LEGAL MEDICINE PART 2

• Death – complete cessation of all vital functions without possibility of resuscitation;

Irreversible loss of the properties of living matter

• "Organ Donation Act of 1991." Sec. 2 (j) "Death".- the irreversible cessation of
circulatory and respiratory functions or the irreversible cessation of all functions of
the entire brain, including the brain stem.

• A person shall be medically and legally dead if either:

• (1) In the opinion of the attending physician, based on the acceptable standards of
medical practice, there is an absence of natural respiratory and cardiac function and,
attempts resuscitation would not be successful in restoring those functions. In this
case, death shall be deemed to have occurred at the time these function ceased ; or

•
The death of the person shall be determined in accordance with the acceptable
standards of medical practice and shall be diagnosed separately by the attending
physician and another consulting physician, both of whom must be appropriately
qualified and suitably experienced in the care of such patients. The death shall be
recorded in the patient's medical record.
 DEATH

• Absence of cardiac function

• Absence of respiratory function

• Absence of brain activity

• Brain death – absence of electrical brain activity – no reflexes, circulation, respiration,

dilated non-reactive pupils, flat Electroencephalogram “Two Physicians Rule”

• Cardio-respiratory death – continuous and persistent cessation of heart action and

respiration

• "Organ Donation Act of 1991." Sec. 9 xxx

• In all donations, the death of a person from whose body an organ will be
removed after his death for the purpose of transplantation to a living person, shall be
diagnosed separately and certified by two (2) qualified physicians neither of whom
shall be:

2 Physicians -must not be:

(a) A member of the team of medical practitioners who will effect the removal of the organ from
the body; nor

(b) The physician attending to recipient of the organ to be removed; nor

(c) The head of hospital or the designated officer authorizing the removal of the organ.

• Legal Implications of Death

• Civil personality extinguished

• Succession

• Contracts – partnership, agency, insurance

• Criminal liability

• Organ transplantation

If death is sudden, unexplained, violent, under suspicious circumstance  Investigate

 • Types of Death

• Natural – death may be made to look as though it resulted from natural causes

• Accidental – death may not be accidental but a result of suicide or crime

• Suicide – death may be caused by crime

• Homicide, Murder, as a result of Crime

• Unexplained

Duties: Medical Examiner

1. Establish Fact of Death

2. Identification of Deceased

3. Determination of Time of Death

4. Determination of cause and manner of death

5. Obtain evidence in the body

- Evidence relevant to circumstances of death – weapons, tools, blood

Signs of Death

• Cessation of cardiac activity and circulation– no heartbeat and no pulse, blood settles in
dependent portion due to gravity (livor mortis)

• Cooling of body (algor mortis), Skin becomes pale

• Stiffening (rigor mortis) and Decomposition

• Eyes become non-reactive and would later start to cloud

• Action of heat

IDENTIFICATION

• Visual Recognition, Personal effects or ornaments

• Fingerprints, DNA, also palm prints, foot print

• Medical history: Blood type – to rule out, Dental Records

• Forensic anthropologist – gender, height, race and age; Forensic odontologist – age
range
• Forensic entomologist – location, approximate time of death

• Important:

1. Legal certification of death

2. Succession

3. Insurance

4. Criminal Law
PUTREFACTION
the process of decay or rotting in a body or other organic matter.

• Tropical region

12 hours – rigor mortis

24 hours – rigor mortis , greenish discoloration of abdomen

48 hours – trunk bloated, face discolored, there may be maggots

72 hours – whole body swollen, disfigured

• 1 week – internal organs putrefied

• 2 weeks – almost all soft tissues gone, cannot be distinguished

• 1 month – skeletonized

* Temperate areas – slower process 2-5 months after death – soft parts change into thick, semi-
fluid black mass

• Insects will help

- ties suspect to victim

- insect parts in car, clothes

- whether body was moved

 - time of death based on life cycle of insect

Time of Death

• STAGES OF DIGESTION

Stomach:

• Light meal – empty within 11/2 – 2 hours after being eaten

• Medium sized 3-4 hours

• Heavy 4-6 hours

*Stomach empties 4-6 hours after a meal

• STAGES OF DIGESTION

• Small Intestines

• After 6-8 hours from eating – reaches distal ileum

• Small intestine – 12 hours to be empty

*Must find out when victim last ate, or if there is vomit near body
Suicide

People vs. Operaña, Jr., 343 SCRA 43, October 13, 2000

the presence of multiple injuries all over the body and the suspicious presence of multiple
abrasions on the area of the neck not related to the hanging

• Investigating a suicide

1. Obtain information

• any condition that deceased may have – disease, psychiatric

• current medications

. Obtain evidence on circumstances surrounding death

• frame of mind, behavior near time of death, history

• Look for:

• suicide note

• History of previous attempts

• Self-mutilation

• Jokes, communications, writing about suicide

• Giving away possessions

• Depression or anxiety

• Increased risk-taking behaviour

3. Clues in crime scene

• weapons near body

• crime scene – movement of body, lividity

*For death investigation, a timeline must be established

• Not a guaranty of accuracy, depends on the examiner, based on available information

• Manner of Death – circumstance, condition of body, medical findings

• Natural, suicide, homicide, accident, undetermined

 • External Examination and Internal Examination: Examination of injury, determination of
possible weapon used, identifying marks

• Microscopy, Xrays, Samples for toxicology

Evidence obtained in body important

DEATH CERTIFICATE

• A death certificate is conclusive evidence only as to the fact of death of the deceased.

• The cause of death may be estabished by other evidence.

INJURY

 Wound – injury to body resulting from force, violence or trauma

Causes of Physical Injuries

 Physical Violence

 Heat or Cold

 Electrical injury

 Chemical injury

 Radiation

 Change of atmospheric pressure

 Infection

Extent of Injuries

 Speed ex. Bullet v. Stone

 Mass ex. Baseball bat v. Stick

 Elasticity of tissue ex. Scalp v. Abdomen

 Area of contact ex. Stabbing

Reactions of Tissues to Trauma

 Rubor

 Calor

 Dolor

 Tumor

 Loss of

function

TYPESOF WOUNDS

 Mortal wound location– heart, brain, brain stem, lungs, stomach, liver, intestine, spleen

 Non-mortal – extremities unless injuring big vessels

BASED ON INSTRUMENTS

 Blunt – contusion, hematoma, lacerated wound

 Sharp – incised, punctured, stab

  Tearing force – lacerated wound

 Chemical explosion – GSW

 Heat or cold – frost bite, burn

Infliction

 Hit

 Thrust

 Explosion

 Sliding abrasion

Depth

 Penetrating

 Perforating

Special Types

 Defense wound

 Patterned wound

 Self-inflicted wound
Medical Classification of Wounds

1. Closed

a. Superficial – petechiae, contusion, hematoma

b. Deep – musculoskeletal - sprain, dislocation, fracture, strain, subluxation,

Internal hemorrhage, cerebral concussion

2. Open – abrasion, incised, stab, punctured, lacerated

Closed Wound – Superficial

1.Petechiae - love bite?

2. Contusion – pasa, bruise

3. Hematoma – bukol, swelling

Petechiae - love bite?

 Pinhead size

 Blood from capillaries under subcutaneous tissue, mucous membrane

 May be caused by Trauma, asphyxia

Contusion

 Caused by blood from blood vessels due to trauma, blunt force

 Force compresses vessel forcing blood out of area to tissue beneath skin

 Develops after lapse of minutes to hours

 Location may be different from site of application, size different from object causing it
due to gravity

 Shape – object used, size – degree of force

 Age of contusion:

1. immediate - Red to purple

2. 4-5 days – green

3. 7-10 days -- yellow

4. 14-15 days – begins to disappears (1 week to 1 month)

 More bruising – bloody parts, with excessive fat

 May be caused by disease too – hemophilia

  Cold compress/warm compress

Extensive Blunt Force Injuries

 Head Trauma – could develop subdural hematoma/epidural hematoma which may

appear later

 Arrhythmia – great force on chest

 Liver, Spleen, Kidney Injuries, Internal bleeding

 Hypovolemic shock due to extensive bleeding in extremities

 Rhabdomyolysis -breakdown of damaged skeletal muscle

Hematoma

 Blunt force, usually where there is bone

 Cavity develops – blood flows to cavity

 Head, chest, anterior part of legs

 Closed wound that is elevated

 If aspirated, there may be blood

 May lead to abscess, gangrene

Deep Closed Wound

 Sprain – muscle or ligament torn

 Strain – over-stretching of muscle or ligament

 Fracture – closed, open, comminuted

 Internal hemorrhage – rupture of blood vessels

Cerebral Concussion

▪ Unconsciousness

▪ Eyelids close

▪ Muscles relax

▪ Shallow respiration

▪ Fast pulse

▪ Low temperature

▪ Sluggish reflex
 ▪ Sphincters relax

▪ Loss of memory just before injury

OPEN WOUNDS

 Abrasion – removal of superficial epithelial layer – “gasgas”

1. Scratch and Graze – sharp pointed object sliding across skin

2. Imprint abrasion – scratching of skin shows pattern or stamping

3. Friction abrasion – caused by pressure accompanied by movement

 Post mortem abrasion – usually over bony prominence (elbow), yellowish instead of
reddish-bronze

 Incised Wound – produced by sharp-edged or sharp-linear edge

 Hacked wound - heavy cutting instrument

1. Wound is straight, profuse hemorrhage, gaping due to retraction of edges

2. Paralysis if nerve affected

 Punctured wound

1. Thrust of sharp pointed instrument

2. Usually internal hemorrhage

3. External wound may be sealed by dried blood, clot

4. Small opening

5. Infection may develop due to sealing

 Lacerated wound

1. Tear of skin and underlying tissues due to forcible contact with a blunt instrument

2. Force greater than cohesive force and elasticity of skin

3. Rugged tear, irregular extremities

4. Contused and swollen edges

5. bleeding not extensive

6. rarely suicidal, may be accidental

STAB WOUND

 Penetration of sharp-pointed and sharp-edged instrument

 Common cause of death - hemorrhage

Suicidal Stab Wound

 Located over vital parts of the body

 Solitary, if multiple, located in one part only

 If on covered parts, clothing is not involved

 Accessible to hand of victim

 Hand of victim smeared with blood

 Wounding weapon may be firmly grasped by hand of victim

 Wound tailing towards hand inflicting injury

 Suicide note may be present

 There is presence of motive for self-destruction

 No disturbance in death scene

Evidence of Intent to Kill

 More than one stab wound

 Stab wounds located in different parts of the body or where vital organs located

 Deep stab wounds

 Serrated or zigzag borders infers alternative thrust and withdrawal of wounding

instrument to increase internal damages

 Irregular stellate skin defects – changing direction of weapon with portion of weapon at
level of skin acting as lever

GUNSHOT WOUND

 Cause of Injury:

1. Flame – scorching or burning of skin, hair, edges may be burned in contact fire; flame
does not go beyond distance of 6 inches, pistols or revolvers – 3 inches

2. Smoke – light, almost black, does not penetrate skin, deposited on target, seen with
distance up to 12 inches
 3. Powder grains – may penetrate skin and cause hemorrhage in deeper tissues, cannot be
removed by wiping, seen around wound entrance up to 24 inches

 Cause of Injury:

1. Powder burns – blackening of gsw entrance, gunpowder tattooing

2. Abrasion collar – pressure of bullet causes skin to be depressed, bullet lacerates skin,
depressed portion rubs with rough surface of bullet

GSW Entrance Wound

 Higher caliber – usually bigger wound entrance

 Usually oval or circular except in near shots or grazing wound

 Short range fire 1-6 inches – edges of wound inverted, may have areas of burning,
smudging, powder tattooing, abrasion collar

 Medium range 6 inches but less than 24 inches – inverted edges, abrasion collar,
smudging, lesser density of tattooing

 More than 24 inches– circular or oval, no burning, smudging, tattooing

GSW Exit Wound

 Exit wound not always present

 Everted edges of wound

 Portions of tissue may be protruding

 Usually bigger than missile/bullet

 No definite shape

 No abrasion collar, tattooing or smudging

 Paraffin test may be negative

Shotgun Wound

 Shotgun cartridge – more gunpowder

 Not more than 6 inches:

1. entrance wound burned

2. blackening due to smoke

3. tattooing densely located in limited area

 4. hair burn

5. severe disruption of tissue

Shotgun Wound

 More than 6 inches:

1. Single wound of entry but may have isolated shots causing independent entry

2. 3-4 feet – serrated or scalloped circumference

3. 5-6 feet distance – wad tends to produce independent injury usually an abrasion

4. 6 feet – shots begin to separate 10 feet – independent wounds of entry

 Smudging due to smoke up to 15 inches

 Tattooing up to 24 inches

How do you determine number of shots?

 Number of entrance wounds

 Number of spent shells

 Shots heard by witness

Suicidal GSW

 Shot fired in closed or locked room, open but isolated or uninhabited place

 Weapon in crime scene

 Shot at close range

 Location accessible to wounding hand

 Usually a solitary shot

 Personal history consistent with suicde

 Hand of victim may show gunpowder

 Usually entrance do not involve clothings

 Fingerprints of victim on butt

 Suicide note
Homicidal GSW

 Site of entrance no point of election

 Usually made with assailant some distance from the victim

 Signs of struggle

 Firearm not at crime scene

 Testimony of witness

Expert witness

 Wound caused by weapon

 What range fired

 Direction of fire

 Can they be self-inflicted

 Signs of struggle

 Could victim have resisted attack or died spontaneously

 Relative position of assailant and victim

Whether Person fired a firearm

 dorsum of hands examined to determine presence of gunpowder

 may be gross examination

 paraffin test – coated with melted paraffin, powder particles will be extracted and
embedded in paraffin cast; lung-s reagent – will turn blue if there is nitrate; not
conclusive

 fertilizers, cosmetics, cigarettes, urine – contain nitrites and nitrates and will give
positive reaction

Location of GSW

 Head, brain matter

1. Serious if breathing centers affected or critical areas

2. If cerebral hemisphere – victim may survive

3. Face – not serious but may cause infection

4. Neck - depends

 Chest wall – may be fatal -- hemorrhage, hemothorax,

 1. may hit lungs causing bleeding

2. GSW to heart – victim may still be able to run death not instantaneous

 Abdomen – not as serious

 Spine – disabilities if spinal cord, may cause compression of cord

 Upper cervical cord – may cause death

 Extremities – you will see characteristic of GSW, not so serious

PHYSICAL INJURIES

 Mutilation – depriving a person, totally or partially, of some essential organ for

reproduction

1. Cutting off

2. Must be intentional to be punishable

3. If other parts of body mutilated  mayhem

 Art. 262 of RPC

PHYSICAL INJURIES

 Serious Physical Injuries

1. Person becomes insane, imbecile, impotent or blind (both eyes)

2. Loss of speech, hearing (both ears) or smelling, one eye, hand, foot, arm, leg,
incapacitated for work

3. Deformed (loss of teeth, pigmented scar, pinna of ear), loss part or use of part of body, ill
or incapacitated to do work for which person is habitually engaged >90 days

4. Illness or incapacity for labor > 30 days to 90 days

Same penalty for Administering injurious substance without intent to kill (art. 264)

 Less Serious Physical Injuries

- Incapacitated for 10 days or more or medical attendance for same period, not more than 30
days (10-30 days)

 Slight physical injury – up to 9 days

 AUTOMOTIVE CRASH

 Driver and Passengers:

1. First collision – moving vehicle with another vehicle or fixed object

2. Second collision – the occupants with ineterior of vehicle

 Cause of death or injury:

1. Displacement of occupants within vehicle with impact against structures

2. Ejection

3. Distribution of the passenger compartment, direct impact injuries

Criminal Investigation

• Criminal Investigation – is a process where authorized persons, usually part of the law
enforcement agency, determines if a violation of the law has been committed, including
who is responsible and who has been victimized, through the discovery, collection,
processing and reporting of all forms of evidence

• Crime Scene Investigation – is a component of criminal investigation and refers to the

complete process of obtaining evidence and relevant information in an area where a
violation of law is supposedly committed

Overview of Crime Scene Investigation

1. Securing and initial management of the Crime Scene

2. Documentation

3. Walk Through and Crime Scene Search

4. Obtaining and Processing Evidence

• Locard’s principle of exchange – objects that come in contact with each other always
transfer material to each other

• in attempting to identify an individual, crime scene investigators work with the

notion that in nature no two individuals are identical and as individuals we are all
unique.

• Questions that must be kept in mind by the investigator

Has a crime been committed?

• Consider what crime, and what evidence would be relevant

• Try to obtain information related to what, when and how a crime was committed
Who may have committed the crime?

• Crime Scene investigators should watch out for evidence that may point to the identity
of the perpetrator of the crime

Who is the victim?

• Evidence that may provide information about the victim, his or her identity, lifestyle,
and personal circumstance are relevant

Why was the crime committed?

• The investigator should consider as relevant evidence that might point to intent or
motive in the commission of the crime

Securing and initial management of the Crime Scene

• Emergency Management – when a crime scene has been reported, the initial responders
must prioritize emergency situations

• A violent suspect may still be in the crime scene posing a risk to the police officers, crime
scene investigators, or other people in the area

• Crime Scene Investigation begins with securing the crime scene for purposes of:

1. safety

2. medical assistance

3. preservation of crime scene

Evacuate injured persons to nearest hospital

*Witnesses and Possible Suspects should be taken in custody, kept calm and isolated

• Supposed witnesses may be suspects

• Supposed victims may be perpetrators of the crime

• Initial impressions and reports of witnesses are important

 • If it is a complex case, a command center may be needed to keep track of the different
teams of investigator, to serve as communication center, and to aid in processing of
collected evidence.

DOCUMENTATION

• Part of crime scene investigation from beginning to end

• If resources allow, a separate team is usually in charge of documentation

• The first responders and officers who arrive at the scene should be interviewed for their
initial impressions

• Documentation involves (1)making notes, (2) Photography/Videography, (3) Sketching

• Items that may be relevant are marked or numbered, photographed and sketched before
they are moved

• Note Taking during the investigation aids in making a reliable and valid report,
especially information that may no longer be recalled as the investigation proceeds

• Notes should include date and time, description of the physical scene, a report on the
first responders, and any other information that appears relevant

Photography/Video

• Purpose - to reproduce the undisturbed crime scene

• General area of commission of the crime should be photographed taking into

consideration the critical areas, entry and exit points

• Initial pictures should be overlapping, include general view and focused view

• If a body is photographed, the injury in relation to body and surroundings are taken first
before a detailed and closer picture

SKETCH

• Rough sketch” – initial sketch which provides a general lay-out of the crime scene, the
location of the body or significant objects; it is not drawn to scale but sketch should be
labeled including distances and notes. Sketch should be reassessed.

• Finished Scale Drawing – this may be completed later; sketch is more refined drawn to
scale
WALK-THROUGH AND CRIME SCENE SEARCH

• Walk-through – preliminary to actual search to aid in planning; general assessment of

the crime scene

1. assess crime scene and document important factors

2. Note relevant evidence, and establish evidence that will most likely be encountered

3. Extent of search area, manpower and equipment needs identified

4. Develop theory of crime

• Primary Crime Scene – where the crime was committed

• Secondary Crime Scene – related to the crime, but not site of its actual commission;
evidence found at a secondary crime scene may be relevant in determining the primary
crime scene

• Strip Search Method – outdoors *Lane Method

• Grid Search Method

OBTAINING AND PROCESSING EVIDENCE

Discover and Recognize Evidence

• Consider the who, what, where, how and why of a crime

• Evidence must be photographed and sketched before they are moved

• Some evidence may not be visible with ordinary lighting (E.g. semen and fibers may be
more visible using ultraviolet light, blood cleaned may still be detected through
chemicals)

Collecting Evidence

• The investigator must be impartial and detached and must collect all relevant evidence
whether they support the initial impression or not

• Relevant evidence include soil samples, hairs, fibers, chemicals, drugs, blood, semen,
glass fractures, paints, finger prints, documents, firearms, bullet, tool marks

• Evidence collected must be labeled, bagged or packaged and stored appropriately

• Avoid cross-contamination of evidence

• Remember Locard’s principle

PROTECT AND STORE EVIDENCE

• Storage – free from pets, insect, excessive heat or moisture, controlled temperature

• Item is bagged, labeled, logged

• Specialized facilities for sensitive evidence (explosives)

• Chain of Custody – documentation of what happened to evidence from time discovered

to time when it is presented in court

People vs. Velarde, 384 SCRA 646, July 18, 2002

W/N Atty Domingo, then municipal mayor of Malolos, could act as counsel for appellant. No

• SC: inadmissible in evidence -

• The victim‟s vody was found in the Municipality of

• Guiguinto, Bulacan but appellant (a resident of Tikay, Municipality of Malolos) was

brought and detained in the Malolos Police Station, where he was investigated by the
Malolos Police;

• Under the circumstances, Atty. Domingo cannot be considered as an independent

counsel
 • EVIDENCE OBTAINED

• Object Evidence – admissible in court if relevant to case, provided that chain of custody
can be established

Examples:

• Trace evidence – extremely small

- hair or fibers – microscopy

- Soil samples – may be compared with soil samples in tires, shoes