LEGAL MEDICINE

DEFINITIONS

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


Anthropometry/Bertillon System
For identification of human body

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

Circumstances:
Aggravating Circumstances:
Increase the penalty/crime

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

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

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

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

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

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

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

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


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

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

Summons
Written notification commanding a person to
attend to court; addressed to a defendant

Tokyo Declaration: Tokyo=Torture
guidelines to be observed by physician concerning
torture, inhuman and degrading punishment

Torts
Legal wrong independent of contract
Includes
Direct invasion of some legal right
Infraction of some public duty
Violation of some private obligation
Elements
Legal duty
Breach of legal duty
Injury is the approximate result

GENERALITIES
Medico-Legal Systems (3):
Medico-legal officer
Medical examiner
Coroner

Divisions of Civil Law:
Persons
Property
Obligations and contracts

Ex-Officio medico legal officers (5):
PHO
Staff of Hospital

Kinds of Damages:
Nominal
Actual/Compensatory
Temperate/Moderate
Moral

Types of Subpoena (court summons) (3):
Testificandum - oral testimony
Duces Tecum - for production of evidence
Duces Tecum et ad Testificandum

May not comply with subpoena:
Court has no jurisdiction over the matter and
person of case
Residence if > 50km from the court
Transportation allowance not given (civil case)
MD w/ emergency case and no equal substitute
If with infirmity aggravated if complies with
subpoena

EVIDENCES
Forms of Medical Evidence (4):
Real/Autoptic - can be perceived by the senses
Testimonial oral under oath
Documentary
Experimental

Privileged Communication:
Can be claimed in a civil case but not in criminal
Once waived, can never be claimed
Expressed waiver
Implied waiver

Hearsay Evidence:
Dying declaration the only exception to hearsay
evidence rule
Requisites:
Consciousness of impending death
Concerns the cause & circumstances of
death
Competent witness
Use in criminal case & declarant is a
victim
Admissible: necessity, trustworthiness

Presumption of Survivorship:
< 15 yo older survives
>60 yo younger survives
< 15 yo survives vs >60yo
15-60 yo male or older survives

Presumption of Death:
Absence of 10 years
>75 yo absent for 5 years
Board a vessel lost during sea voyage or an
aeroplane
Armed forces in the war missing for 4 years
Under danger of death missing for 4 years

Diputable Presumption of Death:
Not heard of for 7 years

Presumption of Legitimacy:
Requisites:
Born after 180 days after marriage and before 300
days after dissolution or separation
Valid marriage
No physical impossibility
Documentary Evidences:
Formal written report
Written opinions
Certificates
Dying Declaration

Witness:
Ordinary witness:
Based on senses, may not be skilled
Expert witness:
May give opinion, deduction, conclusion, inference,
must be skilled
Stages in the Examination of a Medical Witness:
Preliminary stage
Direct examination (Prosecution)
Cross-examination (Defense)
Re-direct examination
Re-cross examination
*Expert medical testimonies are corroborative
evidences
*Not required in cases of Res Ipsa Loquitur

Principals of Felony:
Direct participation
Inducement
Cooperation

Elements of Felony:
Freedom
Intelligence

Methods of preserving evidence (6):
Photo, videotape,photocopy
Sketching
Description
Manikin method
In the mind of the witness
Special methods: embalming

Probative value of standard medical textbooks:
Not admissible in court as evidence (hearsay)
But medical witness can base opinion on textbook

Legal Importance of Blood:
Parentage
Circumstantial or corroborative evidence
Direction of escape
Cause of death
Approximate time of the crime
Place of commission of crime

Chemical Examination of Blood:
Saline extract + NH$
Guanicum test
Benzidine Test
Phenolphthalein
Leucomalachite Green Test

Legal Importance of Sex Determination:
Identification
Marriage
Exercise of right to one sex only
Differences of rights granted by law
Primogeniture - rights of firstborn to inheritance

Bones to determine sex of skeleton (5):
Skull
Sternum
Pelvis
Humerus
Femur

Relative position of the victim:
Testimony of witness
Nature of the instrument
Wound
Location
Direction

For Dying Declaration to be admissible to court:
Must concern the cause and circumstances of
declarants death
Conscious of impending death
Competent witness
Victim in a criminal case to which this will be used

Ballistic Examination:
Shell
Bullet

TEST PURPOSE RESULT
Ascheim-Zendek
Test
Sign of recent
deliver/Pregnancy
test

Breslaus Test

Foderes
/Hydrosatic/
Static Test
Livebirth vs
Stillborn
Unsectioned and
Sectioned lungs
float in water
Gettlers Test Drowning in a fresh
water pool
Chloride
difference of
25mg
Fresh RV>LV
Sea LV>RV
Paraffin /
Dermal Nitrate/
Diphenyllamine/
LUNGS Test
Corroborative
(+) even after 3 days
& with washing
Blue reaction w/
Lungs reagent
(+) nitrite/ nitrate


Saline extract +
NH3
Benzidine Test

Guaiacum/Van
Deens Dyas/
Schombeins Test
Phenolphthalein/
Kastle-Meyer test
Leucomalachite
Green Test

Takayama Test/
Hemochromogen
crystal
Teichmanns Blood
crystals / Hemin
crystal test

Wagenhaars/
Acetone-haemin
test

Blood & Blood
Stains












Microchemical Tests




Brownish
(alkaline hematin)
Blue color in
white filter paper
Blue


Pink

Green


Aa


Best test
Dark brown
rhoimbic prisms
of Cl, hematin





Schourups
Formula
Time of death CSF lactic acid
15mg 200mg
in 5 hrs after
death
Aa, nitrogen,
axillary temp
Walker/
Naphthalinamine
Presence of
Gunpowder in
clothings
Dark red spots on
foto paper
Test


Magnus test

Icards Test

Diaphanous test
Peripheral
Circulation


Ligature around
base of the finger
Flourescein SQ,
greenish yellow
discolor. Of skin
Fingers are
spread wide
through a strong
light - red
Winslows Test Respiration no movement in
the image formed
by reflecting
artificial light on
the water in a
saucer and placed
in the chest if
respiration is
taking place.


Winslows test no movement in the
image formed by reflecting artificial
light on the water in a saucer and
placed in the chest if respiration is
taking place.


DECEPTION DETECTION
Methods used (6):
Lie detector / Keelers Polygraph
Intoxication
Word association time interval between question & answer
Truth serum
Narcoanalysis Na amytal, Na penthotal
Hypnotism

Factors for Unreliability of Polygraph:
Extreme emotions
Physiologic abnormalities
Mental abnormalities
* Use of control questions > Most reliable & effective questioning

SEXUAL CRIMES
Kinds of Virginity:
Physical
Moral
Demi
Virgo intacta

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

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

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

Acts of Lasciviousness

Consented Abduction:
Must be a virgin
Over 12, under 18 yo
With consent
With lewd design

Forcible Abduction:
Woman
Against will
With lewd design

Extent of Hymenal Lacerations:
Complete
Incomplete
Complicated
Infection
Hemorrhage
Fistula
Scar

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

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

Reasons for abortion:
Preserve life and health of woman
Preserve body form
Illegitimate pregnancy
Financial constraints

Legal justification for therapeutic abortion:
No other practical and most practical means
Evil sought to be avoided exists
Injury greater if it was not done

Difficulty in prosecuting MDs with crime of
abortion:
Intelligent & aware of criminal act
Medical justifications
Products of conception as corpus delicti* is lost
Woman, witness, is in pari delicto*
Medical society lukewarm against helping state
prosecute abortionist

Legal viewpoint of when is a child born:
Civil purposes, fetus is considered born if:
Alive at the time it is completely delivered
*Preterm (<7mos) dies within 24 hours is not
considered born

MARITAL RELATIONS
Summary of causes of dissatisfaction:
Sexual desires, aversions, etc.
Pregnancy/Fertility-related
Diseases
Infidelity
Ignorance

*Requirements before inserting IUD;
contraindications

INJURIES/WOUNDS:
Legal Classification:
Slight physical injuries 1-9days
Less serious physical injuries
Serious physical injuries
Mutilation
Administering injurious beverage?

Causes of Physical Injuries:
Chemical
Electrical
Physical
Violence
Thermal
Atmospheric pressure

Radiation
Infection

Diagnosis of Drunkenness:
History
Observations
Irregular behavior
Tremor or error of coordination and orientation
Impaired speech/articulation
Physical Examination
Smell
Congested conjunctivae
Dry furred tongue/excessive salivation
Laboratory
Blood and urine alcohol content
DEATH
Legal Importance of Determining Death:
Extinguished
Civil personality
Criminal liability
Civil Case dismissed
Properties transmitted to heir

Signs of Death (Check):
Heart/Circulation
Lungs/Respiration
Skin/Cooling, heat, insensibility, movement
Eye

Changes of the body after death:
Putrefaction
Autolytic/Autodigestion
Muscles
Blood

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

5 Points in Determining duration of death of body:
Rigor mortis
Post-mortem lividity
Decomposition
Stage of decomposition
Entomology

Medico-legal Classification of Death:
Natural
Violent: Penal Classification
Accidental
Suicidal
Negligent
Homicide
Murder
Parricide
Infanticide

Psychological classification of causes of death:
Sncope
Asphyxia
Coma

Methods of Judicial Death:
Electrocution
the only method recognized by civil laws
Mechanisms of Death
Vfib
Respi failure
Mechanical asphyxia
Gas chamber
Hanging in military & court marshal
Musketry in military & court marshal
(Lethal injection?)

*MD murder vs. accessory to suicide

Asphyxia:
Classification:
Hanging
Strangulation
Ligature
Manual throttling
Palmar
Garroting
Mugging
Stick compression
Suffocation
Submersion/Drowning
Pressure
Gases

Stages:
Hyspneic
Convulsive
Phassic

Burns & Scalds:
Delayed causes of death:
Exhaustion
Dehydration with hemoconcentration
Secondary shock
Hypothermia

Gunshots
Suicide Evidences:
Suicide note
One gunshot wound
Contact or near contact
Burning
Smudging
Tattooing
Portion accessible to hand
Weapon held tightly or found nearby
With history or cause of despondency
Exclusion of others by evidence


AUTOPSIES
Persons authorized to perform autopsies:
1. Health Officers
2. Medical officer of law enforcement agencies.
3. Members of the medical staff of accredited
hospitals.

Autopsies shall be performed in the following
cases.
1. Required by special laws
2. Order of competent court, mayor, fiscal
3. Written request of police officers
4. SolGen, fiscal disinter to determine cause of
death.
5. Written request of nearest kin to ascertain cause
of death.

Points noted when unknown body is found:
Place where body is found
Time when found
Time of death
Cause of death
Approximate age
Supposed profession
Description of the body

Ophtha Findings:
Pale & atrophic optic disc, retina
Fundus yellow brown / gray
Segmented & indistinguishable retinal vessels

Determining height of abnormally developed
person:
Vertex symphysis pubis X 2
Sternal notch symphysis pubis X 3
Base of skull coccyx 44% of height

Determining age of fetus: Haases Rule
<25cm = square root of length age in months
>25cm = length (cm) / 5 age in months

Poisoning
Arsenic (chronic):
Emaciated body
Yellowish brown skin
Scarce hair
Pigmentation, eczema, localized thickening

Opium (post-mortem):
Livid face
Congested brain
Pinpoint pupils
Engorged lungs with frothy fluid

Drowning:
Death occurs in 2-5 minutes
Phases:
Respiration de surprise one deept inspiration
Phase of resistance
Dyspneic phase
Apneic phase
Termination of respiration

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


Asphyxia (hanging) -La facies sympathetic
Asphyxia (drowning)
Burns Pugilistic position of the body


******************************************

MEDICAL JURISPRUDENCE

Objectives of Medical Act of 1959:
Standardization & regulation of medical education
Board exam
Supervision, control, regulation of practice of
medicine

Asumpsit on quantum meruit:
A person employs another to do work for him
without prior agreement as to his compensation
but the law implies that the worker be paid for his
services as he merits

PD 223: Composition of PRC
Appointed by the President w/o reappointment:
Full time Commissioner (1) 9 years
Fulltime Associate Commissioners (2)
6y, 3y

RA 5912: No selling of samples; P1000-4000,
6mos-4years
RA 6111: Medical Care Act of 1969
Program I SSS, GSIS except AFP
Program II all others

RA 6425: Prescription of Dangerous Drugs

BOARD OF MEDICAL EDUCATION
Composition of Board of Medical Education (5):
Chairman: Secretary of Education/Rep
Director of Bureau of Private schools/rep
Chairman of Board of Med Ed/rep
Dean UP College of Medicine/rep
Rep of APMC

Function of Board of Med Ed:
Admission requirements to college of medicine
Minimum physical facilities of med school
Qualification of teachers
Curriculum
Number of students allowed to take preparatory
course
Select & approve hospitals for training
Rules and regulation for implementation

Quasi-judicial functions:
To subpoena
To issue injunction

Candidates for Board Exam:
Filipino Citizen / Foreigner from country with
reciprocal medical practice
Good moral character, Sound mind
Not convicted of offense on moral turpitude
Degree of MD from govt. recognized med school
Completed internship

PRACTICE OF MEDICINE
Prerequisites:
21 yo
Board passer
Licensed

Legal Duties towards patients (5):
Skill
Knowledge
Ordinary care & diligence
Best judgment
Good faith

May attend to Emergency cases:
Any person
Medical student and RNs
MDs

Grounds for reprimand, suspension, revocation of
license:
Conviction of any criminal offense of moral
turpitude
Immoral/dishonorable conduct
Insanity
Fraud
Gross negligence, ignorance, incompetence
resulting to injury or death of patient
Addiction or gambling rendering him incompetent
False, extravagant, unethical advertisements
Criminal abortion
Issuing false medical certificate
Spreading news/rumor derogatory to another
physician with no objective motive
Dummy of an unqualified or unregistered person
Violation of PMA Code of Ethics

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

Why Judicial persons cannot practice medicine:
Cannot be subjected to examination
May do so through its agents as subordinates to
MDs

Not Practice of Medicine:
Application of medicine does not always constitute
practice of medicine
Electric machine by barbers - beautifying body
Electric vibrator, sunrays lamp
Medicated massage
Administration of anesthetics by RNs in surgery
Sale of medicine or drugs
Limitations in Practice of healing art imposed by:
Self
Specialization, Ignorance, Retirement
Public
Religion
Ethics
Medical Society
Law

Prescription of Regulated Drugs:
3 copies
Pharmacist original copy x 1 year
Issuing MD
Buyer until drug is consumed

*Medical Malpractice vs. Illegal Practice of
Medicine

Kinds of Medical Malpractice:
Administrative
Criminal
Civil

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

Facts to be proved to recover medical fee:
MD who served is qualified and licensed
Performed professional services
Reasonable fee
Person is liable for payment

Responsible for Payment in Order:
Spouse
Descendants
Ascendants
Siblings
Third person

HOSPITAL
Responsibilities in Emergency cases:
Admission
Transfer
Discharge

PRINCIPLES
Informed Consent:
Not needed:
In emergency
When compulsory accdg to law

DOCTRINES:
Malpractice:
Doctrine Description
Assumption of Risk
Borrowed Servant Temporary master must
be responsible for the
wrongful act of servant
Contributory
Negligence

Forseeability
Independent Contractor
theory
Contract for Service
Use of hospital for the
px
Last Clear Chance
Res Ipsa Loquitor Due to negligence
Exclusive control of
Defendant
No contribution from
the plaintiff
Respondent Superior Contract of Service
A master is liable for
the wrongful acts of his
servant w/in scope of
authority (hospital)
Administrative or
ministerial duties
Vicarious Liability Negligence of his
partner
Acts of his agent
Not his partner
Interns

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

PUNISHMENTS:
Violation of ethical law of profession:
Civil liability
Public censure
Suspension or revocation of license

Penalty for Illegal Practice of medicine:
>/= P1500 and/or
1-5 years imprisonment

PATIENTS RIGHTS:
Right of Privacy from Privileged Communication