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INTRODUCTION TO LEGAL MEDICINE

DECEPTION DETECTION

Scope of Legal Medicine: transcends all where medical & para-

medical sciences are applied as demanded by law for the Effects of Devices w/c Record the Psycho-Physiological
administration of justice Response Upon the Local Courts
 inadmissible, but w/ strong PERSUASIVE effects
Nature of the Study
1. ability to acquire facts and draw conclusions therefrom
2. must possess powers to impart to others verbally or in DEVICES W/C RECORD THE
writing all those he has observed PSYCHO-PHYSIOLOGICAL RESPONSE
Reason for Inadmissibility of The Polygraph
Titles Results in Courts:
1. medical jurist - no degree of standardization of acceptance
2. medical examiner yet
3. medico-legal officer - the trier of fact is apt to give almost
4. medico-legal expert conclusive weight
- no qualification parameters for the examiner
Who May Perform Autopsies POLYGRAPH/ - examinee may unwittingly waive his right
1. medical officers of law enforcement agencies LIE DETECTOR against self-incrimination
2. medical staff of accredited hospitals as authorized by law - error factors of the examination itself

Error Factors:
PHYSICIAN JURIST - nervousness & extreme emotional tension
Cure cause experienced by the subject
To diagnose & render To testify before all - physiological abnormalities
treatment courts or tribunal - mental abnormalities
Minor injuries are ignored All are recorded - unresponsiveness in a living or guilty subject
DOH DOJ - attempts to beat the machine
WORD - measures the “time interval” bet. the
ASSOCIATION stimulus words & the response
BRANCHES OF LAW TEST - answer is no concern
WHERE LEGAL MEDICINE MAY BE APPLIED - based on the science of graphonics where
- determination of civil personality speech is composed of audible & inaudible
- limitation of person’s capacity to act PSYCHOLOGICAL frequencies at an oscillation rate of 8-14
CIVIL - marriage & legal separation STRESS cycles per second
- paternity & filiation EVALUATOR - where a person is stressed or lying, the
- testamentary capacity microtremor in the voice utterance is
- circumstances affecting criminal liability suppressed
CRIMINAL - crimes against persons - the “Truth Serum” (hyoscine hydorbromide) –
- crimes against chastity a state of delirium is induced
- physical & mental examination of the person USE OF DRUGS - when the proper point is reached, the
- proceeding for the hospitalization of an insane person THAT INHIBIT questioning beings & the subject feels a
REMEDIAL - rule on evidence THE INHIBITOR compulsion to answer the questions truthfully
- dangerous drugs act - narcoanalysis & narcosynthesis
- youth & child welfare code - alcohol/intoxication
SPECIAL - insurance law Why Hypnosis is Inadmissible in Court
- code of sanitation - It lacks general scientific acceptance of
- labor code reliability
- employee’s compensation - The judge may give it uncritical & absolute
reliability
HYPNOSIS - The hypnotized subject may deliberately
MEDICAL EVIDENCE fabricate
- The subject may be in a state of “heightened
- addressed to the senses of the court
suggestibility”
- vision, smell, hearing, taste, touch
- The state of mind, skill & professionalism of
AUTOPTIC/
the examiner are too subjective
REAL Limitations:
- indecency or impropriety SCIENTIFICT - Mutt & Jeff Technique
- repulsive objects INTERROGATION - Split-Pair Technique
- a physician may be commanded to appear in CONFESSION
court
TESTIMONIAL - his testimony must be given orally & under
oath or affirmation Psychological & Physiological Signs & Symptoms of Guilt
- ordinary & expert 1. sweating
- a medical witness may be allowed in court to 2. color change
EXPERIMENTAL confirm his allegation as a corroborative proof 3. excessive activity of the adam’s apple
to an opinion he previously stated 4. fidgeting
- e.g. lethality of poisons, drowning, etc 5. inability to look “eye to eye”
6. peculiar feeling inside
DOCUMENTARY
7. swearing
8. spotless past record

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9. “not that I remember” 1. That w/c incapacitated the offended party for labor from 1-9
days or required medical attendance during the same period
2. That w/c did not prevent the offended party from engaging in his
PHYSICAL INJURIES habitual work or did not require medical attendance
3. Ill-treatment of another by deed w/o causing any injury
ART. 262: MUTILATION CLASSIFICATION OF WOUNDS

Kinds of Mutilation Physical Injuries: the effect of some form of stimulus on the body
1. Intentionally mutilating another by depriving him, totally or from w/in or w/o
partially, of some essential organ for reproduction 1. real – when the effect is visible
Elements 2. apparent – when stimulus is not enough
a. Castration-mutilation of organs necessary for generation
b. purposely and deliberately Vital Reactions: rubor, calor, dolor, function-laizza
2. Intentionally making another mutilation - lopping, clipping off
any part of the body of the offended party, other than the CLASSIFICATION OF WOUNDS
essential organ for reproduction, to deprive him of that part of 1. mortal
the body - brain, heart, lungs, big
vessels, upper spinal cord, stomach,
ART. 263: SERIOUS PHYSICAL INJURIES As to SEVERITY liver, spleen, intestines
2. non-mortal
How Committed - not capable of producing death
1. Wounding immediately or shortly thereafter
2. Beating 1. blunt instrument
3. Assaulting - contusion
4. Administering injurious substances - hematoma
As to kind of - laceration
Serious Physical Injuries INSTRUMENT used 2. sharp instrument
1. Injured person becomes insane, imbecile, impotent or blind - sharp-edged
2. Injured person – - sharp-pointed
a. loses the use of speech or the power to hear or to smell, - sharp-edged & sharp-pointed
loses an eye/hand/foot/arm/leg 1. hit
b. loses the use of any such member 2. thrust
c. becomes incapacitated for the work in which he had been 3. stab
habitually engaged As to manner 4. gunpowder
3. Injured person – of INFLICTION 5. explosion
a. become deformed 6. sliding
b. loses any other member of his body 7. rubbing
c. loses the use thereof 8. abrasion
d. becomes ill or incapacitated for the performance of the work 1. superficial
in w/c he had been habitually engaged in for more than 90 As to DEPTH 2. deep
days of the WOUND - penetrating
4. Injured person becomes ill or incapacitated for labor for more - perforating
than 30 days (but not more than 90 days) As to the SITE OF 1. coup
APPLICATION in 2. contre coup
ART. 264: ADMINISTERING INJURIOUS SUBSTANCES OR relation to 3. coup contre coup
BEVERAGES LOCATION of INJURY 4. locus minoris resistencia
5. extensive injuries
Elements
1. the offender inflicted upon another person any serious physical
injury
MEDICAL CLASSIFICATION OF WOUNDS
2. it was done knowingly administering to him any injurious
CLOSED WOUND OPEN WOUND
substances or beverages or by taking advantage of his weakness
No breach in the continuity of w/ break in the continuity of the
of mind of credulity
the skin or mucous membrane skin or mucous membrane
3. He had no intent to kill
Petechiae, contusion, hematoma Abrasions scratch, graze,
ART. 265: LESS SERIOUS PHYSICAL INJURIES impression mark, frictionmark
Sprain, dislocation, fracture, Incised, hacked, stab, lacerated,
Elements strain, internal hemorrhage punctured
1. That the offended party is incapacitated for labor for 10 days or
more (but not more than 30 days), or needs medical attendance
for the same period of time SPECIAL TYPES OF WOUND
2. That the physical injuries must not be those described in the - the wound assumes the shape of
preceding articles PATTERNED the offending instrument
WOUNDS - e.g. belt buckles, tire marks,
Qualifying Circumstances radiator grill
1. there is manifest intent to insult or offend the injured person - wounds sustained by the victim
2. there are circumstances adding ignominy to the offense while parrying the thrusts of the
3. the victim is either the offender’s parents, ascendants, DEFENSE assailant in an attempt to defend
guardians, curators or teachers WOUNDS himself
4. the victim is a person of rank or person in authority, provided - always found on the extremities of
the crime is not direct assault the victim
HESITATION CUTS - found commonly among suicide
ART. 266: SLIGHT PHYSICAL INJURIES & MALTREATMENT OR TEST CUTS victims
- usually found on the area where the

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mortal cut is located proper care & treatment, the offender is still held
SELF-INFLICTED Motives: responsible
WOUNDS 1. to escape obligations/punishment  a person is not bound to seek medical attention for the
2. to create a new identity or destroy injuries sustained
an existing one  the fact that the victim would have lived had he received
3. to gain attention/sympathy treatment is immaterial

ANTE-MORTEM WOUND POST-MORTEM WOUND

Hemorrhage more or less Slight or non at all; always MEDICO-LEGAL ASPECTS OF DEATH
copious; generally arterial venous
Marks of spouting No spouting Christian Barnard: World’s first successful heart transplant
Clotted blood Non-clotted or soft clot
Deep staining of wound edges Edges are not deeply stained; Smith vs. Smith
no removed by washing removable by washing  Argument: Since Mr. Smith was in a state of irreversible coma
Presence of inflammatory & No inflammatory or repair from day one, she might as well be declared as having died
reparative processes process simultaneously w/ Mr. Smith
Gaping wound edges Not gaping  Held: a person through unconscious, if breathing, is still alive!

Psychotic Behaviors of Self-Mutilation

1. head banging or bumping MEDICAL DEATH LEGAL DEATH
2. thermophilia (love for fire) Continuing process Precise event
3. castration/amputation The ceasing to exist of such Civil personality is extinguished
4. onychophagia (chewing of nails) animal & vegetative functions
5. pricking of acne eruptions Concerns of post-mortem care Concerns of succession
6. bruxism (grinding of teeth)
7. self disfigurement
8. tricho-tillomania (swallowing of hair) The Philadelphia Protocol
9. subcutaneous injection of air  Lack of responsiveness to internal & external environment
 Absence of spontaneous breathing in room air
Features of a Stab Wound  Absence of reflexes & response to painful stimuli
1. character of the knife  Falling arterial pressure w/o support from drugs or other
2. relative position of the assailant to the victim means
3. width of the knife  No muscular movements w/ generalized flaccidity
4. length of the knife  Iso-electric electroencephalogram

Maxims Brain Death Ottawa Protocol

1. the length of the wound is the width of the knife  Pupils dilated & non-reactive to light
2. the length of the wound may be longer than the width of  Absence of deep reflexes
the knife but it could never be shorter  Absence of circulation
3. in the presence of a HILT MARK, the depth of the wound is  Absence of respiration
the length of the knife  Flat electro-encephalogram
4. in the absence of a hilt mark: “I cannot tell you know how
long is the knife but I can tell you how not short is the Who Determines Brain Death?
knife!”  “Two-Physician Rule”
 For Transplants: 2 physicians + neurologist/neurosurgeon
CUT THROAT
SUICIDAL HOMICIDAL Cause of Death: the injury, disease, or combination of both,
Oblique Horizontal responsible for initiating the trend or disturbance, brief or prolonged,
Not so deep Deep w/c produce the fatal termination
Test or hesitation cuts present Defense wounds may be present 1. immediate: there is no opportunity for sequelae or
Facing a mirror Lying on the ground complications to develop
Cadaveric spasm w/ hand Weapon is usually absent or 2. proximate: injury or disease was survived for a prolonged
grasping the weapon hidden elsewhere interval w/c permitted the development of serious sequelae
Blood in front of the body, Blood at the back of the neck,
hands smeared w/ blood hand are usually clean Quo Vadis After Brain Death
Suicide note None  The right to die
History of mental depression, History of recent altercation  Legal consequences of death
domestic or financial problem usually in a drinking spree  Organ harvest & transplant
Prior history of self-destruction No prior  Whither though goest my mortal remains?

The Right to Die

Effect of Medical & Surgical Intervention
 “triad of consent”
 offender may still be held liable for the death of the victim if it
 May be invoked by the patient through a:
can be proven that death is inevitable & that even w/o the
o Living will
operation, death is the normal & direct consequence of the
injuries sustained o Donor card
 it must be shown that the physician treating the victim is o Any legal document
competent & that he exercised care & diligence
 that the wound inflicted must be the direct & proximate cause Legal Consequences of Brain Death
of the death  The civil personality of a natural person is extinguished by
death
Effect of Negligence of the Injured Person  Transmission of properties to his heirs at the time of death
 if death occurred from complications arising from a simple  One of the causes of dissolution of a partnership agreement
injury owing to the negligence of the injured person in its  Death of either the principal or agent extinguishes the agency

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RPC: the criminal liability of a person is totally extinguished when his RIGOR MORTIS CADAVERIC SPASM
death occurs before final judgment Onset at 3-6 hours AD Immediately AD
Involvement: all muscles Certain groups of muscles
RULES OF COURT: the civil case for claims w/c do not survive is Occurrence: as a natural May or may not appear at
dismissed upon death of the defendant phenomenon the time of death
Significance: to establish To establish nature of death
Penal Classification of Deaths time of death
1. accidental Changes in the Blood
2. negligent 1. coagulation
3. suicidal a. accelerated in infectious fevers
4. parricidal b. delayed in asphyxia & opium, cyanide or carbon
5. murder monoxide poisoning
6. homicidal 2. livor mortis; post-mortem suggilation; post-mortem
7. infanticidal hypostasis; lividity
8. tumultuous affray 3. accumulation in the most dependent part of the body due to
9. exceptional circumstances coalescence of capillaries resulting in a dull red or purplish
color of the skin
Deaths of Medico-Legal Concern
 violent Livor Mortis
 accidental  Onset: 3-6 hrs
 suspicious  Useful in determining if body has been moved after death
 undetermined  May also be a good determinant of time of death
 suicidal
 unattended Types of Livor Mortis
1. hypostatic - movable
Violent Deaths 2. diffusion - permanent
 those due to injuries inflicted in the body by some forms of
outside force Putrefaction
 the physical injury must be the immediate or proximate cause  breakdown of complex proteins into simpler components
of death  greenish discoloration on the right iliac fossa followed by
rapid spread
Elements of a Violent Death  generalized swelling
1. that the victim at the time of infliction was healthy
2. the death may be expected from the physical injuries Effects of Pressure of Gases of Putrefaction
3. that death ensued w/in a reasonable time 1. displacement of blood
2. fluid coming out of nostrils & mouth
The “Living Will” 3. bloating
 may be executed by any person 18 years or over w/ a sound 4. floating
mind 5. extrusion of the fetus in a gravid uterus
 if under 18, must be w/ parental consent
 binding as a mandatory directive written in a public Mummification
instrument, unless there is actual notice of contrary  body becomes dry, dark brown & brittle due to long
intention exposure to warm & dry environment
 or by the next-of-kin in the order of hierarchy called the “legal
surrogate” Adipocere Formation
 Recipients: any specified individual, hospital or organ bank  fatty tissues are replaced w/ white greasy products due to
hydrolysis of fats forming fatty acids & soap
CHANGES AFTER DEATH
Skeletonization
CHANGES IN THE MUSCLES  the soft tissues being to liquefy and are consumed by
 Immediately after death bacteria & scavengers leaving behind only the bony
PRIMARY  Muscles are relaxed structures
FLACCIDITY  Urine & feces are expelled due to
relaxation of the sphincters Kinds of Death
 Lasts for 3-6 hours 1. somatic
RIGOR MORTIS  Onset at 3-6 hours after death 2. molecular
(POST-MORTEM  Completed at 12 hours & lasts for 36- 3. apparent or state of suspended animation
RIGIDITY, 48 hours
CADAVERIC  Begins at the muscles of the neck & Signs of Death
RIGIDTY jaw, spreads to the chest, arms & 1. cessation of heart activity
legs 2. palpation
 Appears immediately after death 3. auscultation
involving only a certain group of 4. fluoroscopy
CADAVERIC muscles 5. electrocardiogram
SPASM  Results from extreme nervous tension 6. magnus’ test
 Explains why some suicide victims are 7. icard’s test
found grasping the knife or gun used 8. diaphanous test
in committing suicide
Cessation of Respiration
SECONDARY  Beings after the “waning” of rigor
1. mirror test
FLACCIDITY/ mortis
2. winslow’s test
STAGE OF  Due to dissolution of the coagulated
3. feather test or cotton test
PUTREFACTION proteins
4. water test

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4. blue tips w/ frothy saliva drooling
Algor Mortis 5. state of erection or semi-erection of the
 “Cooling of the body” penis w/ some seminal fluid on the meatus
 Begins after metabolism has ceased and no more heat is 6. lividity or eccyhymosis on the legs
produced
 Body loses heat by evaporation or conduction resulting in Mechanism of Death
progressive fall of temperature 1. tracheal obstruction
 Rapid on the 1st 2 hours then slows down 2. carotid compression
3. vagal stimulation
4. atlanto-axial dislocation
(NORMAL TEMP) 98.4 – (RECTAL TEMP) = approximate number Strangulation
1.5 of hours after death  by ligature
 rarely suicidal
 usually homicidal & accompanied by
Chronology of Putrefactive Changes evidence of struggle or marks of violence
1. 12 hours STRANGULATION
a. Rigor mortis complete Forms
b. Livor mortis complete 1. manual strangulation or throttling
c. Greenish discoloration over cecum 2. palmar strangulation
2. 24 hours 3. garrotting
a. Rigor moris waned 4. muggling or strangle-hold
b. Greenish discoloration over whole abdomen 5. stick compression
spreading to the chest Mechanism - closure of air opening or
c. Abdomen distended w/ gases obstruction of the air passageway
3. 48 hours
a. Ova of flies seen Types:
b. Trunk bloated 1. smothering
c. Face discoloured & swollen a. overlaying
d. Blisters present b. gagging
e. moving maggots seen c. plastic bag suffocation
4. 72 hours d. accidental smothering of epileptic
a. whole body grossly swollen & disfigured SUFFOCATION 2. choking: impaction of foreign body in the
b. hair & nails loose respiratory passage such as
c. tissues soft & discolored a. vomitus
5. 1 week b. regurgitation from the stomach
a. soft viscera putrefied c. bolus of food (café coronary)
6. 2 weeks d. false teeth
a. resistant viscera distinguishable; soft tissues e. blood in oral operations
largely gone f.tuberculosis
7. 1 month 3. burking
a. beginning skeletonization Submersion
8. 2-3 months  nostrils & mouth are submerged in water for
a. complete skeletonization some time to prevent the free entrance of
air into the air passage & the lungs
Asphyxia  it is not necessary for the whole body to be
 The general term applied to all forms of violent death which submerged
results from the interference with the process of respiration.  children drown in “shallow” pools or ponds
 The condition in which the supply of oxygen to the blood or to  drunks may drown in shallow creeks
the tissues has been reduced below normal level.
Phases of Drowning
Types of Asphyxial Death 1. respiracion de surprise
1. anoxic: failure of the arterial blood to become normally 2. phase of resistance (1st apnea)
saturated w/ oxygen 3. dyspneic phase
2. anemic: due to decreased capacity of heart to carry oxygen 4. another apena
3. stagnant: brought about by the failure of circulation 5. terminal respiration
4. histotoxic: failure of the cellular oxidative process
Causes of Death in Drowning
1. typical – cause of death is asphyxia
CLASSIFICATION OF ASPHYXIA DROWNING 2. atypical – cardiac inhibition due to vagal
Classification stimulation, laryngeal spasm, submersion
1. as to location of the ligature & knot when unconscious
a. typical
b. atypical Time Factor in Drowning
2. as to amount of constricting force 1. 1 min – considered fatal
a. complete 2. 4 min - possibility of revival
b. partial 3. 2-3 min – average time for death
4. N.B. – the length of time for survival in
Post Mortem Findings drowning is proportional to the amount of
1. neck elongated & stretched w/ the head froth in the respiratory tract
inclined on the side opposite the knot
2. lividity or pallor of the face w/ swollen & Post-Mortem Findings
HANGING protruded tongue  Wet clothes, pale face w/ foreign bodies
3. eyes closed or partly opened w/ pupils clinging on skin surface
dilated on one side & small on the other  Cutis anserine or goose skin or goose flesh

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 Firmly clenched hands w/ objects, weeds or the site opposite the knot depth in its whole course
stones
 Mouth closed or half-open w/ tongue Subdivisions of Ballistics
protruding 1. internal
 Physical injuries due to struggle 2. external
 Penis & scrotum are retracted 3. terminal
 Washerwoman’s hands & feet a. medical
 Livid eyes, conjuctival injection & dilated
pupils What Constitutes a Legal Firearem?
1. bullet
2. barrel
Internal findings 3. hammer
 Emphysema aquosum Cartridge or Ammunition
 Edema aquosum 1. shell or casing
 Champignon d’ocume 2. percussion cap
 Tracheo-broncial congestion 3. primer
 Fluid w/ blood froth 4. powder or propellant
 Right side of the heart is usually distened 5. bullet or projectile

Conclusive Findings in Drowning Shape of Free End

 Foreign bodies in hands; cadaveric spasm 1. conical
 Emphysema aquosum & edema aquosum 2. hemispherical
 Stomach contents: water or fluid 3. hollow point
corresponding to the medium where body 4. wad cutter
was submerged 5. glazer
 Froth, foam or foreign body in the air 6. dumdum
passage consistent w/ the medium 7. armor piercing
 Water in the middle ear 8. flare or tracer
9. plastic sabot
Floating 10. double action
 Naked body floats after 24 hours 11. soft point
 Those w/ clothes or apparels take more time
 “tete de negri” Movements of the Bullet
Causes 1. forward
1. landslide & masonry accidents 2. spinning
2. highway accidents 3. tumbling
3. rubble of collapsed buildings a. end-over-end
TRAUMATIC 4. mine collapse & stampede 4. wobbling
CRUSH a. tailwag
ASPHYXIA Burking b. yaw
 burke & hare 5. downward
 murderer sits or kneels on the chest w/ 1
hand covering the mouth & nostrils of the CLASSIFICATION OF SMALL FIREARMS
victim 1. low velocity
Carbon Monoxide As to < 1400 ft/sec
 carbon oxide Wounding 2. high powdered
 “silent killer” powder > 1400 ft/sec
 From incomplete combustion of carbon fuel 2200-2500 ft/sec
as in burning of wood, oil coal, kerosene, 1. smooth bore – inside of the barrel
gasoline & charcoal As to has no grooves (e.g. shotgun)
 Limits oxygen carrying capacity of the blood nature of 2. rifled bore – w/ spiral lands &
due to its 250x more affinity to hemoglobin the bore grooves taking a gradual twist (e.g.
military rifle)
INHALATION OF Carbon Dioxide As to 1. pistol – fired by a single hand
IRRESPIRABLE  product of respiration, complete combustion Manner 2. rifle – fired from the shoulder
GASES & fermentation or decomposition of organic of firing
matters
 found also in drainage pipes, deep wells, Things Coming Out of a Gun
sewage tanks 1. bullet – wound, contusion collar
2. flame - burns
War gases 3. unburned powder – smudge, soot
1. tear gas - lacrimator 4. burning powder - tatooing
2. blistering gas - vesicant 5. expansile gas – everted wound edges in contact fire
3. nerve gas - paralysant
4. blood gas Characteristics of an Entrance Wound
 proportional to the calibre of the weapon
HANGING STRANGULATION  generally oval or circular in shape
Frequently above the adam’s Usually below the adam’s apple  presence of contusion or abrasion collar
apple  edges are ordinarily inverted
Ligature mark is inverted v- Ligature mark is usually  shape of the missile modifies the wound
shape, the apex is on the site of horizontal, knot is on the same  dependent on the range
the knot horizontal plane  high-powdered vs. low-powdered
Ligature groove is deepest at Ligature groove is uniform in
PRESSED & FIRM LOOSE CONTACT

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CONTACT FIRE OR NEAR FIRE  non-selected area
 entrance wound large & star-  entrance oval or circular  testimony of assailant
shaped  distinct abrasion collar or  possibility of accident
 everted edges ring  testimonies
 wound blackened by burns,  smudging, burning &
tattooing & soot or smudge tattooing prominent Suicidal
 muzzle imprint  muzzle imprint may or may  closed or locked rooms, uninhabited or open places
 radiating fractures underneath not be seen  death weapons almost always present
 pink blood & tissues  blackened bullet tract  muzzle contact or very near contact
 metal fouling  carboxyhemoglobin present  location should be accessible to wounding hand
 singeing of hair on wound  solitary wound
 compatible direction & trajectory
 personal history, suicide note, prior attempts
Instances When Entrance Does Not Approximate the Caliber  positive paraffin test
BIGGER SMALLER  entrance does not involve clothing
 contact or near fire  fragmentation LEGAL ASPECTS OF DNA
 deformed bullet  tissue contraction
 angular approach The DNA Outside the Courtroom
 sideways entry
Cabatania vs. CA
Outshoot or Exit Wound  In this age of genetic profiling & deoxyribonucleic acid (DNA)
 no definitive shape analysis, the extremely subjective test of physical
 edges are everted resemblance or similarity of features will not suffice as
 bony spicules may be carried along evidence to prove paternity & filiation before the courts
 shored exit
o back against the wall Probability of Mismatch
o tight fit clothing 1. American blacks: one in 1.4 B
o waist band, belt, brassieres 2. Caucasians: one in 840 M
3. Afro-Americans: one in 76,000
ENTRANCE EXIT 4. Filipinos: one in 85 M
Smaller than missile Bigger than missile
The DNA Technology
Inverted edges Everted edges
1. RFLP – restriction fragment length polymorphism
Oval or round Irregular
2. PCR – polymerase chain reaction
Contusion collar (+) Absent
3. STR – short tandem repeat
Tattooing or smudging present Tattooing or smudging always 4. MTDNA – mitochondrial DNA
in near fire absent
Tissues not protruding Tissues protruding Weight of DNA Evidence
Always present May be absent  In the absence of legislation as to the admissibility of DNA
Paraffin test may be positive Paraffin test always negative evidence, the courts may still take judicial notice of such
since it is capable of unquestionable demonstration by an
Instances Where the Entrance Wounds Are Less than the Exit expert witness.
Wounds  The weight of the prosecution’s evidence must be appreciated
1. bullet fragmentation in light of the well-settled rule which provides that an
2. bullet entered a natural orifice accused can be convicted even if no eyewitness is available,
3. common entrance phenomenon as long as sufficient circumstantial evidence is presented by
4. near gunshot wounds the prosecution to prove beyond doubt that the accused
committed the crime.
Instances Where There is no Exit but the Bullet Could not Be
Found Inside the Body People vs. Yatar: On the Credibility of the DNA Witness
1. bullet lodged in GI tract or pharynx  Absent any showing that the trial judge overlooked,
2. near fire w/ blank cartridge misunderstood, or misapplied some facts or circumstances
3. common entrance-exit of weight which would affect the result of the case, the trial
judge’s assessment of credibility deserves the appellate
Problems in the Identification of Gunshot Wounds court’s highest respect. Where there is nothing to show that
1. alteration due to natural process the witnesses for the prosecution were actuated by
2. surgical intervention improper motive, their testimonies are entitled to full faith
3. embalming and credit.
4. inherent to the injury itself
5. xrays Chain of Evidence: "An overriding feature of any forensic
a. migratory bullet examination is maintenance of continuous control over all specimens
b. bullet embolism and information, so that one can testify with certainty as to their
c. bullet souvenir identity." - Wobeser 1996
 Chain of custody log
Homicidal  Dick tracy acts
 non selected entrance sites
 victim is usually at some distance from assailant Presentation of DNA in the Courts
 defense wounds
 disturbances in the surrounding Issues
 firearm not present at the scene 1. expertise of the witness
 witnesses 2. admissibility of evidence
3. jurisprudential back-up
Accidental 4. constitutional issues
 solitary wound

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The Ideal Witnesses  The ultimate value underpinning the rights of the accused is
1. laboratory technician not really the discovery of truth, but the upholding of
2. molecular biologist human dignity, regardless of the quilt of the suspect.
3. population statistician
4. geneticist Due Process Concerns
Expert’s Concerns 1. presumption of innocence
1. reliability of method 2. right of the accused to prepare for trial – independent
2. qualification of the witness to render expert opinion expert review
3. scientific protocol was observed in this particular procedure 3. right to examine evidence

Grounds Affecting Weight of DNA Evidence CRIMES AGAINST CHASTITIY

1. inherent errors
2. testing errors The New Anti-Rape Law
3. laboratory procedure errors  The reclassification of RAPE in the taxonomy of felonies, from
4. interpretative errors crime against chastity to one against persons has
consequently produced not only SUBSTANTIVE but also
On Admissibility of DNA Evidence PROCEDURAL effects on the related provisions of the RPC &
 The significance of DNA in aid of the Philippine Courts comes the Rules of Court
from the responsibility of the courts to provide the search  The New Anti-Rape Law has also set aside jurisprudence
for truth and if that process can be aided by forensic science based on the repealed provisions of the former law &
that yields reliable results, the interests of the justice provided for a different governance in rape cases committed
system and society are served. & filed after its effectivity
 Under Rule 128 of the Rules of Court, for evidence to be
admissible, it only has to be RELEVANT. ART. 266A-266B. RAPE
 Evidence, to be relevant, need not conclusively prove the
ultimate fact in issue, but only have any tendency to make How Committed
the evidence of any fact that is of consequence to the 1. By a man who have carnal knowledge of a woman under any of
determination of the point in issue more probable or less the following circumstances:
probable than it would be without the evidence. a. through force, threat or intimidation
 DNA evidence would be invaluable as CORROBORATIVE b. when the offended party is deprived of reason or otherwise
EVIDENCE even without statistical backup if the accused unconscious
has been identified by other proof (FRYE Test). c. by means of fraudulent machination or grave abuse of
 Under our Rules, even COLLATERAL MATTERS are allowed authority
when they tend in any reasonable degree to establish the d. when the offended party is under 12 years of age or is
probability or improbability of the fact in issue. demented, even though none of the circumstances
mentioned above be present
People vs. Kelly: Three Prong Approach 2. By any person who, under any of the circumstances mentioned
 That the method is reliable & has gained acceptance in the in par 1 hereof, shall commit an ac of sexual assault by inserting
scientific community a. his penis into another person’s mouth or anal orifice, or
 The witness is qualified to render an expert opinion b. any instrument or object, into the genital or anal orifice of
 The technique followed an established procedure & is capable another person
of being repeated
On Force, Threat, or Intimidation
People vs. Tijing, et al.  as to degree of force or intimidation
 Eventually, as the appropriate case comes, Courts should not  doctrine of tenacious resistance
hesitate on the admissibility of DNA evidence. The courts  as to subsequent consent
should apply the results of science when competently obtained
in aid of situations presented, since to reject said result is to On Deprivation of Reason or Unconscious
deny progress.  partial deprivation of reason will suffice
 the cause thereof may be organic, or due to lack of sleep or
Tecson vs. Comelec induced by drugs
 In case proof of filiation or paternity would be unlikely to
satisfactorily establish or would be difficult to obtain, DNA Note: any of the aggravating/qualifying circumstances if duly alleged
testing, which examines genetic codes obtained from body & proved will warrant the imposition of a single indivisible penalty of
cells of the illegitimate child and any physical residue of the death
long dead parent could be resorted to.
Qualified Statutory Rape: on victims below 7 years old
Constitutional Issues
1. privilege against self-incrimination Simple Statutory Rape: on victims over 7 and under 12 years old
2. right against unlawful searches & seizure
3. due process concerns Rape committed under par 1 is punishable by:
4. right to privacy 1. victim is under 18 and the offender is a person of moral
ascendancy over the victim
Art. 3, Sec. 17: No person shall be compelled to be a witness 2. victim is below 7 years old
against himself 3. when committed by any member of the AFP, paramilitary,
 The privilege merely prohibits the use of physical or moral PNP or any law enforcement agency or penal institution,
compulsion to extort communication from the defendant when the offender took advantage of his position
 Refers only to evidence which is communicative in nature 4. victim is under the custody of the police or military
authorities or any law enforcement or penal institution
Art. 3, Sec. 2: The right of the people to be secure in their 5. when by reason or on occasion of rape, the victim has
persons, houses, papers, and effects against unreasonable suffered permanent physical mutilation or disability
searches and seizures 6. when rape is committed in full view of the spouse, parent,
children, or 3rd degree relatives
7. when the offender knew of the pregnancy of the victim

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8. offender knowingly harbors HIV or any other STD and such 6. crime of lust or passion
disease is transmitted to the victim a. lust, is no respector of time & place
9. when the victim is of religious calling or vocation & is 7. relationship theory
personally known to be such by the offender before or at a. being sweethearts would not exempt the man
the time of the commission from criminal liability if the sexual intercourse was
10. when the offender knew of the mental disability, emotional against the woman’s will
disorder and/or physical handicap of the victim
Predisposing Causes of Vulvo-Vaginal Injuries During Sexual
People vs. Conde Act
 a woman in her deep sleep is considered unconscious 1. virginity-prepuberty
2. genital disproportion
State vs. Lung 3. unprepared or unaroused female
 if cantharides were used to incite the victim’s passion, there is 4. position
no depreciation of reason hence physical access does not 5. male brutality
constitute rape 6. recent vaginal surgery
7. renewed activity after prolonged abstinence
Silvano vs. CA 8. over-active female
 The use of tongue or finger upon the genitals shall constitute 9. sex deviants
“object rape”
People vs. Campuhan RA 7610: Special Protection of Children Against Child Abuse,
 Mere touching of the labia minora is not enough Discrimination & Exploitation Act
 It must be shown that there was an “animus “ to penetrate  any act w/c debases, degrades or demeans the intrinsic worth
& dignity of a child as a human being
People vs. Ballaran  failure to immediately give treatment to an injured child
 Abuse of confidence is aggravating resulting in serious impairment of his growth & devt
 One crime of rape where several acts were committed on the  unreasonable deprivation of his basic needs for survival
same woman by the same offender on one occasion  exploitation
 discrimination
On Victims of Low Repute…  child trafficking
 Rape is a heinous crime even to immoral victims  obscene publication & indecent shows
 If at all bad repute or immoral of the victim should primarily
affect her credibility on the theory that woman who sell RA 8505: Rape Victim Assistance & Protection Act of 1998
their virtue just as probably would be willing to sell their  Sec. 4 – it shall be the duty of the examining physician, who
testimony must be of the same gender as the offended party

People vs. Blance RA 9262: Anti-Violence Against Women & Their Children Act
 The character of the victim is immaterial if the crime of rape is  causing or threatening or attempting to cause harm to the
committed by force or intimidation woman or her child
 The husband loses the “right of consortium” arising from their  placing woman & child in fear of imminent physical harm
connubial relations  compelling a woman or her child to engage in conduct w/c the
woman or her child has a right to desist from
People vs. Aldana: Guiding Principles in Deciding Rape Cases  depriving a woman or her child custody or access to her
 A rape can be made w/ facility, is difficult to prove but more family, deprival of legal rights
difficult for the accused, though innocent, to disprove  engaging in reckless conduct that alarms or causes substantial
 In view of the intrinsic nature of rape where only 2 persons emotional or psychological distress to the woman or her
are involved, the testimony of the complainant must be child
scrutinized w/ extreme caution  depriving a woman or her child of financial support legally due
 The evidence of the prosecution must stand or fall on its to her family or deliberately providing insufficient financial
merits & cannot draw strength from the weakness of the support
evidence for the defense  preventing a woman from engaging in any legitimate
profession or business
Doctrinal Myths in Rape Cases
1. rape is easily fabricated PATIENT PHYSICIAN RELATIONSHIP
a. an accusation for rape is easy t make, difficult to
prove & even more difficult to disprove Nature of PPR
2. Filipina of decent repute 1. consensual
a. It is hard to believe that an unmarried woman… 2. fiduciary
would publicly declare that she had been raped,
thereby practically foreclosing the probability of a Requisites of the Contractual Relationship
happy married life 1. consent
3. assault on chastity, virtue or honor 2. object
a. chastity is a virtue 3. cause
b. being virtuous is honorable
c. losing one’s honor may mean losing one’s life No PPR in the ff. Instances
4. doctrine of tenacious resistance 1. autopsy
a. mere resistance is not sufficient to convict 2. pre-employment
b. the SC no longer requires the victim to prove 3. pre-insurance
resistance if the prosecution can prove force or 4. court appointment
intimidation 5. casual inquiry
5. normal conduct doctrine
a. the demeanor of the victim before, during & after Psychological Patterns of PPR
the assault is judged according to the supposed or 1. Activity-Passivity Relation
expected conduct of a woman whose virtue is a. No interaction between them
about to, or has just been, violated b. Patient unable to contribute to the relationship

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c. eg: emergencies where patient is unconscious b. complete recovery may be achieved through
2. Guidance-Cooperation Relation nursing care, continuous medication, etc.
a. Patience is conscious but severely ill, distressed & c. premature termination constitutes abandonment
in pain & thus ready & willing to cooperate 2. withdrawal by the physician
b. Patient’s desires are unimportant a. must be for a valid cause
c. Physician is in a position of “trust” b. 2-day prior notice
3. Mutual-Participation Relation c. Physician must recommend an equally able
a. Patient thinks he is juridically equal to the doctor substitute
b. Their relation is in the nature of a negotiated d. Valid even if patient refuses the new physician &
agreement bet. equal parties instead chooses his own doctor
c. Failure to obtain the anticipated results may make e. Patient must chose his own doctor
patient feel injured & may seek redress in the law f. Patient must be given ample time & notice
3. discharge of the physician by the patient
Medical Services a Patient may Solicit from his Physician 4. death of the patient
1. to perform specific test/examination 5. death or incapacity of the physician
2. examine & inform him of his state of health 6. fulfilment of the obligations stipulated in the contract
3. examine, diagnose, inform & recommend appropriate 7. in cases of emergency when physician of choice is already
remedy, w/o treatment available or when the emergency ceases to exist
4. examine, diagnose & give emergency RX only 8. expiration of the period, if the contract of medical service is
5. examine, diagnose & treat only 1 or more, but not all for a specific period
conditions, w/ or w/o follow-up care 9. in cases of emergency when physician of
6. examine, diagnose & treat w/ full follow-up care
choice is already available OR when the
Duties & Obligations Imposed on the Physician in the PPR
1. he should possess the knowledge & skill of w/c an average
emergency ceases to exist
physician is expected TERMINATION OF PPR
a. Corpus Juris Secundum – a physician holding PATIENT PHYSICIAN
himself out as having special knowledge & skill in Any time of 1. Valid cause
a particular medical discipline is bound to day or night 2. prior notice
discharge his duty to a patient employing him as 3. “able substitute
such specialist, & NOT merely the average skill
possessed by general practitioners COMMON MEDICO-LEGAL ISSUES IN MEDICAL PRACTICE
2. he should use such knowledge & skill w/ ordinary care &
diligence Sources of Legal Responsibilities
a. Locality Rule – the yardstick to measure whether a 1. Revised Penal Code
physician exercised care & diligence is determined 2. Civil Code
by how other physicians in the locality could have 3. Code of Ethics
acted under similar situations 4. Medical Act of 1959
3. he is obliged to exercise the best judgment 5. PRC
a. honest “errors of judgement” in the diagnosis &
management of a patient will not always mean Imprudence: a deficiency in action, failing to take the necessary
negligence, provided it is not so gross precaution once they are forseeable
4. he has the duty to observe utmost good faith
a. borne out of its fiduciary nature Reckless Imprudence: consists in voluntary, w/o malice, doing or
b. must be strictly honest in his opinion failing to do an act, from w/c material damage results by reason of
c. timely notice to the family as to the prognosis inexcusable lack of precaution
d. unprofessional to conceal the gravity of patient’s
condition Negligence: deficiency in perception or when the wrongful action
may be avoided by paying proper attention & using due diligence in
Duties & Obligations Imposed on the Patient in the PPR foreseeing them
1. give an honest medical history of the illness
2. cooperate & follow orders & instructions even if he has to How is Negligence Pursued?
submit to painful management 1. civil
3. must inform the physician of what occurred in the course of 2. criminal
the treatment 3. ethical
4. must state whether he understands the instructions & the 4. administrative
contemplated course of action
5. Must exercise prudence expected of an ordinary patient. He ELEMENTS OF MALPRACTICE
cannot act as a stranger to his own problem. FOREIGN LOCAL
DUTY to the patent DUTY
Terms w/c are NOT Included in the PPR - duty to possess a license
1. it does NOT promise that the physician will not commit - duty to possess the knowledge
errors in an honest way BREACH of that duty DERELICTION
2. it does NOT imply any promise/guaranty by the physician
that the treatment Basis
a. will be successful - locality rule
b. will be benefit the patient - national standard rule
c. not harm the patient Patient suffered an DAMAGE
INJURY - patient suffers an adverse medical event
Termination of PPR
The injury was a DIRECT CAUSATION
1. recovery of the patient OR when the physician considers
DIRECT RESULT of - the harm is the result of the physician NOT
that his further services will no longer be beneficial
the breach providing the “standard of care”
a. recovery need not be complete
- “Standard of Care” – the degree of conduct
to w/c a reasonable man must conform to

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avoid being negligent 1. it is a process not just a form whereby information must be
- “doing your best” is NOT ENOUGH presented to enable persons to voluntarily decide w/n to
participate in research as a subject
Tests to Establish Direct Causation 2. to ensure respect & designated to educate the subject in
1. foreseeability test terms that they can understand describing the overall
2. Cause or Condition Test experience in “lay language”
3. Natural & Probable Consequence Test 3. agreement to permit an action, based on full understanding
4. “But For” Test or “Sine Qua Non” of action, including risks & alternatives

Abandonment: Legal Responsibility until: Factors to Consider in Obtaining Informed Consent

1. patient no longer needs help 1. legal capacity of the person giving the consent
2. patient or parent refuses further assistance 2. separate consent for each procedure
3. care is transferred to an “adequate” substitute
Legal Issue: Refusal of Medical Treatment for a Minor
Elements of Abandonment 1. minors cannot refuse
1. existing patient-physician relationship 2. parental refusal even when child badly needs medical
2. physician unilaterally terminates the PPR treatment may hold the parent guilty of neglect
3. continuing need for treatment
4. ensuing injury must be caused by the abandonment What about emancipated minors?
1. over 14 and
“Non-Payment of Bill” NOT a defense for abandonment: in a a. pregnant
perfected patient-physician relationship, financial consideration is an b. self-supporting
irrelevant issue c. married (???)
Failure to Institute Proper Prophylaxis d. enlisted in the AFP
1. treatment is not limited to the existing condition at the time e. orphans
of consultation
2. failure of the physician to prevent a foreseeable Requisites of Assumption of Risk
consequence makes him liable 1. must be explained fully by the person performing the
procedure & shall include the details, risks, alternatives &
Negligence in Blood Transfusion benefits
1. transfusion of the wrong type of blood 2. in the language known to & understood by the patient
2. transfusion to wrong patient avoiding the use scientific jargons
3. needle slip 3. notwithstanding the explanation, the patient chooses to
4. over-transfusion stay w/in the realm of the risk
5. post-transfusion infection
6. “benefit-to-risk ratio” DOCTRINAL DEFENSES
1. Doctrine of Patient’s behavior itself contributes to a less
Liabilities in Administration of Drugs: 5 Rights: Contributory than optimal outcome & may reduce the
1. right drug 2. Fault liability
2. right dose 3. Doctrine of The cause of the cause is the cause of the
3. right patient Proximate Cause evil caused
4. right time 4. Calculated Risk When an accepted method of medical
5. right route treatment involves hazards regardless of
care
Liabilities in Drug Reactions 5. Bad Result Rule A procedure resulting badly or diametrically
1. failure to note history of allergy opposed to the expected outcome is not
2. failure to test signs for reaction sufficient to infer negligence
3. improper prescription 6. Respectable - 2 or more schools of though
4. failure to stop treatment when drug reaction has been 7. Minority Rule - Variability in clinical judgement
observed 8. Honest Error in
5. failure to counter a drug reaction Judgment Doctrine
9. Good Samaritan - Step forward!
Manufacturer’s Liabilities Acts - Don’t hide out for fear of litigious reprisals
1. inadequate pre-marketing tests 10. Clinical There is a fine line between clinical
2. lack of productive quality control Innovation innovation & experimentation
3. failure to provide adequate warning as to its adverse effects
11. Last Clear Whomsoever had the chance to rectify a
Chance prior wrong
Product Liability - Doctrine of Strict Liability
12. Continuing Failure to investigate non-response after
1. A person injured by a defective product can recover
Negligence prolonged treatment
compensation from anyone in the distributive chain even
13. Fellow Servant Employer cannot be held liable for the
though the seller exercised every conceivable caution
injuries of an employee on account of the
2. negligence or carefulness is not an issue
negligence of another employee
3. nor is warranty or protection an issue
4. on contamination & impurities 14. Vicarious Liability - imputed negligence
5. preventive measures by the manufacturer - respondeat superior
- command responsibility
Types of Consent
1. express/direct 1. ostensible agent - apparent authority
2. implied/assumed a. anaesthesiologist
3. involuntary/representative- parent/ legal guardian b. pathologist
c. radiologist
Informed Consent d. ER consultant
2. borrowed servant - the visiting surgeon
3. captain of the ship – the captain is not

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only responsible for the safety of the crew - no abandonment of patient
but also of the passengers - always give general instructions
4. pilot co-pilot – shared responsibility or to - understanding the matter of fees
each his own? - secure legal advice when so required
15. Practice - optimal approach vs. acceptable minimum 4. Medical - liability contract insurance
Guidelines & - outside experts are not allowed to malpractice - indemnity or full coverage
Parameters challenge the standards liability - insurer can only be liable for the full amount of
16. Ipsa Loquitur - the common knowledge doctrine insurance coverage in the policy
- the thing speaks for itself
- no expert testimony is required because Overtreatment: application of a medical management more than
the injury itself is proof that w/c is the demand of the occasion, the application of a
- “Layman’s test” diagnostic or treatment procedure w/o conceivable indication

Requisites of Res Ipsa Loquitur QUALITATIVE QUANTITATIVE

1. the accident would not occur w/o OVERTREATMENT OVERTREATMENT
negligence - Application of therapeutic procedure or - Unjustified procedures
2. the cause must be w/in the exclusive supporting devices ordinarily prescribed
control of the defendant only to much more serious conditions or Examples:
3. no contributing conduct by the plaintiff for injury or disease different from the 1. excessive laboratory
one w/c such treatment is directed tests
When Res Ipsa Shall NOT Apply 2. more xrays
1. calculated risk doctrine Examples: 3. frequent visits
2. bad result rule 1. Performing CS to a normal pregnancy 4. longer treatment
3. honest errors of judgment as tot the 2. Application of cast w/o no justification 5. indiscriminate
appropriate procedure 3. confinement for a minor ailment prescriptions
4. mistakes in the diagnosis
Continuity of Care After
1. the signs & symptoms have disappeared
Advance Directives 2. when maximum repair & rehabilitation have been achieved
1. DNR – do not rescucitated/revive 3. when the best possible cure has been attained
2. Health Care Proxies Effects of Overtreatment
3. Living Will 1. unnecessary financial losses to patient
2. risks of physical & emotional harm to patient
DEFENSE MEDICINE 3. there may be symptoms actually resulting from
overtreatment itself
PHYSICIAN’S REACTION TO MALPRACTICE 4. possible injury to patient that may serve as catalyst to a
1. Partial or After arduous years of medical education, his malpractice suit
complete phantom fear of a suit or the distressing
abandonment experience of being involved in a malpractice
of medical litigation may make a physician forsake the RIGHTS OF PHYSICIANS
practice vocation of saving lives!
2. Practice of Negative Defense Medicine RIGHT OF PHYSICIANS
defensive - the physician avoids performing hazardous INHERENT INCIDENTAL
medicine procedures such as: brain surgery, open-heart, 1. to choose patients 1. right of way while responding to
spinal surgery, radiation therapy, cancer 2. to limit the practice of his a call of emergency
surgery profession 2. exemption from execution of
- “best interest rule” 3. to determine appropriate instruments & library
management procedures 3. perform services
Positive Defense Medicine 4. to avail of hospital services 4. right to compensation
- physician performs additional management 5. hold public or private office
procedures to avoid liability 6. membership in medical societies
- hospitalization of a patient for a procedure w/c
are usually done in clinics INHERENT RIGHT OF PHYSICIANS
- consultations to confirm diagnostic or 1. to choose - Hurley vs. Eddingfield
therapeutic proposal patients - Code of Ethics: a physician is free to choose
- additional diagnostic tests whom he will serve. He may refuse medical
- overtreatment services for reasons satisfactory to his
3. Professional - more caring & more knowledge of legal duties professional conscience.
liability - avoidance of destructive criticisms of works of - Exception: emergency cases
prophylaxis other physicians - RA 6615: hospitals & clinics are required to
- keeping an “ideal” medical re cord render emergency assistance & provide
- avoidance of admitting things that might be facilities & medicine
construed as admission of fault 2. to limit the Limitations of Medical Practice
- more tact & avoidance of overoptimistic practice of his 1. only to his field of specialty
prognostication profession 2. in a private clinic or hospital
- advice patient of any intended absence & 3. w/in a political or geographical boundary
recommend an available & qualified substitute 4. on certain days of the week and/or certain
- always secure an informed consent hours of the day
- selection & supervision of assistants 5. to a certain class or group of people
- limitation to one’s field of specialization 6. on account of ignorance
- frequently check the condition of his 7. on account of retirement
equipments 8. by the dictates of his conscience
- no experimentation w/o explicit consent 3. to determine - physician is given the full authority to

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appropriate determine the diagnostic & treatment 4. after 2 years of exemplary behavior, the Board may
management procedure to be adopted reinstate the physician whose license has been revoked
procedure - subject to patient’s enlightened or “informed
consent” Grounds for Reprimand, Revocation, or Suspension
4. to avail of - a govt hospital may not curtail the rights of a 1. insanity
hospital duly licensed physician to use the facilities of 2. immoral or dishonourable conduct
services the hospital subject to rules concerning internal 3. conviction of any offense involving moral turpitude
discipline 4. fraud in the acquisition of license
- a private hospital is given more leeway in 5. issuance of false medical certificate
making regulations as t who may avail of 6. gross negligence, ignorance, or incompetence resulting in
hospital facilities injury to the death of the patient
7. addiction & alcoholism
INCIDENTAL RIGHTS OF PHYSICIANS 8. doing or aiding in any criminal action
1. right of way while An established social rule that ambulance & 9. false, extravagant or any unethical advertisement
responding to a vehicles of physicians are given preference 10. violation of the code of ethics
call of emergency in the use of the road
2. exemption from - for both civil & criminal cases
execution of - attachment is a process to enable the DISQUALIFICATIONS
instruments & plaintiff to acquire a lien upon the property PERSONAL CRIMINAL
library of the defendant for the satisfaction of 1. insanity 1. conviction of a crime involving
judgment 2. immoral/dishonourable moral turpitude
- properties exempt: conduct 2. fraud in acquisition of license
 tools & implements 3. gross negligence, ignorance 3. doing/aiding in any criminal
 professional libraries or incompetence abortion
 so much of the earnings 4. addiction & alcoholism 4. issuance of a false medical
3. perform services - the law confers upon trained physicians to certificate
perform some services w/c cannot be
delegated to paramedics Dishonorable Conduct
- some intricate diagnostic or operative 1. false, extravagant, or unethical advertisement
procedures can only be performed by 2. issuing any statement or spreading any news or rumor w/c
qualified physicians is derogatory to the character & reputation of another
4. right to - arises from patient-physician contractual physician w/o justifiable motive
compensation relationship & that services rendered shall
be for a medical fee
- sometimes, services are motivated by
generosity or liberality
- gratuitous services are in the concept of
DONATION
- express or implied

LIABILITIES OF PHYSICIANS

LIABILITIES OF PHYSICIANS
1. CIVIL
2. CRIMINAL a. personal
b. incidental
a. suspension
3. ADMINISTRATIVE b. reprimand
c. revocation
a. abortion
b. issuance of false medical certificate
c. failure to report treatment of physical
4. PERSONAL injuries
d. simulation of births, substitution of 1
child for another, & concealment or
abandonment of a legitimate child
e. refusal to render treatment in
emergency cases
a. criminal negligence & imprudence
5. INCIDENTAL b. violation of dangerous drugs act
c. violation of pharmacy law
d. defamation (slander or libel)

Notes on Administrative Liabilities

1. being penal in nature, the doctor is entitled to be
“presumed innocent”
2. quantum of evidence is merely preponderance
3. decisions by the Board of Medicine becomes final after 30
days unless appeal is filed before the Professional
Regulations Commission & later to the Office of the
President

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