single fertilization effort.
 Only 3 to 5 of these embryos are implanted in the women‘s uterus.
 Ethical questions arise as to what to do with remaining embryos.
 Although the procedure has allowed infertile couples to have children, some are concerned that it is unnatural.

PEDIATRIC NURSING
 As in all areas of nursing practice, negligence involving pediatric clients is possible. Paediatric nurses are responsible for
preventing children, in their care, from accidentally harming themselves.
 Cribs which sometimes have a restraining device over the top are designed to keep infants and toddlers from climbing out of
bed and injuring themselves. All poisonous substances and sharp objects should be kept out of the reach of children.
MEDICAL SURGICAL NURSING
As in the case of paediatric clients, disoriented adults may require form of restraints to prevent accidental self injury. Standard
care, laws and regulations about the use of restraints and supervision apply to nursing practice with medical surgical patient. Side
rails are available on hospital beds for adult patients. Some common acts of negligence in medical surgical nursing are as
follows:-
 Over looked sponges, instruments needles
In the operation theatre, it is a responsibility of the nurse to count the sponges, instruments, needles before the closure of the
abdomen or any cavity. The nurse may be liable if she makes an error in their court.
 Burns
The professional nurse is required to know the cause and effect of any heat application so as to avoid burns. Some of the common
heat applications are applications, of hot water bags, heating pads, double sitz bath etc. The nurse could be held liable if she/he
neglects to take proper safety measure prior to application of such measures.
 Falls
The nurse could be held liable if a patient falls from the bed or due to improper securing of patient on examination table or
improper application of restraint or provision of a proper bed for an unconscious patient or a child.
 Assault and battery
Failure to take the informed consent of the patient prior to any procedure, treatment, investigation or operation, the nurse be held
liable.
 Failure to report accidents
The nurse has a moral and legal responsibility to report to the concerned authority any accidents, losses or unusual occurrences.
Failure to do this is an act of negligence.
 Maintenance of records and reports
Failure to maintain accurate record and reports or removing a position of record may also make the nurse liable. Nurses working
in critical care units are also legally accountable for performing their duties. Critical care nurses require additional training and
ongoing intensive education to provide them with information about advances in care methods to handle high- techmachines and
electric and electronic apparatus in addition to other critical care nursing measures.
 Critical care units
Nurses working in critical care settings are legally accountable for performing their duties. Critical care nurses require additional
training and ongoing in service education to provide them with information about advances in methods of patient care. Possible
legal problems for critical care nurses are associated with the use of electronic monitoring devices. No monitor can be considered
totally reliable, and the nurse must not completely depend on it. There may also be electrical hazards. The equipments should be
checked routinely.
PSYCHIATRIC NURSING
The practice of psychiatric nursing is influenced by the law, particularly in concern for the rights of patients and the quality of
care they are receiving. A psychiatric nurse should be sufficiently acquainted with the legal aspects of psychiatry so that she/he
can be aware of the patient‘s rights and can avoid giving poor advice or innocently involving herself/himself in a legal
entanglement.
 Informal Admission
This type of admission to the psychiatric hospital occurs in the same way as a person is admitted to a general medical hospital, i.e.
without formal or written application. The individual is then free to leave at any time, as he would be in a general medical
hospital.
 Restraints
 Discharge
COMMUNITY HEALTH NURSING
In older days nurses were working under the control and supervision of doctors. But in modern practice nurses are able to assess,
diagnose, plan, implement and evaluate nursing care independently. As we begin professional practice, it is essential to understand
the law that defines the nurse‘s responsibility and duties. Especially the community health nurse must be very careful while doing
services in the community. Because there is team of people working in the hospital. Whereas in the community the community
health nurses are alone and most of the time she is in a position to implement the services at home. So, she must be more careful
and she should have enough knowledge on legal issues.
a. Intentional Torts
 Assault: It is a threat or an attempt to make bodily contact with another person without that person‘s consent.
 Battery: It is an assault that is carried out with willful angry and violent or negligent touching of another person‘s body or
clothes.
Examples:-
 Forcibly removing patient‘s cloth.
 Injection with force or when refused by patient.
 Pushing a patient in floor or the chair.
 Defamation: It is an intentional tort makes derogatory remarks about another .
Slander: oral defamation of character.
Libel: Written defamation (petition)
E.g. About patient or co workers.
 Invasion of Privacy
 All information should be confidential.
 Interacting with the family members.
 Avoid unnecessary exposure.
 Checking of all machines.
 Carryout research activities.
 False Imprisonment: A person cannot be legally forced to remain in health centers or hospital. (Unjustified intension)
 Fraud: Willful and purposeful interpretation or misinterpreting the outcome of procedure or a treatment. (License may be
prosecuted under the Nurse Practice Act ) .
b. Unintentional Torts
 Negligence: An act of negligence may be enacting of omission or commission.
 Malpractice or Negligence
 Liability: It involves four elements that must be established to prove that malpractice or negligence has occurred.
 Duty: Execution of safety measures.
 Breach of Duty: Failure to note and report to the higher authority about the seriousness.
 Causation: Failure to use appropriate safety measures.
 Damages: Lengthened hospital stay and need for rehabilitation (Injection abscess)
Nurses Responsibilities
 Practice within the scope of nurse practice act.
 Observe agency policies and procedures.
 Establish standards by using evidence based practice.
 Always prefer patient‘s welfare.
 Be aware of relevant law and understand the limits.
 Practice within the area of individual competence.
 Upgrade technical skills by attending continuing nursing education (CNE) and seeking certification.
Legal Safe Guards of Community Health Nurses
 Informed consent: Granted freedom, written or oral form (procedures, expected outcome, Complication, side effects, and
alternative treatment) .
 Collective bargaining: Policies, legal procedures, up to date knowledge.
 Competent practice: It is most important and best legal safeguard.
Respecting Legal Boundaries
 Institutional policies/ procedures should be adopted.
C. Legal, Ethical, Professional Issues in Nursing
These three main duties are generally considered to respect a patient's confidentiality and autonomy , to recognise the duty of care
.
 The Nursing and Midwifery Council
The NMC contains guidelines regarding the expectations of particular duties such as confidentiality, medical research obligations,
consent rights and autonomy. The nursing practice is expected to comply at an individual level with these guidelines on a daily
basis. The NMC’s ‘Code of Professional Conduct: Standards for conduct, performance and ethics’ is widely adhered to in the
profession. To be registered, it is a general rule that nurses must undergo education in addition to personally indicating through
performance and training that they intend to follow ethical standards to retain a licence for nursing .
 Respecting Confidentiality
 Its stipulates that Patients have a right to expect that information about them will be held in confidence by their doctors &
nurses . Confidentiality is central to trust between health professionals and patients. Without assurances about
confidentiality, patients may be reluctant to give doctors & nurses the information they need in order to provide good care.
 In addition to the civil requirement to maintain confidentiality there is a professional requirement for to maintain the patient's
confidentiality and failure to do so is a breach of good medical practice and will attract sanctions. There are also professional
guidelines on how a nurse must deal with a situation should she make a mistake.
 Respecting Autonomy
 The right to determine what happens to ones own body is the right to autonomy. The words autonomy and autonomous are
used in respect of a capacity, a condition and a right. Successful relationships between doctors and patients depend on trust.
 To establish that trust you must respect patients' autonomy - their right to decide whether or not to undergo any medical
intervention even where a refusal may result in harm to themselves or in their own death.
List of do‟s and don‟ts as guidelines for safe practice
Do‟s
 Documention of all unusual incidences.
 Report all unusual incidences.
 Know your job description.
 Follow policies and procedures as established by your employing agency.
 Keep your registration updated.
Don‟ts
 Remove side rails from patient‘s bed unless there is an order or hospital policy to do so.
 Allow patients to leave the hospital or nursing home unless there is an order or a signed release.
 Accept money or gifts from patients.
 Give advice that is opposite to physician orders or the nursing care plan.
Roles and Functions of Nurse Manager in Legal Issues
The following are the leadership roles and managerial functions of a nurse manager in legal and legislative issues:-
a. Serve as a role model by providing nursing care that meets or exceeds accepted standards of care.
b. Seeks professional certification to increase expertise in a specific field.
c. Reports substandard nursing care appropriate authorities.
d. Maintain nurse/ patients relationships that are respectful, caring and honest, thus reducing the possibility of future lawsuits.
e. Practices nursing within the area of the individual competence.
f. Prioritizes patient‘s rights and welfare first in decision- making.
g. Demonstrates vision, risk taking and energy in determining appropriate legal boundaries for nursing practices thus defining
what nursing is and should be in the future.
h. Delegates to subordinates wisely, looking at the managers scope of practice and that of those they supervise.
i. Understands and adheres to institutional policies and procedures.
j. Practices nursing with scope of state nursing within the scope of the state nurse practice act.
k. Monitors subordinates to ensure that they have a valid, current and appropriate license to practice nursing.
CONCLUSION
Medico-legal issues center mainly on the issue of consent, duty of care and rules of professional ethics. If the clinicians properly
obtained consent before starting medical procedure & treatment medical procedure or treatment and also exercise care to the
patient as well as observance of the rule of professional ethics, by so doing the clinician can easily release himself from any
charge or allegation arising from medico-legal cases