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LEGAL MEDICINE

DEFINITIONS

the acts of the actor are in accordance


with law
No criminal and civil liability
Ex. Self Defense, Defense of relative,
Defense of stranger, State of necessity,
Fulfillment of duty, Obedience to superior
(w/ lawful purpose)

Information:
A formal accusation of the public
prosecutor or a proceeding in
a
prosecution
Ex. Vs. Complaint

Complaint:
A formal allegation or charge against a
party by a private person
Ex. Vs. Information

Postmortem Caloricity:
The rise of temp. of the body after death
due to rapid and early putrefactive
changes. Usually in the first 2 hours.

Anthropometry/Bertillon System
For identification of human body

Coroner:
Investigative, judicial
Barrister, solicitor, medically qualified MD
>5yrs
Vs. Medico Legal Officer - MD

Privileged Communication:
An exchange of information between two
individuals in a confidential relationship.

Breach of Contract:
Breach of meeting of minds between 2
persons whereby one binds himself with
respect to the other to give something or
to render some service
Ex. MD-Px relationsship

Corpus delicti
Principle that it must be proven that a
crime has occurred before a person can
be convicted of committing the crime.
Ex. Products of conception to prove
abortion

Circumstances:
Aggravating Circumstances:
Increase the penalty/crime

Crime:
Attempted Crime:
Offender has not yet performed all acts
of execution which will produce felony
(subject phase)
Ex. Vs. Frustrated Crime
Frustrated Crime:
Offender has performed the acts that will
produce felony (subjective phase) but did
produce the crime (objective phase) due
to some independent causes.
Ex. Vs. Attempted Crime
Complex Crime:
A single act constituting 2 or more grave
felonies OR one offense is a necessary
means for committing the other.
Ex. Rape with homicide where rapist
with venereal disease and victim died
due to peritonitis (?) its complicated!

Algor Mortis:
Cooling of the body
After death the metabolic process inside
the body ceases.
The progressive fall of the body temp. is
one of the most prominent signs.
First two hours after death the cooling is
rapid.
Fall of temp. of 15 to 20 degrees
Fahrenheit is considered as a certain sign
of death.

Mitigating Circumstances:
Lessen the penalty/crime
Ordinary Mitigating Circumstances:
Can be offset by aggravating
circumstances
Lessen penalty to a minimum period w/in
a degree
Privileged Mitigating Circumstances:
Cannot be offset by aggravating
circumstances
Lessen penalty one or two degrees
Exempting Cicumstances:
Act is not voluntary
No criminal liability but with civil liability
except in accident and lawful or
insuperable cause
Ex. Imbecility & Insanity (except in
lucid interval), Minority, Accident,
Compulsion of irresistible force, Impulse
of uncontrollable fear, absolutory causes
Justifying Circumstances:

In pari delicto
Two persons or entities are equally at
fault
Ex. Woman who had an abortion
testifiying as

witness against abortionist

Subpoena
Written
notification
commanding
person to attend to court as a witness

Ex-Officio medico legal officers (5):


PHO
Staff of Hospital
Kinds of Damages:
Nominal
Actual/Compensatory
Temperate/Moderate
Moral
Types of Subpoena (court summons) (3):
Testificandum - oral testimony
Duces Tecum - for production of evidence
Duces Tecum et ad Testificandum

Summons
Written
notification
commanding
a
person to attend to court; addressed to a
defendant
Tokyo Declaration: Tokyo=Torture
guidelines to be observed by physician
concerning torture, inhuman and
degrading punishment
Torts
Legal wrong independent of contract
Includes
Direct invasion of some legal
right
Infraction of some public duty
Violation
of
some
private
obligation
Elements
Legal duty
Breach of legal duty
Injury is the approximate result
GENERALITIES
Medico-Legal Systems (3):
Medico-legal officer
Medical examiner
Coroner

Divisions of Civil Law:


Persons
Property
Obligations and contracts

May not comply with subpoena:


Court has no jurisdiction over the matter
and person of case
Residence if > 50km from the court
Transportation allowance not given (civil
case)
MD w/ emergency case and no equal
substitute
If with infirmity aggravated if complies
with subpoena
EVIDENCES
Forms of Medical Evidence (4):
Real/Autoptic - can be perceived by the
senses
Testimonial oral under oath
Documentary
Experimental
Privileged Communication:
Can be claimed in a civil case but not in
criminal
Once waived, can never be claimed
Expressed waiver
Implied waiver
Hearsay Evidence:
Dying declaration the only exception to
hearsay evidence rule
Requisites:

Consciousness

of

impending

death
Concerns
the
cause
&
circumstances of
death
Competent witness
Use in criminal case & declarant
is a
victim
Admissible: necessity, trustworthiness
Presumption of Survivorship:
< 15 yo older survives
>60 yo younger survives
< 15 yo survives vs >60yo
15-60 yo male or older survives
Presumption of Death:
Absence of 10 years
>75 yo absent for 5 years
Board a vessel lost during sea voyage or
an aeroplane
Armed forces in the war missing for 4
years
Under danger of death missing for 4
years
Diputable Presumption of Death:
Not heard of for 7 years
Presumption of Legitimacy:
Requisites:
Born after 180 days after marriage and
before 300 days after dissolution or
separation
Valid marriage
No physical impossibility
Documentary Evidences:
Formal written report
Written opinions
Certificates
Dying Declaration
Witness:
Ordinary witness:
Based on senses, may not be skilled
Expert witness:
May give opinion, deduction, conclusion,
inference, must be skilled
Stages in the Examination of a Medical
Witness:

Preliminary stage
Direct examination (Prosecution)
Cross-examination (Defense)
Re-direct examination
Re-cross examination
*Expert medical testimonies are
corroborative evidences
*Not required in cases of Res Ipsa
Loquitur
Principals of Felony:
Direct participation
Inducement
Cooperation
Elements of Felony:
Freedom
Intelligence
Methods of preserving evidence (6):
Photo, videotape,photocopy
Sketching
Description
Manikin method
In the mind of the witness
Special methods: embalming
Probative value of standard medical
textbooks:
Not admissible in court as evidence
(hearsay)
But medical witness can base opinion on
textbook
Legal Importance of Blood:
Parentage
Circumstantial or corroborative evidence
Direction of escape
Cause of death
Approximate time of the crime
Place of commission of crime
Chemical Examination of Blood:
Saline extract + NH$
Guanicum test
Benzidine Test
Phenolphthalein
Leucomalachite Green Test
Legal Importance of Sex Determination:
Identification

Marriage
Exercise of right to one sex only
Differences of rights granted by law
Primogeniture - rights of firstborn to
inheritance
Bones to determine sex of skeleton (5):
Skull
Sternum
Pelvis
Humerus
Femur
Relative position of the victim:
Testimony of witness
Nature of the instrument
Wound
Location
Direction
For Dying Declaration to be admissible to
court:
Must
concern
the
cause
and
circumstances of declarants death
Conscious of impending death
Competent witness
Victim in a criminal case to which this will
be used

Stains
Saline extract
+ NH3

Brownish
(alkaline
hematin)

Benzidine Test

Blue color in
white filter
paper

Guaiacum/Van
Deens Dyas/
Schombeins
Test

Blue

Phenolphthalei
n/ Kastle-Meyer
test
Leucomalachite
Green Test

Pink
Microchemical
Tests

Takayama Test/
Hemochromoge
n crystal

Aa

Teichmanns
Blood crystals /
Hemin crystal
test

Best test
Dark brown
rhoimbic
prisms of Cl,
hematin

Wagenhaars/
Acetonehaemin test

Schourups
Formula

Time of death

Walker/
Naphthalina
mine Test

Presence of
Gunpowder in
clothings

Ballistic Examination:
Shell
Bullet
TEST

PURPOSE

AscheimZendek Test

Sign of recent
deliver/Pregna
ncy test

Breslaus Test
Foderes
/Hydrosatic/
Static Test
Gettlers Test

Paraffin /
Dermal Nitrate/
Diphenyllamine
/ LUNGS Test

RESULT

Drowning in a
fresh water pool

Corroborative
(+) even after 3
days
& with
washing
Blood & Blood

CSF lactic acid


15mg
200mg in 5
hrs after
death
Aa, nitrogen,
axillary temp
Dark red spots
on foto paper

Peripheral
Circulation
Ligature
around base
of the finger

Magnus test

Livebirth vs
Stillborn

Green

Unsectioned
and Sectioned
lungs float in
water
Chloride
difference of
25mg
Fresh RV>LV
Sea LV>RV
Blue reaction
w/
Lungs
reagent
(+) nitrite/
nitrate

Icards Test

Flourescein
SQ, greenish
yellow
discolor. Of
skin

Diaphanous
test

Winslows
Test

Respiration

Fingers are
spread wide
through a
strong light red
no movement
in the image
formed by

reflecting
artificial light
on the water
in a saucer
and placed in
the chest if
respiration is
taking place.

Winslows test no movement in the


image formed by reflecting artificial
light on the water in a saucer and
placed in the chest if respiration is
taking place.
DECEPTION DETECTION
Methods used (6):
Lie detector / Keelers Polygraph
Intoxication
Word association time interval between question &
answer

Truth serum
Narcoanalysis
Hypnotism

Na amytal, Na penthotal

Factors for Unreliability of Polygraph:


Extreme emotions
Physiologic abnormalities
Mental abnormalities
* Use of control questions > Most reliable & effective
questioning

Carnal knowledge
With deceit
Qualified Seduction:
Must be a virgin
Over 12, under 18 yo
Carnal knowledge
With abuse of authority,
relationship

Financial constraints

confidence,

Acts of Lasciviousness
Consented Abduction:
Must be a virgin
Over 12, under 18 yo
With consent
With lewd design
Forcible Abduction:
Woman
Against will
With lewd design
Extent of Hymenal Lacerations:
Complete
Incomplete
Complicated
Infection
Hemorrhage
Fistula
Scar

SEXUAL CRIMES
Kinds of Virginity:
Physical
Moral
Demi
Virgo intacta

BIRTHING & ABORTION:


Legal Importance of Pregnancy:
Suspension of death sentence
Conceived child
Capable of receiving donation
May exercise civil rights
Annulment when concealed

Rape:
Carnal knowledge of a woman +
Force/Intimidation
Deprived of reason
Unconscious
Under 12 years old Statutory Rape

Legal importance of birth:


Personality
Appearance is a ground for revocation of
donation
Proof of live birth before death in
infanticide

Simple Seduction:
May not be a virgin
Over 12, under 18 yo
Single/Widow + good reputation

Reasons for abortion:


Preserve life and health of woman
Preserve body form
Illegitimate pregnancy

Atmospheric pressure

Legal
justification
for
therapeutic
abortion:
No other practical and most practical
means
Evil sought to be avoided exists
Injury greater if it was not done
Difficulty in prosecuting MDs with crime
of abortion:
Intelligent & aware of criminal act
Medical justifications
Products of conception as corpus delicti*
is lost
Woman, witness, is in pari delicto*
Medical society lukewarm against helping
state prosecute abortionist
Legal viewpoint of when is a child born:
Civil purposes, fetus is considered born if:
Alive at the time it is completely
delivered
*Preterm (<7mos) dies within 24 hours is
not considered born
MARITAL RELATIONS
Summary of causes of dissatisfaction:
Sexual desires, aversions, etc.
Pregnancy/Fertility-related
Diseases
Infidelity
Ignorance
*Requirements before
contraindications

inserting

INJURIES/WOUNDS:
Legal Classification:
Slight physical injuries 1-9days
Less serious physical injuries
Serious physical injuries
Mutilation
Administering injurious beverage?
Causes of Physical Injuries:
Chemical
Electrical
Physical
Violence
Thermal

IUD;

Radiation
Infection
Diagnosis of Drunkenness:
History
Observations
Irregular behavior
Tremor or error of coordination and
orientation
Impaired speech/articulation
Physical Examination
Smell
Congested conjunctivae
Dry furred tongue/excessive salivation
Laboratory
Blood and urine alcohol content
DEATH
Legal Importance of Determining Death:
Extinguished
Civil personality
Criminal liability
Civil Case dismissed
Properties transmitted to heir
Signs of Death (Check):
Heart/Circulation
Lungs/Respiration
Skin/Cooling,
heat,
movement
Eye

insensibility,

Changes of the body after death:


Putrefaction
Autolytic/Autodigestion
Muscles
Blood
Stages of Muscular tissue changes after
death:
Primary Flaccidity
Relaxed muscles
(+) contraction when stimulated
Dilated pupils
Relaxed sphincters
Postmortem Rigidity
Cadaveric rigidity/Death struggle
Rigor mortis
*3-6 hours after death up to 24-36hrs

Secondary Flaccidity/Commencement of
Putrifaction
(-) contraction when stimulated
Alkaline reaction
5 Points in Determining duration of death
of body:
Rigor mortis
Post-mortem lividity
Decomposition
Stage of decomposition
Entomology
Medico-legal Classification of Death:
Natural
Violent: Penal Classification
Accidental
Suicidal
Negligent
Homicide
Murder
Parricide
Infanticide
Psychological classification of causes of
death:
Sncope
Asphyxia
Coma
Methods of Judicial Death:
Electrocution
the only method recognized by civil
laws
Mechanisms of Death
Vfib
Respi failure
Mechanical asphyxia
Gas chamber
Hanging in military & court marshal
Musketry in military & court marshal
(Lethal injection?)
*MD murder vs. accessory to suicide
Asphyxia:
Classification:
Hanging
Strangulation
Ligature
Manual throttling

Palmar
Garroting
Mugging
Stick compression
Suffocation
Submersion/Drowning
Pressure
Gases
Stages:
Hyspneic
Convulsive
Phassic
Burns & Scalds:
Delayed causes of death:
Exhaustion
Dehydration with hemoconcentration
Secondary shock
Hypothermia
Gunshots
Suicide Evidences:
Suicide note
One gunshot wound
Contact or near contact
Burning
Smudging
Tattooing
Portion accessible to hand
Weapon held tightly or found nearby
With history or cause of despondency
Exclusion of others by evidence
AUTOPSIES
Persons authorized to perform
autopsies:
1. Health Officers
2. Medical officer of law enforcement
agencies.
3. Members of the medical staff of
accredited hospitals.
Autopsies shall be performed in the
following cases.
1. Required by special laws
2. Order of competent court, mayor,
fiscal
3. Written request of police officers

4. SolGen, fiscal disinter to determine


cause of death.
5. Written request of nearest kin to
ascertain cause of death.
Points noted when unknown body is
found:
Place where body is found
Time when found
Time of death
Cause of death
Approximate age
Supposed profession
Description of the body

Respiration de surprise one deept


inspiration
Phase of resistance
Dyspneic phase
Apneic phase
Termination of respiration
Summary
Cause of
Death

Asphyxia

Ophtha Findings:
Pale & atrophic optic disc, retina
Fundus yellow brown / gray
Segmented & indistinguishable retinal
vessels
Determining
height
of
abnormally
developed person:
Vertex symphysis pubis X 2
Sternal notch symphysis pubis X 3
Base of skull coccyx 44% of height
Determining age of fetus: Haases Rule
<25cm = square root of length age in
months
>25cm = length (cm) / 5 age in
months
Poisoning
Arsenic (chronic):
Emaciated body
Yellowish brown skin
Scarce hair
Pigmentation,
eczema,
thickening
Opium (post-mortem):
Livid face
Congested brain
Pinpoint pupils
Engorged lungs with frothy fluid
Drowning:
Death occurs in 2-5 minutes
Phases:

localized

Burns
CO
poisoning
Coma
Electricity
Gunshot
Opium
poisoning
Starvation

Important Post-Mortem Findings


La Facies Sympathetic (hanging)
Inverted V shape ligature mark
---------------------------------------------------------Washerwomans Hands (drowning)
Champignon d acume (specific for
drowning; froth in the mouth and
nose)
Cutis anserine/gooseflesh
Emphysema
aquosum(distended
lungs)
Edema aquosum (frothy)
----------------------------------------------------------Tardieus
spot
(Punctiform
hemorrhages)
R heart congested, L empty
Rigor mortis slow onset
Pugilistic position of the body
Bright pink color of blood
Congestion of brain & spinal cord
Burns with metallization
Contusion collar
Pinpoint pupils
General reduction in the size &
weight of all organs except the
BRAIN

Asphyxia
(hanging)
-La
facies
sympathetic
Asphyxia (drowning)
Burns Pugilistic position of the body
******************************************
MEDICAL JURISPRUDENCE
Objectives of Medical Act of 1959:

Standardization & regulation of medical


education
Board exam
Supervision, control, regulation of
practice of medicine
Asumpsit on quantum meruit:
A person employs another to do work for
him without prior agreement as to his
compensation but the law implies that
the worker be paid for his services as he
merits
PD 223: Composition of PRC
Appointed by the President w/o
reappointment:
Full time Commissioner (1) 9
years
Fulltime
Associate
Commissioners (2)
6y, 3y
RA 5912: No selling of samples; P10004000,
6mos-4years
RA 6111: Medical Care Act of 1969
Program I SSS, GSIS except AFP
Program II all others
RA 6425:
Drugs

Prescription of Dangerous

BOARD OF MEDICAL EDUCATION


Composition
of
Board
of
Medical
Education (5):
Chairman: Secretary of Education/Rep
Director of Bureau of Private schools/rep
Chairman of Board of Med Ed/rep
Dean UP College of Medicine/rep
Rep of APMC
Function of Board of Med Ed:
Admission requirements to college of
medicine
Minimum physical facilities of med school
Qualification of teachers
Curriculum
Number of students allowed to take
preparatory course
Select & approve hospitals for training
Rules and regulation for implementation

Quasi-judicial functions:
To subpoena
To issue injunction
Candidates for Board Exam:
Filipino Citizen / Foreigner from country
with reciprocal medical practice
Good moral character, Sound mind
Not convicted of offense on moral
turpitude
Degree of MD from govt. recognized
med school
Completed internship
PRACTICE OF MEDICINE
Prerequisites:
21 yo
Board passer
Licensed
Legal Duties towards patients (5):
Skill
Knowledge
Ordinary care & diligence
Best judgment
Good faith
May attend to Emergency cases:
Any person
Medical student and RNs
MDs
Grounds for reprimand, suspension,
revocation of license:
Conviction of any criminal offense of
moral turpitude
Immoral/dishonorable conduct
Insanity
Fraud
Gross negligence, ignorance,
incompetence resulting to injury or death
of patient
Addiction or gambling rendering him
incompetent
False,
extravagant,
unethical
advertisements
Criminal abortion
Issuing false medical certificate

Spreading news/rumor derogatory to


another physician with no objective
motive
Dummy of an unqualified or unregistered
person
Violation of PMA Code of Ethics

Kinds of Medical Malpractice:


Administrative
Criminal
Civil

Can practice medicine w/o license:


Foreign MDs w/ definite work authorized
by Board of Medical Examiners
US Armed Forces commissioned medical
officers
Foreign exchange professors authorized
by BME
Medical students, graduates, RNs during
national emergency

FEES:
Instances when it cannot be recovered:
Gratuitous agreement
Charity institutions to indigent patients
Govt. and private
Waived by MD
Previous agreement on compensation of
MD
Expressed contract of cure and failure to
comply even with diligence and outmost
good faith

Why Judicial persons cannot practice


medicine:
Cannot be subjected to examination
May do so through its agents as
subordinates to MDs
Not Practice of Medicine:
Application of medicine does not always
constitute practice of medicine
Electric machine by barbers - beautifying
body
Electric vibrator, sunrays lamp
Medicated massage
Administration of anesthetics by RNs in
surgery
Sale of medicine or drugs
Limitations in Practice of healing art
imposed by:
Self
Specialization, Ignorance, Retirement
Public
Religion
Ethics
Medical Society
Law
Prescription of Regulated Drugs:
3 copies
Pharmacist original copy x 1 year
Issuing MD
Buyer until drug is consumed
*Medical Malpractice vs. Illegal Practice
of Medicine

Facts to be proved to recover medical


fee:
MD who served is qualified and licensed
Performed professional services
Reasonable fee
Person is liable for payment
Responsible for Payment in Order:
Spouse
Descendants
Ascendants
Siblings
Third person
HOSPITAL
Responsibilities in Emergency cases:
Admission
Transfer
Discharge
PRINCIPLES
Informed Consent:
Not needed:
In emergency
When compulsory accdg to law
DOCTRINES:
Malpractice:
Doctrine
Assumption of Risk
Borrowed Servant

Description
Temporary master
must be

responsible for the


wrongful act of
servant
Contributory
Negligence
Forseeability
Independent
Contractor theory

Last Clear Chance


Res Ipsa Loquitor

Respondent
Superior
Contract
for
Service
Use of hospital for
the px
Due to negligence
Exclusive control of

Vicarious Liability

Defendant
No contribution
from the plaintiff
Contract of Service
A master is liable
for the wrongful
acts of his servant
w/in scope of
authority (hospital)
Administrative or
ministerial duties
Negligence of his

partner
Acts of his agent
Not his partner
Interns
MD not liable for the act of another:
Substitute practitioner
Recommended practitioner
Negligence of another in operating in
wrong place
Interns, nurses orderlies employed by
hospital

PUNISHMENTS:
Violation of ethical law of profession:
Civil liability
Public censure
Suspension or revocation of license
Penalty for Illegal Practice of medicine:
>/= P1500 and/or
1-5 years imprisonment
PATIENTS RIGHTS:
Right
of
Privacy
Communication

from

Privileged