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.

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

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)

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
Ascheim-Zendek Test Breslaus Test Foderes /Hydrosatic/ Static Test Gettlers Test

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 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.

Magnus test Icards Test

PURPOSE
Sign of recent deliver/Pregnancy test

RESULT

Diaphanous test

Winslows Test

Respiration

Livebirth vs Stillborn
Drowning in a fresh water pool

Unsectioned and Sectioned lungs float in water Chloride difference of 25mg Fresh RV>LV Sea LV>RV Blue reaction w/ Lungs reagent (+) nitrite/ nitrate

Paraffin / Dermal Nitrate/ Diphenyllamine/ LUNGS Test

Corroborative (+) even after 3 days & with washing Blood & Blood Stains

Saline extract + NH3 Benzidine Test Guaiacum/Van Deens Dyas/ Schombeins Test Phenolphthalein/ Kastle-Meyer test Leucomalachite Green Test Microchemical Tests Takayama Test/ Hemochromogen crystal Teichmanns Blood crystals / Hemin crystal test Wagenhaars/ Acetone-haemin test

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

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

Pink Green

Aa

Best test Dark brown rhoimbic prisms of Cl, hematin

Schourups Formula

Time of death

Walker/ Naphthalinamine

Presence of Gunpowder in clothings

CSF lactic acid 15mg 200mg in 5 hrs after death Aa, nitrogen, axillary temp Dark red spots on foto paper

Annulment when concealed 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 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 contraindications before inserting IUD;

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

INJURIES/WOUNDS: Legal Classification: Slight physical injuries 1-9days Less serious physical injuries Serious physical injuries

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 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
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 Pugilistic position of the body Bright pink color of blood Congestion of brain & spinal cord Burns with metallization Contusion collar Pinpoint pupils General reduction in the size & weight of all organs except the BRAIN

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:

Asphyxia

Burns CO poisoning Coma Electricity Gunshot Opium poisoning Starvation

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

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.

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 Assumption of Risk Borrowed Servant

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

Description Temporary master must be responsible for the wrongful act of servant

Contributory Negligence Forseeability Independent Contractor theory Last Clear Chance Res Ipsa Loquitor

Contract for Service Use of hospital for the px Due to negligence Exclusive control of Defendant No contribution from the plaintiff Contract of Service A master is liable for the wrongful acts of his servant w/in scope of authority (hospital) Administrative or ministerial duties Negligence of his partner Acts of his agent Not his partner Interns

Respondent Superior

Vicarious Liability