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Emailing Legal Med Notes Based On Olarte
Emailing Legal Med Notes Based On Olarte
LEGAL MEDICINE
Legal Medicine
- Is that branch of medicine that applies, medical and surgical concepts, scientific
knowledge and skills to medico legal issues, in order to assist the trier of facts in
the proper dispensation of justice.
Medical Jurisprudence
- is the study of the Medical Law and its applicable Jurisprudence that governs,
regulates and defines the practice of medicine.
• In the Philippines, Legal Medicine is the appropriate name for Forensic Medicine.
- In the Phil. , the father of Legal Medicine can be rightfully bestowed to Dr. Pedro
P. Solis. His book on Legal Medicine copyrighted in 1987, contains the most
extensive treatise and teachings in Philippine Legal Medicine.
2. Criminal Law
3. Remedial Law
4. Special Laws
- Dangerous Drug Act
- Youth and Child Welfare Code
- Sanitation Code
- Insurance law
- Labor Code
- Employees Compensation Law
5. CORPUS DELICTI
- Is the body or substance of the crime and is defined as the fact that a crime
actually has been committed. In all criminal prosecutions, the burden is on the
prosecution to prove the corpus delicti.
QUANTUM OF PROOF
1. In Civil Cases – the quantum of proof necessary to prove a civil complaint is a
PREPONDERANCE OF EVIDENCE. The party filing or bringing a civil complaint
has the burden of proof and must establish the truth and righteousness of his
allegations by a preponderance of the evidence admitted by a competent court.
2. In Criminal Cases
– the quantum is proof beyond reasonable doubt.
- In a criminal case the accused is entitled to an acquittal, unless his guilt is shown
beyond reasonable doubt
- Presumption of INNOCENCE is a conclusion drawn by the constitution and the
law in favor of the accused , while REASONABLE DOUBT, is a condition of mind
produced by proof resulting from evidence in the case.
5. To establish Alibi
- It must be proved by positive, dear and satisfactory evidence. “ Oral Evidence”
of alibi is so easily manufactured and usually unreliable that it can rarely be given
credence.
6. In Administrative Complaints
- In cases filed before administrative or quasi judicial bodies, a fact maybe
deemed established if it supported by “ substantial evidence” which means that
amount of relevant evidence which a reasonable mind might accept as adequate
to justify a conclusion.
CHAPTER 2
MEDICAL AND HOSPITAL JURISPRUDENCE
Medical Jurisprudence:
- Is the study of the Medical Law and its applicable Jurisprudence, that governs,
regulates, and defines the practice of medicine.
- It includes the rights, duties, obligations and liabilities of both physician and
patient to each other in a physician patient professional contract.
• Any person who practice any of the above acts enumerated, without any valid
certificate of registration as a physician, is practicing illegal medicine.
2. Fiduciary:
- founded in trust, faith, and confidence reposed by one person in the integrity
and fidelity of another.
2. He must use such knowledge and skill with ordinary care and due diligence.
4. He has the duty to keep the secrets and confidentialities of his patients.
• The Terms and Conditions not included in the Physician Patient Professional
Relationship Contract ( refer to book )
• The only promise or guaranty that the law requires is that, the physician will treat
the patient in accordance with the standards of medical care.
Liabilities of a Physician Which May Arise from His Negligent or Wrongful Acts or
Omissions:
1. Administrative Liability
- A complaint under oath can be filed before the Professional Regulation
Commission Board of Medicine, for reprimand, of the license to practice medicine.
2. Criminal Liability
- When an act or omission constitutes a crime, the physician can be imprisoned
or fined or both, as any other profession.
3. Civil Liability
- The aggrieved party can be awarded monetary damages for any wrongful or
negligent act or omission, when the professional is found guilty.
• Ex. Whether A Hospital may be Held Liable for the Negligence of Physicians –
Consultants allowed to Practice in its Premises.
CHAPTER 3
DEATH
Death maybe
A. Brain Death – occurs when there is a deeply irreversible coma, and absence of
electrical brain activity.
4 Kinds of Death:
1. Clinical or Somatic Death
2. Brain Death
3. Biological Death
4. Cellular Death
Clinical or Somatic Death
- This particular kind of death occurs when in the judgment of the physician with
the use of his clinical eye the body’s vital signs of life cease to exist continuously
and permanently.
- The clinical death is verifiable only by a physician after he observes that the
patient no longer has a heart beat no pulse rate, no spontaneous breathing and
movement, with the pupils of the eye widely dilated and not reactive to light and
accommodation.
- When a clinically dead person is brought to the morgue the generalized
contraction of the muscles or Rigor Mortis of the body within 3 to 6 hours, may
simulate a return to life, because of the motion or movement of the body.
BRAIN DEATH
- This kind of death follows clinical death – almost immediately unless
resuscitative procedures are started promptly, because the human brain under
normal conditions cannot survive loss of oxygen for more than 6 to 10 minutes.
- Brain Death may occur in the
Stage 1 – Cerebral Cortex- the highest center of the brain that is most sensitive to
changes in the supply of oxygen and blood to the brain. When the cerebral cortex
dies, the patient is in cortical death.
Stage 2 - Cerebellum – It deals with the function of equilibrium. It follows the death
of the cerebral cortex.
BIOLOGICAL DEATH
- All the components of the brain are dead
- There is also permanent extinction of bodily life.
- It is cardiorespiratory and brain death altogether with permanent cessation of all
the anatomic and physiological functions of the body organs.
CELLULAR DEATH:
- The death of the different parts of the body occurs at different times and stages.
- This is the reason why such organs as the corneas and the kidneys can be
removed immediately after biological death and transplanted successfully.
SIGNS OF DEATH:
1. Cessation of heart action and circulation
2. Cessation of respiration
3. Cooling of the body ( Algor Mortis )
- The temperature of 15 – 20 degrees Fahrenheit is considered as a certain sign
of death.
4. Loss of motor power
5. Loss of sensory power
6. Changes in the skin
7. Changes in and about the eye
- There is loss of corneal reflex
Kinds of Putrefaction:
1. Mummification
2. Saponification – This is also called Adipocere Formation.
3. Maceration
2. Presence of live Fleas in clothing – in death by drowning, a flea can survive for
about 24 hours submerged in water. After 24 hours submersion in water the fleas
die.
5. Rigor Mortis- begins to develop in 3 to 6 hours after death and may last for 24 to
36 hours after death.
6. Onset of decomposition – Decomposition takes place within 24 – 48 hours after
death.
8. Skeletal soft tissues – soft tissues may disappear from 1.5 years to 2 years
after burial.
Cadaveric spasm occurs immediately after death and is useful to ascertain the
circumstances of death.
Underlying Cause of Death is the basic cause or bottom line cause of death. It is
the diagnosis of the patients or victim’s illness or sickness that resulted to his
death
Ex. Acute Appendicitis, Hepatocarcinoma, Pelvic Fracture, Stab or Gunshot
Wound to the chest.
Death Warrant – is a warrant from the proper executive authority appointing the
time and place for the execution of the sentence of death upon a convict judicially
condemned to suffer death.
Manner of Death
- Is the explanation as to how the cause of death arose, and maybe either Natural
Death or Violent Death
Lazarus Syndrome
- Is also called Lazarus Phenomenon is the spontaneous return of circulation after
failed attempts at resuscitation.
Lazarus Sign
- Lazarus sign or Lazarus reflex is a reflex movement in brain dead patients,
which causes them to briefly raise their arms and drop them crossed on their
chests.
- The phenomenon has been observed to occur several minutes after the removal
of medical ventilators used to pump air in and out of brain dead patients to keep
their bodies alive.
Classification of Euthanasia:
1. Voluntary euthanasia – is euthanasia conducted with consent
2. Involuntary euthanasia
– is euthanasia conducted without consent.
-is conducted where an individual makes a decision for another person incapable
of doing so.
- also known as physician assisted death, physician assisted suicide or mercy
killing.
4. Active euthanasia – entails the use of lethal substances or forces to end life and
is the most controversial means.
CHAPTER 4
REGIONAL TRAUMA
Trauma
– is the leading cause of death in the first four decades of life and the 3rd leading
cause of death in all age groups today.
-Penetrating trauma particularly handguns is becoming common in nearly all
areas of the country.
3. Several days to weeks of Injury – these are due to sepsis or organ failure.
SPECIFIC INJURIES
1. Head
a. Types of Head Injuries:
a.1 Hematoma
a.2 Contusions
a.3 Skull fractures
a.4 Hemorrhage
2. Spine and Spinal Cord Injuries
The most common causes of severe spinal trauma are motor vehicular
accidents, falls, diving accidents, and gunshot wounds.
3. Chest
a. Life Threatening Injuries
Pnumothorax
Hemothorax
Flail chest as in multiple rib fractures Cardiac tamponade due to penetrating
injuries
- In stab wounds of the abdomen , only 2/3 penetrate the peritoneal cavity; of
these only ½ cause significant visceral injury that requires surgical repair.
b. Blunt
- The spleen and liver are the most commonly injured organs due to blunt trauma.
- Their frequent incidence also explains why the mortality rate following blunt
trauma is higher than that of penetrating injury.
7. Arterial trauma
8. Burns
CLASSIFICATION OF WOUNDS
1. AS TO LEGAL CLASSIFICATION
Chapter 1
DESTRUCTION OF LIFE
a. Article 246. Parricide
b. Article 247. Death or Physical Injuries Inflicted Under Exceptional
Circumstances
c. Article 248. MURDER
- Any person who, not falling within the provisions of Article 246 shall kill
another, shall be guilty of murder and shall be punished by Reclusion Perpetua, to
death if committed with any of the following attendant circumstances;
1. With treachery
2. In consideration of a price , reward or promise
3. By means of inundation etc.
4. On occasion of any of the calamities etc.
5. With evident premeditation
6. With cruelty etc
CHAPTER 2
PHYSICAL INJURIES
a. Article 262. Mutilation – Any person who shall intentionally mutilate another by
depriving him, either totally or partially , of some essential organ of reproduction.
b. Article 263. Serious Physical Injuries – Any person who shall wound, beat, or
assault another, shall be guilty of the crime of serious physical injuries
d. Article 265. Less Serious Physical Injuries – Any person who shall inflict upon
another physical injuries which shall incapacitate the offended party for labor for
10 days or more, or shall require medical attendance for the same period
Classification of Wounds
2. AS TO THE DEPTH OF THE WOUND
a. Superficial – When the wound involves only the layer of the skin
b. Deep – When the wound involves the structures beyond the layers of the skin.
b.1 Penetrating – the wound enters the body but does not come out. Punctured,
stab and gunshot wounds usually belong to this type of wound.
b.2 Perforating – there is a communication between the outside, inner and the
outer side. There is both a point of entry and exit.
Classification of Wounds
3. AS TO MORTALITY
a. Deadly Wound- Death results immediately, after the infliction of the wound.
Deadly wounds though mortal, maybe prevented with prompt medical treatment.
b. Non Deadly Wounds – Does not result to death immediately, after the wound is
inflicted. A non deadly wound may cause death later, due to complications i.e.
tetanus, septicemia
Classification of Wounds:
4. AS TO THE WOUNDING INSTRUMENTS USED:
a. Sharp Instruments – Ex. incised wound, punctured wound, stab wound dagger
or kitchen knife
b. Blunt Instruments – A block of wood or iron produces contusion, hematoma,
abrasions, lacerated wound when used to strike, attack, wound, beat or assault
another
Classification of Wounds:
5. AS TO THE CONSEQUENTIAL INJURY AFTER THE APPLOCATION OF
FORCE
a. Coup Injury -
b. Coup Centre Coup Injury
c. Contre Coup Injury
d. Locus Minoris resistancia
e. Extensive injury
Classification of Wounds:
6. AS TO THE INTEGRITY OF THE SKIN
A. CLOSED WOUNDS – Presents no break in the integrity or continuity of the skin.
There maybe only outward manifestations of injury internally.
Ex. of closed wounds:
1. petechiae – a circumscribe extravasation of blood in the subcutaneous tissue.
2. contusion – effusion of blood into the tissues underneath the skin as a result of
a blunt force. Ex. black eye
3. Hematoma
4. Blunt injury
5. Musculoskeletal injuries
Ex. Sprain, Dislocation, Fracture, Strain
B. OPEN WOUNDS
- There is a break in the continuity of the skin
Examples:
1. Abrasion
2. Bruise
3. Incised wound
4. Stab wound
5. Punctured wound
6. Perforating wound
7. Lacerated wound
8. Bites
9. Gunshot wounds
2. Defense wounds – in the process of defending himself from the attacks, assault,
wounding, beating or violence of the assailant, the victim sustains defensive
wounds usually in the upper extremities.
3. Victim’s wounds – these are wounds sustained by the victim, from the assailant,
the former not having the chance or opportunity to defend himself. The victim’s
wounds maybe located in any part of the body.
4. Self – Inflicted wounds – these are wounds self inflicted by the person on
himself. The wounds are usually found on the accessible parts of the body, usually
with no intention to kill himself. Unless the victim is insane, self inflicted wounds
are for a fraudulent or self serving purpose.
5. Homicidal wounds – these are the serious wounds sustained by the victim
resulting to his death, from the criminal assailant. Usually the wounds are situated
in the areas of the neck, chest, the abdomen and the skull.
6. Accidental wounds – these wounds are sustained by the victim, without any
fault or intention whatsoever on the part of the accused to inflict the wounds on the
victim. The wounds are usually located on any part of the victim’s body.
7. Suicidal wounds – these are wounds self inflicted by the victim on himself, and
usually seen on the temple, the roof of the mouth, and other fatal body areas,
accessible to the hand of the victim.
CHAPTER 5
COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002
B. REGULATED DRUGS
1. Self inducing sedatives such as secobarbital, phenobarbital, pentobarbital,
barbital and any drug which contains salt or derivative of a salt of barbituric acid.
B. Drug Habituation – is the desire to have a continuous use of the drug but with
the capacity to refrain physically from using it.
6. Protector
7. Pusher
8. Controlled Delivery
9. Den, Dive or Resort
10. PDEA – The Philippine Drug Enforcement Agency, which is the implementing
arm of the Dangerous Drugs Board.
Section 56. Temporary Release from the Center; After Care and Follow up
Treatment Under the Voluntary Submission Program
Section 58. Filing of Charges Against a Drug Dependent who is not rehabilitated
Under the Voluntary Submission Program.
Section 70. Probation or Community Service for a First Time Minor Offender In
Lieu of Imprisonment
Section 91. Responsibility and Liability of Law Enforcement Agencies and Other
Government Officials and Employees in Testifying as Prosecution Witnesses in
Dangerous Drug Cases
A.Hypnotics:
Opiates and Their Derivatives – Opium is obtained from the milky exudates of the
unripe seed capsules of the poppy plant, Papaver Sornoiferum.
B. SEDATIVES:
Barbiturates: - are the products of malonic acid and urea, synthesized on St.
Barbara day.
- Used to treat anxiety and to induce sleep can cause both psychologic and
physical dependence.
D.STIMULANTS:
Amphetamines – methamphetamines ( Shabu, speed );
methylenedioxymethamphetamine ( MDMA, ecstasy or Adam )
- Acts on the cerebral cortex causing alertness, excessive self confidence and
feeling of well being. Physical performance may to some degree temporarily
improve.
Untoward Effects:
- They increase the blood pressure and heart rate. Fatal heart attacks have
occurred even in healthy, young athletes. The blood pressure maybe so high that
a blood vessel in the brain ruptures causing a stroke.
Coccaine – is an alkaloid from the leaves of the coca shrub cultivated in Bolivia
and Peru.
- It produces effects similar to amphetamines, but is a much more powerful
stimulant.
- Is used to excite the undersexed.
- Is a euphoriant and readily relieves fatigue
Untoward Effects:
- Same as amphetamine
E. DEPRESSANTS:
- Angel dust
- Depresses the brain and abusers usually become confused and disoriented
shortly after taking the drug.
- Can be combative and because they don’t feel the pain they may continue
fighting even when hit hard.
CHAPTER 6
SEXUAL DYSFUNCTIONS AND SEXUAL CRIMES
2. Sado – masochism
a. Sadism
b. Masochism
3. Fetishism
a. Anatomic
b. Clothing
.
c. Necrophilic
d. Odor ( ospresiophilia )
Kinds of Ospresiophilia
1. Urolagnia
2. Coprolagnia
3. Mysophilia
a. Narcissism
b. Saboteur Fetish
c. Vampirism
E. As to visual stimulus
1. Voyeurism
2. Scoptophilia
F. As to number
1. Troilism
2. Pluralism
SEXUAL CRIMES:
Chaste – An unmarried woman who has had no carnal knowledge with men or
that she never voluntarily had unlawful sexual intercourse. These also denotes
purity of mind and innocence of heart.
Virgin – A woman who has had no carnal knowledge of man. Her genital organs
have not been altered by carnal connection.
Kinds of virginity
1. Moral virginity – the state of not knowing the nature of sexual life and not having
experience sexual relation.
3. Demi – virginity – This term refers to a condition of a woman who permits any
form of sexual liberties as long as they abstain from rupturing the hymen by
sexual act. The woman allows sexual intercourse, but only inter femora or even
inter labia, but not to the extent of rupturing the hymen.
4. Virgo intacta – A truly virgin woman. There is no structural change in her organ,
notwithstanding the fact of a previous sexual intercourse.
C. Seduction
- is the art of a man enticing women to have unlawful intercourse with him by
means of persuasion, solicitation, promises, bribes or other means without
employment of force
D. Acts of Lasciviousness
E. Acts of Lasciviousness with Consent of the Offended Party
F. Abduction
1. Forcible Abduction
2. Consensual Abduction
G. Adultery
H. Concubinage
I. Bigamy
J. Marriage Contracted Against the Provisions of Law
K. Premature Marriage
L. Performance of Illegal Marriage Ceremony
M. Prostitution
N. Corruption of Minors
O. White Slave Trade
P. Abuse Against Chastity
7. Grave Coercions
CHAPTER 7
MENTAL HEALTH DISORDERS
1. Heredity – the most frequent factor that contributes to insanity and a good
history will reveal the ascendants afflicted with the same.
2. Incestous Marriage – The mental illness is accentuated when they are blood
relatives.
3. Impaired Vitality – Stress, tension, worry, grief may predispose to insanity
4. Poor Moral Training and Breeding – Corrupt moral upbringing in the family due
to immorality of the parents
5. Psychic Factors – Factors like love, hate, rage, anger, passion disappointments
6. Physical Factors
a. Non toxic factors – exhaustion resulting from severe physical and mental
strain and traumatic injuries to the head.
b. Toxic factors – drug addiction, infections of the brain
5. Phobic Disorders
a. Agoraphobia
b. Specific phobias
c. Social phobia
6. Obsessive Compulsive Disorder
7. Post Traumatic Stress Disorder
8. Depression and Mania
9. Bipolar Disorder
10. Suicidal Behavior
11. Eating Disorders
a. Anorexia nervosa
b. Bulimia nervosa
c. Binge eating disorder
12. Personality Disorders
a. Paranoid
b. Schizoid
c. Histrionic
d. Narcissistic
e. Antisocial
f. Borderline
g. Avoidant
h. Dependent
i. Obsessive – Compulsive
j. Passive Aggressive
k. Dissociative
13. Schizophrenia – a serious mental disorder characterized by loss of contact
with reality ( psychosis ) , hallucinations, delusions ( false beliefs ) , abnormal
thinking, disrupted work and social functioning
Types of Schizophrenia:
a. Paranoid
b. Hebephrenic
c. Catatonic
Types of Compulsion:
a. Pyromania
b. Kleptomania
c. Dipsomania
d. Homicidal impulse
e. Sex impulse
f. Suicidal impulse
5. In true insanity, the patient can endure a violent or stressful activity without
fatigue, which is not present in false insanity
6. In true insanity, the patient does not observe personal hygiene, in false insanity,
the pretender observes hygiene
2. As a mitigating Circumstance
Article 13, of the Revised Penal Code provides, the following are mitigationg
circumstances:
a. That the offender is deaf and dumb, blind or otherwise suffering from physical
defect which thus restricts his means of action, defense or communication with his
fellow beings
The American Law Institute formulated the following Rules on Criminal
Responsibility and states that;
1. A person is not responsible for his criminal conduct if at the time of such
conduct as a result of mental illness or defect, he lacks essential capacity to
appreciate the criminality of his conduct or to conform his conduct to the
requirement of the law.
The Legal Importance of determining the person’s state of mind are the following
Insanity at the time of marriage of any or both parties is a ground for the
annulment of marriage.