Reyes, Jerickson A.

2019-12807-MN-0
Final Exam Answers

1. Yes, there is a legal liability on the group of licensed doctors in prescribing the
ivermectin for their COVID-19 patients.

Under the law, medical malpractice is done when breach of duty occurs. This
happens when the doctor fails to comply with or improperly performs his duties
under professional standards.

In the given set of facts, a group of doctors prescribe ivermectin for their COVID-
19 patients even it is not approved locally by the regulatory authorities in curing
COVID-19 cases. Prescribing an unapproved medicine constitute a medical
malpractice. Hence, there is a legal liability on the group of licensed doctors in
prescribing the ivermectin for their COVID-19 patients.

2. The complainant may file a motion for reconsideration on the appellate court or
the Court of Appeals since rape cases is lodged in the Regional Trial Court. Under
the Rules of Court, if the Court of Appeals affirmed the lower court decision, the
complainant may file a Petition for Certiorari to review the decisions of the lower
court based on the evidence presented in those proceedings.

3. Surgeon X, assistant surgeon Y, anesthesiologist Z, internist C, chief operating

room nurse are liable for medical malpractice.

Under the law and jurisprudence, to constitute medical malpractice the following
must concur:
a) The physician has a duty to the patient;
b) The physician failed to perform such duty to his patient;
c) As a consequence of the failure, injury was sustained by the patient;
d) The failure of the physician is the proximate cause of the injury sustained by
the patient.

Here, Surgeon X, assistant surgeon Y, anesthesiologist Z, internist C, chief

operating room nurse cleared and sent home patient A despite that he has
experiencing abdominal discomfort after a surgery for ruptured acute appendicitis
and later found out that such discomfort is associated small forceps. This actuation
constitutes medical negligence. Hence, Surgeon X, assistant surgeon Y,
anesthesiologist Z, internist C, chief operating room nurse are liable for medical
malpractice. Accordingly, the hospital management are also liable under doctrine
of vicarious liability since under this doctrine it assigns liability for an injury to a
person who did not cause the injury but who has a particular legal relationship
being the employer to the person/s who did act negligently which in this case are
Surgeon X, assistant surgeon Y, anesthesiologist Z, internist C, chief operating
room nurse.

4. No, ABC has no medico-legal basis. Under the law, having inconsistent COVID
19 RT-PCR results does not constitute negligence on the part of the administering
laboratory since there is no law punishing it. Here, ABC had inconsistent RT-PCR
results from different laboratory causing him so much anxiety and anguish.
However, such COVID 19 test is not absolutely accurate and there is a possibility
of false positive results. Hence, ABC do not have medico-legal basis on his claim.

5. I will require Mr. A’s household helpers and driver to have a Written Affidavit
of Mr. A’s household helpers and driver to prove that Mr. A’s wife and young son
were the ones who killed in the fire and gather other necessary physical evidence
that will proved that indeed they are ones who are killed in the fire. Accordingly, I
will also require Mr. A to provide the following documents:
a) Death Certificate – duly certified and must bear the proof of registration from
LCR; b) Official investigation report of PNP or NBI; and c) Autopsy report if
possible. This document is needed to claim the subject insurance under the law.

6. I will advise Mrs. B to invoke that she is the wife of the deceased Mr. B and she
can legally refused her husband for a medical autopsy. Under the law, autopsy is
only required if the deceased victim cannot be identified or with the consent of the
next of kin of the deceased person. Here, Mrs. B was no longer amenable to
subject the dead husband to an autopsy. Hence, Mrs. B can legally invoke that the
said autopsy is no longer needed since the identity of her deceased husband has
been established.
7. No, the subject unauthorized recording is inadmissible in a court of law and Dr.
D is liable for unauthorized recording of his telephone conversation with Mr. X.

Under the law, recording of telephone conversation without authority from all of
the parties to the private communication or spoken words shall not be admissible in
evidence in any judicial, quasi-judicial, legislative or administrative hearing or
investigation.

Here, Dr. D recorded his telephone conversations without the consent of Ms. X.
The blackmailing of Ms. X in this case is immaterial. Subject unauthorized
recording of his telephone conversation with Mr. X is inadmissible in a court of
law. Thus, Dr. D is liable for unauthorized recording of his telephone conversation
with Mr. X.

8. As the hospital lawyer, I will convinced Mr. F and Mrs. F that no mishandling
occurred in their premature baby by presenting them several options:
1. I will let the Spouses with their counsel if they so desire to review the CCTV
footage of the hospital to verify and ascertained such claims; and/or
2. I will offer with the hospital consent, a DNA test to determine if there really a
baby-switching happened;
3. If after all, there is indeed a baby-switching happen, I will advise the hospital to
pay them necessary damages and pin-point the location of the spouses real baby
and sanction the erring nurse.

9. No, Dr. M has no legal basis on his actions. Under the law, giving professional
diagnosis is legal and does not constitute any crime. Here, Dr. M’s filling of a
complaint before the PRC charging Dr. P of unethical conduct and
unprofessionalism and refusal to give back the downpayment made by Mr. A based
on Dr. P’s diagnosis to Mr. A is frivolous and unfounded. Hence, Dr. M has no
legal basis on his actions.

10. As represented in this case, the trajectory of the bullet in the head

A Muntinlupa inmate was killed with a lone gunshot wound hitting the head while
walking to his prison dormitory. Two persons of interests who’re members of rival
gangs and known enemies of the killed inmate, were immediately apprehended
and was found to have similar home-made guns. When the shooting happened,
one was on the 3rd floor, the other one was on the ground floor. What findings in
the medico-legal report will help you identify the killer? Explain.

Case No. 11
In a massive fire in a squatter area, one of the charred bodies recovered is
beyond recognition but with relatively preserved skeletal structures. Based on the
medico-legal report, the length is 1.3 meters; the cranium has superciiary ridges
which are more rounded, and styloid process that are shorter than average for
age. The zygomatic arches are also prominent. X-ray examination shows
complete fusion of the epiphysis of the tibia and fibula bones of the legs.
What is the sex, age and apparent disorder of the person? Give your basis/es.
Case No. 12
Mr. V, a 72-year old retired bank manager, has always been suspicious about his
29-year old wife, although she claims the suspicions are all just product of his
unreasonably jealous and paranoid imagination because of the wide age gap.
After 5 years of marriage, they finally had a baby. When Mr. V looked at the
nursery records, he noted that their baby was Type O Rh (+), but he was Type A,
Rh (-); while his wife was Type B, Rh (+). He argued that he couldn’t be the
father of the baby, and its real father must also have the same blood type, which
is O Rh (+). Is he correct? Explain.
Case No. 13
During the siege in Marawi, a massively bleeding soldier, who was in shock, was
rushed to the emergency room of a makeshift hospital for treatment. He was
tested as blood type A, Rh (+). The only available blood was type O, Rh (-) and it
was rapidly transfused to him after cross-matching. However, three days after the
transfusion, he developed severe skin allergies, which subsequently got infected
and led to septic shock which caused his death. The wife filed a case of criminal
negligence and incompetence on the medical staff who attended to her for
transfusing allegedly “a wrong type of blood”, which was implicated as the cause
of the severe allergy. Is there any medico-legal basis for the accusation? Explain.
Case No. 14
A morbidly obese 52-year old man, known diabetic and on insulin therapy, was
brought by good Samaritans to the nearby emergency room when he suddenly
collapsed on the pavement, and could not be aroused. At the ER, the young
attending physician noted that he was completely unarousable, with no audible
heartbeat on auscultation, no evidence of respiration, and no palpable pulses. He
was therefore declared DOA (dead on arrival), and was sent to the hospital
morgue. When he was about to be placed in the freezer, he suddenly moved and
was restless. He was immediately brought back to the ER and blood tests
showed that his blood sugar was extremely low (hypoglycemia). Although he
recovered, his brain function was already markedly abnormal. The wife sued the
hospital for criminal charges for the erroneous declaration of DOA and initial
mismanagement. Assume the role of counsel for either the complainant (wife) or
defendant (hospital and its medical staff) and give your respective arguments to
boost or refute the charges. Just choose which party you would like to represent
as counsel.

1.
Legal Medicine is a branch of medicine which deals with the application of medical knowledge
to the purposes of law and in the administration of justice. It is the application of basic and
clinical, medical and paramedical sciences to elucidate legal matters.

Legal medicine – Application of medicine to legal cases.

Forensic medicine – Application of medical science to elucidate legal problems.
Medical jurisprudence – Knowledge of law in relation to the practice of medicine.

Nature of the study of Legal Medicine

A knowledge of legal medicine means the ability to acquire facts, the power to arrange those
facts in their logical order, and to draw a

Stare decisis it is a principle that, when the court has once laid down a principle of law or
interpretation as applied to a certain state of facts, it will adhere to and apply to all future cases
where the facts are substantially the same.

Res ipsa loquitur is literally translated as "the thing or the transaction speaks for itself." The
doctrine res ipsa loquitur means that "where the thing which causes injury is shown to be under
the management of the defendant, and the accident is such as in the ordinary course of things
does not happen if those who have the management use proper care, it affords reasonable
evidence, in the absence of an explanation by the defendant, that the accident arose from want of
care."

- “The thing speaks for itself”; nature of the wrongful act or injury is suggestive of negligence.
- General rule: expert testimony is necessary to prove that a physician has done a negligent act or
that has deviated from the standard of medical practice.

Requisites of Res Ipsa Loquitor Doctrine:

1.The accident must be of a kind which ordinarily does not occur in the absence of someone’s
negligence;
1. It must be caused by an agency or instrumentality within the exclusive control of the
defendant;
2. It must not have been due to any voluntary action or contribution on the part of the plaintiff.

Instances where the Doctrine of Res Ipsa Loquitor does not apply:

1.   Where the Doctrine of Calculated Risk is applicable;

When an accepted method of medical treatment involves hazards which may produce injurious
results regardless of the care exercised by the physician.
2.   Bad Result Rule;
3.   Honest Errors of judgment as to Appropriate Procedure;
4.   Mistake in the Diagnosis.
 
- In most medical malpractice suits, there is a necessity for a physician to give his expert medical
opinion to prove whether acts or omissions constitute medical negligence. This doctrine has been
regarded as rule of sympathy to counteract the ‘conspiracy of silence’

FELLOW SERVANT DOCTRINE

- This doctrine provides that if a servant (employee) was injured on account of the negligence of
his fellow servant (employee), the employer cannot be held liable.

MEDICAL MALPRACTICE
– failure of a physician to properly perform the duty which devolves upon him in
his professional relation to his patient which results to injury.
– It may be defined as bad or unskillful practice of medicine resulting to injury of
the patient or failure on the part of the physician to exercise the degree of care,
skill and diligence, as to treatment in a manner contrary to accepted standards of
medicine resulting to injury to the patient. 
Elements:
1.  The physician has a duty to the patient;
2. The physician failed to perform such duty to his patient;
3.  As a consequence of the failure, injury was sustained by the patient;
4.  The failure of the physician is the proximate cause of the injury sustained by the patient.

Proximate Cause – is that cause, which, in natural continuous sequence, unbroken by an efficient
intervening cause, produces the injury and without which the result would not have occurred.
 
1.  There must be a direct physical connection between the wrongful act of the physician and the
injury sustained by the patient.
2.  The cause or the wrongful act of the physician must be efficient and must not be too remote
from the development of the injury suffered by the patient.
3.  The result must be the natural continuous and probable consequences.

Doctrine of Efficient Intervening Cause

In the causal connection between the negligence of the physician and the injury sustained
by the patient, there may be an efficient intervening cause which is the proximate cause of the
injury.

DOCTRINE OF VICARIOUS LIABILITY

-Doctrine of Imputed Negligence/Command Responsibility.

-Vicarious liability means the responsibility of a person, who is not negligent, for the wrongful
conduct or negligence of another.

DOCTRINE OF OSTENSIBLE AGENT

- In cases wherein the employees are at the same time are independent contractors of the
hospital;
- Because of this peculiar situation, they are considered ostensible agents and therefore, the
hospital must be held liable for their negligent acts.(pathologist, radiologist, anesthesiologist).

BORROWED SERVANT DOCTRINE

Ordinarily, resident physicians, nurses and other personnel of the hospital are employees or
servants of the hospital;
In some instances, they are under the temporary supervision and control of another other than
their employer while performing their duties;
By fiction of law, they are deemed borrowed from the hospital by someone and for any wrongful
act committed by them during the period, their temporary employer must be held liable for the
discharge of their acts and duties;

REASONS FOR APPLICATION OF THE DOCTRINE OF VICARIOUS LIABILITY

1.   Deep pocket theory;

2. The employer has the power to select his employee and to control his acts;
3.  Since the employer benefits monetarily from the employee, the employer has to bear the loss
when neither the employer nor the employee is at fault;
4.   To treat them as operating expense.

CAPTAIN-OF-THE-SHIP DOCTRINE

This doctrine enunciates liability of the surgeon not only for the wrongful acts of those who are
under his physical control but also those wherein he has extension of control.

Distinction between an Ordinary Physician and a Medical-Legal Officer:

1. An ordinary physician sees an injury or disease on the point of view of treatment, while a
Medical-Legal Officer sees injury or disease on the point of view of cause.

2. The purpose of an ordinary physician examining a patient is to arrive at a definite diagnosis so

that appropriate treatment can be instituted, while the purpose of the Medical-Legal Officer in
examining a patient is to include those bodily lesions in his report and testify before the court or
before an investigative body in order to guide them in arriving in their decision.

3. Ordinary Physician usually ignored minor injuries as they do not require usual treatment since
it will heal without medication. However, a Medical-Legal Officer must record all bodily injuries
even if they are small or minor because these injuries may be proofs to qualify the crime or to
justify the act.
Basic Principles of Legal Medicine

Autonomy
Requires that the patient have autonomy of thought, intention, and action when making
decisions regarding health care procedures. Therefore, the decision-making process must be free
of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must
understand all risks and benefits of the procedure and the likelihood of success. Because ARTs
are highly technical and may involve high emotions, it is difficult to expect patients to be
operating under fully-informed consent.

Justice

The idea that the burdens and benefits of new or experimental treatments must be distributed
equally among all groups in society. Requires that procedures uphold the spirit of existing laws
and are fair to all players involved. The health care provider must consider four main areas when
evaluating justice: fair distribution of scarce resources, competing needs, rights and obligations,
and potential conflicts with established legislation. Reproductive technologies create ethical
dilemmas because treatment is not equally available to all people.

Beneficence

Requires that the procedure be provided with the intent of doing good for the patient involved.
Demands that health care providers develop and maintain skills and knowledge, continually
update training, consider individual circumstances of all patients, and strive for net benefit.

Non-maleficence

Requires that a procedure does not harm the patient involved or others in society. Infertility
specialists operate under the assumption that they are doing no harm or at least minimizing harm
by pursuing the greater good. However, because
assistive reproductive technologies have limited success rates uncertain overall outcomes, the
emotional state of the patient may be impacted negatively. In some cases, it is difficult for
doctors to successfully apply the do no harm principle.

1. “Ignorantia legis nominem excusat “ – prevent use as defense in violation

2. Law shall have no retro-active effect.
3. Rights may be waived, unless the waiver is contrary to law, public order, public policy,
morals or good customs, or prejudiced to a third person with a right recognized by law.
4. Customs which are contrary to law, public order or public policy shall not be countenanced.
5. Laws are repealed by subsequent ones, and their violation or non-observance shall not be
excused by dis-use, custom or practice to the contrary.

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.

MEDICAL EVIDENCE
- is the means sanctioned by the rules of court of ascertaining in a judicial proceeding the truth
respecting a matter of fact.

Proof beyond reasonable doubt

(hardest to prove, required in Criminal Case)
Clear and convincing proof
Preponderance of Evidence
(second easiest to prove, required in Civil Case)
Substantial evidence
(easiest to prove, required in Administrative Case)

Types of evidence:

1. Autoptic or Real evidence – This is an evidence made known or addressed to the senses of the
court. It is not limited to that which is known through the sense of vision but is extended to what
the sense of hearing, taste, smell and touch is perceived.
2. Testimonial evidence – oral under oath
Sec. 21(c), Rule 130, Rules of Court — Privileged communication
— 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 information which he may have acquired in
attending such patient in a professional capacity, which information was necessary to enable him
to act in that capacity, and which would blacken the character of the patient. A medical witness
can only testify on matters derived by his own perception. Hearsay information are as a rule not
admissible in court. Hearsay evidences are those not proceeding from the personal knowledge of
the witness but from mere repetition of what he has heard others say. It is”second hand" evidence
which rest mainly on the veracity and competence of its source.

Exceptions to the hearsay rule. Sec. 31, Rule 130, Dying declaration — The declaration of a
dying person, made under a consciousness of an impending death, may be received in a criminal
case wherein his death is the subject of inquiry, as evidence of the cause and surrounding
circumstances of such death.

3. Experimental evidence. A medical witness may be allowed by the court to confirm his
allegation or as a corroborated proof to an opinion he previously stated.

4. Documentary evidence. A document is an instrument on which is recorded by means of letters,

figures, or marks intended to be used for the purpose of recording that matter which may be
evidentially used. The term applies to writings, to words printed, lithographed or photographed;
to seals, plates or stones on which inscriptions are cut or engraved; to photographs and pictures;
to maps or plans.

5. Physical Evidence: These are articles and materials which are found in connection with the
investigation and which aid in establishing the identity of the perpetrator or the circumstances
under which the crime was committed, or in general assist in the prosecution of a criminal. The
identification, collection, preservation and mode of presentation of physical evidence is known in
modern parlance as criminalistics. Criminalistics is the application of sciences such as physics,
chemistry, medicine and other biological sciences in crime detection and investigation.

a. Corpus Delicti Evidence — Objects or substances which may be a part of the body of the
crime. The body of the victim of murder, prohibited drugs recovered from a person, dagger with
blood stains or fingerprints of the suspect, stolen motor vehicle identified by plate number and by
body or engine serial numbers are examples of corpus delicti evidence.

b. Associative Evidence — These are physical evidences which link a suspect to the crime. The
offender may leave clues at the scene such as weapon, tools, garments, fingerprints or foot
impression. Broken headlights glass found at the crime scene in "hit and run" homicide may be
associated with the car found in the repair shop. Wearing apparel of the offender and other
articles of value may be recovered where the crime of rape was committed.

c. Tracing Evidence —These are physical evidences which may assist the investigator in locating
the suspect. Aircraft or ship manifest, physician's clinical record showing medical treatment of
suspect for injuries sustained in an encounter; blood stains recovered from the area traversed by
the wounded suspect infer direction of the movement are examples of tracing evidence.

1. Direct Evidence:
That which proves the fact in dispute without the aid of any inference or presumption. The
evidence presented corresponds to to the precise or actual point at issue.

2. Circumstantial Evidence:
The proof of fact or facts from which, taken either singly or collectively, the existence of a
particular fact in dispute may be inferred as a necessary or probable consequence.
When is circumstantial evidence sufficient to produce conviction?
a. When there is more than one circumstance;
b. When the facts from which the inferences are derived are proven; and
c. When the combination of all the circumstances is such as to produce a conviction beyond
reasonable doubt (Sec. 4, Rule 123, Rules of Court).

Methods of preserving evidence:

1. Photo, videotape,photocopy
4.Manikin method
2. Sketching
5.In the mind of the witness
3.Description
6. Special methods: embalming
DECEPTION AND DETECTION
Knowledge of truth is important in the administration of justice, lies solely in the
ability to evaluate the statement given by the suspect or witness.

Methods of deception detection:

1. Devices which record the psycho-physiological response:
a) Use of a polygraph or lie detector machine
b) Word association test
c) Psychological stress evaluator
2. Use of drugs that try to “ inhibit the inhibitor”
a) Administration of the truth serum
b) Narcoanalysis or Narcosynthesis
c) Intoxication
3. Hypnotism
4. By observation
5. Scientific interrogation
6. Confession

A. Use of a Lie Detector or Polygraph

= The fear of the subject when not telling the truth activates the symp.
= To a series of automatic and involuntary physiological changes which are
recorded by the instrument.
= Use of control questions > Most reliable & effective questioning technique.
= Supplemetary tests:
a. Peak of tension test - peak of tension on relevant questions
b. Guilt complex test - does not response to added relevant quest.
c. Silent answer test - subject verbal response creates distortion in the tracing or clearing of the
throat.

Reason for admissibility to the court of the result of Polygraph exam :

1. Have not received the degree of standardization of acceptance.
2. Trier of fact is apt to give almost conclusive weight to the experts opinion
3. No way to assure the a qualified examiner administered the test.
4. May waive right against self-incrimination.
5. It has many errors.
Factors responsible to 25% errors:
1. Nervousness experienced by a subject who is telling the truth
- apprehension by the fact that he is a suspect.
- over-anxiety to cooperate
2. Physiological abnormalities > BP inc. or dec., Cardiac prob.
3. Mental abnormalities
4. Unreponsiveness in a guilty subject – no fear of detection
5. Attempt to beat the machine
Can a person be compelled? No, use of intelligence and other faculties.
B. Word association test:
 -Time interval between the words uttered by the examiner and the answer of the subject is
recorded.
C. Psychological Stress Evaluator
- when a person is under stress/lying, the microtremor in the voice utterance is moderately or
completely suppressed.
- degree of suppression varies inversely to degree of psychological stress .

II. USE OF DRUGS THAT INHIBIT THE INHIBITOR

- Not admissible in court
A. Administration of truth serum
- Hyocine hydrobromide given hypodermically until state of delirium which the
subject feels a compulsion to answer the question truthfully.
B. Narcoanalysis or Narcosynthesis
- Sodium amytal or sodium penthotal
C. Intoxication with alcohol - In wine there is truth
III. HYPNOSIS
- alteration of consciousness, not all subjects can be hypnotized
IV. OBSERVATION
Physiological and psychological signs and symptoms of guilt:
a) Sweating, color change
b) Dryness of the mouth
c) Excessive activity of adams apple
d) Fidgetting
e) Peculiar feeling inside
f) Swearing, spotless past record
g) Inability to look at the investigator
V. INTERROGATION
- emotional appeal, mutt and jeff technique
VI. CONFESSION
- expressed acknowledgement of his guilt.
TOKYO DECLARATION
- contains guidelines to be observed by physician concerning torture, inhuman and degrading
punishment.

MEDICO-LEGAL ASPECTS OF IDENTIFICATION

- determination of the individuality of a person
Importance of identifying a person:
1. In the prosecution of a crime, the identity of the offender and victim.
2. Settlement of estates, retirement, insurance
3. Resolves anxiety of nest of kin.
4. In some transactions – sales, release of dead body
Rules in personal identification:
1. Law of multiplicity of evidence in identification – greater number of similarities
2. Value of different points of identification – fingerprints , moles Visual recognition of relatives
–lesser value than fingerprints/dental
3.The longer interval between death the more experts are needed in establishing the identity.
4.The team to act in shortest time because it is perishable.
5. No rigid rule in the procedure of identification of the person.
Methods of identification:
1. By comparison – Id found in the crime scene compared with the file.
2. By exclusion

IDENTIFICATION OF PERSONS
A. Ordinary methods of identification
1. Characteristics which may easily be changed:
a) growth of hair, beard d) grade of profession
b) clothing e) body ornamentations
c) frequent place of visit

2. Characteristics that may not be easily be changed:

a) mental memory f) hands and feet
b) speech g) complexion
c) gait h) changes in the eyes
d) mannerism i) facies
e) handedness-left /right j) degree of nutrition

Points of identification applicable to both living and dead before onset of Decomposition:
1. Occupational marks – painters have stains
2. Race: Malay:brown, flat nose round face, Round head, Wearing apparel
3. Stature: Tips of middle fingers of both hands extended laterally
4. Tatoo marks
5. Weight – not good point – changes from time to time
6. Deformities, injuries leaving permanent deformities
7. Birth marks moles, scar
Age of Scar:
Recently formed: Slightly elevated, reddish/bluish, tender to touch
Few week-2 months: Inflammatory redness, soft, sensitive
2 – 6 months: brownish, free from contraction, soft
> 6 months: white, glistening, contracted, tough
Scar formation is delayed by: sepsis, age, depth of wound, mobility
May not develop – mall, superficial, healed by first intention.
8. Tribal marks, Sexual organs, blood exam.

ANTHROPOMETRY ( BERTILLON SYSTEM) Alphonse Bertillon

- utilizes anthropometrical measurement of the human body for identification.
Basis:
1. Human skeleton is unchangeable after 20 years.
2. No two human beings have exactly the same bones.
3. Use of simple instrument
Information:
1. Descriptive data – color of hair, eyes, shape of nose…
2. Body marks
3. Anthropometric measurement – height
4. Measurement of the head, limbs
Portait Parle ( spoken picture) – picturesque description of a person

Extrinsic factors in identification:

1. ornamentation
2. personal belongings
3. wearing apparel
4. foreign bodies
5. identification by close friends, police records, photographs

Light as a factor in identification:

1. Clearest moonlight = Less than 16-17 yards Starlight = Less than10-13 yards
2. Broad daylight = Not farther than 100 yards not seen before
Almost strangers =recognized at 25 yards
3. Flash of firearm
= 2 inches letters can be read with the aid of the flash of 22 caliber at a distance of 2 feet.
4. Flash of lightning – sufficient light to identify
5. Artificial light – relative to the intensity of light
B. Scientific methods of identification
1. Fingerprinting
2. Dental identification
3. handwriting
4. Identification of skeleton
5. Determination of Sex, Age
6. Identification of blood, blood stains
7. Identification of hair, fibers
1. FINGERPRINTING
= most valuable method of identification.
a) No two identical fingerprints 1 : 64,000, 000, 000
b) Not changeable - 4th month formed in the fetus
= Practical uses
a) Identity of dead bodies
b) Prints recovered at crime scene
c) Prints on file for comparison
d) Right thumb print is substitute for signature
= DACTYLOGRAPHY: art and study of recording fingerprints as means of id.
= DACTYLOSCOPY: art of id by comparison of fingerprints
= POROSCOPY: study of pores found on the papillary friction ridges of skin
Fingerprints can’t be effaced:
=as long as the dermis of the bulbs of the finger is not completely destroyed.

2. DENTAL IDENTIFICATION
= possibility of 2 persons to have the same is remote
= enamel is the hardest substance of the body,
 outlast other tissues in putrifaction
3. HANDWRITING

= BIBLIOTIC : Science of handwriting analysis

= GRAPHOLOGY : study of handwriting for the purpose of determining the
writers personality, character and aptitude.
4. IDENTIFICATION OF THE SKELETON
human – shape, size, general nature
single individual – plurality or excess of bones
Height – add 1 to 1 ½ in. for the soft tissues
Pearson’s formula – for the reconstruction of the living stature of long bones
Topinard and Rollet
= two French anatomist devised a formula for the determination of the
height fro males and females.
Humphrey’s table
= Table of different height of bones for different ages and their
corresponding statures.
Manouvrier – made the following co-efficient for the determination of height.

Determination of the duration of interment:

- All soft tissues in a grave disappear within one year.
Basis of the estimate fro duration of interment:
1) Presence or absence of soft tissue adherent to the bones.
2) Firmness and weight, brittleness, dryness of the bones.
3) Degree of erosion of the surface of the bones.
4) Changes in the clothings, coffin, and painting.
5. IDENTIFICATION OF SEX
Test to determine the sex:
1. Social test
2. Genital test
3. Gonadal test
4. Chromosomal test – barr cells in females
Evidences of sex:
1. Presumptive evidence
= General features, hair in some parts
= Transvestism – sexual deviation by desire to assume the attire and be
accepted as a member of the opposite sex.

6. DETERMINATION OF AGE
Legal importance
a) Aid to identification
b) Determination of criminal liability
c) Determination of right of suffrage
d) Determination whether a person can exercise civil rights
e) Determination of the capacity to marriage
f) Requisite to certain crimes
Determination of age of fetus:
Hess’s rule or Haase’s rule
a) Fetus of less than 25 cm long- get square root of length in cm, result in months
b) > 25 cm- divide the length of the fetus by 5 and the result is the age in month.
7. IDENTIFICATION OF BLOOD AND BLOOD STAINS
Legal importance:
a) Disputed parentage
b) Circumstantial evidence against perpetrator of a crime
c) Determination of the cause of death
d) Determination of the direction of the escape
e) Determination of the appropriate time crime was committed
f) Determination of the place of the crime
g) Determination of the presence of certain diseases.
Physical examination
a) Solubility test
b) Heat test
c) Luminescence test: 3 amino-phtalic-acid-hydrazide-HCL,
Sodium peroxide , distilled water
> Bluish-white in a dark room
Chemical examination:
a) Saline extract of the blood plus ammonia – brownish > alkaline hematin
b) Benzidine test – blue color in white filter paper
c) Guaiacum test ( Van Deen’s Dyas or Schombein’s test) – blue
d) Phenolpthalein test ( Kastle-Meyer test) - pink
e) Leucomalachite Green test
Microscopic examination
- saline extract of stain
Micro-chemical tests:
1. Hemochromogen crystal or Takayama test:
2. Teichmann’s blood crystals or Hemin crystal test-
= Sodium chloride – dark brown rhombic prisms of chloride, hematin formed
= best of the micro-chemical test.
3. Acetone-haemin or Wagenhaar test
Spectrospcopic examination
- blood pigments have the power to absorb light of certain length and produce the
characteristic absorption bands on the spectrum.
= Fresh blood – oxyhgb, Hgb, reduced hematin
= olders stains – methemoglobin, alkaline hematin
Biologic examinations
1. Precipitin test – blood is human or not
2. Blood grouping
Age of blood stains:
Hgb converted to Methgb of hematin red to red-brown
= warm weather- within 24 hours
8. IDENTIFICATION OF HAIR AND FIBERS
Differences between hair forcibly extracted and naturally shed hair:
- bulb is irregular , undulating surface, excrescence of diff, size and shape

MEDICO-LEGAL ASPECTS OF DEATH

Importance of Death determination:
1, The civil personality of a natural person is extinguished by death.
2.The property of a person is transmitted to his heirs at the time of death.
3. The death of a partner is one of the causes of dissolution of partnership
agreement.
4. The death of either the principal or agent is a mode of extinguishment of
agency.
5. The criminal liability is extinguish by death.
6. The civil case fro claims which does not survive is dismissed upon death of the
defendant.
Death – is the termination of life.
Kinds of death:
1. Somatic or clinical death – persistence of vital functions
2. Molecular or cellular death – 3 to six hours after cessation of life
3. Apparent death or State of suspended animation –
transient loss of consciousness in hysteria, uremia, electric shock
Signs of death:
1. Cessation of heart action and circulation., Usually the auricle contract after
somatic death fro a longer period than the ventricle, last to stop so called
ULTIMEN MARIENS.
Methods of detecting the cessation of heart action and circulation:
a) Examination of the heart- pulse, aucultation, flouro, ECG

b) Examination of peripheral circulation

= Magnus test – application of ligature around the base of the finger
- bloodless area at site of application
- dead man – no change

= Opening of small artery- spurting

= Icards test – injection of flourescein SQ
- greenish yellow discoloration in the whole skin
- dead man only in the area of injection
= Pressure on fingernails
= Diaphanous test – fingers are spread wide through a strong light- Red
= Application of heat on the skin - blister
= Palpation of Radial pulse
= Dropping of melted wax
2. Cessation of respiration – more than 3 ½ minutes
Methods of detecting cessation of respiration:
a) Observance of movement of chest and abdomen
b) With the aid of stet.
c) Examination with a mirror
d) Examination with a feather or cotton fibers
e) Examination with a glass of water
f) Winslow’s 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.
3. Cooling of the body ( ALGOR MORTIS)
- 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.

POST-MORTEM CALORICITY – is the rise of temp. of the body after death

due to rapid and early putrefactive changes. Usually in the first 2 hours.
= seen in cholera, liver abscess, tetanus, RF,Strynine poisoning, Peritonitis
A. Conditions connected with the body:
Factors delaying the rate of cooling of the body:
1. Acute pyrexial disease
2. Sudden death in good health
3. Obesity of person
4. Death from asphyxia
5. Death of the middle age
Factors accelerating cooling:
1. Leaness of the body
2. Extreme age
3. Long-standing illness
4. Chronic pyrexial disease with wasting
B. Conditions that are connected with the surroundings
Factors delaying cooling:
1. Clothings
2. Want of access of air to the body
3. Small room
4. Warm surroundings
Factors accelerating cooling:
1. Unclothed body
2. Conditions allowing the access of air
3. Large room permitting the dissipation of heat
4. Cooling more rapid in water than in air
Methods of estimating how long a person has been dead from the cooling
of the body:
1. If body temp. is normal at the time of death:
= the average rate of fall of the temp. during the first 2 ½ hours is ½ of the
difference of the body temperature and that of the air.
= the body attains the temp. of the surrounding air from 12 to 15 hours after
death in tropical countries.
2. Chemical Method ( Schourup’s formula for the determination of the time of
death of any cadaver whose CSF is examined for the concentrations of L.A.,
NPN, A.A.
= L.A> 15 mg to 200 mg/100cc rapid in 1st 5 hours.
= NPN inc. from 15 to 40 mg/100 cc in 1st 15 hours
= A.A. inc. from 1 mg to 12 mg% 1st 15 hours.
4. INSENSIBILITY OF THE BODY AND LOSS OF POWER TO MOVE
= may be seen in the living with- apoplexy, epilepsy , trance, catalepsy, hysteria
5. CHANGES IN THE SKIN – opacity, flattening, loss of elasticity
6. CHANGES IN AND ABOUT THE EYE
a) Loss of corneal reflex – seen I n live pts: G.A., uremia, narcotic poisoning
b) Clouding of cornea
c) Flaccidity of the eyeball
d) Pupil in the position of rest.
e) TACHE NOIR DE LA SCLEROTIQUE – spot found in the sclera after
death.

Pallor Mortis
The first change that occurs in a corpse is the increased paleness in the face and other parts. This
is due to the cessation of blood circulation.

The capillaries right below our skin provide us with the lively glow of being alive. We don’t
realize it unless we blush, but when blood stops circulating to the extremities like the skin, the
skin looks pale, like a zombie!

This is the very first sign and occurs very rapidly, within 15-30 minutes of death. Due to this, it
is usually insignificant in determining the time of death, unless, of course, death has occurred
shortly before the finding of the body. Studies have also proven that paleness is unaffected by
gender differences in bodies.

Algor Mortis
Humans are warm-blooded organisms, which means that we maintain a constant internal
temperature, regardless of the outside environment. The brain is our thermostat, and the
circulatory system is the main heat dissipator. However, within seconds of death, the brain cells
begin to die, and the heart stops pumping blood. Without the brain and the blood distributing
heat, the corpse eventually starts to match the outside temperature.

Rigor Mortis
Immediately after death, a corpse will go flaccid. All the muscles will become relaxed and limp,
but the whole body will stiffen after a few hours. The muscles will now contract and become
rigid, a stage called Rigor Mortis. Rigor Mortis is one of the most useful methods of determining
the time of death since its progression is mostly predictable.

Livor Mortis
This is the final stage of death. When the heart stops beating, the blood is now at the mercy of
gravity. It tends to collect at certain parts of the body. Depending on the position of the body,
these parts would vary. For instance, if the person were flat on their back when they died, the
blood would collect in the parts that are touching the ground. If the person were hanging, it
would collect in their fingertips, toes, and earlobes.

Lividity starts with the skin where the blood has settled, developing a bright red color. After a
few hours, the color changes from red to bluish-purple. This can take 6 to 8 hours.