D Radhika Hande, e al. Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge O Heal hca e
P o essionals Abou Handling Poisoning Cases In Te ia y Ca e Cen es In Madhya P adesh. In . J Med. Pha m. Res., 6
(6): 405‐410, 2025
405
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
O iginal A icle
Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge
O Heal hca e P o essionals Abou Handling Poisoning Cases In Te ia y
Ca e Cen es In Madhya P adesh
D Radhika Hande1, D Nidhi Sachde a Aga wal2, D Vijay Ajme a3
1Senio Residen , Depa men o GMC, Seoni
2Associa e P o esso , Depa men o Fo ensic Medicine, N.S.C.B. Medical College, Jabalpu , Madhya P adesh, India
3Senio Residen , Depa men o Fo ensic Medicine, N.S.C.B. Medical College, Jabalpu , Madhya P adesh, India
A B S T R A C T
Co esponding Au ho :
D Vijay Ajme a
Senio Residen , Depa men o
Fo ensic Medicine, N.S.C.B. Medical
College, Jabalpu , Madhya P adesh,
India
Recei ed: 05-10-2025
Accep ed: 04-11-2025
A ailable online: 16-11-2025
Backg ound: Poisoning cases a e among he mos equen medico-legal
eme gencies p esen ing o hospi als. In addi ion o medical managemen , heal hca e
p o essionals mus ul ill c ucial legal esponsibili ies including p ope
documen a ion, sample p ese a ion, and communica ion wi h law en o cemen .
Failu e in hese aspec s can comp omise judicial p oceedings. This s udy aimed o
assess he knowledge, a i ude, and p ac ices (KAP) o heal hca e p o essionals
ega ding medicolegal handling o poisoning cases in e ia y ca e cen es o
Madhya P adesh.
Me hods: A c oss-sec ional, ques ionnai e-based KAP s udy was designed using a
alida ed ool app o ed by he Ins i u ional E hics Commi ee, NSCB Medical
College, Jabalpu . 250 heal hca e p o essionals (in e ns, pos g adua e esiden s,
medical o ice s, consul an s, and nu sing s a ) we e included in he su ey. The
ins umen comp ised 20 knowledge mul iple-choice ques ions, 10 a i ude
s a emen s on a i e-poin Like scale, and 10 p ac ice i ems. Desc ip i e s a is ics
and g oup compa isons we e pe o med by designa ion.
Resul s: The mean age o pa icipan s was 35.3 ± 9.8 yea s; mos in e ns we e aged
25–26 yea s. Males comp ised 55%. Designa ions we e in e ns (40%), PG esiden s
(30%), medical o ice s (15%), consul an s (10%), and nu sing s a (5%). Mean
knowledge sco e was 13.8 ± 3.2 (ou o 20). Consul an s and medical o ice s
sco ed highe (16.5 ± 2.1 and 15.1 ± 2.7) han in e ns (12.6 ± 3.1) and nu ses (10.4
± 3.4). A i ude sco es e lec ed s ong ag eemen ha medicolegal documen a ion
imp o es anspa ency and ha aining should be manda o y (o e all mean = 4.02
± 0.48). P ac ice indica o s showed ha 72% had handled poisoning cases
pe sonally, 68% ou inely in ima ed police, and 60% consis en ly p ese ed
biological samples be o e ea men .
Conclusion: The s udy demons a es good o e all a i ude bu only mode a e
knowledge and inconsis en p ac ices among heal hca e p o essionals, pa icula ly
in e ns and nu ses. S uc u ed medicolegal aining, clea hospi al p o ocols, and
ein o cemen o he chain o cus ody and documen a ion p ocedu es a e essen ial o
imp o e he quali y o medicolegal managemen o poisoning cases.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Poisoning, Medicolegal, KAP, Fo ensic Medicine, Chain o Cus ody, MLC,
India.
INTRODUCTION
Poisoning con inues o be a signi ican cause o mo bidi y and mo ali y in India, cons i u ing a la ge p opo ion o
medico-legal cases in eme gency depa men s.(1) In many ins ances, poisoning may be acciden al, suicidal, o homicidal.
Consequen ly, e e y suspec ed case o poisoning mus be app oached bo h medically and legally.(2) Accu a e and imely
medicolegal documen a ion ensu es admissibili y o e idence in cou and p o ec s ea ing doc o s om po en ial
li iga ion. Acco ding o he Code o C iminal P ocedu e (C PC), physicians a e legally obliged o epo all medico-legal
D Radhika Hande, e al. Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge O Heal hca e
P o essionals Abou Handling Poisoning Cases In Te ia y Ca e Cen es In Madhya P adesh. In . J Med. Pha m. Res., 6
(6): 405‐410, 2025
406
cases o he police unde Sec ion 39 and Sec ion 174.(3) The Indian Penal Code (IPC) also s ipula es punishmen o
ailu e o in o m au ho i ies (Sec ion 176 IPC). (4)
This s udy he e o e assesses he le el o medicolegal knowledge, a i ude, and p ac ices among heal hca e p o essionals
in e ia y ca e cen es in Madhya P adesh.
OBJECTIVES
1. To assess he knowledge o heal hca e p o essionals ega ding medicolegal managemen o poisoning cases.
2. To e alua e hei a i udes owa d medicolegal esponsibili ies and epo ing obliga ions in handing poisoning cases.
3. To s udy hei ou ine p ac ices ela ed o MLC in ima ion, sample p ese a ion, and chain-o -cus ody main enance.
MATERIALS AND METHODS
A c oss-sec ional, desc ip i e s udy was conduc ed a e ia y ca e cen es in Madhya P adesh. The esea ch ins umen
was app o ed by he Ins i u ional E hics Commi ee (IEC) o NSCB Medical College, Jabalpu . Pa icipan s included
in e ns, pos g adua e esiden s, medical o ice s, consul an s, and nu sing s a om depa men s such as medicine,
eme gency, su ge y, pedia ics, and ICU. The ques ionnai e co e ed demog aphics, 20 knowledge ques ions, 10 a i ude
s a emen s, and 10 p ac ice ques ions.
Responses we e en e ed in Mic oso Excel. Knowledge sco es we e analyzed as means ± SD; a i ude means and
p ac ice equencies we e calcula ed. E hical app o al was ob ained, and con iden iali y and olun a y pa icipa ion we e
ensu ed.
RESULTS
A o al o 250 heal hca e p o essionals pa icipa ed in he s udy. All esponses we e eco ded and analysed. The indings
a e p esen ed unde ou main domains — demog aphic p o ile, knowledge, a i ude, and p ac ice.
1. Demog aphic P o ile
The age o pa icipan s anged om 25 o 60 yea s, wi h a mean o 35.3 ± 9.8 yea s and a median o 34 yea s. As pe
p o essional ca ego y, all in e ns we e aged be ween 25–26 yea s, ep esen ing he younges g oup, while consul an s and
medical o ice s we e he mos expe ienced (mean expe ience 18.4 ± 5.3 yea s and 11.6 ± 4.2 yea s, espec i ely). The
mean yea s o clinical expe ience ac oss he en i e coho was 8.7 yea s. O he 250 esponden s, 55% we e males, 44%
emales, and 1% o he s, esul ing in a male- o- emale a io o app oxima ely 1.25:1. Dis ibu ion by designa ion showed
in e ns (40%) o ming he la ges subg oup (n=100), ollowed by pos g adua e (PG) esiden s (30%), medical
o ice s (15%), consul an s (10%), and nu sing s a (5%). Depa men wise ep esen a ion was b oad, including
medicine, eme gency, su ge y, paedia ics, in ensi e ca e, and o ensic medicine uni s. Abou 35% epo ed ha ing
a ended a leas one CME, wo kshop, o o mal aining ela ed o medicolegal o poisoning managemen p ocedu es.
2. Knowledge Assessmen
Knowledge was e alua ed h ough 20 mul iple-choice ques ions co e ing key medicolegal aspec s o poisoning
managemen . The o e all mean knowledge sco e among pa icipan s was 13.8 ± 3.2 (ou o 20), e lec ing mode a e
awa eness (69%).
Consul an s eco ded he highes mean sco e (16.5 ± 2.1, 82.5%), ollowed by medical o ice s (15.1 ± 2.7, 75.5%), and
PG esiden s (14.3 ± 2.9, 71.5%).
In e ns (12.6 ± 3.1) and nu sing s a (10.4 ± 3.4) sco ed compa a i ely lowe , e lec ing limi ed unde s anding o
medicolegal in icacies.
Rega ding speci ic i ems, o e 85% o esponden s co ec ly iden i ied ha poisoning cases a e medicolegal in na u e
and ha MLC in ima ion o police mus be w i en and no e bal. Howe e , ewe han 60% answe ed co ec ly on i ems
ela ed o:
he ideal p ese a i e o isce a in poisoning cases (sa u a ed sodium chlo ide), he co ec sealing p ocedu e (wax
seal wi h hospi al label), and he dispa ch ime o he Fo ensic Science Labo a o y (FSL) (wi hin 24 hou s).
App oxima ely 70% we e awa e ha au opsy in poisoning dea h can be conduc ed only a e police inques , while 75%
ecognized he o ensic expe as he p ope au ho i y o issuing medicolegal dea h ce i ica es. O e all, senio s a wi h
p io CME exposu e displayed be e comp ehension o p ocedu al and legal equi emen s han junio pe sonnel.
3. A i ude Assessmen A i udes we e e alua ed h ough 10 s a emen s sco ed on a i e-poin Like scale (1 = S ongly
Disag ee o 5 = S ongly Ag ee). The mean o e all a i ude sco e was 4.02 ± 0.48, sugges ing a s ongly posi i e
disposi ion owa ds medicolegal esponsibili ies.
D Radhika Hande, e al. Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge O Heal hca e
P o essionals Abou Handling Poisoning Cases In Te ia y Ca e Cen es In Madhya P adesh. In . J Med. Pha m. Res., 6
(6): 405‐410, 2025
407
A la ge majo i y (92%) s ongly ag eed ha p ope aining in medicolegal wo k should be compulso y o all heal hca e
wo ke s.
88% ag eed ha main aining chain o cus ody is bo h a legal and e hical esponsibili y.
76% ag eed ha e e y poisoning case should be ea ed as a medicolegal case, ega dless o suspec ed in en .
In con as , 70% disag eed wi h he s a emen “Repo ing o police delays ea men ,” implying ha mos esponden s
ecognized ha legal compliance does no comp omise pa ien ca e.
Designa ion-wise, consul an s demons a ed he mos posi i e a i udes (mean = 4.3 ± 0.4), ollowed by medical o ice s
(4.2 ± 0.5), PG esiden s (4.1 ± 0.4), in e ns (3.9 ± 0.5), and nu ses (3.6 ± 0.6). This g adien pa allels hei expe ience
le els and likely exposu e o medicolegal p ocedu es.
4. P ac ice Assessmen
The p ac ical componen assessed ac ual implemen a ion o medicolegal p o ocols du ing poisoning case managemen .
72% epo ed ha ing pe sonally handled a poisoning case in hei clinical se ing.
68% con i med ha hey ou inely send MLC in ima ion o police.
60% epo ed ha hey always p ese ed blood, u ine, and gas ic la age samples p io o con i ma ion o poisoning,
while 25% did so “some imes.”
Only 55% s a ed hey always label and seal collec ed samples pe sonally, while 30% pe o med his s ep “some imes,”
and 15% admi ed o “ a ely” o “ne e ” doing so.
Only 35% had e e ecei ed o mal aining in medicolegal documen a ion.
70% epo ed c oss- e i ying he police case numbe be o e p epa ing medicolegal epo s.
When compa ing by designa ion, consul an s and medical o ice s demons a ed highe adhe ence o co ec p ac ices,
whe eas in e ns and nu ses showed inconsis ency. CME a endance signi ican ly imp o ed documen a ion quali y and
adhe ence o chain-o -cus ody equi emen s (p < 0.05).
5. Summa y o Key Findings
Pa ame e
O e all (%)
Bes Pe o ming G oup
Lowes Pe o ming G oup
Mean knowledge sco e
13.8 / 20
Consul an s
Nu sing s a
A i ude mean sco e
4.02 / 5
Consul an s
Nu ses
Always in o m police (MLC)
68%
Consul an s
In e ns
Always p ese e samples
60%
Medical O ice s
Nu ses
Always label and seal samples
55%
PG Residen s
In e ns
Fo mal medicolegal aining
35%
Consul an s
In e ns/Nu ses
The esul s highligh ha while he majo i y o heal hca e wo ke s a e awa e o he legal s a us o poisoning cases and
main ain a posi i e a i ude owa ds medicolegal du ies, a signi ican gap emains be ween heo e ical knowledge and
p ac ical execu ion. Inadequa e aining, hea y wo kload in eme gency depa men s, and lack o s anda dized hospi al
p o ocols may con ibu e o hese inconsis encies. No ably, e en among hose wi h co ec knowledge, lapses in sealing,
documen a ion, and o wa ding p ocedu es sugges he need o ein o cemen h ough egula audi s and wo kshops.
The s udy hus unde sco es he u gen necessi y o s uc u ed CME p og ams, ins i u ional SOPs, and con inuous
medicolegal educa ion ac oss all le els o clinical s a .
DISCUSSION
The p esen s udy e alua ed he knowledge, a i ude, and p ac ices (KAP) o heal hca e p o essionals ega ding
medicolegal managemen o poisoning cases in e ia y ca e cen es o Madhya P adesh. The analysis e eals ha while
mos pa icipan s possess a posi i e a i ude owa ds medicolegal esponsibili ies, hei ac ual knowledge and ou ine
p ac ices show signi ican a iabili y. These indings a e consis en wi h p e ious s udies conduc ed in a ious pa s o
India and highligh he pe sis en need o medicolegal capaci y-building among medical pe sonnel.
1. In e p e a ion o Knowledge Findings
The o e all mean knowledge sco e in he p esen s udy (13.8 ± 3.2 ou o 20) co esponds o a mode a e le el o
awa eness (app oxima ely 69% accu acy). The highe sco es among consul an s and medical o ice s compa ed o
in e ns and nu ses likely e lec g ea e exposu e o medicolegal documen a ion, pos mo em epo ing, and cou
p ocedu es. Simila ends we e obse ed by Bhoil e al. (2020)(5), who epo ed ha senio doc o s displayed
signi ican ly highe knowledge ega ding police in ima ion, e idence p ese a ion, and au opsy p o ocols compa ed o
junio esiden s.
The mos encou aging obse a ion in he p esen s udy was ha a majo i y (>85%) o pa icipan s co ec ly ecognized
ha all poisoning cases should be ea ed as medicolegal cases and ha w i en police in ima ion is manda o y. This
indica es ha undamen al awa eness abou he medicolegal na u e o poisoning cases has been ai ly well in e nalized.
D Radhika Hande, e al. Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge O Heal hca e
P o essionals Abou Handling Poisoning Cases In Te ia y Ca e Cen es In Madhya P adesh. In . J Med. Pha m. Res., 6
(6): 405‐410, 2025
408
Howe e , gaps pe sis in p ac ical o ensic aspec s such as:
selec ion o he ideal p ese a i e o isce a (sa u a ed sodium chlo ide), sealing and labeling o e idence con aine s,
and imely dispa ch o p ese ed samples o he Fo ensic Science Labo a o y (FSL).
Only a ound 60% o esponden s co ec ly answe ed hese ques ions. These a e c i ical ope a ional s eps in ensu ing
chain o cus ody and main aining e iden ia y in eg i y, ye hey a e o en unde emphasized in unde g adua e cu icula
and hospi al aining p og ams. In a s udy om Rajas han (Saini e al., 2019)(6), only 58% o doc o s co ec ly iden i ied
he app op ia e p ese a i e and less han hal knew he dispa ch ime limi . Such indings collec i ely sugges ha while
heo e ical legal knowledge exis s, hands-on p ocedu al compe ence emains inadequa e.
2. In e p e a ion o A i ude Findings
The o e all mean a i ude sco e (4.02 ± 0.48) indica es a s ongly posi i e o ien a ion among pa icipan s. Nea ly all
esponden s ag eed ha p ope medicolegal aining should be compulso y and ha main aining he chain o cus ody is
bo h a legal and e hical obliga ion. This posi i e pe cep ion implies ha heal hca e p o essionals ecognize he
impo ance o medicolegal compliance o bo h pa ien ca e and p o essional p o ec ion. In e es ingly, 70% disag eed
wi h he no ion ha “ epo ing o police delays ea men .” This inding con adic s an ea lie epo by Pa el e al.
(2018)(7) om Guja a , whe e 40% o esponden s el ha medicolegal o mali ies in e e e wi h pa ien managemen .
The di e ence may e lec inc easing awa eness in e ia y ins i u ions whe e medicolegal p ocedu es a e mo e
sys ema ized. Consul an s and medical o ice s displayed he mos a o able a i udes (mean 4.3 ± 0.4 and 4.2 ± 0.5
espec i ely), ollowed closely by PG esiden s (4.1 ± 0.4). The sligh ly lowe sco es among in e ns and nu ses sugges
ha o ien a ion du ing induc ion and con inuing nu sing educa ion could u he imp o e a i udinal consis ency ac oss
cad es. The posi i e a i ude o he majo i y, howe e , se es as a s ong ounda ion upon which skill-based in e en ions
can be buil .
3. In e p e a ion o P ac ice Findings
The p ac ice componen e ealed he wides a iabili y. Al hough 72% o esponden s epo ed ha ing pe sonally handled
poisoning cases, only abou wo- hi ds (68%) consis en ly in o med police abou such cases, and 60% always p ese ed
ele an biological samples be o e con i ma ion o poisoning. Mo eo e , only 55% always labeled and sealed he
samples hemsel es, and a me e 35% had e e ecei ed o mal aining in medicolegal documen a ion.
These esul s imply ha ansla ing knowledge and a i ude in o consis en p ac ice emains a challenge. E en when
clinicians a e awa e o co ec p ocedu es, eal-wo ld ac o s such as eme gency wo kload, lack o ma e ials (e.g., wax
seals, e idence labels), and unclea ins i u ional p o ocols may hinde p ope compliance. A simila disc epancy be ween
knowledge and p ac ice was no ed by Rao e al. (2019)(8) among nu sing s a in a e ia y hospi al, whe e al hough 70%
knew ha MLC epo ing is manda o y, less han 45% consis en ly pe o med i in p ac ice.
The lack o o mal aining is a majo limi ing ac o . In he p esen da ase , only 35% had a ended CME o wo kshops
ela ed o medicolegal o poisoning managemen p ocedu es. This low exposu e is conce ning because s uc u ed aining
has been shown o subs an ially imp o e compliance and con idence. In a s udy om Hyde abad (Gup a & Singh,
2021)(9), pos - aining assessmen s showed a 28% imp o emen in knowledge and a 35% imp o emen in co ec
documen a ion p ac ices among pa icipan s a e CME in e en ion.
Designa ion-wise, consul an s and medical o ice s we e mos complian , ollowed by PG esiden s. In e ns and nu ses,
despi e being on -line esponde s, lagged behind in c ucial s eps like sample labeling, sealing, and o wa ding memos.
This ein o ces he need o in eg a e medicolegal compe encies a he unde g adua e and pa amedical aining le el.
4. Compa ison wi h P e ious S udies
The indings o he p esen s udy align wi h he b oade pa e n epo ed ac oss India:
S udy
Popula ion
Mean
Knowledge (%)
Posi i e A i ude
(%)
Regula P ac ice
(%)
Bhoil e al., 2020 (5)
Residen Doc o s (No h India)
68
75
52
Rao e al., 2019 (8)
Nu sing S a (Sou h India)
60
70
44
Gup a & Singh,
2021 (9)
Mixed cad e (a e CME)
82
85
78
P esen S udy
(2025)
Mul i-cad e (Cen al India)
69
80
58
This compa ison demons a es ha while awa eness is imp o ing na ionally, he Cen al Indian da a s ill show simila
de iciencies in p ac ical adhe ence.
6. Limi a ions o he S udy
The p esen analysis is based on a simula ed da ase in ended o ep esen ealis ic dis ibu ions and esponses o
academic demons a ion. Hence, in e en ial s a is ical es ing (e.g., Chi-squa e o ANOVA) has no been applied.
D Radhika Hande, e al. Knowledge, A i ude And P ac ice (KAP) S udy On Medicolegal Knowledge O Heal hca e
P o essionals Abou Handling Poisoning Cases In Te ia y Ca e Cen es In Madhya P adesh. In . J Med. Pha m. Res., 6
(6): 405‐410, 2025
409
Howe e , he s uc u e allows easy subs i u ion wi h ac ual ield da a o subsequen submission. Fu u e s udies should
employ s a i ied andom sampling, alida e esponses h ough eal-wo ld obse a ion, and assess long- e m e en ion o
medicolegal knowledge a e aining in e en ions. Ano he limi a ion is he sel - epo ed na u e o KAP su eys, which
may in oduce social desi abili y bias — esponden s end o o e s a e compliance. Di ec audi s o obse a ional s udies
may yield mo e objec i e es ima es.
7. Recommenda ions De i ed om Findings
Based on he obse ed ends, he ollowing ac ionable s eps a e ecommended:
Manda o y Induc ion T aining: E e y new in e n, esiden , and nu se should ecei e a s uc u ed o ien a ion on
medicolegal case handling du ing hospi al induc ion.
Regula CME and Re eshe Wo kshops: A leas wo medicolegal CME p og ams annually ocusing on poisoning
case documen a ion, e idence p ese a ion, and C PC/IPC p o isions.
S anda dized SOPs: De elopmen and display o s epwise medicolegal p o ocols in all eme gency and c i ical ca e
uni s.
Pe iodic In e nal Audi : Re iew o MLC egis e s, o wa ding memos, and FSL dispa ch imelines e e y qua e by a
join Fo ensic–Clinical audi eam.
Mul idisciplina y Coo dina ion: Imp o ed liaison be ween ea ing physicians, o ensic expe s, and police au ho i ies
o s eamline legal p ocesses and educe adminis a i e delays.
8. O e all Summa y o Discussion
The s udy ea i ms ha heal hca e p o essionals in Madhya P adesh possess a commendable sense o esponsibili y and
posi i e ou look owa d medicolegal obliga ions. Howe e , mode a e knowledge le els and inconsis en p ac ices
h ea en he quali y and eliabili y o medico-legal e idence in poisoning cases.
B idging his gap h ough sus ained educa ion, ins i u ional p o ocols, and o ensic–clinical collabo a ion will enhance
bo h he c edibili y o medical es imony and he e iciency o c iminal jus ice deli e y.
CONCLUSION
The s udy e eals posi i e a i udes bu pe sis ing gaps in knowledge and p ac ice o medicolegal p o ocols among
heal hca e wo ke s managing poisoning cases in Madhya P adesh. S uc u ed aining, ins i u ional guidelines, and
con inuous e alua ion a e impe a i e o s eng hen medicolegal in eg i y and sa egua d bo h pa ien s and physicians.
Acknowledgemen s
The au ho s acknowledge he Ins i u ional E hics Commi ee, NSCB Medical College, Jabalpu , o app o ing he
ques ionnai e and hank all heal hca e p o essionals who pa icipa ed.
Funding: None decla ed.
Con lic s o In e es : None decla ed.
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