LEGAL MEDICINE

WHY STUDY LEG MED?

Rules of Court, Rule 138 §5

 Sec. 5. Additional requirements for other applicants. - xxx No applicant shall be

admitted to the bar examinations unless he has satisfactorily completed the following
courses in a law school or university duly recognized by the government: civil law,
commercial law, remedial law, criminal law, public and private international law,
political law, labor and social legislation, medical jurisprudence, taxation and legal
ethics.

Code of Hammurabi

 ―If a physician make a large incision with the operating knife, and kill him, or open a
tumor with the operating knife, and cut out the eye, his hands shall be cut off.‖

Law and Medicine

 It is inevitable that the two disciplines intersect.

1. Medical knowledge and the forensic science can help elucidate legal problems.

2. The practice of medicine, administration of hospitals and other health related fields
remain to be governed by law.

Legal Medicine
  Branch of medicine which deals with the application of medical knowledge to the
purpose of law and in the administration of justice (Solis, Legal medicine p. 1)

 Application of Medicine to Law

Medical Jurisprudence

 Legal aspect of medical practice (Solis, Medical Jurisprudence p.1)

 Application of Law to Medicine

 Suicide is the third leading cause of death among attorneys, after cancer and heart
disease.

 So, why are lawyers far more prone to ending their own lives than almost everyone else?
Part of the answer lies in their significantly heightened rates of depression and
substance abuse. Studies have shown that lawyers are more than three times more likely
to be depressed than others, and roughly twice as addicted to alcohol or other drugs as
the rest of the population.

 Forensic Science

 Forensic Medicine

 Forensic Science

Application of a broad range of scientific disciplines to public or legal concerns

Forensic Medicine

 Forensic Medicine – branch of medicine that deals with use of medical knowledge to
elucidate legal problems; sometimes it is used synonymously with Legal Medicine.

Application of Medicine to Law

CIVIL LAW

 determination of civil personality (NCC, art 40,41,42)

 limitation of person’s capacity to act (NCC, article 38, 39)

 marriage and legal separation - psychological incapacity

 paternity and filiation

 testamentary capacity of a person making a will

CRIMINAL LAW

 Circumstances affecting criminal liability (insanity)

 Crimes against persons

 Crimes against chastity

 Dangerous Drugs Act

 VAWC

REMEDIAL LAW

 Physical and mental examination of the person (rule 28)

 Proceeding for hospitalization of an insane person (rule 101)

 DNA evidence

 Labor Law – Employee’s Compensation

 Insurance Law

 Special laws – Juvenile Justice Act, Code of Sanitation

 Capacity to Enter Contracts

OTHERS

 Regulation of Professions – Medicine and Allied Medical Sciences

 Licensing of Hospitals

 Duties imposed by law on Health Care providers

 Health Insurance

 Health related Laws

 Medical Negligence

 Hospital Liability

 Health Maintenance Organizations

 Medical Privacy

 Rights of Patients

 Medical Records

Forensic Medicine

 Clinical Forensic Medicine

 Forensic Psychiatry

 Forensic Pathology

CLINICAL FORENSIC MEDICINE

 Clinical Forensic Medicine –branch of medicine that deals specifically with cases
involving both legal and medical aspects of patient care.

 Examples: Request for Physical Examination of person in custody, Aging of Wounds to

determine if consistent with Alleged date of infliction

Forensic Pathology

 Forensic pathology – subspecialty of pathology that focuses on medico-legal death

investigation; for death under suspicious circumstances, medico-legal officer can
conduct an autopsy

Autopsy

 Code on Sanitation, P.D. 856 §95 (1975)

  Person authorized to perform Autopsies:

1. Health officers;

2. Medical officers of law enforcement agencies; and

3. Members of the medical staff of accredited hospitals.

 Autopsies shall be performed in the following cases:

1. Whenever required by special laws

2. By Order of Court or Fiscal

3. Upon written request of police authorities

4. Whenever the Solicitor General, provincial or city fiscal as authorized by existing laws,
shall deem it necessary to disinter and take possession of remains for examination to
determine the cause of death

5. Whenever the nearest kin shall Request in writing the authorities concerned to ascertain
the cause of death

AUTOPSIES MAY BE PERFORMED ON PATIENTS WHO DIE IN ACCREDITED

HOSPITALS SUBJECT TO THE FOLLOWING REQUIREMENTS:

1. The Director of the hospital shall notify the next of kin of the death of the deceased and
request permission to perform an autopsy.

2. Autopsy can be performed when the permission is granted or no objection is raised to such
autopsy within 48 hours after death.

3. In cases where the deceased has no next of kin, the permission shall be secured from the local
health authority.

Behavioral Science

 Forensic Psychiatry – use of psychiatric evaluation and knowledge on human behavior

to elucidate legal problems, provision of therapeutic services

 Forensic Psychology – use of knowledge of the behavioral science for assessment of

criminal behavior, provision of therapeutic services provided to individuals in forensic
settings

 Application: Determination of Age, Capacity to Act and competence, Circumstances that

modify criminal liability, Drug abuse, mental illness, suicide, sexual deviance, Support
for Victims of Sexual Assault, Violence or Abuse, Criminal Profiling
 FORENSIC SCIENCE

 Forensic entomology

 Forensic odontology

 Forensic anthropology

 Forensic toxicology

 Forensic Chemistry

 Forensic Computer Science

Forensic Entomology

 Forensic Entomology – application of knowledge about insects, insect identification;

knowledge of their developmental and reproductive stages to deal with legal problems
such as time of death, and reconstruction of crime scene.

Forensic Odontology

 Forensic Odontology – the application odontology to legal problems such as

identification of human remains, and analysis of bitemarks

 Presidential Decree No. 1575 requires practitioners of dentistry to keep and maintain an
accurate and complete record of the dentition of all their patients.

 Upon the lapse of ten years from the last entry, dental practitioners shall turn over the
dental records of their patients to the National Bureau of Investigation for record
purposes

Forensic Anthropology

 Forensic Anthropology –discipline concerned with study of skeletonized human

remains as they apply to identification, determination of age, sex, presence of trauma or
disease, includes both anthropology and archaeology

 Anthropology is the study of humans, their cultures, and their biology.

FORENSIC TOXICOLOGY

 Forensic Toxicology – discipline that concerns itself with a study on drugs and
metabolites in biological fluids with application in medico-legal cases; study of poisons
and the different types of poisoning.

FORENSIC CHEMISTRY
Forensic Chemistry – scientific examination and identification of physical evidence such as
blood and seminal fluids, gunpowder residues, explosives, hairs and fibers, tool marks, glass
fragments/fractures, paints and soil

 Forensic instrumentation - analytical chemistry such as spectroscopy (how a material

absorbs light – comparison of paint chips, textile fibers), chromatography(techniques to
separate mixtures of solids or liquids into individual components for analysis of drugs,
explosive residues) and microscopy as applied to forensic examinations.

 DNA Analysis – use of DNA to elucidate legal problems including identification of body
fluids, stains, and determination of species.

FORENSIC COMPUTER SCIENCE

 Forensic Computer Science – the application of knowledge on computers and

technology to elucidate legal problems such as recovery and analysis of digital evidence,
documentation and interpretation of computer data, and other legal issues involving use
of computer or networks as a tool or target in the commission of the crime.

OTHERS

 Questioned Document Examination - study of all types of questioned documents

including handwriting analysis, examination of signatures, study of document
alterations of obliterations and examination of counterfeit bills

 Forensic Photography – documentation of crime scene and physical evidence

 Dactyloscopy - study of fingerprint principles in criminal investigation

 Polygraphy- specific detection of deception in relation to criminal investigation.

HISTORY

So the other disciples told him, ―We have seen the Lord!‖ But he said to them, ―Unless I see
the nail marks in his hands and put my finger where the nails were, and put my hand into his
side, I will not believe.‖ (John 20:25)

St. Thomas the Doubter – said to be the patron saint of Forensic Science

 Hippocrates (460-355 BC) – discussed lethality of wounds

 Antistius - he is the forensic pathologist who performed an autopsy on Julius Cesar

(100-44 BC) and found out that Julius Cesar suffered from 23 wounds, only one
penetrated the chest cavity through the space between the first and second ribs.

 Song Ci – Father of forensic medicine

He published a 5 volume book on forensic medicine that was useful reference for the

Justice bureaucracy, His Yuan Lu (Instructions to Coroner), included topics like

abortion, infanticide, drowning, poisoning, examination of dead
 FORENSICS IN THE PHILIPPINES

 1858 - first medical textbook related to medico-legal practice by Spanish Physician Dr.
Rafael Genard y Mas

 1871 - Legal Medicine was included as a subject in the School of Medicine of Real y
Pontifica Universidad de Santo Tomas

 1895 – Medico-legal laboratory was established in the City of Manila

 December 10, 1937 – Commonwealth Act No. 181 was passed creating the Division of
Investigation under the Department of Justice. Medico-Legal Section was an integral
part and Dr. Gregorio Lantin was chief

 June 19, 1947 – Republic Act No. 157 created the Bureau of Investigation

 June 18, 1949 – Republic Act 409 – creation of the Office of the Medical Examiners and
Criminal Investigation Laboratory under the Police Department of the City of Manila

Read Solis, Legal Medicine, 6-11 (1988)

CSI TV SHOWS – FACT OR FICTION?

 State-of-the art technology

 Single hair or flake of paint leads to culprit

 glamorous CSIs

 CSIs confronting witnesses during the investigation

 Persons under investigation will confess

MODERN FORENSICS

 Before, criminal investigation relied on fingerprints and eyewitness

 Trace evidence

 DNA Evidence

 Improved Database

 Fingerprint Database

FINGERPRINT DATABASE IN THE PHILIPPINES

 Fingerprint database – mostly those with criminal records

 Half a million prints in database

  39M unclassified fingerprint cards

 Automated Fingerprint Identification System or (AFIS) - which can process 40,000

prints a minute

FORENSICS IN THE PHILIPPINES

 Major agencies of government concerned with forensic investigations:

1. National Bureau of Investigation – Taft Avenue, Manila

2. Philippine National Police – Camp Crame, Quezon City- Scene of the Crime Operation
(SOCO Units)

3. Local Crime Laboratories

 Resources usually go to analysis of drugs and DNA

4. PAO Forensic Laboratory – to provide support to public attorneys and indigent clients;
Forensic Osteology, Forensic Odontology, Forensic Archaelogy, Bloodstain Pattern Analysis
and Crime Scene Reconstruction, Evidence and Forensic Photography; Director Atty. Erwin
Erfe, MD.

5. Philippine General Hospital – Child Protection Unit

NBI TECHNICAL DIVISIONS

 Behavioral Science Division

 Dactyloscopy Division

 Electronic Data Processing Division

 Firearms Investigation Division

 Forensic Chemistry Division

 Identification and Records Division

 Medico-Legal Division

 Photography and Publication Division

 Polygraph Division

 Questioned Documents Division

OTHERS

 Senate Bill No. 1868 - seeks to establish and provide funding for a Forensic Science
Institute in the University of the Philippines system to provide competent, scientific
and modern technical services for the detection and investigation of crimes.
  Technical Group already working on curriculum for a B.S. Forensic Science under CHED

 SAMPLE QUESTION

 1. The body vested by law to have general supervision and

regulation over the practice of medicine is:

A.

Commission on Higher Education

B.

Department of Education

C.

Professional Regulatory Commission

D.

Board of Medical Education

When is a Person considered born?

• Art. 40. Birth determines personality; but the conceived child shall be considered born
for all purposes that are favorable to it, provided it be born later with the conditions
specified in the following article.

• Art. 41. For civil purposes, the fetus is considered born if it is alive at the time it is
completely delivered from the mother's womb. However, if the fetus had an intra-
uterine life of less than seven months, it is not deemed born if it dies within twenty-four
hours after its complete delivery from the maternal womb.

What is the Intrauterine Life?

A conceived child shall be considered born for all purposes favorable to it provided that:

a. Delivered alive – INTRAUTERINE LIFE of 7 months or older (7m, >7m)

b. Delivered alive at less than 7 months, does NOT die within 24 hours (<7m)

• Whether an infant survives for 24 hours is a determination made in the hospitals or by

someone who attends to a woman during childbirth. In very rare instance, some
newborn babies would appear dead but are in fact still alive.

Gestational Age

The law assumes that a baby born at 7 months would survive.

 • In the Philippine General Hospital – a baby born at 27 weeks survived

• In the United States – A baby named Amillia Taylor was born at 21 weeks and 6 days
weighing only 283 grams (2006)

Gestational Age

• Counted from first day of last menstruation of mother

• May also be based on early ultrasound

• From first day of last menstruation – expected date of delivery will be from 38 to 42
weeks

CAPACITY TO ACT

• NCC, Art. 38. Minority, insanity or imbecility, the state of being a deaf-mute, prodigality
and civil interdiction are mere restrictions on capacity to act, and do not exempt the
incapacitated person from certain obligations, as when the latter arise from his acts or
from property relations, such as easements. (32a)

• Art. 39. The following circumstances, among others, modify or limit capacity to act: age,
insanity, imbecility, the state of being a deaf-mute, penalty, prodigality, family relations,
alienage, absence, insolvency and trusteeship. The consequences of these circumstances
are governed in this Code, other codes, the Rules of Court, and in special laws. Capacity
to act is not limited on account of religious belief or political opinion.

• A married woman, twenty-one years of age or over, is qualified for all acts of civil life,
except in cases specified by law. (n)

AGE

• R.A. 9344, SEC. 6. Minimum Age of Criminal Responsibility. - A child fifteen (15) years
of age or under at the time of the commission of the offense shall be exempt from
criminal liability.

• Sec. 7. xxx The age of a child may be determined from the child's birth certificate,
baptismal certificate or any other pertinent documents. In the absence of these
documents, age may be based on information from the child himself/herself,
testimonies of other persons, the physical appearance of the child and other relevant
evidence. xxx

• *OLD AGE –over 70 years old – mitigating circumstance

MENTAL RETARDATION

IMBECILITY

• Wechsler IQ test ratings identify those as imbeciles who suffer moderate mental
retardation.

- Idiot - 2 years old, profound Mental Retardation IQ – below 20

- Imbecile - 2-7 years old, moderate to severe mental retardation – IQ 20-49

- Moron – 7-12 years old, Mild mental retardation -- IQ 50-69

 - DEAF MUTE

- The absence of a qualified interpreter in sign language and of any other means, whether
in writing or otherwise, to inform the accused of the charges against him denied the
accused his fundamental right to due process of law. [People vs. Parazo, 310 SCRA
146(1999)]

• INSANITY - a person with a psychiatric condition is considered insane, usually those

who suffer hallucinations, delusions, disordered thinking

• Lucid intervals - usually, those with a psychiatric condition, controlled by medication,

or therapy would ―think clearly‖

• Ex. Schizophrenia (medical criteria)

• Developmental disorders include autism and mental retardation, disorders which are
typically first evident in childhood

• Personality disorders are clinical syndromes which have a more long lasting symptoms
and encompass the individual's way of interacting with the world. They include
Paranoid, Antisocial, and Borderline Personality Disorders.

• the intention of the law to confine the application of Article 36 to the most serious cases
of personality disorders, clearly demonstrative of an utter insensitivity or inability to
give meaning and significance to the marriage; that the psychological illness that must
have afflicted a party at the inception of the marriage should be a malady so grave and
permanent as to deprive one of awareness of the duties and responsibilities of the
matrimonial bond he or she is about to assume. [Suazo vs. Suazo, 615 SCRA 154(2010)]

• PSYCHOLOGICAL INCAPACITY

• Pathological Lying (Magical Thinking) - Antonio vs. Reyes, 484 SCRA 353, March 10,
2006

• Constant nonfulfillment, senseless and protracted refusal to have sexual intercourse [Chi
Ming Tsoi vs. Court of Appeals, 266 SCRA 324(1997)]

INSANITY MENTIONED IN LAW

• Competency to stand Trial

• Exempting Circumstance

• Death convict who becomes insane after his final conviction cannot be executed while in
a state of insanity

• Detention by reason of insanity or imbecility is not considered a penalty

NO TEMPORARY INSANITY

• Neither are we persuaded by EDGARDO’s plea of ―temporary insanity.‖ As the OSG

aptly stated, ―temporary insanity‖ is not recognized in this jurisdiction. Insanity, under
Article 12 of the Revised Penal Code, connotes that the accused must have been
 deprived completely of reason and freedom of the will at the time of the commission of
the crime, or that he must have acted without the least discernment. Mere abnormality
of the accused’s mental faculties does not exclude imputability. [People vs. Aquino, 322
SCRA 769(2000)]

MEDICA;L JURISPRUDENCE

• Dentistry (R.A. No. 9484)

• Medical Technology (R.A. No. 5527)

• Medicine (R.A. No. 2383, as amended)

• Midwifery (R.A. No. 7392)

• Nursing (R.A. No. 9173)

• Nutrition and Dietetics (P.D. No. 1286)

• Optometry (R.A. No. 8050)

• Pharmacy (R.A. No. 5921)

• Physical Therapy and Occupational Therapy (R.A. No. 5680)

• Psychology (R.A. No. 10029)

• Radiologic and X-Ray Technology (R.A. No. 7431)

• Sanitary Engineering (R.A. No. 1364)

• Social Workers (R.A. No. 4373)

• Veterinary Medicine (R.A. No. 9268)

• Health related professions are generally regulated by law and have a Code of Ethics
applicable to the profession

• Law and Code of Ethics embody the ideals expected of the health professional, and
serve basis for self-regulation and administrative liability.

HEALTH INFORMATION PRIVACY

• Privacy - the state of being free from intrusion or disturbance in one's private life or
affairs

• Confidentiality - privacy of information and its protection against unauthorized

disclosure

• Medical or Health Privacy – protection of the confidential nature of personal health

information, includes communications between health provider and patient, personal
data and information about disease or patient’s condition as contained in medical
records
 Rules of Court, Rule 128 Sec. 24

• Disqualification by reason of privileged communication. — The following persons

cannot testify as to matters learned in confidence in the following cases: xxx

• (c) A person authorized to practice medicine, surgery or obstetrics cannot in a civil case,
without the consent of the patient, be examined as to any advice or treatment given by
him or any information which he may have acquired in attending such patient in a
professional capacity, which information was necessary to enable him to act in capacity,
and which would blacken the reputation of the patient. xxx

PHYSICIAN AND HOSPITAL ;LIABILITY

Sources of Obligation

• Delict

• Quasi-delict

• Contract

• Quasi-contract

PRACTICE OF MEDICINE

A person shall be considered as engaged in the practice of medicine

(a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or
through another, or even without the same, physical examine any person, and diagnose, treat,
operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or
physical condition or any ailment, real or imaginary, regardless of the nature of the remedy or
treatment administered, prescribed or recommended; or

(b) who shall, by means of signs, cards, advertisements, written or printed matter, or through
the radio, television or any other means of communication, either offer or undertake by any
means or method to diagnose, treat, operate or prescribe any remedy for any human disease,
injury, deformity, physical, mental or physical condition; or

(c) who falsely shall use the title M.D. after his name. (Republic Act No. 2382, §10)

The following are NOT acts constituting the practice of medicine

(a) any medical student duly enrolled in an approved medical college or school under training,
serving without any professional fee in any government or private hospital, provided that he
renders such service under the direct supervision and control of a registered physician;

(b) any legally registered dentist engaged exclusively in the practice of dentistry;

(c) any duly registered masseur or physiotherapist, provided that he applies massage or other
physical means upon written order or prescription of a duly registered physician, or provided
that such application of massage or physical means shall be limited to physical or muscular
development;
(d) any duly registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or
other similar appliances or who is engaged in the mechanical examination of eyes for the
purpose of constructing or adjusting eye glasses, spectacles and lenses;

(e) any person who renders any service gratuitously in cases of emergency, or in places where
the services of a duly registered physician, nurse or midwife are not available;

(f) any person who administers or recommends any household remedy as per classification of
existing Pharmacy Laws; and

(g) any psychologist or mental hygienist in the performance of his duties, provided such
performance is done in conjunction with a duly registered physician.

(Republic Act No. 2382, §11)

CRIMINAL LIABILITY

* Degree of Instruction as an Alternative Circumstance

• Illegal Practice of Medicine

• False Medical Certificate

• Abortion practiced by a physician or midwife

• Simulation of births, substitution of one child for another and concealment or

abandonment of a legitimate child.

• Criminal Negligence

• The elements of reckless imprudence are:

(1) that the offender does or fails to do an act;

(2) that the doing or the failure to do that act is voluntary;

(3) that it be without malice;

(4) that material damage results from the reckless imprudence; and

(5) that there is inexcusable lack of precaution on the part of the offender, taking into
consideration his employment or occupation, degree of intelligence, physical condition,
and other circumstances regarding persons, time and place.

 Gross negligence, ignorance, or incompetence in the practice of Medicine resulting in an

injury to or death of the patient may be basis for award of damages under the Civil Code
which makes every person who negligently causes damage to another liable to
indemnify the latter for the same. (New Civil Code, , arts. 19-21, 2176.)

 CIVIL LIABILITY
  Direct Liability under article 2176

 Vicarious Liability, article 2180 in relation to article 2176

• Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no
pre-existing contractual relation between the parties, is called a quasi-delict and is
governed by the provisions of this Chapter.

Elements of Medical Negligence

• duty

• breach

• injury

• proximate causation

• TEST to determine negligence: Did the defendant in doing the alleged negligent act
use that reasonable care and caution which an ordinarily prudent person would have
used in the same situation? If not, he is guilty of negligence.

• Conduct is said to be negligent when a prudent man in the position of the tortfeasor
would have foreseen that an effect harmful to another was sufficiently probable to
warrant his foregoing the conduct or guarding against its consequences.

• Negligence – Conduct which creates undue risk of harm to others; risk means a
danger which is apparent or should be apparent, to one in the position of the actor;
determination of negligence is a question of foresight on the part of the actor
(FORSEEABILITY); effect harmful to other was sufficiently probable to warrant his
conduct or guarding against its consequence (PROBABILITY)

• The fault or negligence of the obligor consists in the omission of that diligence which
is required by the nature of the obligation and corresponds with the circumstances of
the persons, of the time and of the place.

• PROXIMATE CAUSE: that cause, which, in natural and continuous sequence,

unbroken by any efficient intervening cause, produces the injury, and without which
the result would not have occurred.