Identifying gaps and challenges in medico legal practice: a multidisciplinary workshop

A multidisciplinary workshop titled “Increasing Competence on Documentation: A multidisciplinary workshop on medico legal” is held on July 31-August 1, 2019 to primarily identify the gaps and challenges in the medico legal practice in the country and to get physicians and other stakeholders on board in the establishment of the medico legal reviewer (MLR) teams in Luzon, Visayas, and Mindanao. The workshop also meant to develop necessary guidelines and protocols for more effective coordination among medical, legal, and civil society members. This included public doctors, emergency doctors, lawyers, and representatives from Department of Health (DOH).

Workshop results: During the workshops, the participants had able to identify the gaps and challenges along with recommendations on the medico legal practice from different perspectives such as from municipal health officers (MHOs), emergency physicians, and lawyers.

According to MHOs, their primary concern is the refusal of hospital doctors to attend and issue the medico legal certificate or death certificate. This is due to outdated medico legal guidelines. MHOs are known as the all-around doctor of the rural vicinity. Attending to medico legal cases and testifying in court warrants their time and effort thus eating their time supposedly for treating patients in the rural health unit. What aggravates their situation is the lack of training and facility for medico legal examination. This municipal health officers are deployed in communities with little medico legal knowledge. Thus, “autopsy reports” are either partial or focused on injuries because they do not know how to do autopsy. MHOs recommended the Department of Health (DOH) to issue a standard comprehensive guideline for medico legal. They also took note of re-orientation on local chief executives for compulsory budget allocation for medico legal and review of existing guidelines and aligning it to existing local policies.

To ER doctors, lack of mandate on medico legal procedures is their biggest hurdle. They observed that hospitals have different procedures and practices. A mandated policy would require hospitals to comply with a certain standard. Further, ER physicians do not issue temporary medico legal certificate rather the medical records or the medico legal officer (MLO) issues them. The ER doctors called for the training of their residents and consultants for medico legal processes. As emergency doctors, they encounter the patient first thus their documentation is crucial. They also recommended to practice the “chain of custody” because they tend to be first in line of the preservation of evidence.

Likewise, the lawyers also raised their concerns on the inadmissible evidence or evidence that are not accepted in trials. Further, they shared that the Philippine National Police and National Bureau of Investigation (NBI) are the assigned medico legal officers according to law. But these investigating bodies are not independent thus posing transparency and impartiality issues. So, lawyers recommended to assign the human rights violations (HRV) medico legal cases to Department of Health (DOH) or a duly constituted independent and competent body. They also suggested for more joint seminars and conferences of lawyers and doctors with police investigators. Also during the plenary discussion, Dr. Fortun suggested that the DOH should also regulate the morgue of regional hospitals.