LEGAL MEDICINE and MEDICAL JURISPRUDENCE

Wilfredo L. Mirasol, Jr., M.D.,DPBO,LLB

Legal Medicine - branch of medicine that deals with the application of medical knowledge to
the purposes of law and in the administration of justice
Medical Jurisprudence - deals with the aspect of law and legal concepts in relation with the
practice of medicine
Forensic Medicine - application of medical science to elucidate legal problems
Medical Jurisprudence includes:
Licensure and regulatory laws
Physician-patient-hospital relationship together with the other paramedical personnel,
their rights, duties and obligations;
Liabilities for non-compliance with the law
Scope of Legal Medicine
Application of medical and paramedical sciences as demanded by law and
administration of justice.
Nature of the study of Legal Med
The ability to acquire facts, arrange them and draw a conclusion from facts in the

administration of justice.
Medical jurists, Medical examiner, Medicolegal officer, Medicolegal expert
A physician who specializes primarily with medicolegal duties.

EVIDENCE - means sanctioned by the Rules of Court of ascertaining in judicial proceedings the
truth respecting a matter of fact

TYPES OF MEDICAL EVIDENCE

1. Autoptic or Real Evidence
addresses to the senses of the court
2. Testimonial Evidence
ex. MD on the witness stand
a. Ordinary Witness
b. Expert Witness
3. Experimental Evidence
if allowed by the court to confirm or corroborate
4. Documentary Evidence
writings/photographs
a. medical certificates
b. medical expert opinion
c. deposition
5. Physical Evidence
articles and materials found in connection with the investigation and which aids in
establishing the identity of the perpetrator
Kinds of Evidence
1. Direct Evidence
-that which proves the fact in dispute without the aid of any inference or presumption
2. Circumstantial Evidence
- the proof of 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
Purposes of Medical Jurisprudence
1. To protect public from charlatans
2. To promote professionalism and foster professional interrelationship
3. To develop awareness of the rights, duties and obligations of the patient, physician, and
the hospital
4. To control the increasing number of medical malpractice suits against physicians
5. To explain the purpose and procedure of certain legislation
6. To study the need to amend, repeal our health care laws in harmony with the recent
scientific and social development
Sources of Law
1. Constitution
2. Laws enacted by the legislative body
3. Decrees, Orders, Proclamation, Letters, Court of Appeals, BP, RA
4. Administrative acts, orders, Rules and Regulation
5. Local customs
6. Generally accepted principles of International law
Law and the Practice of Medicine

1. The State must maintain high standard of practice by setting up rules and regulations

with regards to qualifications and procedure for the admission to the profession. These
are legal safeguards to guarantee the safety of the patient and impose liability to the
practitioner who through his act or omission causes damage or injury to the health and
welfare of the patient.
2. The right to regulate the practice of medicine is based on the police power of the state.
Licensure and Regulatory Laws
1. Administrative Bodies
2. Board of Medical Education
- primarily concerned with the standardization and regulation of medical
education
3. Professional
4. Regulation Commissions
- to have general supervision and regulation of all professions requiring
examinations which includes the practice of medicine
5. Board of Medicine
- its primary duties are to give examinations for the registration of physicians and
supervision, control and regulation of the practice of medicine
What constitute Practice of Medicine?
1. Article III Section 10 Medical Act of 1959
Who shall, for compensation, fee, salary or reward in any form paid to him directly or through
another, or even without the same, physically examine any person, and diagnose, treat, operate
or prescribe any remedy for human disease, injury, deformity, mental, physical condition or any
ailment, real or imaginary;
2. Article III Section 10 Medical Act of 1959

Who shall, by means of signs, cards or advertisements, written or printed matter, or through
the radio, television or any other means of communication, either offer or undertake by any
method, diagnose, treat or operate, or prescribe any remedy for human disease, injury or
deformity, physical, mental or psychical condition;
3. Article III Section 10 Medical Act of 1959

Who shall falsely use the title of M.D. after his name.
Who can Practice Medicine?
Who are qualified to practice in the Philippines?
Holder of a CR issued by the BOM
- 21 years old
- Passed board exams
Who are qualified to practice in the Philippines?

1. Limited practice without CR issued by the BOM

2. Balikbayan MDs
3. Foreign MDs by reciprocity or endorsement

Illegal Practice of Medicine

Practice of medicine by any person not qualified and not duly-admitted to perform medical acts
in compliance with law
Grounds for Malpractice
1. Negligence
2. Intentional Felonies
3. Failure of informed consent
4. Abandonment
5. Breach of Confidentiality
6. Breach of Contract
-warranty to cure
7. MDs Liability for other health care providers
Negligence
Breach of duty to behave reasonably and prudently under the circumstances, causing
foreseeable harm to others.
Four Elements for a Successful Suit: (4 Ds)
1. Duty
2. Derelection of Duty
3. Direct Causation
4. Damages
*The four elements must be proven
Four Distinct Elements are Necessary to Prove Negligence as a Cause of Action:
1. A duty owed, or Standard of Conduct required to be met by the alleged wrongdoer in relation
to the injured party.
2. Failure to perform to that duty or standard of conduct.
3. A link showing that the failure was a proximate or direct cause of injury to the complaining
party
4. Actual loss or injury that can be measured for compensation in money damages
Duty
MD must act according to specific standards of care established by the profession
Requires every MD to possess the requisite skill, care, and diligence that a particular case
demands
Dereliction of Duty
Physician did not comply with duty toward patient

Fails to act according to norms or standards

Through commission or omission of certain acts
Direct Causation
Alleged acts or omission must be the proximate cause of the patients injury
-Any intervening material cause other than the doctors negligence will not result in
liability
Proximate Cause a.k.a. Legal cause
-That which in the natural and continous sequence, unbroken by any intervening cause,
produce injury without which the result would not have occurred
Tests to determine Proximate Cause:
1. But For or Sine Qua Non Rule
Negligent act is material to the occurrence of the event
End result would not be the same if defendants conduct was removed from the
scenario
2. Foreseeability Test
Patients damages must be the foreseeable result of defendant health care providers
substandard practice.
Need only to prove that the patients injuries were of a type that would have been
foreseen by a reasonable physician as likely resulting from the breach of medical
standard of care.
3. Cause and Condition Test
Alleged condition must be an active cause and not a passive one of the event in question
4. Natural and Probable Consequence Test
Event appeals to a rational mind as a natural or logical consequence to the doctors
conduct
Damages
If the patient is not harmed, there can be no recovery
Damages are merely part of the remedy allowed for the injury caused by a breach or
wrong.
Contemplates actual loss or damage to the interests of the patient by the MDs breach of the
standard of care.
No monetary claim can be recovered without proof that the patient actually incurred physical
injury
Physicians Defenses Against Claims of Negligence
1. Did not violate the four elements
2. Assumption of Risk
Patient assumes responsibility for all possible complications in the contemplated
treatment
Informed consent critical

3. Contributory Negligence

Patients own negligence was the immediate and proximate cause of the injury- no
recovery
Physicians negligence merely contributory- mitigation of damages

Other Defenses
Suit not properly laid
-Acts in his capacity as an employee
Statute of Limitations
-Prescriptive period depends on nature of crime
Homicide- 20 years
Physical injuries- 5 to 15 years
Intentional Felonies
1. Infanticide
Killing of a child less than 3 days old
2. Abortion
Intentional
Unintentional
3. Physical Injuries
4. Homicide
5. Acts of Lasciviousness
Victims can be male and female
1. Acts of Lasciviousness with Consent
Offended is < 12 but <18
Victims are females only
Scope of Consent
1. Delimits what MD can do or not do
2. Must not be exceeded
3. Outside the scope
Wrong procedure
Right procedure plus a wrong procedure
4. Within scope
Conditions not anticipated which if not corrected endangers life or health
Extension of procedure to treat an emergency
Consent to one procedure does not imply consent to a prohibited extension of such
procedure
Failure of Informed Consent
Negligence may result when MD proceeds to diagnose and treat a patient without getting an
adequate informed consent for such diagnosis and treatment.
- MDs actions not based on informed consent is a deviation from recognized standard of
care.
MD Duty to Advise the Patient or Patients Responsible Party

1. Problem to be treated or symptom to be diagnosed

2. Proposed test or Prescription
3. Risks, consequences, complications or side effects of the test or treatment
4. Indications for the choice
5. Expected results to be achieved by the test or treatment
6. Reasonable, available alternative methods and costs of diagnosis and treatment
7. Consequences of doing nothing
Situations Where Implied Consent Readily Apparent
1. Emergency
2. Minor requiring emergency care
3. Comatose requiring immediate treatment
4. Mentally incompetent
5. Unavailability of a legal guardian
6. Intoxicated patient temporarily lacking capacity to reason
7. Patient who did not sign consent form but allowed treatment to proceed without
objections
Responsibility for Informed Consent
Attending physician is responsible for getting the informed consent.
-Such responsibility cannot be delegated
-But authority can be delegated to another MD
Abandonment
Generally, no duty to treat any person who is not already a patient
No physician can be available at all times and in all circumstances
-Brief lapses of coverage are generally reasonable
Provide an adequate surrogate if unavailable for one reason or another
-Liable if unavailability of coverage for several hours harms hospital patients
Breach of Confidentiality
Confidentiality not absolute
-In life threatening emergencies to adequately manage the patient
-Information to other treating physicians and consultants
-To other third parties with patients consent
Breach of Contract or Warranty to Cure
MD liable for promises to effect a cure or to achieve a particular result
Basis of suit is breach of contract
- No need to show compliance with medical standard of care
MD Liability for Other Health Care Providers
MDs have the duty to their patients to supervise properly other health team members
and subordinates
Duty creates vicarious liability
-One person liable the wrongful acts or omissions of another
Standard of care of subordinates is that of the same profession or occupation and not
that of an MD performing the same service

Referrals
Failure to refer may make MD liable if referral is an established standard of care

MD Liability for Other Health Care Providers

Physicians Employees
- Physicians may be liable for hiring, training, assigning, supervising, or retaining
employees who harm patients or others