MANILA LAW COLLEGE

Sales St., Quiapo, Manila

LEGAL MEDICINE

Submitted By:

EDWIN D. VILLA

Submitted To:
ATTY. RODOLFO RABAJA

Date Submitted:
May 11, 2019

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LEGAL MEDICINE

is the 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.

a branch of medicine which deals with the application of medical knowledge to the
purposes of law and in the administration of justice.

HISTORY OF LEGAL MEDICINE

Paulus Zacchias (1584 – 1659) is the “Father of Forensic Medicine”; an Italian practical
physician, teacher of medical science, medio-legal jurist, philosopher, and poet. His most well
known book is Quaestiones medico-legales (written in 1557).

He was the first to describe the importance and application of medicine to the proper
administration of justice.

He is said to have occupied the position as personal physician for Pope Innocentius X.
Zacchias was also an adviser for the Rota Romana, the highest Papal court of appeals.

In the Phil., the father of Legal Medicine can be rightfully bestowed to Dr. Pedro P.
Solis.

The late Dr. Pedro P. Solis completed his elementary education at Julugan Elementary
School, secondary education at the University of the Philippines (U.P.) High School and
Associate in Arts in U.P.. Dr. Pedro Solis finished Medicine at the U.P. College of Medicine and
Law at the Manila Law College. His graduate degree in Criminology was obtained from
Cambridge University in England.

For forty-four years Dr. Solis served the government initially as medico-legal officer,
eventually becoming the National Bureau of Investigation's Deputy Director for Technical
Services.

He taught in various institutions such as the Colleges of Law, Medicine and Public
Health of the University of the PHilippines, Manila Law College, Philippine College of

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Criminology, the medical colleges of Far Eastern University (FEU), University of the East (U.E.),
Manila Central University (M.C.U.) and the colleges of Law of Lyceum and San Sebastian.

Dr. Solis wrote textbooks in Legal Medicine, Medical Jurisprudence and Criminal
Investigation, which are still widely used at present. He represented the country in various
international organizations and committees in the fields of law, medicine and criminology.

APPLICATION OF LEGAL MEDICINE TO LAW

1. CIVIL LAW

- the determination and termination of civil personality

- the limitation or restriction of a natural person’s capacity to act
- marriage and legal separation
- testamentary capacity of a person making a will
- paternity and filiation
- the right to hereditary succession

2. CRIMINAL LAW

- Felonies and circumstances which affect criminal liability

- Civil liability ex delictu
- Crimes relative to opium and prohibited drugs
- Crimes against civil status of persons
- Crimes against chastity
- Crimes against persons
- Quasi – offenses

3. REMEDIAL LAW

- Physical and Mental Examination of a person

- Hospitalization of insane persons
- Rules of Evidence

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4. SPECIAL LAWS

- Dangerous Drug Act

- Youth and Child Welfare Code
- Insurance law
- Sanitation Code
- Employees Compensation Law
- Labor Code

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.

WHAT IS FORENSIC MEDICINE?

Forensic medicine is the practice of medicine as it pertains to the Law. It involves areas
like determining the nature and cause of death, medical negligence and identification of
human remains. It can include medical examination of suspects and victims in support of the
investigation of crime such as medical examination of the victims of rape, for the purpose of
determining the nature and extent of any injuries and the taking of samples, fitness of
suspects to be interviewed where it may be in doubt for medical reasons, and determining
whether a person is acting under the influence of drugs.

There are various branches within the field of forensic medicine including Forensic
pathology that is concerned primarily with establishing the nature and cause of suspicious
death.

Forensic Odontology is the application of dentistry to legal matters. Amongst other

tasks the Forensic Odontologists can identify individuals using their dentition and through
bite marks.

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 Forensic Radiography is the application of science of diagnostic imaging to questions
of law. Forensic Radiography can be used to identify the individual, identify the cause of the
injury or death and to identify evidential material.

WHAT IS MEDICAL 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.

In the Philippines, Legal Medicine is the appropriate name for Forensic Medicine.

What are the “Acts” which constitute Medical Practice?

- To physically examine and diagnose a patient.

- To physically examine and treat a patient
- To physically examine and perform surgery in a patient
- To physically examine and prescribe any remedy to a patient.

What are the “Rights” inherent in the practice of Medicine?

- The right to choose his patients

- The right to limit the practice of his profession
- The right to determine appropriate treatment procedures in the discretion
and judgment of the physician.
- The right to avail of hospital privileges after being qualified.
- The right to receive just and fair compensation from his patients.

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What is the difference between Medical Negligence and Medical Malpractice?

Medical Malpractice

general term used when a medical practitioner (Doctor) or an allied medical

practitioner (Dentist, Nurse, Medical Technologist) KNOWINGLY deviates from the standard
practice of medicine

Medical Negligence

specific term used when a medical practioner does not exercise due diligence and
standard care required of him thus resulting to injury to the patient. Usually connotes
accidental or unintentional injury.

Common complaints about doctors who commit malpractice include:

- Error in anesthesia
- Mistake during childbirth
- Surgical errors
- Unnecessary surgery
- Wrongful death
- Wrong diagnosis or misdiagnosis

Examples of medical negligence include:

- Failure to revise a diagnosis

- Failure to warn patients of the risks of treatment
- Failure to remove surgical instruments from the patient during surgery
- Failure to attend to or treat a patient
- Incompetence
- Failure to refer a patient to a specialist relevant to their disease or injury
- Wrongful diagnosis

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Doctrine of Proximate Cause

“That cause, which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have
occurred.”

a legal concept of "cause-and-effect" relationships

determines whether an injury would have resulted from a particular cause.

In Malpractice - An element required to prove negligence; i.e., the plaintiff–Patient or

Patient's estate must prove that the Patient's injury is reasonably connected to the physician's
action.

What is the Degree of Care needed to be applied by Physicians?

Standard of care required is more than just ordinary care and diligence but a HIGHER
degree of care expected from an average physician or general practitioner.

Source: Solis MEDICAL JURISPRUDENCE 1988

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Doctrine of Res Ipsa Loquitur

Literally means: “the thing speaks for itself”.

Originated in the English Jurisprudence of Byrne V. Boadle (1853 Case)

If one eventuality happens unusually or not occasionally, NEGLIGENCE is presumed if

one has control over things.

Its function is to aid the plaintiff in proving the elements of negligence by

circumstancial evidence.

The doctrine can only be invoked when and only when, under the circumstances,
involved, direct evidence is absent and not readily available.

Literally means: “the thing speaks for itself”.

Originated in the English Jurisprudence of Byrne V. Boadle (1853 Case)

If one eventuality happens unusually or not occasionally, NEGLIGENCE is presumed if one has
control over things.

Its function is to aid the plaintiff in proving the elements of negligence by

circumstancial evidence.

The doctrine can only be invoked when and only when, under the circumstances,
involved, direct evidence is absent and not readily available.

Medical malpractice can be established by the doctrine of res ipsa liquitur. It is

applicable to cases where the court, from its fund of knowledge, can determine the standard
of care or where an ordinary layman can conclude that there was negligence on the part of
the doctor.

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 Case study: Cantre vs Sps Go,
G.R. No. 160889, April 27, 2007

Facts:

Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr.
Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora S. Go,
who was admitted at the said hospital on April 19, 1992.

Nora Go delivered a baby boy by normal vaginal delivery, with Dr. Cantre in
attendance. After the delivery, Nora had massive vaginal bleeding.

Because of profuse bleeding, patient went into hypovolemic shock.

The BP dropped to 0/0.

Dr. Cantre was able to stabilize the patient. She ordered a drop light to be placed near
the patient and her blood pressure monitored.

However, a gaping wound was caused by the blood pressure cuff that was used to
monitor the patient’s blood pressure.

Issues:

Is petitioner liable for the injury suffered by respondent Nora Go?

Injury – gaping wound in the arm where the BP cuff was placed.

Cause - either the BP cuff or the drop light which was placed too near the arm of the
patient

Ruling:

The Hippocratic Oath mandates physicians to give primordial consideration to the

well-being of their patients. If a doctor fails to live up to this precept, he is accountable for his
acts. This notwithstanding, courts face a unique restraint in adjudicating medical negligence
cases because physicians are not guarantors of care and, they never set out to intentionally

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cause injury to their patients. However, intent is immaterial in negligence cases because
where negligence exists and is proven, it automatically gives the injured a right to reparation
for the damage caused.

In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere
existence of an injury to justify a presumption of negligence on the part of the person who
controls the instrument causing the injury, Provided that the following requisites concur:

The accident is of a kind which ordinarily does not occur in the absence of someone's
negligence;

It is caused by an instrumentality within the exclusive control of the defendant or

defendants; and

The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.

As to the first requirement, the gaping wound on Nora's arm is certainly not an
ordinary occurrence in the act of delivering a baby, far removed as the arm is from the organs
involved in the process of giving birth. Such injury could not have happened unless negligence
had set in somewhere.

Second, whether the injury was caused by the droplight or by the blood pressure cuff
is of no moment. Both instruments are deemed within the exclusive control of the physician
in charge under the “CAPTAIN OF THE SHIP" doctrine. -This doctrine holds the surgeon in
charge of an operation liable for the negligence of his assistants during the time when those
assistants are under the surgeon's control.

In this particular case, it can be logically inferred that petitioner, the senior consultant
in charge during the delivery of Nora's baby, exercised control over the assistants assigned to
both the use of the droplight and the taking of Nora's blood pressure. Hence, the use of the
droplight and the blood pressure cuff is also within petitioner's exclusive control.

Third, the gaping wound on Nora's left arm, by its very nature and considering her
condition, could only be caused by something external to her and outside her control as she
was unconscious while in hypovolemic shock. Hence, Nora could not, by any stretch of the
imagination, have contributed to her own injury.

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NO CONTRIBUTORY NEGLIGENCE ON THE PART OF THE PATIENT

Doctrine of Contributory Negligence

Doctrine of Common Fault.

It is the conduct on the part of the plaintiff, contributing as a legal cause to the harm
he has suffered, which falls below the standard to which he is required to conform for his own
protection.

Legal Basis

Article 2179, Civil Code:

When the plaintiff’s own negligence was the immediate and proximate cause of his
injury, he cannot recover damages. But if his negligence was only contributory, the immediate
and proximate cause of the injury being the defendant’s lack of due care, the plaintiff may
recover damages, but the court shall mitigate the damages to be awarded.

Article 2214, Civil Code

In quasi-delicts, the contributory negligence of the plaintiff shall reduce the damages that he
may recover.

Liabilities of Hospitals

The hospital’s liability is also anchored upon the following doctrines: agency principle of
apparent authority or agency by estoppel ; doctrine of corporate negligence/corporate
responsibility

which have gained acceptance in the determination of a hospital’s liability for negligent acts
of professionals because of the actions for a principal or an employer .

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Doctrine of Apparent Authority

“Where it is shown that a hospital, by its actions, has held out a particular physician
as its agent and/or employee and that a patient has accepted treatment from that physician
in the reasonable belief that it is being rendered in behalf of the hospital, the hospital will be
liable for physician’s negligence.”

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

Doctrine of Corporate Responsibility

A hospital has the duty to see that it meets the standards of responsibilities for the
care of patients. Such duty includes the proper supervison of the members of its medical
staff.

If a hospital breached its duties to oversee or supervise all persons practicing medicine
within its walls and also failed to take an active step in fixing the negligence committed, it will
be vicariously liable for the negligence of the doctor under Art. 2180, and directly liable for its
own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

Doctrine of respondent Superior

A hospital has the duty to see that it meets the standards of responsibilities for the
care of patients. Such duty includes the proper supervison of the members of its medical
staff.

If a hospital breached its duties to oversee or supervise all persons practicing medicine
within its walls and also failed to take an active step in fixing the negligence committed, it will
be vicariously liable for the negligence of the doctor under Art. 2180, and directly liable for its
own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

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Liabilities of a Physician Which May Arise from His Negligent or Wrongful Acts or
Omissions

- 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.

- CRIMINAL LIABILITY- When an act or omission constitutes a crime, the physician can
be imprisoned or fined or both, as any other profession.

- CIVIL LIABILITY- The aggrieved party can be awarded

monetary damages for any wrongful or negligent act or omission, when the
professional is found guilty.

The most important goal of the medical profession is the preservation of life and health of
the people. But what happens when a medical professional causes bodily harm or even
death to his or her patient? What is the remedy available to the patient?

The remedy available is called a medical malpractice suit. In the Philippines, a medical
malpractice suit is primarily governed by the Civil Law concept of damages. In order to
successfully pursue a medical malpractice suit, the patient must prove the four (4) elements
of medical negligence. The four (4) elements are (1) duty; (2) breach; (3) injury; and (4)
proximate causation. Recent cases will illustrate how these 4 elements interact in order to
pursue a successful medical malpractice suit.

Is there a Physician-Patient Relationship?

Duty means that there is a professional relationship between the doctor and the patient.
This relationship is created when the patient engages the services of the doctor and the
doctor agrees to provide care to the patient.

To illustrate, let us take the case of Jarcia v. People of the Philippines (G.R. No. 187926,
February 15, 2012). In Jarcia, the patient was hit by a taxicab and was rushed to the

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hospital. The two doctors who attended the patient ordered an X-ray, which showed no
fracture. The doctors informed the mother of the patient that since it was only the ankle of
the patient that was hit by the taxicab, there is no need to examine the upper leg.
Unfortunately, the patient subsequently developed fever, swelling of the right leg, and
misalignment of the right foot. A new X-ray revealed a mid tibial fracture and a linear
hairline fracture in the shaft of the patient’s bone.

The two doctors raised the argument that there is no physician-patient relationship in this
case. They claim that they were merely passing by the emergency room for lunch when the
nurse requested them to see the patient. The Supreme Court struck down the arguments of
the doctors and said that when they examined the victim and gave assurances to the
victim’s mother, a clear physician-patient relationship existed between the parties. Thus,
the two doctors were under a duty to exercise the same degree of care, skill and diligence
which physicians in the same line of practice ordinarily possess.

Standard of Breach

The breach referred to in medical malpractice cases is the breach of the standard of care
expected of other similarly trained medical professionals acting under the same
circumstances.

Let us take the example of Borromeo v. Family Care Hospital, Inc. (G.R. No. 191018, January
25, 2016). In Borromeo, the patient was complaining of acute pain and fever for two days.
The doctor suspected that the patient might be suffering from acute appendicitis. After
several inconclusive tests, the doctor decided to perform an exploratory laparotomy. After
the surgery, the patient’s blood pressure suddenly dropped. Furthermore, the patient
developed petechiae in various parts of her body. The doctor suspected that the patient has
Disseminated Intravascular Coagulation, which is a blood disorder. Unfortunately, attempts
to resuscitate the patient failed.

The Supreme Court held that there is no medical malpractice since the cause of the
uncontrollable bleeding was a medical disorder, Disseminated Intravascular Coagulation. In

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this case there is no proof that the doctor fell short of the expected standard required under
the circumstances.

Injury as a Result of Breach

The element of injury to the patient in medical malpractice cases is straightforward – it is

the direct result of the doctor’s breach.

The case of Rosit v. Davao Doctors Hospital (G.R. No. 210445, December 7, 2015) perfectly
illustrates how an injury to the patient can take place. In Rosit, the patient figured in a
motorcycle accident, which fractured his jaw. During the operation, the doctor used a metal
plate fastened to the jaw of the patient with metal screws to immobilize his mandible.
However, despite the doctor’s knowledge that the operation requires the smallest screws
available, the doctor simply cut the larger screws which were on hand. The doctor also knew
that the smaller screws were available in Manila, but he simply assumed that the patient
would not be able to afford the same.

Following the procedure, the patient could no longer properly open or close his mouth and
was in constant pain. X-rays done on the patient revealed that the modified screws placed
by the doctor reached the molar of the patient. The patient then had to seek the services of
another doctor to undo the damage. In this case, the Supreme Court held that the doctor is
liable for at least three types of damages, namely: actual, moral and exemplary damages.
First, the patient was able to claim actual damages since he was able to prove the definite
expenses that he incurred due to the negligence of the doctor. Second, the patient was
likewise able to claim moral damages because of the unnecessary physical suffering he
endured as a consequence of the doctor’ negligence. Third, the patient was entitled to
exemplary damages because the doctor acted in bad faith or in a wanton, fraudulent,
reckless, oppressive manner when he did not inform the patient of the risks of using large
screws for the operation.

Proximate Cause

Proximate causation refers to the relation between the negligence or breach of the doctor
and the resulting injury of the patient. The negligence or breach must have played an

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integral part in causing the injury or damage. In other words, the injury to the patient is
either a direct result or a reasonably probable consequence of the negligence or breach of
the doctor.

An illustration of proximate causation is provided for in the case of Casumpang v. Cortejo

(G.R. No. 171127, March 11, 2015). In Casumpang, the patient is an 11-year old boy who
initially complained of difficulty in breathing, chest pain, stomach pain and fever. The doctor
who examined the patient diagnosed him with bronchopneumonia. However, the mother of
the patient raised her doubts with the doctor’s diagnosis since her son had a high fever but
did not have any colds or cough.

The following day, the mother of the patient informed the doctor that there were traces of
blood in her son’s sputum. However, the doctor simply nodded and reassured them that it
was due to bronchopneumonia. Later that morning, the patient vomited phlegm with blood
streaks. He was attended to by one of the resident physicians. Several tests were ordered
done on the patient. When the tests came out, the results showed that the patient was
suffering from Dengue Hemorrhagic Fever.

The Supreme Court held that the doctor is liable for medical malpractice. In determining
whether or not the negligence of the doctor is the proximate cause for the patient’s death,
the court looked at the nature of Dengue. The court considered expert testimony stating
that with correct and timely diagnosis and proper medical management, dengue fever is not
a life threatening disease and could easily be cured. In fact, the mortality rate of dengue
fever should fall to less than 2%. Thus, the proximate cause of patient’ death is the failure of
the doctor to timely diagnose dengue, despite the presence of its characteristic symptoms.

Captain of the Ship Doctrine

Aside from the four (4) elements of Medical Malpractice cases, there are specific doctrines
that should be taken into consideration in determining physician’s liability.

Under the Captain of the Ship Doctrine, the operating surgeon is the person in complete
charge of the surgery room and all personnel connected with the operation. In Professional
Services Inc. v. Agana (G.R. No. 126297, February 2, 2010), the patient was rushed to the

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hospital wherein a doctor diagnosed her to be suffering from cancer of the sigmoid. While
performing anterior resection surgery on the patient, the doctor discovered that the
malignancy in the patient’s sigmoid had already spread to her ovary. This prompted the
doctor to obtain the consent of the patient’s husband, to permit another doctor to perform
hysterectomy.

After completion of the hysterectomy, the first doctor took over and decided to close the
incision despite the fact that the attending nurses informed him that there were missing
gauzes. After her release from the hospital, the patient complained of excruciating pain in
her anal region. Subsequently, the patient’s daughter found a piece of gauze protruding
from her vagina. The doctor was able to remove the gauze but the pain did not subside.
Upon consulting other doctors, another gauze was found inside the patient’s vagina, which
was already causing infection.

The Supreme Court applied the Captain of the Ship Doctrine in upholding the liability of the
doctor. The Court stressed that as the lead surgeon, the doctor had the duty to remove all
foreign objects from the patient’s body before the closure of the incision. At the very least,
the doctor should have informed the patient of his failure to do so. The act of ordering the
closure of the incision notwithstanding that the pieces of gauze remained unaccounted for
bolstered the application of the doctrine.

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