CHAPTER 1 LEGAL MEDICINELegal Medicine

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Is that branch of medicine thatapplies, medical and surgicalconcepts, scientific knowledge andskills to
medico legal issues, inorder to assist the trier of facts inthe proper dispensation of justice.Medical
Jurisprudence-is the study of the Medical Law andits applicable Jurisprudence thatgoverns, regulates
and defines thepractice of medicine.

In the Philippines, Legal Medicine is theappropriate name for ForensicMedicine.

Modern Legal medicine has a broadrange of applications, it is used in civilcases such as paternity and
filiation,annulment of marriage, DNA testing ,etc.

In all cases the medical examiner must conduct an investigation of the crime scene and also an autopsy.
TECHNIQUES OF LEGAL MEDICINE:-Legal Medicine uses sophisticated laboratory techniques to detect
the presence of substances in the victim, in the suspected criminal, or at the crime scene.-Forensic
examination of substances found at a crime scene can often establish the presence of the suspect at the
crime scene. LEGAL MEDICINE AND THE LEGAL SYSTEM-Courts routinely call upon physicians to give
expert testimony in a trial, especially concerning the findings of an autopsy and the results of laboratory
tests.-As an expert witness he is allowed to express an opinion about the validity of the evidence in a
case and may quote the statements of other experts in support of an opinion.-Ordinary testimony is
restricted to statements concerning what the witness actually saw or heard.-The evidence to be
presented by the legal medicine expert must signify a relation between the facts called the Factum
Probandum or proposition to be established and the factum Probans which is the material
evidencing the proposition.-The Physician must present RELEVANT, MATERIAL ANDCOMPETENT
EVIDENCE.HISTORY OF LEGAL MEDICINE:
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Paulus Zacchias (1584 1659) is the Father of Forensic Medicine. He was the first to describe the
importance and application of medicine to the proper administration of justice.-In the Phil., the father of
Legal Medicine can be rightfully bestowed to Dr. Pedro P. Solis. His book on Legal Medicine copyrighted
in 1987, contains the most extensive treatise and teachings in Philippine LegalMedicine.APPLICATION OF
LEGAL MEDICINE TOLAW: Legal Medicine is Applied to Law1. Civil law- the determination and
termination of civil personality- the limitation or restriction of a natural persons capacity to act-
marriage and legal separation- paternity and filiation- testamentary capacity of a person making a will-
the right to hereditarysuccession2. Criminal Law-Felonies and circumstances which affect criminal
liability-Civil liability ex delictu-Crimes relative to opium and prohibited drugs-Crimes against persons-
Crimes against chastity-Crimes against civil status of persons-Quasi offenses3. Remedial Law-Physical
and Mental Examination of a person-Hospitalization of insane persons-Rules of Evidence4. Special Laws-
Dangerous Drug Act- Youth and Child Welfare Code- Sanitation Code- Insurance law- Labor Code-
Employees Compensation Law5. CORPUS DELICTI- Is the body or substance of the crime and is defined
as the fact that a crime actually has been committed. In all criminal prosecutions, the burden is on the
prosecution to prove the corpusdelicti. QUANTUM OF PROOF1. In Civil Cases the quantum of proof
necessary to prove a civil complaint is a PREPONDERANCE OF EVIDENCE. The party filing or bringing a
civil complaint has the burden of proof and must establish the truth and righteousness of his allegations
by a preponderance of the evidence admitted by a competent court.




2. In Criminal Cases the quantum is proof beyond reasonable doubt.-In a criminal case the accused is
entitled to an acquittal, unless his guilt is shown beyond reasonable doubt-Presumption of INNOCENCE
is a conclusion drawn by the constitution and the law in favor of the accused, while
REASONABLEDOUBT, is a condition of mind produced by proof resulting from evidence in the case.3. To
establish matters of defense- The doctrine of reasonable doubt applies only to incriminativefacts.4. To
establish self-defense- One who sets up SELFDEFENSE must rely on the strength of his own evidence
and not on the weakness of that of the prosecution.5. To establish Alibi- It must be proved by positive,
dear and satisfactory evidence. Oral Evidence of alibi is so easily manufactured and usually unreliable
that it can rarely be given credence.6. In Administrative Complaints- In cases filed before administrative
or quasi-judicial bodies, a fact maybe deemed established if it supported by substantial evidence
which means that amount of relevant evidence which a reasonable mind might accept as adequate to
justify a conclusion. CHAPTER 2 MEDICAL AND HOSPITAL JURISPRUDENCE Medical Jurisprudence:-Is the
study of the Medical Law and its applicable Jurisprudence that governs, regulates, and defines the
practice of medicine.-It includes the rights, duties, obligations and liabilities of both physician and
patient to each other in a physician patient professional contract. The Following Acts Constitute the
Practice of Medicine: 1. To physically examine and diagnosea patient.2. To physically examine and treat
a patient 3. To physically examine and perform surgery in a patient4. To physically examine and
prescribe any remedy to a patient.

Any person who practice any of the above acts enumerated, without any valid certificate of registration
as physician, is practicing illegal medicine. The Nature of the Physician Patient Professional Relationship
is1. Consensual: - based on mutual consent of both patient and physician. - Contracts that are
consensual in nature are perfected upon mere meetings of the minds2. Fiduciary: - founded in trust,
faith, and confidence reposed by one person in the integrity and fidelity of another. DUTIES AND
OBLIGATIONS OF THEPHYSICIAN TOWARDS HIS PATIENTS: 1. He must possess that knowledge andskill
possessed by an average physician.2. He must use such knowledge and skill with ordinary care and due
diligence.3. He is obliged to exercise his best judgment in good faith.4. He has the duty to keep the
secrets and confidentialities of his patients.

The Terms and Conditions not included in the Physician Patient Professional Relationship Contract (refer
to book)

The only promise or guaranty that the law requires is that, the physician will treat the patient in
accordance with the standards of medical care. PATIENTS RIGHTS RESPECTED BYPHYSICIANS: 1. the right
to appropriate medical careand humane treatment.2. The right to his religious belief.3. The right to
refuse treatment.4. The right to Informed Consent.5. The right to choose his physician.6. The right to
medical records.7. The right to privacy and confidentiality.8. The right to a second or third opinion.9.
The right to leave.10. The right to information.11. The right to self-determination.12. The right to refuse
participation in medical research13. The right to express grievance14. The right to be informed of his
rights and obligations.

Obligations of the Patients to their Physicians (Refer to Book)

SOCIATAL RIGHTS OF THE PATIENTSFROM THE GOVERNEMNT (Refer to Book) RIGHTS INHERENT IN THE
PRACTICE OFMEDICINE: 1. The right to choose his patients


2. The right to limit the practice of hisprofession3. The right to determine appropriate treatment
procedures in the discretion and judgment of the physician.4. The right to avail of hospital privileges
after being qualified.5. The right to receive just and fair compensation from his patients. Liabilities of a
Physician Which May Arise from His Negligent or Wrongful Acts orOmissions: 1. Administrative Liability-
A complaint under oath can be filedbefore the Professional RegulationCommission Board of Medicine,
forreprimand, of the license to practicemedicine.2. Criminal Liability- When an act or omission
constitutes a crime, the physician can be imprisoned or fined or both, as any other profession.3. Civil
Liability- The aggrieved party can be awardedmonetary damages for any wrongful ornegligent act or
omission, when theprofessional is found guilty. CASES (Refer to Book)

Ex. Negligent or Wrongful Act Medical malpractice is a particular formof negligence which consists in
thefailure of a physician or surgeon toapply to his practice of medicine that degree of care and skill
which is ordinarily employed by the profession generally, under similar conditions, and in like
surrounding circumstances There are Four Elements involved in medical negligent cases: 1. Duty2.
Breach3. Injury4. Proximate Causation It has beenrecognized that expert testimony isusually necessary
to support the conclusion as to causation.

Ex. Whether A Hospital may be Held Liable for the Negligence of Physicians Consultants allowed to
Practice in its Premises. CHAPTER 3 DEATH Legal Presumption of Death:-If absent without explanation
from his or her usual or last place of residence for a long continuous period.-Circumstantial proof of
deathEx. a passenger on an airplane that crashed is considered to have died even if no remains can be
recovered.

Rules of Evidence in Rule 131, section 5paragraph X, paragraph JJ, and paragraph KK.

In common law the presumption of death does not arise until the expiration of seven years of
continuous absence. DEATH IS THE COMPLETE CESSATION OF ALL THE VITAL FUNCTIONS OF THE BODY
WITHOUTPOSSIBILITY OF RESUSCITATION. THEASCERTAINMENT OF DEATH IS A MEDICAL ANDNOT A
LEGAL PROBLEM. Death maybeA. Brain Death occurs when there is a deeply irreversible coma, and
absence of electrical brain activity.B. Cardio Respiratory Death occurs when there is continuous and
persistent cessation of heart action and respiration.4 Kinds of Death: 1. Clinical or Somatic Death2. Brain
Death3. Biological Death4. Cellular Death Clinical or Somatic Death
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This particular kind of death occurs when in the judgment of the physician with the use of his clinical eye
the bodys vital signs of life cease to exist continuously and permanently.
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The clinical death is verifiable only by a physician after he observes that the patient no longer has a
heartbeat no pulse rate, no spontaneous breathing and movement, with the pupils of the eye widely
dilated and not reactive to light and accommodation.-When a clinically dead person is brought to the
morgue the generalized contraction of the muscles or Rigor Mortis of the body within 3 to 6 hours, may
simulate are turn to life, because of the motion or movement of the body. BRAIN DEATH
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This kind of death follows clinical death almost immediately unless resuscitative procedures are
started promptly, because the human brain under normal conditions cannot survive loss of oxygen for
more than 6 to 10 minutes.-Brain Death may occur in the Stage 1 Cerebral Cortex- the highest center
of the brain that is most sensitive to changes in the supply of oxygen and blood to the brain. When the
cerebral cortex dies, the patient is in cortical death. Stage 2 - Cerebellum It deals with the function of
equilibrium. It
follows the death of the cerebralcortex.Stage 3 Brainstem and Vital centers These centers controlling
respiration, heart rate and blood pressure, ultimately die. When it does, the patient is, Brain Stem
Dead.-If the brain stem is damaged, then the vital centers in the medulla maybe destroyed, causing the
respiratory center to fail.-The occurrence of brain stem death is equivalent to Legal Death, so that
Doctors can now issue a Death Certificate, even though the heart is still beating, and make
arrangements to harvest donor organs and tissues at this stage.-Further, in the presence of brainstem
death, artificial respirators only achieve the maintenance of an oxygenated circulation through a corpse
or cadaver. CRITERIA FOR DIAGNOSING BRAINSTEM DEATH. (refer to textbook)Persistent Vegetative
State (PVS)
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This condition exists, when irreversible destruction of the Cortex of the brain occurs without damage to
the vital centers, and there are permanent eyes open state of unconsciousness, but cardiorespiratory
functions continue, sometimes without respiratory assistance, but most often with respiratory support.-
They do not however match the clinical criteria of Brain Death, in as much as they have
elicitablereflexes, spontaneous respirations and reactions to external stimuli. HARVARD CRITERIA OF
WHOLE BRAINDEATH: 1. Unreceptivity and Unresponsitivity2. No spontaneous movements
orbreathing3. No reflexes4. Flat EEG of Confirmatory value WHOLE BRAIN DEAD-When the brain ceased
all functions, even though the heart continues to beat. As a rule doctors can legally declare whole brain
death twelve hours after they have corrected all treatable medical problems, but the brain still doesnt
respond even to induced pain , they eyes do not react to light and the person doesnt breath without a
respirator. BIOLOGICAL DEATH-All the components of the brain are dead-There is also permanent
extinction of bodily life.-It is cardiorespiratory and brain death altogether with permanent cessation of
all the anatomic and physiological functions of the bodyorgans.CELLULAR DEATH:-The death of the
different parts of the body occurs at different times and stages.-This is the reason why such organs as
the corneas and the kidneys can be removed immediately after biological death and
transplantedsuccessfully.SIGNS OF DEATH:1. Cessation of heart action andcirculation2. Cessation of
respiration3. Cooling of the body ( Algor Mortis )- The temperature of 15 20degrees Fahrenheit is
considered as a certain sign of death.4. Loss of motor power5. Loss of sensory power6. Changes in the
skin7. Changes in and about the eye- There is loss of corneal reflex CHANGES IN THE BODY
FOLLOWINGDEATH1. Changes in the Musclea. Stage of primary flaccidityb. Cadaveric rigidity or
rigormortis- muscular contraction which develops 3 6hours after death and may last for 24 36hours.
- may also be utilized to approximate the length of time the body has been dead from 3 to 36hoursc.
Stage of secondary flaccidity or commencement of putrefaction Cadaveric Spasm- is the immediate or
instantaneous spasm or rigidity of the skeletal muscles occurring at the moment of death due to
exhaustion, etc. Medico legal Importance of Cadaveric Spasm (Refer to Book) 2. Changes in the Blooda.
Coagulation of the bloodb. Postmortem lividity or Livor Mortis3. Autolytic or Auto Digestive Changes
AfterDeath4. Putrefaction of the Body PUTREFACTIVE CHANGES OCCURING AFTERDEATH (Refer to
Book) Kinds of Putrefaction: 1. Mummification

2. Saponification This is also called AdipocereFormation.3. Maceration Factors to Consider in
Approximating the Duration of Death in a Cadaver1. Entomology The presence of maggots in the
cadaver indicates duration of death for more than 24 hours2. Presence of live Fleas in clothing in death
by drowning, a flea can survive for about 24hours submerged in water. After 24 hours submersion in
water the fleas die.3. Blood vessel clots blood clotting occurs in6 -8 hours after death.4. Post Mortem
lividity develops in 3 to 6hours after death.5. Rigor Mortis- begins to develop in 3 to 6hours after
death and may last for 24 to 36hours after death.6. Onset of decomposition Decomposition takes
place within 24 48 hours after death.7. Food in the stomach8. Skeletal soft tissues soft tissues may
disappear from 1.5 years to 2 years afterburial.Position of the Body at the time of Death1. Post Mortem
lividity2. Cadaveric spasm Death due to violence or inflicted physical injuries, usually manifest the
position of the body at the time of death.Ex. In suicide by gunshot wound, the gun maybe tightly
grasped in the hand of thedeceasedIn drowning, the victim maybe holding objects that come in contact
with his hands to cling to life.MEDICOLEGAL IMPORTANCE OF RIGOR MORTISAND CADAVERIC SPASM:
Rigor mortis is utilized to approximate the time of death. Generalized muscular contractions occur from
3 to 6 hours until 36 hours. Cadaveric spasm occurs immediately after death and is useful to ascertain
the circumstances of death. Medico Legal Investigation of Death
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Deaths which are not obviously due to natural causes, but are criminal, suspicious, accidental, suicidal,
murderous, homicidal, sudden or unexpected, or unexplained, need medico legal investigation. The
Death Certificate-The death certificate is a legal document necessary for burial of the dead, as it certifies
the occurrence of death. It is document from the Office of the Civil Registrar General, listing the
particulars of an individuals death.-It contains the Immediate Cause or Primary cause of death, the
antecedent causes and underlying cause of death Immediate Cause or Primary Cause of DeathEx.
Suffocation due to drowningAsphyxiaCardio Respiratory Arrest Antecedent Cause of Death are events
or conditions that substantially contribute to the immediate cause of deathEx. Acute peritonitis, Acute
Hypovolemic shock, Acute SepticShock,Underlying Cause of Death is thebasic cause or bottom line cause
of death. It is the diagnosis of thepatients or victims illness orsickness that resulted to his deathEx.
Acute Appendicitis,Hepatocarcinoma, Pelvic Fracture,Stab or Gunshot Wound to thechest.Non Natural
Causes of DeathEx. Murder, Homecide, Suicide,AccidentDeath Warrant is a warrant from the
properexecutive authority appointing the time andplace for the execution of the sentence of death
upon a convict judicially condemned tosuffer death.Manner of Death
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Is the explanation as to how thecause of death arose, and maybeeither Natural Death or
ViolentDeathLazarus Syndrome
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Is also called Lazarus Phenomenonis the spontaneous return of circulation after failed attempts
atresuscitation.Implications of Lazarus Syndrome-raise ethical and legal issues fordoctors, who must
determine whenmedical death has occurred, whenresuscitation efforts should end,and post mortem
procedures suchas autopsies and organ harvestingmay take place.Lazarus Sign-Lazarus sign or Lazarus
reflex is areflex movement in brain deadpatients, which causes them tobriefly raise their arms and
dropthem crossed on their chests.-The phenomenon has beenobserved to occur several minutesafter
the removal of medicalventilators used to pump air in andout of brain dead patients to keeptheir bodies
alive.

NEAR DEATH EXPERIENCE
-Refers to a broad range of personalexperiences associated withimpending death,
encompassingmultiple possible sensationsincluding detachment from thebody; feelings of levitation
etc.EUTHANASIA-Meaning good death ( well or good )-Refers to the practice of ending lifein a painless
manner.-Deliberate intervention undertakenwith the express intention of endinglife, to relieve
intractable sufferingClassification of Euthanasia:1. Voluntary euthanasia is euthanasiaconducted with
consent2. Involuntary euthanasia is euthanasia conducted without consent.-is conducted where an
individual makes adecision for another person incapable of doingso.- also known as physician assisted
death,physician assisted suicide or mercy killing.3. Passive euthanasia entails withholding of common
treatments4. Active euthanasia entails the use of lethalsubstances or forces to end life and is the
mostcontroversial means.CHAPTER 4 REGIONAL TRAUMA Trauma is the leading cause of death in the
first fourdecades of life and the 3
rd
leading cause of death in all age groups today.-Penetrating trauma particularly handguns isbecoming
common in nearly all areas of thecountry. Trimodal Distribution of Death from Trauma:1. Seconds to
minutes of injury due to theinjury to the brain, high spinal cord, heart,aorta and other large vessels.
These patientscan rarely be salvaged.2. Minutes to Few hours from injury ( TheGolden Hour )- It is in this
period that Advanced Trauma LifeSupport9 ( ATLS ) techniques are important.3. Several days to weeks
of Injury these aredue to sepsis or organ failure.SPECIFIC INJURIES1. Heada. Types of Head Injuries:a.1
Hematomaa.2 Contusionsa.3 Skull fracturesa.4 Hemorrhage2. Spine and Spinal Cord Injuries The most
common causes of severespinal trauma are motor vehicular accidents,falls, diving accidents, and
gunshot wounds.3. Chesta. Life Threatening InjuriesPnumothoraxHemothoraxFlail chest as in multiple
ribfractures Cardiac tamponadedue to penetrating injuriesb. Potentially Lethal Injuriesb.1. Pulmonary
Contussion withor without flail chestb.2. Thoracic Aortic Tear orRupture the most commoncause of
sudden death after avehicular accident or fall ( majordecelaration injury )c. Serious Chest Injuries4.
Abdomen Types of Injuries:a. Penetrating- Gunshot wounds of theabdomen carry 95% probabilityof
significant visceral injury- A bullet when it hits theabdomen will penetrate theabdominal wall, enter
theabdominal cavity and mostlikely injure more than oneorgan.- The incidence of abdominalinjury is
strikingly higher ingunshot wounds than in stabwounds.- The major cause of death ishemorrhage and
this occurswithin the first 24 hours- In stab wounds of theabdomen , only 2/3 penetratethe peritoneal
cavity; of theseonly cause significant visceralinjury that requires surgicalrepair.b. Blunt- The spleen
and liver are themost commonly injured organsdue to blunt trauma.- Their frequent incidence
alsoexplains why the mortality ratefollowing blunt trauma is higherthan that of penetrating injury.5.
Fractures and Dislocations The word fracture comes from the Latinword fractura which means a break
in thecontinuity of the bone. It is also a combinationof a break in the bone and soft tissue injuryA. Open
Fractures - 90% of openfractures are caused by vehicular accident.B. Hip fractures are very common
inelderly people and are usually caused by minorfalls. It is the most common cause of traumaticdeath
after the age of 75.6. Urologic- Hematuria following trauma- Blunt kidney injury is usuallydue to motor
vehicularaccidents which account for 70 90 % of kidney trauma.- Penile injury: The erect penis is
usually 6 8inches long and 1 -2 inches indiameter.

- Avulsion of the prepuce thismay follow accidents where theforeskin called prepuce isdetached or
lacerated by a bluntforce.- Fracture of the penis this isthe traumatic rupture of thecorpora cavernosa
penisresulting from a forceful traumato the flaccid organ.- Amputated penis the penis of an avid
womanizer is sometimesintentionally cut or amputatedby a jealous derange wife orlover. 7. Arterial
trauma8. BurnsCLASSIFICATION OF WOUNDS1.AS TO LEGAL CLASSIFICATIONChapter 1DESTRUCTION OF
LIFEa. Article 246. Parricideb. Article 247. Death or Physical InjuriesInflicted Under Exceptional
Circumstancesc. Article 248. MURDER- Any person who, not falling within theprovisions of Article 246
shall kill another,shall be guilty of murder and shall be punishedby Reclusion Perpetua, to death if
committedwith any of the following attendantcircumstances;1. With treachery2. In consideration of a
price , reward orpromise3. By means of inundation etc.4. On occasion of any of the calamities etc.5.
With evident premeditation6. With cruelty etcArticle 249 HOMICIDEArticle 251. Death Caused in a
TumultousAffrayArticle 252. Physical Injuries Inflicted In a Tumultuous AffrayArticle 253. Giving
Assistance to SuicideArticle 254. Discharge of FirearmsArticle 255. InfanticideArticle 256. Intentional
AbortionArticle 257. Unintentional Abortion who shallcaused an abortion by violence but
notintentional.Article 258. Abortion Practiced by the WomanHerself or By Her ParentsArticle 259.
Abortion Practiced by a Physicianor Midwife and Dispensing of AbortivesArticle 260. Responsibility of
Participants in aDuelArticle 261. Challenging to a DuelCHAPTER2 PHYSICALINJURIESa. Article 262.
Mutilation Any person whoshall intentionally mutilate another bydepriving him, either totally or
partially , of some essential organ of reproduction.b. Article 263. Serious Physical Injuries Anyperson
who shall wound, beat, or assaultanother, shall be guilty of the crime of seriousphysical injuriesc. Article
264. Administering InjuriousSubstances or Beveragesd. Article 265. Less Serious Physical Injuries Any
person who shall inflict upon anotherphysical injuries which shall incapacitate theoffended party for
labor for 10 days or more, orshall require medical attendance for the sameperiode. Article 266. Slight
Physical Injuries andMaltreatment.- When the offender has inflicted physicalinjuries which shall
incapacitate the offendedparty for labor from one to nine days, or shallrequire medical attendance
during the sameperiod.Chapter 3, RAPE When and How rape iscommitted1. By a man who shall have
carnal knowledgeof a woman under any of the circumstancesa. Through force, threat, or intimidationb.
When the offended party is deprivedof reason or otherwise unconsciousc. By means of fraudulent
machinationsor grave abuse of authorityd. When the offended party is undertwelve ( 12 ) years of age
or is demented, eventhough none of the circumstances mentionedabove is present.2. By any person
who, under any of thecircumstances mentioned in paragraph 1hereof, shall commit an act of sexual
assaultby inserting his penis into another personsmouth or anal orifice or any instrument orobject into
the genital or anal orifice of anotherperson.Classification of Wounds2. AS TO THE DEPTH OF THE
WOUNDa. Superficial When the wound involves onlythe layer of the skinb. Deep When the wound
involves thestructures beyond the layers of the skin.b.1 Penetrating the wound enters the bodybut
does not come out. Punctured, stab andgunshot wounds usually belong to this type of wound.b.2
Perforating there is a communicationbetween the outside, inner and the outer side. There is both a
point of entry and exit.Classification of Wounds3. AS TO MORTALITYa. Deadly Wound- Death results
immediately,after the infliction of the wound. Deadlywounds though mortal, maybe prevented
withprompt medical treatment.b. Non Deadly Wounds Does not result todeath immediately, after the
wound is inflicted.A non deadly wound may cause death later,due to complications i.e. tetanus,
septicemiaClassification of Wounds:4. AS TO THE WOUNDING INSTRUMENTS USED:
a. Sharp Instruments Ex. incised wound,punctured wound, stab wound dagger orkitchen knifeb. Blunt
Instruments A block of wood or ironproduces contusion, hematoma, abrasions,lacerated wound when
used to strike, attack,wound, beat or assault anotherClassification of Wounds:5. AS TO THE
CONSEQUENTIAL INJURY AFTER THE APPLOCATION OF FORCEa. Coup Injury -b. Coup Centre Coup
Injuryc. Contre Coup Injuryd. Locus Minoris resistanciae. Extensive injuryClassification of Wounds:6. AS
TO THE INTEGRITY OF THE SKINA. CLOSED WOUNDS Presents no break in theintegrity or continuity of
the skin. There maybeonly outward manifestations of injuryinternally.Ex. of closed wounds:1. petechiae
a circumscribe extravasation of blood in the subcutaneous tissue.2. contusion effusion of blood into
the tissuesunderneath the skin as a result of a bluntforce. Ex. black eye3. Hematoma4. Blunt injury5.
Musculoskeletal injuriesEx. Sprain, Dislocation, Fracture, StrainCerebral Concussion there is a brief loss
of consciousness and sometimes memory after ahead injury that doesnt cause obviousphysical
damage.Cerebral Contusion they are bruises to thebrain, usually caused by a direct, strong blowto the
head. They are more serious thanconcussions.B. OPEN WOUNDS- There is a break in the continuity of
the skinExamples:1. Abrasion2. Bruise3. Incised wound4. Stab wound5. Punctured wound6. Perforating
wound7. Lacerated wound8. Bites9. Gunshot woundsB. OPEN WOUNDS there is a break in
thecontinuity of the skinB.1. Abrasion Scratch, friction markB.2. Bruise cause by a blunt injury to
thetissues which damage blood vessels beneaththe surface, allowing blood to extravasate orleak into
the surrounding tissues.B.3. Incised woundB.4. Stab woundB.5. Punctured woundB.6. Perforating
woundB.7. Lacerated wound result of an injury froma blunt instrument. In cerebral laceration,
thebrain tissue is torn often with anaccompanying visible head wounds and skullfractures.B.8. Bites
they maybe abraded, bruised orrarely lacerated. They are usually seen insexual assaults and in child
abuse and also byanimal bitesB.9. Gunshot wounds TEST FOR THE PRESENCE OF POWDERRESIDUES:1.
Paraffin test or Dermal Nitrate test presenton the skin of the hand dorsum or site of thewound of
entrance. This test is not conclusivebecause fertilizers, cosmetics, cigarettes, urineand other nitrogenous
compounds withnitrates will give a positive reaction. A negativetest is also not conclusive . The test
usuallygives a positive result even after a lapse of 3days or even if the hands are subjected toordinary
washing2. Use of Scanning Electron Microscope with alinked X ray analyzer. This method appearsto be
more specific but seldom used becausethe instrument is expensive.SPECIAL TYPES OF WOUNDS1.
Assailants wounds these wounds aresustained by the assailant from the victim,while the former is in
the process of attacking,wounding, assaulting, beating or killing hisvictim.2. Defense wounds in the
process of defending himself from the attacks, assault,wounding, beating or violence of the assailant,the
victim sustains defensive wounds usuallyin the upper extremities.3. Victims wounds these are
woundssustained by the victim, from the assailant, theformer not having the chance or opportunity
todefend himself. The victims wounds maybelocated in any part of the body.4. Self Inflicted wounds
these are woundsself inflicted by the person on himself. Thewounds are usually found on the
accessibleparts of the body, usually with no intention tokill himself. Unless the victim is insane, self
inflicted wounds are for a fraudulent or self serving purpose.5. Homicidal wounds these are the
seriouswounds sustained by the victim resulting to hisdeath, from the criminal assailant. Usually
thewounds are situated in the areas of the neck,chest, the abdomen and the skull.6. Accidental wounds
these wounds aresustained by the victim, without any fault orintention whatsoever on the part of
theaccused to inflict the wounds on the victim. The wounds are usually located on any part of the
victims body.7. Suicidal wounds these are wounds self inflicted by the victim on himself, and
usuallyseen on the temple, the roof of the mouth, andother fatal body areas, accessible to the handof
the victim.


CHAPTER 5 COMPREHENSIVE DANGEROUSDRUGS ACT OF 2002REPUBLIC ACT 9165A DANGEROUS DRUG
is a drug whose use isattended by risk and therefore is unsafe,perilous and hazardous to people and
society.A DRUG is any substance , vegetable, mineralor animal in origin, used in the composition
orpreparation of medicines or any substanceused as medicines. The Dangerous Drug Act of 1972,
include thefollowing Dangerous Drugs as follows:A. PROHIBITED DRUGS1. Opium and its active
componentsand derivatives such as heroin andmorphine.2. Coca leaf and its derivatives,principally
cocaine.3. Hallucinogenic drugs such asmescaline, lysergic acid diethylamide( LSD ) and other substances
producingsimilar effects.4. Other drugs whether natural orsynthetic with the physiological effectsof a
narcotic drug.B. REGULATED DRUGS1. Self inducing sedatives such assecobarbital,
phenobarbital,pentobarbital, barbital and any drugwhich contains salt or derivative of asalt of barbituric
acid.2. Any salt of amphetamine such asBenzedrine or any drug which producesa physiological action
similar toamphetamine.3. Hypnotic drugs, such asmethaqualone producing similarphysiologic
effects.IMPORTANT TERMS in the DANGEROUSDRUG ACT OF 20021. Drug Syndicate2. Illegal
Trafficking3. Chemical Diversion4. Planting Evidence5. Drug Dependence Two Classes of Drug
Dependence:a. Drug Addiction is a state of periodicor chronic intoxication produced by therepeated
consumption of a drug,whether synthetic or natural and foundto be detrimental to the individual andto
the society.Characteristics of Drug Addiction:A. An overpowering desire orneed to continue taking the
drug or toobtained it by any means.- a tendency to increase thedose.-a psychological and
physicaldependence on the effects of the drug.- a detrimental effect to thesociety and to the
individualB. Drug Habituation is the desire tohave a continuous use of the drug butwith the capacity to
refrain physicallyfrom using it.Characteristics of Drug Habituation:- The desire to use the drug isnot
compulsive but merely psychical.- There is little or no tendency toincrease the dose- The detrimental
effect if any, isprimarily on the individual.6. Protector7. Pusher8. Controlled Delivery9. Den, Dive or
Resort10. PDEA The Philippine DrugEnforcement Agency, which is theimplementing arm of the
DangerousDrugs Board.UNLAWFUL ACTS AND PENALTIES IN THE DANGEROUS DRUGS ACT OF 2002( R.A.
9165:1. Importation of Dangerous Drugs andor Controlled Precusors and EssentialChemicals.2. Sale,
Trading, Administration,Dispensation, Delivery, Distribution and Transportation of Dangerous Drugs
andor Controlled Precursors and essentialChemicals.3. Maintenance of a Den, Dive or Resort4.
Employees and Visitors of a Den,Dive or Resort5. Manufacture of Dangerous Drugs andor Controlled
Precursors and EssentialChemicals6. Illegal Chemical Diversion of Controlled Precursor and
EssentialChemicals7.Manufacture or Delivery of Equipment, Instrument, Apparatus and
Otherparaphernalia for Dangerous Drugs andor Controlled Precursors and EssentialChemicals8.
Possession of Dangerous Drugs9. Possession of Equipment,Instrument , Apparatus and
OtherParaphernalia for Dangerous drugs.10. Possession of Dangerous D DuringParties, Social Gatherings
or Meetings11. Possession of Equipment,Instrument, Apparatus and OtherParaphernalia for Dangerous
DrugsDuring Parties, Social Gatherings orMeetings12. Use of Dangerous drugs13. Cultivation or Culture
of PlantsClassified as Dangerous Drugs or areSources thereof 14. Failure to Maintain and Keep
theOriginal Records of transactions on
Dangerous drugs and or ControlledPrecursors and Essential chemicals15. Unnecessary Prescription of
Dangerous Drugs16. Unlawful Prescription of Dangerousdrugs THE CUSTODY AND DISPOSITION
OFCONFISCATED, SEIZED AND ORSURRENDERED DANGEROUS DRUGS,PLANT SOURCES OF
DANGEROUSDRUGS, CONTROLLES PRECURSORSAND ESSENTIAL CHEMICALS,INSTRUMENTS AND
PARAPHERNALIAAND OR LABORATORY EQUIPMENT The PDEA shall take charge and havecustody of all
dangerous drugs, plantsources of dangerous drugs, controlledprecursors and essential chemicals, aswell
as Instruments paraphernalia andlaboratory equipment so confiscated,seized and or surrendered, for
properdisposition in the following manner( Refer to Book ).IMPORTANT PROVISIONS OF R.A. 9165OR
THE COMPREHENSIVE DANGEROUSDRUGS ACT OF 2002Section 22. Grant of Compensation,Reward and
AwardSection 23. Plea Bargaining ProvisionSection 36. Applicants for DriversLicenseSection 38.
Laboratory Examination ortest on Apprehended / ArrestedOffendersSection 39. Accreditation of Drug
Testing Centers and PhysiciansSection 40. A physician, dentist,veterinarian or practitioner authorizedto
prescribe any dangerous drug shallissue the prescription therefore in oneoriginal and 2 duplicate
copies.Section 54. Voluntary Submission of aDrug Dependent to Confinement, Treatment and
RehabilitationSection 55 Exemption from CriminalLiabilityUnder the Voluntary
SubmissionProgramSection 56. Temporary Release fromthe Center; After Care and Follow up Treatment
Under the VoluntarySubmission ProgramSection 58. Filing of Charges Against aDrug Dependent who is
notrehabilitated Under the VoluntarySubmission Program.Section 61. Compulsory Confinement of a
drug dependent who refuses to applyunder the Voluntary SubmissionProgramSection 62. Compulsory
Submission of aDrug Dependent Charged with anOffense, to Treatment andRehabilitationSection 70.
Probation or CommunityService for a First Time Minor OffenderIn Lieu of ImprisonmentSection 73.
Liability of a Parent, Spouseor Guardian Who refuses to Cooperatewith the Board or any
ConcernedAgencySection 77. The Dangerous Drugs BoardSection 82. Creation of the PhilippineDrug
Enforcement Agency ( PDEA )Section 85. The PDEA AcademySection 90. JurisdictionSection 91.
Responsibility and Liabilityof Law Enforcement Agencies andOther Government Officials andEmployees
in Testifying as ProsecutionWitnesses in Dangerous Drug CasesSection 92. Delay and Bungling in
theProsecution of Drug CasesPHARMACOLOGIC CLASIFICATION OFDANGEROUS DRUGS1.Hypnotics2.
Sedatives and Tranquilizers3. Hallucinogens and Psychomimetics4. Stimulants5. Depressants6. Deliriants
and IntoxicantsA.Hypnotics:Opiates and Their Derivatives Opiumis obtained from the milky exudates
of the unripe seed capsules of the poppyplant, Papaver Sornoiferum.Derivatives of opium commonly
usedare morphine, heroin, and codeine.Its synthetic preparation are Demeroland Methadone. Narcotics
that have a legitimatemedical used as powerful pain relieversare called Opioids, and include
codeine,oxycodone, meperidine, morphine andhydromorphone.Heroin which is prohibited is a
verystrong pain reliever and narcoticSigns and Symptoms of OpiumAdministration:1. Stage of
Excitement2. Stage of Stupor3. Stage of NarcosisB. SEDATIVES:Barbiturates: - are the products of
malonic acid and urea, synthesized onSt. Barbara day.-Used to treat anxiety and to inducesleep can
cause both psychologicand physical dependence.C. HALLUCINOGENS ORPSYCHOMIMETIC
DRUGS:Marijuana ( Cannabis Sativa ) is aMexican term for pleasurable feeling.Marijuana is not
addictive. Physicaldependence and dose tolerance do notdevelop with its use. Psychicdependence may
occur.
Subjective effects of Marijuana:-There is a feeling of lightness of theextremities followed by rushes of
warmth and well being thateventually lead to a sense of relaxation, mild euphoria and adreamy state
where ideas aredisconnected.Objective Effects of Marijuana:-Moderate increase in resting pulserate,
reddening of the eyes due todilatation of the conjunctival bloodvessels. Difficulty of speech and of
remembering of the logical trend of what was being said.Lysergic Acid Dsethylamide ( LSD )-These drugs
are false hallucinogens.-It produces impaired judgement sothat a user might think that he canfly, and
may even jump out awindow to prove it, resulting insevere injury or
death.D.STIMULANTS:Amphetamines methamphetamines( Shabu, speed
);methylenedioxymethamphetamine( MDMA, ecstasy or Adam )-Acts on the cerebral cortex
causingalertness, excessive self confidenceand feeling of well being. Physicalperformance may to some
degreetemporarily improve.Untoward Effects:-They increase the blood pressureand heart rate. Fatal
heart attackshave occurred even in healthy,young athletes. The blood pressuremaybe so high that a
blood vesselin the brain ruptures causing astroke.Coccaine is an alkaloid from theleaves of the coca
shrub cultivated inBolivia and Peru.-It produces effects similar toamphetamines, but is a much
morepowerful stimulant.-Is used to excite the undersexed.-Is a euphoriant and readily
relievesfatigueUntoward Effects:-Same as amphetamineE. DEPRESSANTS:-Angel dust-Depresses the
brain and abusersusually become confused anddisoriented shortly after taking thedrug.-Can be
combative and because theydont feel the pain they maycontinue fighting even when hithard.CHAPTER
6 SEXUAL DYSFUNCTIONS ANDSEXUAL CRIMESSEXUALITY IS A NORMAL BIOLOGICAL URGEAND AN
IMPORTANT PART OF THE HUMANEXPERIENCE.4 Stages of a Sexual Response:1. Desire2. Arousal3.
Orgasm4. ResolutionSEXUAL DYSFUNCTIONS ( Classification )A. As to choice of sexual partners1.
Homosexual2. Infanto sexual3. Besto sexual4. Auto sexual5. Gerontophilia6. Necrophilia7. IncestB. As to
instinctual strength of the sexual urge:1. Over sex2. Under sex or sexual frigiditya. Sexual anesthesiab.
Dyspareuniac. Vaginismusd. Old ageC. As to the mode of sexual expression1. Oralisma. Fellatiob.
Cunnilingusc. Analism2. Sado masochisma. Sadismb. Masochism3. Fetishisma. Anatomicb. Clothing.c.
Necrophilicd. Odor ( ospresiophilia )Kinds of Ospresiophilia1. Urolagnia2. Coprolagnia3. Mysophiliaa.
Narcissismb. Saboteur Fetishc. VampirismD. As to the part of the body1. Sodomy2. Uranism3. Frottage4.
PartialismE. As to visual stimulus1. Voyeurism2. ScoptophiliaF. As to number1. Troilism2. PluralismG.
Other sexual deviates.1. Don Juanism2. Indecent exposure3. CoprolaliaH. Disorders of sexual function:1.
Premature ejaculation2. Retarded ejaculation

3. Low sexual desire disorder4. Sexual aversion disorder5. Sexual arousal disorder in women6. Inhibited
orgasm7. Dyspareunia8. VaginismusI. Sexual reversal1. Transvertism2. Transexualism3.
IntersexualitySEXUAL CRIMES:Chaste An unmarried woman who has had nocarnal knowledge with
men or that she nevervoluntarily had unlawful sexual intercourse. These also denotes purity of mind
andinnocence of heart.Virgin A woman who has had no carnalknowledge of man. Her genital organs
havenot been altered by carnal connection.Kinds of virginity1. Moral virginity the state of not knowing
thenature of sexual life and not having experiencesexual relation.2. Physical virginity A condition
whereby awoman is conscious of the nature of sexual lifebut has not experienced sexual intercourse.3.
Demi virginity This term refers to acondition of a woman who permits any form of sexual liberties as
long as they abstain fromrupturing the hymen by sexual act. The womanallows sexual intercourse, but
only interfemora or even inter labia, but not to theextent of rupturing the hymen.4. Virgo intacta A
truly virgin woman. Thereis no structural change in her organ,notwithstanding the fact of a previous
sexualintercourse.DEFLORATION This is the laceration orrupture of the hymen, as a result of
sexualintercourse. All other lacerations which are notdue to coitus are not considered
defloration.SEMEN AND SPERMATOZOA:ERECTILE DYSFUNCTION ( Impotence )-The diagnosis of
ErectileDysfunction is important especiallyin complaints of rape. It must beproven convincingly that
theaccused is permanently impotent,so that the crime of rape cannot beproved beyond reasonable
doubt.-Impotence usually results fromvascular impairment, neurologicdisorders, drugs, abnormalities of
the penis or psychological problemsthat interfere with sexual arousal.-These includes injury,
diabetesmellitus, stroke and drugs like allantihypertensive and psychotics,antidepressants and
somesedatives.-Alcohol can also cause impotenceand also low levels of testosteroneSEX CRIMES IN THE
REVISED PENALCODE:A. RapeB. Carnal Knowledge- is the act of a man in havingsexual bodily connection
with awoman. There is carnal knowledgeif there is the slightest penetrationin the sexual organ of the
female bythe sexual organ of the male.C. Seduction- is the art of a man enticingwomen to have unlawful
intercoursewith him by means of persuasion,solicitation, promises, bribes orother means without
employment of forceD. Acts of LasciviosnessE. Acts of Lasciviousness withConsent of the Offended
PartyF. Abduction1. Forcible Abduction2. Consensual AbductionG. AdulteryH. ConcubinageI. Bigamy J.
Marriage Contracted Against theProvisions of LawK. Premature MarriageL. Performance of Illegal
MarriageCeremonyM. ProstitutionN. Corruption of MinorsO. White Slave TradeP. Abuse Against
ChastityPROVISIONS OF THE REVISED PENALCODE APPLICABLE TO UNNATURAL SEXUALOFFENSES1.
Grave Scandal ( Art. 200 )2. Immoral Doctrines, Obscene Publicationsand Exhibitions ( Art. 201 )3.
Vagrants and Prostitutes ( Art. 202 )4. Grave Threats ( Art. 282 )5. Light Threats ( Art. 283 )6. Other Light
Threats ( Art. 285 )7. Grave Coercions8. Unjust Vexation or Any Other Coercion ( Art.287 )CHAPTER 7
MENTAL HEALTHDISORDERSMental Health Disorders include disturbancesin thinking, emotion, and
behavior. There is acomplex interaction between the physical,psychologic, social, cultural and
hereditaryinfluences.Factors that Contribute to the Development of Mental Disorders:1. Heredity the
most frequent factor thatcontributes to insanity and a good history willreveal the ascendants afflicted
with the same.2. Incestous Marriage The mental illness isaccentuated when they are blood relatives.

3. Impaired Vitality Stress, tension, worry,grief may predispose to insanity4. Poor Moral Training and
Breeding Corruptmoral upbringing in the family due toimmorality of the parents5. Psychic Factors
Factors like love, hate,rage, anger, passion disappointments6. Physical Factorsa. Non toxic factors
exhaustionresulting from severe physical and mentalstrain and traumatic injuries to the head.b. Toxic
factors drug addiction,infections of the brainKINDS OF MENTAL HEALTH DISORDERS:1. Psychosomatic
disorders physicaldisorders caused by psychologic factors.2. Somatiform disorders
encompassesseveral psychiatric disorders in which peoplereport physical symptoms but deny
havingpsychiatric problems.3. Generalized Anxiety Disorders4. Panic Attacks and Panic Disorder5.
Phobic Disordersa. Agoraphobiab. Specific phobiasc. Social phobia6. Obsessive Compulsive Disorder7.
Post Traumatic Stress Disorder8. Depression and Mania9. Bipolar Disorder10. Suicidal Behavior11.
Eating Disordersa. Anorexia nervosab. Bulimia nervosac. Binge eating disorder12. Personality
Disordersa. Paranoidb. Schizoidc. Histrionicd. Narcissistice. Antisocialf. Borderlineg. Avoidanth.
Dependenti. Obsessive Compulsive j. Passive Aggressivek. Dissociative13. Schizophrenia a serious
mental disordercharacterized by loss of contact with reality( psychosis ) , hallucinations, delusions (
falsebeliefs ) , abnormal thinking, disrupted workand social functioning Types of Schizophrenia:a.
Paranoidb. Hebephrenicc. Catatonic14. Delusional Disorder15. Psychological Incapacity a waste
basketdiagnosis because it is so broad a term, that itcovers all possible Mental Disorders.SOME
MANIFESTATIONS OF MENTALDISORDERS:1. Disorders of Cognition ( Knowing )a. Illusionb.
Hallucination2. Disorders of Memorya. Dementia3. Disorders in the Content of ThoughtA. Delusiona.
Delusion of grandeurb. Delusion of persecutionc. Delusion of referenced. Delusion of Self Accusatione.
Delusion of infidelityf. Nihilistic delusiong. Delusion of povertyh. Delusion of controli. Delusion of
depressionB. Obsession4. Disorders in the trend of thought Types:a. Maniab. Melancholia5. Disorders of
Emotions or Feelings adisorder in the state of mind, fervor, orsensibility, not in accord with reality.6.
Disorders of volition or conation ( doing )Kinds of Conation:A. Impulsion or Impulse ( Compulsion ) a
sudden and irresistible forcecompelling a person to the consciousperformance of some action
withoutmotive or forethought. Types of Compulsion:a. Pyromaniab. Kleptomaniac. Dipsomaniad.
Homicidal impulsee. Sex impulsef. Suicidal impulseDISTINCTIONS BETWEEN TRUE ANDFALSE INSANITY:1.
True insanity develops insidiouslyusually with the existence of somepredisposition to an exciting cause if
careful history is taken, while falseinsanity develops suddenly with noexisting predisposition.2. In true
insanity, there is a peculiarfacial expression, which is absent infalse insanity3. In true insanity, there is a
continuousand persistent manifestation of insanity, which is only present in falseinsanity when the
pretender is underobservation, and absent when notunder observation.4. In true insanity, there is a
clinicalentity of a specific mental disorder,which is absent in false insanity.5. In true insanity, the patient
canendure a violent or stressful activitywithout fatigue, which is not present infalse insanity

6. In true insanity, the patient does notobserve personal hygiene, in falseinsanity, the pretender
observeshygieneInsanity or Mental Illness is anexempting or mitigating circumstanceto Criminal Liability
as provided in thefollowing:1. As an exempting CircumstanceArticle 12 of the Revised PenalCode
provides, When the imbecile oran insane person has committed an actwhich the law defines as felony,
thecourt shall order his confinement in oneof the hospitals or asylums establishedfor persons thus
afflicted and he shallnot be permitted to leave without firstobtaining the permission of the samecourt.2.
As a mitigating CircumstanceArticle 13, of the Revised PenalCode provides, the following aremitigationg
circumstances:a. That the offender is deaf anddumb, blind or otherwise suffering fromphysical defect
which thus restricts hismeans of action, defense orcommunication with his fellow beings The American
Law Institute formulatedthe following Rules on CriminalResponsibility and states that;1. A person is not
responsible for hiscriminal conduct if at the time of suchconduct as a result of mental illness ordefect,
he lacks essential capacity toappreciate the criminality of hisconduct or to conform his conduct tothe
requirement of the law. 2. The term mental disease or defect does not include an
abnormalitymanifested only by repeated criminal orotherwise anti social conductFundamental
Principles of Insanity andCriminal Responsibility:1. A sane man is assumed to be whollyresponsible for
the consequence of hiscrime.2. A person who commits a criminal actis presumed to be sane.3. Crime is
always considered as anaffair of the mind as well as the bodyand to make an act or omission acrime,
there must be a criminal act( actus reus ) and an criminal mind( mens rea ) . Actur facit reum, nisimens
sit rea.Mental Deficiency or mentalretardation, is sub average intellectualability present from birth or
earlyinfancy. Intelligence is both determinedby heredity and environment. In mostcases of mental
deficiency, the cause isunknown.Classification of mental deficiency:1. Idiot The idiots intelligence
neverexceeds that of a normal child over 2years old. The IQ is between 0 20. This is usually
congenital.2. Imbecile the imbeciles intelligenceis compared to a normal child from 2 7 years old and
the IQ is 20 40.3. Feeble Minded his mentality issimilar to that of a normal childbetween 7 12 years
old and an IQ of 40 70. The Legal Importance of determiningthe persons state of mind are
thefollowingIn Criminal law, insanity exempts aperson from criminal liabilityIn Civil law, Insanity is a
restriction of the capacity of a natural person to actas provided in Article 38 of the CivilCode.Insanity
modifies or limits the capacityof a natural person to act as providedinArticle 39, also of the Civil
Code.Insanity at the time of marriage of anyor both parties is a ground for theannulment of marriage.