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