Legal Med

LEGAL/FORENSIC-MEDICINE- Atty.%Tony%D.
%Rebosa,MD,BSCrim%%
Trans%by:%Jod%
%%%%%%%%
LEGAL-MEDICINE%
o
%application%of%medical%knowledge%to%the%purposes%of%law%
and%in%the%administration%of%justice%
MEDICAL-JURISPRUDENCE%%
o
knowledge%of%law%in%relation%to%the%practice%of%medicine%
%
PRINCIPLE-OF-STARE-DECICIS
When%the%court%has%once%laid%down%a%principle%of%law%or%interpretation%
as%applied%to%certain%state%of%facts,%it%will%adhere%to%and%apply%to%all%
future%cases%where%the%facts%are%substantially%the%same%%
%
BASIC-PRINCIPLES-GOVERNING-APPLICATIONS-AND-EFFECTS-OF-LAWS1. Ignorance%of%the%law%excuses%no%one%from%compliance%therewith%
2. Laws%shall%have%no%retroactive%effect%unless%the%contrary%is%provided%
3. Rights%may%be%waived%unless%the%waiver%is%contrary%to%law%,%public%
order,%morals%or%good%customs%or%prejudicial%to%a%third%person%with%a%
right%recognized%by%law%
4. Customs%which%are%contrary%to%law,%public%order%and%public%policy%shall%
not%be%countenanced.%A%custom%must%be%proved%as%a%fact%according%to%
the%rules%of%evidence.%%%
5. Laws%are%repealed%only%by%subsequent%ones%and%their%violation%and%
nonPobservance%shall%not%be%excused%by%disuse,%custom%or%practice%to%
the%contrary%
%
EVIDENCE
means%sanctioned%by%the%Rules%of%Court%of%ascertaining%in%a%judicial%
proceeding%the%truth%respecting%a%matter%of%fact%
%
TYPES-OF-MEDICAL-EVIDENCE1.%AUTOPTIC--or-REAL-EVIDENCE%
addresses%to%the%senses%of%the%court%
2.%TESTIMONIAL-EVIDENCE%%
ex.%MD%in%the%witness%stand%
%%%%%%%%%a)%Ordinary%Witness%
%%%%%%%%%b)%Expert%%Witness%
3.%EXPERIMENTAL-EVIDENCE%
if%allowed%by%the%court%to%confirm%or%corroborate%
4.%DOCUMENTARY-EVIDENCE%
writings/photographs%
%%%%%%%%%a)%medical%certificates%
%%%%%%%%%b)%medical%expert%opinion%
%%%%%%%%%c)%deposition%
5.%PHYSICAL-EVIDENCE%
articles%and%materials%found%in%connection%with%the%investigation%and%
which%aids%in%establishing%the%identity%of%the%perpetrator%
%
CRIMINALISTICS%
o
ID,%collection,%preservation,%and%mode%of%presentation%of%%
physical%evidence;%application%of%sciences%in%crime%detection%
and%investigation%
CORPUS-DELICTI-EVIDENCE-%
o
objects/substances%which%maybe%a%part%of%the%body%of%the%
crime%
ASSOCIATIVE-EVIDENCE%%
o
evidence%that%may%link%suspect%to%the%crime%
TRACING-EVIDENCE%%
o
evidence%that%may%assist%investigator%in%locating%the%suspect%%
SKETCHING%%
o
rough%drawing%of%the%scene%or%object%
Rough%%
o
made%at%the%crime%scene%
Finished-%
o
sketch%prepared%from%the%rough%sketch%for%court%
presentation%
%
KINDS-OF-EVIDENCE-NECESSARY-FOR-CONVICTION
DIRECT%%
o
that%which%proves%the%fact%in%dispute%without%the%aid%of%any%
inference%or%presumption%
CIRCUMSTANTIAL%%
o
the%proof%of%facts%from%which%taken%either%singly%or%
collectively,%the%existence%of%a%particular%fact%in%dispute%may%
be%inferred%as%a%necessary%or%probable%consequence%
%
WEIGHT,-SUFFICIENCY-AND-APPRECIATION-OF-EVIDENCE
CIVIL-CASE%%
o
preponderance%of%evidence%
CRIMINAL-CASE%
o
proof/guilt%beyond%reasonable%doubt%
ADMINISTRATIVE-CASE%
o
%substantial%evidence%
DECEPTION-DETECTION1. Devices-that-record-the-psychoP%physiological%responses%
Polygraph/lie%detector%machine%(25%%error)%
Word%Association%test%
Psychological%Stress%Evaluator%
2. Drugs-that-try-to-inhibit-the-inhibitor-
Truth%Serum%%hyoscine%hydrobromide%%
Narcoanalysis%/%narcosynthesis%%
Intoxication%
3. Hypnotism%%
alteration%of%consciousness%and%concentration%in%which%the%
subject%manifests%heightened%suggestibility%%
4. Observation5. Scientific-Interrogation6. Confession%%
expressed%acknowledgement%by%the%accused%in%a%criminal%
case%of%the%truth%of%his%guilt%as%to%the%crime%charged%%
%
TYPES-OF-CRIMINAL-OFFENDERS1. Based-on-Behavioral-Attitude%
Active-Aggressive-Offender%%
o
impulsive,%aggressive%behavior%
Passive-Inadequate-Offender%
o
%inducement,%promise,%reward%
2. Based-on-the-State-of-Mind%
Rational-Offender%%
o
with%motive,%%intention,%prePevident%meditation%
Irrational-Offender%%
o
does%not%know%nature%and%quality%of%act%
3. Based-on-Proficiency%
Ordinary-%
o
lowest%form%of%criminal%%career,%limited%skill%
Professional%%
o
highly%skilled,%rarely%detected%%%ex.pickpockets,shoplifter%
4. Based-on-Psychological-Classification%
Emotional%
o
heat%of%passion,%anger,%revenge%
NonSEmotional%%
o
commit%crimes%for%financial%gain%and%are%usually%recidivist%
%
TECHNIQUES-OFINTERROGATION1. EMOTIONAL%APPEAL%
2. MUTT%AND%JEFF%
3. BLUFF%ON%SPLIT%PAIR%TECHNIQUE%
4. STERN%APPROACH%
5.% LENGHTY,%TIME%CONSUMING%NARRATION%
%
%
%
%
%
%
IDENTIFICATIONLAW-OF-MULTIPLICITY-OF-EVIDENCE-IN-IDENTIFICATION-
the%greater%the%number%of%points%of%similarities%and%dissimilarities%
of%2%persons%compared,%the%greater%is%the%probability%for%the%
conclusion%to%be%correct%%
%
CHARACTERISTICS-THAT-MAY-NOT-EASILY-BE-CHANGED
Mental%memory%
Speech%
Gait%
Mannerism%
Hands%and%feet%
Complexion%
Eye%changes%
Facies%%
Left/right%handedness%
Degree%of%nutrition%
%
GAIT%%manner%of%walking%
ATAXIC%P%tabes%dorsalis%
CEREBELLAR%P%staggering%movement%
COWS%P%swaying%movement,%knockPknee%
PARETIC%Pshort%steps,%foot%drag,%
SPASTIC%Pstiff%
FESTINATING%P%involuntary%movement%
FROG%P%hopping%gait,%infantile%%
WADDLING%P%duck%
%
FACIES/FACIAL-EXPRESSIONS
HIPPOCRATIC%P%pinched%nose%
MONGOLIAN%Palmond%eyes%
FACIES-LEONINE-P%lionPlike%
MYXEDEMIC%P%pale,%edematous%face%
%
FINGERPRINTINGConsidered%the%most%valuable%method%of%identification%and%is%universally%
used%because:%
1. There%are%no%two%identical%fingerprints%
2. Fingerprints%are%not%changeable%%
%
DACTYLOGRAPHY%
o
%is%the%art%and%study%%of%recording%fingerprints%as%a%means%of%
identification%
DACTYLOSCOPY-%
o
%is%the%art%of%identification%by%comparison%of%fingerprints.%%It%
is%the%study%and%utilization%of%fingerprint%
POROSCOPY%%
o
study%of%the%pores%found%on%the%% papillary%or%friction%
ridges%of%the%skin%for%purposes%of%identification%
%
KINDS-OF-IMPRESSION
REAL-IMPRESSION%%
o
impression%of%the%finger%bulbs%with%the%printing%ink%on%
the%surface%of%the%paper%
CHANCE-IMPRESSION%%
o
fingerprints%impressed%by%mere%chance%without%any%
intention%to%produce%it.%It%may%be:%
%%%%%%%%%%P%Visible%
%%%%%%%%%%P%Plastic%
%%%%%%%%%%P%Latent%%%%%
%
CAN-FINGERPRINTS-BE-EFFACED?%
CAN-FINGERPRINTS-BE-FORGED?%
%
%
%
%
BIBLIOTICS%%
o
science%of%handwriting%analysis%
GRAPHOLOGY%%
o
study%of%handwriting%for%the%purpose%of%determining%
the%writers%personality,%character%and%aptitude%
DISGUISED-WRITING%%
o
deliberate%attempt%on%the%part%of%the%writer%to%alter%his%
writing%habit%by%endeavoring%to%invent%a%new%writing%
style%or%imitating%the%writing%of%another%person%
SIGNATURE-FORGERY-EXAMINATION%%
o
the%most%common%activity%of%a%Question%Document%
Examiner.%Such%documents%may%be%found%in%checks,%
deeds%of%conveyances,%anonymous%letters,%suicide%
notes,%receipts,%etc.%%
%
CLASSIFICATION-OF-SIGNATURE-FORGERY%%%P%traced%
%%%P%simulated%
%%%P%spurious%
%
IDENTIFICATION-OF-SKELETAL-REMAINS
SEX%P%pelvis,%skull,%femur,%sternum,%humerus%
MALE-PELVIS-%%%%
LEGAL-IMPORTANCE-IN-THE-STUDY-OF-BLOOD1. For%disputed%parentage%(paternity/maternity)%
2. Circumstantial%or%corroborative%evidence%against%or%in%favor%of%the%
perpetrator%of%the%crime%
3. Determination%of%the%cause%of%death%
4. Determination%of%the%direction%of%escape%of%the%victim%or%the%
assailant%
5. Determination%of%the%approximate%time%the%crime%was%committed%
6. Determination%of%the%exact%place%of%the%commission%of%the%crime%%
7. Determination%of%the%presence%of%certain%diseases%
%
CHEMICAL-EXAMINATION1. Saline%extract%of%the%blood%stain%plus%will%give%a%brownish%tinge%
due%to%the%formation%of%alkaline%hematin%%
2. Benzidene%test%
3. Guiacum%test%
4. Phenolphthalein%test%
5. Leukomalachite%Green%test%%
%
MICROCHEMICAL-TESTS1. Hemochromogen%Crystal%or%Takayama%test%
2. Teichman%Blood%Crystal%Test%%or%Hemin%Crystal%test%
3. Acetone%Haemin%of%Wagenhaar%test%
%
BIOLOGIC-TEST1. PRECIPITIN-TEST%
o
determines%whether%blood/semen%is%of%human%origin%or%
not%
2. BLOOD-GROUPING%
ACADs TEAM
Lecture #
LEGAL MEDICINE
Lectured by: Dr. A. Rebosa
LEGAL MEDICINE
Is a forensic medicine
Branch of medicine that deals w/ the application of medical
knowledge to the purpose of law & administration of justice
The application of basic clinical, medical & paramedical sciences to
elucidate legal matters
Physician is called as an Expert witness
TERMS
INJURY: from the Latin injuria (In- not, jus- the law); is often used
synonymously w/ wound but can have a wider use
o (Medical) damage to tissues by heat, cold, chemicals,
electricity, radiation, in addition to mechanical force
o (Legal) a comprehensive term for any wrong or harm done by
one individual to another individuals body, rights, reputation
&/or property
WOUND:
o (Medical) disruption of the continuity of the tissues produced
by external mechanical force
o (Legal) breach of the full thickness of the skin (or lining of lip);
this excludes abrasions, bruises, internal injuries & fractures
LESION: from the Latin laesio (a hurt). Originally meant injury, now
more widely applied to include any area of injury, disease or local
degeneration in a tissue causing a change in its function or
structure
TRAUMA - bodily harm w/ or w/o structural alterations resulting
from interaction w/ physico-chemical agents, imparting energy to
tissues
o May cause morphologically apparent damage (wound) or
produce physiological imbalance (eg reflex cardiac arrest by
neural stimulation) & secondary effects (eg thrombosis,
infection, obstruction of tubular organs)
WOUND / INJURY
CLASSIFICATION OF INJURIES
CONTUSION / BRUISE / ECCHYMOSIS (PASA)
Escape of blood from ruptured small vessels (vein, capillaries,
arterioles) into the surrounding tissues
The resulting discolouration is seen through the overlying intact
skin
Due to blunt force trauma
Site, shape, size, severity of bruising are very variable
E.g. bumping yourself against something, hitting yourself w/ a
hammer
ABRASION / SCRAPE / GRAZE (GASGAS)
A portion of the body surface from which the skin or mucous
membrane has been crushed or removed by rubbing
A superficial injury, not involving the full thickness of the skin,
confined to epidermis/dermis
Due to:
o Direct impact: imprint (may reflect pattern of causative surface)
o Tangential impact: graze or scratch (may reflect direction of
impact)
Always occur at the site of impact
Types of abrasions:
o Linear
o Multi-linear
o Confluent (tapyas)
E.g. rope burns, dragged by a car, & the like
Transcribed & Edited by: P.G.Montao & J.Wang
LM
LACERATION / TEAR (PUTOK)

Full thickness tearing of skin or tissue due to stretching & crushing
by blunt force
Ragged irregular edge, associated bruising/abrasion, tissue bridges
Provides little specific information about the causal object
E.g. fist blows, pipes, etc.
INCISION / CUT, SLICE OR SLASH (HIWA)
Clean division of the full thickness of skin (or other tissue) by a
sharp-edged instrument.
Clean cut edges, no associated bruising/abrasion, no tissue bridges
& can easily be approximated
Incised wound is LONGER THAN IT IS DEEP due to swipe action
Provides little specific information about the causal object
E.g. knives, razors, blade, scalpel, broken glass, etc.
PUNCTURE / PENETRATING (TUSOK)
A small hole made w/ a sharp point
ITS DEPTH EXCEEDS ITS LENGTH on the body surface
Shape & size of wound often indicate dimensions of weapon
Caused by objects that penetrates into the tissues while leaving a
small surface opening
As a rule, small puncture wounds do not bleed freely
Due to a sharp/thin, e.g. needle (NEEDLE PUNCTURE) or a
blunt/long/rigid, e.g. wooden stake (PUNCTURE)
STAB WOUND (SAKSAK)
A variant of penetrating/punctured wound
Caused by an object or instrument w/ a sharp point and edge
to thrust with a sharp object or instrument
Due to a sharp/flat instrument; e.g. knives, blades, scalpel, etc.
HACKING WOUND / CHOP (TAGA)
Is a variant of incision
Have clean-cut edges but an abraded margin due to inversion &
friction against the sides of the wide blade on insertion
A large incised wound w/ or as w/ heavy irregular blows & that is
usually repetitive
E.g. bolo, axe, etc
HEMATOMA / BLOOD CYST OR TUMOR (BUKOL)
Rupture or injury of a blood vessel wall w/ esxtravasation of blood
to an existing or newly formed space, usually caused by a blunt
object or instrument
An abnormal collection of blood where the blood is usually clotted
or partially clotted, is usually situated w/in an organ or soft tissue
spaces
SPECIAL TYPES OF WOUNDS
PATTERNED WOUND
Due to impact with a hard, patterned object with ridges/grooves
May demonstrate the obvious pattern of the causal surface (tyre,
shoe tread, car bumper, clothing, gun muzzle)
DEFENSE WOUNDS
Due a pattern of injuries sustained by taking protective action
against anticipated trauma (accidental or assault)
Indicates that victim was conscious, not completely surprised by
attack and at least partly mobile
SELF-INFLICTED WOUNDS
Gunshot wounds & incised or stabbed wounds with sharp or
pointed object are preferred, blunt force injuries are rarely selfinflicted
Page 1 of 4
ACADs TEAM
Accessible target sites & is usually unilateral w/ handedness
SUICIDAL WOUNDS
Almost same w/ self-inflicted wounds
More associated w/ multiple, shallow, tentative hesitation
wounds that are closely grouped, parallel & in the same direction
FIRE ARMS
Gunshot wound - a penetrating injury from a bullet that was fired
from a gun
Firearm identification - used to determine whether the gun that is
subject of investigation was the same gun used or fired
Inflamed gunpowder separated the projectile from the shell
(projectile 1st then flame, gas & carbon)
CLASSIFICATION OF FIREARMS
Short - revolver, pistol, etc
Long - rifle (AK47, M16), machine gun, etc
Shotgun - releases multiple of projectiles (pellets)
MAJOR PARTS OF FIREARMS
Barrel
Handle
Trigger
Percussion cap
Firing pin
Muzzle
PARTS OF AMMUNITION (BALA)
Shell / cartridge - basyo
Gun powder - inside the shell
Primer - made up of lead, antimony or barium
Projectile - tingga
KINDS OF BALISTICS
Internal / interior - from the time you pull the trigger
External / exterior - from the time the bullet leaved the barrel of
the gun
o Terminal - effect/s of the bullet on an object when hit
Medical - when a bullet hits a human body
NOTE:
o Only physicians is competent to testify in medical ballistics
o Only ballisticians can testify on internal, external & terminal
ballistics
FIRING DISTNCE
<6-12 inches
o Flame that reaches the skin, burn the skin in split second
o (+) smudging/smoke/soot
o Treat the patient right away
o Clean the wound
>24inches
o Embed in skin, lesser or no products of combustion
o tattoing/stippling/peptering
Shotguns - nearer firing distance causes more concentrated
projectiles, while father causes more spreading of projectiles
PRODUCTS OF COMBUSTION
Smudging smoke or soot
Singeing - curling of hairs
Tattooing, peppering stippling
Lecture #
LM
Contusion/abrasion collar - would help determine the relative

position between the assailant &/or the victim to the trajectory of
the bullet
o Prominent area indicates the direction of the bullet
Point of Entry
Smaller & oval in shape unless it
is a close contact fire
The edges are inverted
Depending upon the distance;
may be positive for the products
of combustion & paraffin test
Have contusion or abrasion
collar
Point of Exit
Usually bigger & irregular or
stellate in shape
Everted & tissues are protruding
Always negative
Absent
PARAFFIN TEST
OBSOLETE (in most countries)
Used to determine whether the subject has recently fired a gun or
not by detecting powder particles or gunshot residues
Not used to determine whether the subject is the killer or shooter
The value of the test is only presumptive & not conclusive because
of false positive & false negative results
False Positive
False Negative
Subject recently fired a gun,
Subject is a professional
totally not related to the incident
Removed by incessant brushing
Subject is a smoker
w/ water or vinegar
Subject is a farmer who deals w/
Paraffin was done beyond 3 days
fertilizers
from the time of incident
POINTS OF ENTRY AND EXIT
There may not be a point of exist but there is always a point of
entry
If only point of entry seen outside, the gun might be fired inside
the mouth, nose or ears
Multiple point of exits, bullet/projectile might have fragmented
Note:
o If there was a chance to defend self = homicide
o If there was a chance to defend self = treachery/murder
DEATH
Complete cessation of all cardio-pulmonary (heart-lung) activities
&/or cessation of all brain activities
3 kinds of death:
o Somatic death / Clinical death - dead for less than 3 hours
- Dead, but cells are still alive
o Molecular / Cellular death - dead for 3-6 hours
- Death also of the cells
o Apparent death or State of suspended animation
- Temporary loss of consciousness
- Temporary cessation of the vital functions of the body
- It is to prevent important to determine the condition of
suspended animation premature burial
MUSCULAR CHANGES IN THE BODY FOLLLOWING DEATH
Importance: to help determine the approximate Time of Death
(ToD)
Stages:
1. Primary Flaccidity
- Aka. post mortem irritability
- The muscles are relaxed & is capable of contracting
when stimulated
- ToD <6hrs
Page 2 of 4
ACADs TEAM
2. Post Mortem Rigidity
- Aka. rigor mortis
- The whole body becomes rigid due to depletion of ATP
w/ permanent contraction of the muscles
- ToD 6-24hrs
3. Secondary Flaccidity / Onset of Decomposition
- Aka. commencement of putrefaction
- Body is relaxed & soft but w/ foul odor, due to
degeneration of tissues & w/ action of bacteria
- ToD >24-36hrs
FORENSIC ENTOMOLOGY
Involves the insects that are eating up the body
POST MORTEM LIVIDITY
It occurs in the most extensive areas of the most dependent
portions of the body after death
Importance: to determine the position of the body when the
portion died
2 kinds:
o Hypostatic lividity - blood is still in fluid form
o Diffusion lividity - blood has already coagulated or clotted
POST MORTEM EXAMINATIONS
Internal examination of the dead
Importance: to determine the Cause of Death (CoD)
Negative results:
o Negative autopsy - after the autopsy CoD is still unknown
o Negligent autopsy - CoD is still unknown because of so many
errors committed during the autopsy
May be official or non-official:
Official
Non-official / Non-medico Legal
Medico Legal or mandatory
Hospital based or elective
autopsy
autopsy
Done on those who died of
Done to those who died of
unnatural causes or w/
natural/biologic causes
suspected foul play
Body is responsibility of the next
Body is property of the state
of kin
NO NEED for consent of the next Consent from the next of kin is
of kin
NEEDED
The next of kin will decide
ALWAYSs a TOTAL autopsy
whether a total or partial
autopsy
Only those authorized by law
Done by the pathologist of the
may perform this kind of autopsy hospital
PERSONS ALLOWED BY LAW TO PERFORM OFFICILA AUTOPSY
Medico legal of PNP
Medico legal of NBI
Municipal Health Officer who are considered ex-officio medical
officer
Those authorized by an ordinance or thru request from the chief of
police, mayor or prosecutor
VIRGINITY
A condition of a female who has not experienced sexual
intercourse & whose genital organs have not been altered by
carnal connection & whose hymen is still intact
VIRTUOUS FEMALE
If her body is pure & if she has never had any sexual intercourse
w/ another, through her mind & heart may be impure
Lecture #
LM
KINDS OF VIRGINITY
MORAL VIRGIN
The state of not knowing the nature of sexual life & not having
experienced sexual relation
Applies mostly to children below age of puberty & whose sex
organs & secondary sexual characteristics has not yet developed
PHYSICAL VIRGIN
Condition whereby a woman is conscious of the nature of sexual
life but has not experienced sexual intercourse
Distinctions between True & False physical virginity:
a) True physical virginity - a condition wherein the hymen
is intact w/ edges distinct & regular & the opening is
small to barely admit the tip of the smallest finger of the
examiner even if the thighs are separated
b) False physical virginity - a condition wherein the hymen
is unruptured but the orifice is wide & elastic to admit
two or more fingers of the examiner w/ lesser degree of
resistance
- The hymen may be laxed & distensible & may have
previous sexual relation; this situation where the
physician may not be able to make a convincing
conclusion that the subject is a virgin or not
DEMI-VIRGIN
The term refers to a condition where the woman permits any form
of sexual liberties as long as they abstain from rupturing the
hymen by sexual act
The woman may be embraced, kissed, may allow her breast to be
fondled, her private organ be held & other lascivious acts
The woman may allow sexual intercourse but only inter-femoral
or even inter-labial but not to the extent of rupturing the hymen
Hymen is still intact
VIRGO INTACTA
Literally the term refers to a truly virgin woman; that there are
structural changes in her organ to infer previous sexual intercourse
& that she is a virtuous woman
In as much as there are no conclusive evidence to prove the
existence of such condition, liberal authorities extend the
connotation of the term to include women who have had sexual
acts or even habitually but had not given birth
DEFLORATION
Is the laceration or rupture of the hymen as a result of sexual
intercourse
All other lacerations of the hymen which are not caused by sexual
act are not considered as defloration
OTHER CAUSES OF HYMENAL LACERATIONS
Passage of clotted blood during menstruation
Ulceration due to disease like diphtheria
Jumping or running
Falling on hard sharp object (not a penis)
Medical instrumentation
Self-scratching or irritation
Masturbation
Insertion of foreign body/s
Previous operation
Horseback riding
Aerobics &/or biking
Trauma to the genitals
Page 3 of 4
ACADs TEAM
DEGREE OF LACERATIONS
INCOMPLETE LACERATION
When rupture or laceration does not involve the whole width or
height of the hymen
o Superficial - the laceration does not go beyond one-half of the
whole width of the hymen
o Deep - the laceration involves more than one-half the width of
the hymen but not reaching the base
COMPLETE LACERATION
When the hymenal laceration or rupture involves the whole width
but not beyond the base of the hymen
Lecture #
LM
In adultery the penalty is the same for both the woman and man
(Prison correctional medium & maximum)
In concubinage the penalty for the man is lower by one degree
(prison correctional minimum & medium) while the concubine is
given a separate penalty which is "destierro" or distance
prohibition; & no imprisonment
--------------------------------------------------------------------------------------END
*Raw files from H.R.Ogalino
*Other sources form the Revised Penal Code & specific laws as
specified
COMPOUND / COMPLICATED LACERATION

When hymenal laceration or rupture involves the hymen & also
the surrounding tissue beyond the base of the hymen
May involve the perineum, vaginal canal, urethra &/or rectum
Often associated w/ forceful or traumatic sexual act
VIOLENCE AGAINST WOMEN AND CHILDREN
R.A. 9262 - Anti-Violence Against Women and Their Children Act of
2004
o Physical violence
o Sexual violence
o Psychological violence
o Economic abuse
RAPE
R.A.8353 - Anti-Rape Law of 1997
Defined as inserting his penis into another persons mouth, vagina
or anal orifice , or any instrumentation or object into the genital or
anal orifice of another person
Committed by a man who have carnal knowledge of a woman
under any of the ff circumstances:
o Through force, threat or intimidation
o The offending party is deprived of reason or otherwise
unconscious
o By means of fraudulent machination or grave use of authority
o The offending party is under 12y/o
Some aggravating / qualifying circumstances
o Victim is under 18y/o
rd
o The offender is relative by consanguinity or affinity w/in the 3
degree, guardian, authority or w/ higher moral standing
o The victims is under the custody of police, military or any law
enforcement authority
rd
o Rape is committed in the view of relatives w/in 3 degree of
consanguinity
Considered as a CRIMINAL offense against persons
Punishable by Reclusion Perpetua
Marital rape - non-consensual sex where the perpetrator is the
victims spouse
ADULTERY AND CONCUBINAGE
Adultery means the carnal relation between a married woman & a
man who is not her husband, the latter knowing her to be married,
even if the constitutes marriage be subsequently declared void;
where each sexual intercourse a crime of adultery (Art.333 of the
Revised Penal Code)
Concubinage is committed by any husband who shall keep a
mistress in the conjugal dwelling, or, shall have sexual intercourse,
under scandalous circumstances, w/ a woman who is not his wife,
or shall cohabit w/ her in any other place (Art.334 of the Revised
Penal Code)
Page 4 of 4
ACADs TEAM
MEDICAL JURIS PRUDENCE

Lectured by: Dr. ALBERT D. REBOSA, M.D., LL.B.
PHYSICIAN
Is a person who after completing his secondary education follows a
prescribed course of medicine at a recognized university or medical school, at
the successful completion of which, is legally licensed to practice medicine by
the responsible authorities and is capable of undertaking the prevention,
diagnosis, and treatment of human illness by the exercising independent
judgment and without supervision. -WHO
LEGAL MEDICINE
Branch of medicine that deals with the application of medical knowledge to
the purposes of law and in the administration of justice
MEDICAL JURISPRUDENCE
Deals with the aspect of law and legal concepts in relation with the practice
of medicine
Includes:
o Licensure and regulatory laws;
o Physician-patient-hospital relationship together with the other
paramedical personnel, their rights, duties and obligations
o Liabilities for non-compliance with the law
PURPOSES
To protect the public from charlatans
To promote professionalism and foster professional interrelationship
To develop awareness of the rights, duties and obligations of the patient,
physician, and the hospital
To control the increasing number of medical malpractice suits against
physicians
To explain the purpose and procedure of certain legislation
To study the need to amend, repeal our health care laws in harmony with
the recent scientific and social development
LM
o Primarily concerned with the standardization and regulation of
medical education
PROFESSIONAL
REGULATIONS COMMISSIONS
o To have general supervision and regulation of all professions
requiring examinations which includes the practice of medicine
BOARD OF MEDICINE
o Its primary duties are to give examinations for the registration of
physicians and supervision, control and regulation of the practice of
medicine
BOARD OF MEDICAL EDUCATION
o Composition:
Chairman - Secretary of Education
Members - Secretary of Health
Director, Bureau of Private Schools
Chairman, Board of Medicine
Representative, PMA
Council of Deans, APMC
Dean, UP-College of Medicine
o Functions:
To determine and prescribe the requirements for admission into
a recognized college of Medicine
To determine and prescribe requirements for the minimum
physical facilities
To determine and prescribe the minimum number and
qualifications of teaching personnel
To determine and prescribe the minimum required curriculum
To authorize the implementation of experimental curriculum
To accept applications for admission to a medical school
To select, determine and approve hospitals for training
To promulgate, prescribe and enforce the necessary rules and
regulations
LICENSURE AND REGULATORY LAWS
Composition:
o Commissioner
o Two Associate Commissioner
Exercise of Power and Functions of the Commission: exercise general
administrative, executive and policy-making functions for the whole agency
ADVERSARIAL TRIAL SYSTEM

Philippine courts is a court litigation where there is competition of
inconsistent version of facts and theories in law during trial
Each party to the contest is given equal opportunity to investigate the case,
gather and present all proofs in support of his allegation, and give
argument that his contention is correct
Ultimate purpose is for a just solution
It often undermines the pursuit of truth as the opposing parties seek to win
at all cost without the obligation to reveal the facts which may be
detrimental to their case. The lawyer aims to win the fight not to help the
court discover facts or establish the truth.
SOURCES OF LAW
Constitution
Laws enacted by the legislative body
Decrees, Orders, Proclamation, Letters, CA, BP, RA
Administrative acts, orders, Rules and Regulation
Local customs
Generally accepted principles of International law
LAW AND THE PRACTICE OF MEDICINE
The State must maintain high standard of practice by setting up rules and
regulations with regards to qualifications and procedure for the admission
to the profession. These are legal safeguards to guarantee the safety of
the patient and impose liability to the practitioner who through his act or
omission causes damage or injury to the health and welfare of the patient
The right to regulate the practice of medicine is based on the police power
of the state
LICENSURE AND REGULATORY LAWS
ADMINISTRATIVE BODIES
BOARD OF MEDICAL EDUCATION
by: P.G.Montanio & J.Wang
BOARD OF MEDICINE
Composition:
o Six members appointed by the president from a list submitted by the
Executive Council of the PMA
Qualifications:
o Natural-born citizen
o Duly-registered physician
o In the practice of medicine for at least 10 years
o Of good moral character and of recognized standing in the medical
profession as certified by PMA
o Not a member of any faculty of any medical school (including any
pecuniary interest)
POWERS, FUNCTIONS AND RESPONSIBILITIES
To determine and prepare the contents of the licensure examinations
To promulgate rules and regulations for the proper conduct of the
examinations, correction and registration
To administer oath
To study the conditions affecting the practice of medicine;
To investigate violations, issue summons, subpoena and subpoena duces
tecum
To conduct hearings or investigations of administrative cases filed before
them
To promulgate decisions on such administrative cases subject to the review
of the Commission
To issue certificate of registration
To suspend, revoke or reissue certificate of registration for causes provided
by law or by the rules and regulations promulgated
To promulgate, with the approval of PRC, rules and regulations in harmony
with the provisions of the Medical Act of 1959 and necessary for the proper
practice of medicine
Page 1 of 16
ACADs TEAM
ADMISSION TO THE PRACTICE OF MEDICINE
PREREQUISITES
1. Minimum age requirement: at least 21 years of age
2. Proper Educational Background
o Requirements for Admission in the College of Medicine
o Holder of a Bachelors degree;
o Not convicted of any crime involving moral turpitude
o Certificate of Eligibility from the Board of Medical Education
o Good moral character
3. Examination Requirements: must have passed the corresponding Board
Examination
o Preliminary Examination
At least 19 years of age
Of good moral character
have completed the first two years of the medical course
o Final or Complete Examination
o Citizen of the Philippines or of any country who has submitted
competent and conclusive
documentary evidence confirmed by the DFA showing that his
countrys existing laws permit citizens of the Philippines to
practice medicine under the same rules and regulations
governing citizens thereof (RECIPROCITY RULE)
4. Holder of certificate of registration
o No issuance to any candidate who has been:
Convicted by a court of competent jurisdiction of any crime
involving moral turpitude
found guilty of immoral or dishonorable conduct after
investigation by the Board of Medicine
Declared to be of unsound mind
SCOPE OF EXAMINATION
Preliminary - Anatomy and Histology, Physiology, Biochemistry,
Microbiology and Parasitology
Final - Pharmacology and Therapeutics, Pathology, Medicine, Obstetrics
and Gynecology, Pediatrics and Nutrition, Surgery and Ophthalmology,
Otorhinolaryngology, Preventive Medicine and Public Health, Legal
Medicine, Ethics and Medical Jurisprudence
PRACTICE OF MEDICINE
What is the practice of medicine?
o It is a privilege or franchise granted by the State to any person to
perform medical acts upon
Compliance with law, that is, the Medical Act of 1959 as
amended which has been promulgated by the State in the
exercise of police power to protect its citizenry from unqualified
practitioners of medicine
It is diagnosing and applying and the usage of medicine and drugs for
curing, mitigating, or relieving bodily disease or conditions
ACTS CONSTITUTING THE PRACTICE OF MEDICINE
Pursuant to Sec.10, Art. III of the Medical Act of 1959 as amended:
A) paid to him directly or through another, or even without the same,
physically examine any person, and diagnose, treat, operate or
prescribe any remedy for human disease, injury, deformity, physical,
mental, psychical condition or any ailment, real or imaginary,
regardless of the nature of the remedy or treatment administered,
prescribed or recommended
B) who shall by means of signs, cards, advertisement, written or printed
matter, or through the radio, television or any other means of
communication, either offer or undertake by any means or method to
diagnose, treat, operate, or prescribe any remedy for human disease,
injury, deformity, physical, mental or psychical condition
C) Who shall falsely use the title of M.D. after his name, shall be
considered as engaged in the practice of medicine
NOT CONSIDERED TO CONSTITUTE A PRACTICE OF MEDICINE
BY DESCISION OF COURT
One who takes BP reading
Application of medicated massage
Hospital
LM
Nurse anesthetists
BY PROVISION OF LAW (SEC.11, ART.III; MEDICAL ACT OF 1959 AS
AMENDED)
Any medical student duly enrolled in an approved medical college
dentist
physiotherapist
optometrist
Any person who renders any service gratuitously in cases of emergency or
in places where the services of a physician, nurse or midwife are not
available
Any person who administers or recommends any household remedy as per
classification of existing Pharmacy Laws
Prosthetist
FAITH HEALING
There is nothing in the Medical Act of 1959 exempting it from the definition
of the acts which constitute practice of medicine
Acted in pursuance of his religious belief and with the tenets of his church
he professes, not deemed to be a practice of medicine but part of his
religious freedom (freedom to believe and freedom to act in accordance
with ones belief)
ILLEGAL PRACTICE OF MEDICINE (SEC.28, ART.IV; MEDICAL ACT OF 1959 AS
AMENDED)
Practice of medicine by any person not qualified and not duly-admitted to
perform medical acts in compliance with law.
PENALTIES
Any person found guilty of illegal practice shall be punished by
o A fine of not <1,000 pesos or >10,000 pesos
o Subsidiary imprisonment in case of insolvency or by imprisonment of
not <1yr or >5yrs
o Or both such fine and imprisonment, in the discretion of the court
QUALIFIED TO PRACTICE MEDICINE IN THE PHILIPPINES
Those who have complied with the prerequisites to the practice of
medicine in accordance with Sec. 8, Art. III, Medical Act of 1959 as
amended
Those who can have limited practice without any certificate of registration
in accordance with Sec.12, Art. III, Medical Act of 1959 as amended:
o Exclusive consultation in specific and definite cases
o Attached to international bodies to perform certain definite work in
the Philippines
o Commissioned medical officers stationed in the Philippines in their
own territorial jurisdiction
o Exchange professors in special branches of medicine
o Foreign medical students who have completed the first four years of
medical course, graduates of medicine and registered nurses who
may be given limited and special authorization by the DOH
Balikbayan Physicians pursuant to PD 541, Allowing Former Filipino
Professionals to Practice Their Respective Professions in the Philippines
o Provisions:
Of good standing prior to their departure and in their adopted
country
Have registered with PRC and paid their professional fee
Pay the corresponding income tax
Foreign physicians qualified to practice by Reciprocity Rule or by
endorsement
Medical Students pursuant to Sec.11 (a) and Sec.12 (d), Art.III, Medical Act
of 1959 as amended
Limited practitioners of medicine: Those that are governed by specific
licensure laws
RATIONALE WHY ARTIFICIAL PERSONE CANNOT PRACTICE MEDICINE
Cannot be subjected to licensure examinations as required by law
Practice of medicine may be employed and controlled by unqualified
physicians
Impairing professional relationship between the patient and the physician
Deprivation of free choice of physicians
Page 2 of 16
ACADs TEAM
CONSTITUTION
Is that written instrument enacted by direct actions of the people by which
the fundamental powers of the government are established, defined, and by
which these powers are distributed among the several departments for their
safe and useful exercise for the benefit of the body politic. Justice Malholm
PURPOSES (11Am. Jur. 606)
To prescribe the permanent framework of a system of government
To assign respective powers and duties to the several departments
To establish certain first principles on which the government is founded
ESSENTIAL PARTS
Constitution of Liberty
Constitution of Government
Constitution of Sovereignty
AMENDEMENTS
Are isolated or piecemeal changes in the constitution while REVISION is the
revamp or the rewriting of the entire instrument
LM
DUTIES AND OBLIGATIONS OF PHYSICIANS IN A PHYSICIAN-PATIENT
RELATIONSHIP
He should possess the knowledge and skill of which an average physician is
concerned; General practitioner vs Specialist
He should use such knowledge and skill with ordinary care and diligence
o locality rule the standard of care is measured by the degree of
care in the locality
o similar locality rule diligence is determined when the other
physicians in the locality or similar locality could have acted the same
way
o national standard of care - the diligence is determined on what is
applicable on a national standard basis
He is obliged to exercise the best judgment
He has the duty to observe utmost good faith
PHYSICIAN-PATIENT REALTIONSHIP DOES NOT IMPLY GUARANTY OR
PROMISE THAT:
The treatment will be successful
The treatment will benefit the patient
The treatment will produce certain result
The treatment will not harm the patient
The physician will not commit errors in an honest way
PHYSICIAN-PATIENT RELATIONSHIP
Contract - is the meeting of minds between two persons whereby one
binds himself with respect to the other, to give something or to render
some service (Art.1305, NCC)
Nature of the relationship:
o Consensual - based on mutual consent both parties
o Fiduciary - based on mutual trust and confidence
REQUISITES OF A CONTRATUAL RELATIONSHIP
Consent manifested by the meeting of the offer and the acceptance upon
the thing and the cause which are to constitute the contract (Art.1319,
NCC)
Object the subject matter of the contract which is the medical service
which the patient wants to be rendered to him by his physician
Cause is the consideration or the factor that instigated the physician to
render the medical service to the patient, which could be remuneratory or
an act of liberality
DUTIES AND OBLIGATIONS OF PHYSICIANS IN THE COURSE OF A PHYSICIANPATIENT RELATIONSHIP

He must give an honest medical history
He must inform the physician of what occurred in the course of the
treatment
He must cooperate and follow the instructions, orders and suggestions of
the physician
He must state whether he understands the contemplated course of action
He must exercise the prudence to be expected of an ordinary patient under
the same circumstances
STAGES OF A PHYSICIAN-PATIENT RELATIONSHIP
COMMENCEMENT
It is the very time the physician is obliged to comply with the legal duties
and obligations to his patient
TERMINATION
FORMS OF PHYSICIAN-PATIENT RELATIONSHIP

Expressed explicitly stated orally or in writing
Implied the existence can be inferred from the acts of the contracting
parties
INSTANCES WHERE THERE IS NO PHYSICIAN-PATIENT RELATIONSHIP BY
DECISION OF COURTS
Pre-employment PE for purposes of determining whether an applicant is
suitable for employment
PE for eligibility for insurance
Physician appointed by court to examine the accused
In performing an autopsy
Casual consultation in an unordinary place
PSYCHOLOGICAL PATTERNS OF PHYSICIAN-PATIENT RELATIONSHIP
It is the time when the duties and obligations by a physician to his patient
ceases
The following are some ways of termination of the relationship
o Recovery of the patient or when the physician considers that his
medical services will no longer be beneficial to the patient
o Withdrawal of the physician provided:
with consent of the patient, and
patient is given ample time and notice
o Discharge of the physician by the patient
o Death of either party
o Incapacity of the physician
o Fulfillment of the obligations stipulated in the contract
o In emergency cases, when the physician of choice of the patient is
already available or when the condition of emergency ceases
Expiration of the period as stipulated
o Mutual agreement for its termination
ACTIVITY-PASSIVITY RELATION
No interaction between physician and patient because the patient is unable
to contribute activity
This is characteristic in emergency cases when the patient is unconscious
GUIDANCE-COOPERATION RELATION
Patient is conscious and suffering from pain, anxiety and other distressing
symptoms, he seeks help and willing to cooperate
The physician is in a position of trust
MUTUAL PARTICIPATION RELATION
It is in the nature of a negotiated agreement between equal parties
RIGHTS OF PHYSICIANS
INHERENT RIGHTS
o To choose patients
o To limit practice of medicine
o To determine appropriate management procedures
o To avail of hospital services
INCIDENTAL RIGHTS
o Right of way while responding to emergency
o Right of exemption from execution of instruments
o Right of library to hold certain public/private offices to perform
certain services
o Right to compensation
o Right to membership in medical societies
RIGHTS GENERALLY ENJOYED BY EVERY CITIZEN
Page 3 of 16
ACADs TEAM
INHERENT RIGHTS
RIGHT TO CHOOSE PATIENTS
Any person who is given right to practice medicine is not obliged to
practice medicine
Cannot be compelled to accept professional employment
Note: The law does not give any qualification the right of the physician to
choose his patient, however, the Code of Medical Ethics and RA 6615 provides
otherwise in cases of emergency
Related provisions:
Art II, Sec.2 Code of Ethics
free to choose whom he will serve...always respond to any
request for his assistance in emergency.
Art. II, Sec.3 Code of Ethics
In cases of emergency ...a physician should administer at least
first aid treatment and then refer to a more qualified and
competent physician
Sec.1 RA 6615
All government and private hospitalsare required to render
immediate emergency medical assistance
Sec.24 No.12, Medical Act of 1959
.although the ethical rule obliges a physician to attend to an
emergency, his failure to respond to it may not make him liable if
in so doing, there is a risk to his life
Refusal of a physician to attend to a patient in danger of death is
not a sufficient ground for revocation or suspension of his
registration if there is a risk to the physicians life
LM
Related provisions:
Art IV, Sec. 2, Code of Ethics
should willingly render gratuitous service to a colleague, to his
wife and minor children or even parents provided the latter are
aged and being supported by the colleague. He should however,
be furnished the necessary traveling expensesthis provision shall
not apply to physicians who are no longer in the active practice
o Doctrine of Unjust Enrichment
No one must enrich himself at the expense of others
service rendered service paid
KINDS OF MEDICAL FEES
Simple Contractual Fee specifically stating the value of such medical
service, either orally or in writing
Retainer Fee measured by the space of time rendered by patient
Contingent Fee depends upon the failure of the treatment instituted
Dichotomous Fee (Fee splitting) the physician may require the services of
a person who may act as agent to solicit patients, and the agent will share
in the medical fee.
UNETHICAL FEES (ART.III, SEC 5, CODE OF ETHICS)
...solicitation of patients, directly or indirectly, through solicitors or agents, is
unethical.
Straight Fee:
o For the amount tendered by the patient to the physician, the latter
shall be responsible for the payment of hospital bill, lab fees,
medicines, and other incidental expenses
o This kind of fee is unethical because the amount wagers with the
unforceable contingencies
RIGHT TO LIMIT HIS MEDICAL PRACTICE

field of specialty
private clinic or hospital
within a political/geographical boundary
certain days of the week/hours of the day
certain class of people
with due regard to dictate of conscience
retirement
imposed by the public, religion, professional ethics, medical society, law,
contract
RIGHT TO DETERMINE THE APPROPRIATE MANAGEMENT OR PROCEDURE
Doctrine of Superior Knowledge:
o The physician has superior knowledge and the patient just follows
orders or instructions and usually places himself in the command and
control of the physician
RIGHT TO AVAIL OF HOSPITAL SERVICES
INCIDENTAL RIGHTS
RIGHT OF WAY WHILE RESPONDING TO THE CALL OF EMERGENCY
RIGHT OF EXEMPTION FROM EXECUTION OF INSTRUMENTS AND LIBRARY
Rule 39, Sec.12, Rules of Court
RIGHT TO HOLD CERTAIN PUBLIC AND PRIVATE OFFICES
Which can only be filled-up by physicians
RIGHT TO PERFORM CERTAIN CERVICES WITH DU COMENSATION
RIGHT TO MEMBERSHIP ON MEDICAL SOCIETIES
Any qualified medical practitioner has the right to become a member of the
PMA through one of its component society
Membership in a medical society may be voluntary or involuntary
Note: Philippine Medical Care Act of 1969(RA 6111 as amended) provides that
membership to the PMA is a requirement before a physician can practice
medicine under the Medicare.
METHODS OF COLLECTION OF PAYMENTS FOR MEDICAL SERVICES

Extra judicial billing or referral to a bill collection agency
Judicial methods
JUDICIAL METHOD: FATCS TO BE PROVEN IN COURT
Physician employed is duly qualified and licensed
The professional fee demanded is reasonable
The person The physician has rendered professional service to the patient
liable for the payment is the defendant
PATIENTS OBLIGATION TO PAY
The obligation to pay devolves on the patient himself provided he is of legal
age, of sound mind and has the capacity to enter into a contractual relation
If the patient dies or becomes legally incapacitated to pay, medical fee shall
be made from the following persons in order:
1. Spouse
2. Descendants, of the nearest degree
3. Ascendants, of the nearest degree
4. Brothers and sisters
Implied promise to pay the physician by the benefactor of the medical
services rendered in emergency cases.
INTANCES WHERE THE PHYSICIAN CANNOT RECOVER PROFESSIONAL FEES
Agreement that the service is gratuitous
In government charity hospitals, health centers and other similar health
units
Rendered in private charitable institutions if expressly gratuitous to the
indigent patients
Waiver on the part of the physician
Breach of contract
When the physician cannot charge the patient pursuant to the Code of
Ethics
Those covered by Phil health
Medical services rendered under a contract of employment unless
expressly provided otherwise
RIGHT GENERALLY ENJOYED BY EVERY CITIZEN
pursuant to the provisions of Art.III, Bill of Rights, Philippine Constitution
1987
RIGHT TO COMPENSATION
Based on the physician-patient contractual relationship
Existence of friendship does not imply gratuitous services
Page 4 of 16
ACADs TEAM
RIGHTS OF PATIENTS
Right to give consent to diagnostic and treatment procedures
Right to religious belief
Right of privacy
Right to disclosure of information
Right to confidential information
Right to choose his physician
Right of treatment
Right to refuse necessary treatments
RIGHT TO GIVE CONSENT TO DIAGNOSTIC PROCEDURES
Patient is the final arbiter of what must be done with his body
Obligations of the Physician to Inform the Patient:
o Diagnosis
o General nature of the contemplated procedure
Risk involved
Prospect of success
Potential danger if not applied
Alternative methods of treatment
BASES OF CONSENT
The physician-patient relationship is fiduciary in nature
Patients right to self-determination
Contractual relationship
PURPOSES OF CONSENT
To protect the patient from unnecessary/unwarranted procedure applied
to him without knowledge
To protect the physician from any consequences for failure to comply with
legal requirements
INSTANCES WHEN CONSENT IS NOT NECESSARY
In cases of emergency, there is an implied consent or the physician is
privilege because he is reasonably entitled to assume consent
When the law made it compulsory for everyone to submit to the procedure
LM
Other person who may give consent having substitute parental authority
Note:
Consent of minor is not valid if the procedure will not benefit him
Expressed refusal of a minor to surgery shall not prevail over the existing
emergency
Doctrine of parens patriae, the court may grant consent for the minor
SUBJECT MATTER MUST BE LEGAL
The subject matter or procedure applied to the patient and which the
patient consented must not be that which the law penalizes or against
public policy
RIGHT TO RELIGIOUS BELIEF
Art. III, Sec. 5, Philippine Constitution
No law shall be made respecting an establishment of religion or
prohibiting the free exercise thereof. The free exercise and enjoyment of
religious profession and worship, without discrimination or preference,
shall forever be allowed. No religious test shall be required for the
exercise of civil or political rights.
RIGHT TO PRIVACY
RIGHT TO DISCLOSURE OF INFORMATION
The physician-patient relationship being fiduciary in nature, the physician is
obliged to make full and frank disclosure to the patient or any person who
may act on his behalf all he pertinent facts relative to his illness
RIGHT TO CONFIDENTIAL INFORMATION
Statutory Privileged Communication
Pursuant to the Rules of Court, Rule 130, Sec. 24(c), a person authorized
to practice medicine, surgery or obstetrics cannot in a civil case, without
the consent of the patient, be examined as to any information which he
may have acquired in attending such patient in a professional capacity,
which information was necessary to enable him to act in that capacity,
and which would blacken the character of the patient.
REQUISITES OF A VALID CONSENT

Informed or enlightened consent
Voluntary
Subject matter must be legal
FORMS OF CONSENTS
Expressed consent written or oral
Implied consent may be deduced from the conduct of the patient
SCOPE OF CONSENTS
General or Blanket consent
Limited or conditional consent
Non-liability or exculpatory clause
INFORMED OR ENLIGHTEN CONSENT
Awareness and assent
full disclosure of facts and willingness of the patient to submit
Ethical/Professional Confidential Information

Pursuant to Art.II, Sec.6, Code of Medical Ethics, the medical practitioner
should guard as a sacred trust anything that is confidential or private in
nature that he may discover or that may be communicated to him in his
professional relation with his patients, even after death. He should
never divulge this confidential information, or anything that may reflect
upon the moral character of the person involved, except when it is
required in the interest of justice, public health or public safety.
INSTANCES WHERE CONFIDENTIALITY IS NOT APPLICABLE
When such disclosure is necessary to serve the best interest of justice
When the disclosure will serve public health and safety
When the patient waives its confidentiality
RIGHT TO CHOOSE HIS PHYSICIANS
RIGHT TO TREATMENT
QUANTUM OF INFORMATION NECESSARY TO FORM THE BASIS OD A VALID

CONSENT
Nature of his condition;
Natured of proposed treatment or procedure;
Possible alternative methods;
Risk involved;
Chances of success or failure
Note: Consent must be given freely or voluntarily
PERNSONS WHO CAN GIVE CONSENT
Patient
If patient is minor, consent must be obtained from the parents/guardian
In the absence of the parents, consent of the grandparents must be
obtained, paternal grandparents having preference
In the absence of parents and grandparents, eldest brother or sister,
provided one is of age and not disqualified by law to give consent
In emergency cases the patient has the right to treatment

Sec. 1, 1st par, RA 6615
all government and private hospital or clinics duly licensed to operate
are required to render immediate medical assistance and to provide
facilities and medicine within its capabilities to patients in emergency
cases who are in danger of dying and or suffered serious physical
injuries
Art II, Sec.3 of the Code of Medical Ethics
In cases of emergency, wherein immediate action is necessary, a
physician should administer at least 1st aid treatment and then refer the
patient to a more qualified and competent physician if the case does not
fall within his particular line.
RIGHT TO REFUSE TREATMENT
In the legal sense, every man of adult age and of sound mind has the right
to determine what must be done in his own body
Page 5 of 16
ACADs TEAM
A man is the master of his own self and may expressly prohibit a life-saving
surgery or medical treatment
Doctrine of parents patria, the State has the right to assume guardianship
when the child is neglected by the parents to have the child treated, and
parents have no right to base it on religious beliefs or any other grounds.
When the law provides for treatment, the patient has no right to refuse
treatment
The social commitment of the physician is to sustain life and relieve
suffering. Where the performance of ones duty conflicts with the other,
the choice of the patient, or his family or legal representative if
incompetent to act on his own behalf, should prevail. In the absence of the
patients choice or authorized proxy, the physician must act in the best
interest of the patient
LIABILITIES OF PHYSICIANS
Administrative
o Right to practice is temporarily withdrawn from the physician
o A valid exercise of the police power of the State
o Laws: Medical Act of 1959 as amended including the Code of Ethics
and Rules and Regulations of the PRC
o Penalty: reprimand, suspension, to revocation of license
Criminal
o An act or omission which constitute a crime by the physician
o Laws: Revised Penal Code and other special laws
o Penalty: imprisonment and/or fine
Civil
o Awarded against a physician to compensate for the injury he suffered
on account of the physicians act or omission as a breach of the
contractual relationship of both parties
o Laws. Civil Code of the Philippines and other related laws
o Art. 100, RPC states that Every person criminally liable is civilly
liable. Penalty: damages
ADMINISTRATIVE LIABILITIES
Quantum of evidence needed: substantial evidence, such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion
Administrative due process:
Right to hearing
Tribunal must consider the evidence presented
Decision must have something to support itself
Evidence must be substantial
Decision must be based on the evidence adduced at the hearing, or at
least contained in the record and disclosed to the parties
The Board or its judges must act on its or their independent
consideration of the facts and the law of the case, and not simply
accept the views of a subordinate in arriving at a decision. (Ang Tibay
vs. CIR)
GROUNDS FOR ADMINISTRATIVE LIABILITIES

Sec.24, Art.III, Medical Act of 1959 as amended
Personal Disqualifications:
Immoral or dishonorable conduct;
Insanity;
Gross negligence, ignorance or incompetence resulting in an injury to
or death of the patient;
Addiction to alcoholic beverages or to any habit-forming drug
rendering him incompetent to practice medicine.
Criminal Acts:
Conviction by a court of competent jurisdiction of any criminal
offense involving moral turpitude
Fraud in the acquisition of the certificate of registration
Performance of or aiding in any criminal abortion
Knowingly issuing false medical certificate
Aiding or acting as dummy of an unqualified or unregistered person
to practice medicine
Unprofessional Conduct:
False or extravagant or unethical advertisements wherein other
things than his name, profession, limitation of practice, clinic hours,
office and home address, are mentioned
Issuing any statement or spreading any news or rumor which is
derogatory to the character and reputation of another physician
without justification
LM
Violation of any of the Code of Ethics as approved by the PMA
CRIMINAL LIABILITIES
A criminal act is an outraged to the sovereignty of the State so it must be
instituted in the name of the sovereign people as party-plaintiff (People of
the Philippines vs. X)
Quantum of evidence is proof beyond reasonable doubt. This does not
mean absolute certainty as excluding possibility of error but only mean
moral certainty, or that degree which produces conviction in an
unprejudiced mind (Rule 133, Sec. 2, Rules of Court)
Presumption of Innocence and Equipoise Rule
Conviction of a physician, aside from imprisonment and/or fine, his
registration may be cancelled or revoked if:
The law imposes revocation of the license
The crime wherein the physician was found guilty involved moral
turpitude
INCIDENTAL TO THE PRACTICE OF MEDICINE
Imprudence and Negligence- Art.365, Revised Penal Code
Any person who, by reckless imprudence, shall commit any act which,
had it been intentional, would constitute a grave felony, shall suffer the
penalty of arresto mayor in its maximum period to prison correctional in
its medium period, if it would have constituted a less grave felony, the
penalty of arresto mayor in its minimum periods shall be imposed; if it
would have constituted a light felony, the penalty of arresto menor shall
be imposed
Imprudence deficiency of action or failing to take the necessary
precaution once they are foreseen.
Reckless imprudence voluntary, without malice, doing or failing to do an
act which results from material damage by reason of inexcusable lack of
precaution on the part of the person performing the act, taking into
consideration his employment or occupation, degree of intelligence,
physical condition and other circumstances regarding persons, time and
place.
Simple imprudence consist in neither the lack of precaution displayed in
those cases in which the damage impending to be caused is not immediate
nor the danger clearly manifest.
Negligence- indicates a deficiency of perception or when the wrongful act
maybe avoided by paying proper attention and using due diligence in
foreseeing them.
CIVIL LIABILITIES
A civil suit filed against physician and/or hospitals is premised on recovery
of damages for their wrongful act or of employees.
Cause of action for damages is based on:
Breach of Contract
physician-patient relationship
specific stipulations in the contract
In an action for breach of contract, the negligence of the doctor
is not an issue, for if the doctor makes contract to effect a cure
and fails to do so, he is liable for breach of contract even though
he uses the highest possible professional skill.
Tort (Quasi-delict)
Legal wrongdoing independent of a contract
Primary basis is negligence or fault of the physician as the one
directly responsible for the injury sustained by the patient
Ordinarily, any malpractice action is based on torts or quasidelict in as much as negligence is usually a ground for injury
Art. 2176 of the Civil Code provides that:
Whoever by act or omission causes damage to another, there
being fault or negligence, is obliged to pay for the damage done.
Such fault or negligence, if there is no pre-existing contractual
relation between the parties, is called quasi-delict
MEDICAL MALPRACTICE
Failure of a physician to properly perform the duty which devolves upon
him in his professional relation to his patient which results to injury.
It may be defined as bad or unskillful practice of medicine resulting to
injury of the patient or failure on the part of the physician to exercise the
degree of care, skill and diligence, as to treatment in a manner contrary to
accepted standards of medicine resulting to injury to the patient.
Elements:
The physician has a duty to the patient
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The physician failed to perform such duty to his patient
As a consequence of the failure, injury was sustained by the patient
The failure of the physician is the proximate cause of the injury
sustained by the patient
Criminal medical malpractice, the act or omission complained of must be
punishable by law at the time of commission or omission
Proximate Cause is that cause, which, in natural continuous sequence,
unbroken by an efficient intervening cause, produces the injury and
without which the result would not have occurred.
There must be a direct physical connection between the wrongful act
of the physician and the injury sustained by the patient
The cause or the wrongful act of the physician must be efficient and
must not be too remote from the development of the injury suffered
by the patient
The result must be the natural continuous and probable
consequences
Doctrine of Efficient Intervening Cause:
In the causal connection between the negligence of the physician
and the injury sustained by the patient, there may be an efficient
intervening cause which is the proximate cause of the injury.
LEGAL PRINCIPLES AND DOCTRINES APPLIED IN MEDICAL MALPRACTICE
Doctrine of Vicarious Liability
Doctrine of Ostensible Agent
Borrowed Servant Doctrine
Captain of the Ship Doctrine
Doctrine of Res Ipsa Loquitor
Doctrine of Common Knowledge
Doctrine of Contributory Negligence
Doctrine of Assumption of Risk
Doctrine of Last Clear Chance
Fellow Servant Doctrine
Rescue Doctrine
DOCTRINE OF VICARIOUS LIABILITY
Doctrine of Imputed Negligence/Command Responsibility
Vicarious liability means the responsibility of a person, who is not
negligent, for the wrongful conduct or negligence of another.
Art. 2180, Civil Code of the Philippines
Obligations is demandable not only for ones own acts or omission
but also fort those persons whom one is responsible
.the owners or managers of an establishment or enterprise are
likewise responsible for damages caused by their employees in the
service of the branches in which the latter are employed or on the
occasion of their functions
Employers shall be liable for the damages caused by their employees
and household helpers acting within the scope of their assigned task,
even though the former are not engaged in any business or
industry
The responsibility treated of this article shall cease when the person
herein mentioned prove that they observe all the diligence of a good
father of a family to prevent injury.
REASONS FOR APPLICATION OF THE DOCTRINE OF VICARIOUS LIABILITY
Deep pocket theory
The employer has the power to select his employee and to control his acts
Since the employer benefits monetarily from the employee, the employer
has to bear the loss when neither the employer nor the employee is at fault
To treat them as operating expense
DOCTRINE OF OSTENSIBLE AGENT
In cases wherein the employees are at the same time are independent
contractors of the hospital
Because of this peculiar situation, they are considered ostensible agents
and therefore, the hospital must be held liable for their negligent acts,
(pathologist, radiologist, anesthesiologist)
DOCTRINE OF BORROWED SERVANT
Ordinarily, resident physicians, nurses and other personnel of the hospital
are employees or servants of the hospital
In some instances, they are under the temporary supervision and control of
another other than their employer while performing their duties
LM
By fiction of law, they are deemed borrowed from the hospital by someone
and for any wrongful act committed by them during the period, their
temporary employer must be held liable for the discharge of their acts and
duties
In the determination whether one is a borrowed servant, it is necessary
that he is not only subjected to the control of another with regard to the
work done and the manner of performing it but also that the work to be
done is for the benefit of the temporary employer
DOCTRINE OF CAPTAIN-OF-THE-SHIP
This doctrine innunciates liability of the surgeon not only for the wrongful
acts of those who are under his physical control but also those wherein he
has extension of control
DOCTRINE OF RES IPSA LOQUITOR
The thing speaks for itself; nature of the wrongful act or injury is
suggestive of negligence
General rule: expert testimony is necessary to prove that a physician has
done a negligent act or that has deviated from the standard of medical
practice
REQUISITES OF DOCTRINE OF RES IPSA LOQUITOR
The accident must be of a kind which ordinarily does not occur in the
absence of someones negligence
It must be caused by an agency or instrumentality within the
exclusive control of the defendant
It must not have been due to any voluntary action or contribution on
the part of the plaintiff
Some cases wherein the Doctrine of Res Ipsa Loquitor has been applied
Objects left in the patients body at the time of caesarian section
Injury to a healthy part of the body
Removal of a wrong part of the body when another part was intended
Infection resulting from unsterilized instruments
Failure to take radiographs to diagnose a possible fracture
Instances where the Doctrine of Res Ipsa Loquitor does not apply:
Where the Doctrine of Calculated Risk is applicable
When an accepted method of medical treatment involves
hazards which may produce injurious results regardless of the
care exercised by the physician
Bad Result Rule
Honest Errors of judgment as to Appropriate Procedure;
Mistake in the Diagnosis
In most medical malpractice suits, there is a necessity for a
physician to give his expert medical opinion to prove whether
acts or omissions constitute medical negligence. This doctrine
has been regarded as rule of sympathy to counteract the
conspiracy of silence
Note: According to one of the most distinguished jurist (Canada), Justice
Mignault:
the practice of medicine and surgery is indispensable to humanity
and should not be fettered by rules and responsibility so strict as to
exactinfallibility on the part of the physician which he does not
possess.
we would be doing a disservice to the community at large if we were
to impose liabilities on hospitals and doctors for everything that goes
wrong. Doctors would be led to think more of their own safety than the
good of the patients. Initiative would be stiffed and confidence shaken.
DOCTRINE OF CONTRIBUTORY NEGLIGENCE
Doctrine of Common Fault
It has been defined as conduct on the part of the plaintiff or injured party,
contributing as a legal cause to the harm he has suffered, which falls below
the standard which he is required to conform to his own protection
It is the act or omission amounting to want of care on the part of the
complaining party which, concurring with the defendants negligence is the
proximate cause of the injury
Related provisions:
Art. 2179, Civil Code
When the plaintiffs 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 injury being the defendants lack of due care,
the plaintiff may recover damages, but the court may mitigate the
damages to be awarded.
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Art.2214, Civil Code
In quasi-delicts, the contributory negligence of the plaintiff shall
reduce the damages that he may recover.
Some Instances where there is contributory negligence:
o Failure to give the physician an accurate history
o Failure to follow the treatment recommended by the physician
o Leaving the hospital against the advice of the physician
o Failure to seek further medical assistance if symptoms persist
DOCTRINE OF SUPERIOR KNOWLEDGE
In the physician-patient relationship, the physician has superior knowledge
over his patient
The patient just follows the instructions and orders of the physician and is
usually inactive and virtually places himself in the command and control of
the physician
The defense of contributory negligence is available only when the patients
conduct is a truly flagrant disregard of his health and cannot apply where
the patient is mentally ill, semiconscious, heavily sedated or of advanced
age
DOCTRINE OF CONTINUING NEGLIGENCE
If the physician, after a prolonged treatment of a patient which normally
produces alleviation of the condition, fails to investigate non-response, he
may be held liable if in the exercise of care and diligence he could have
discovered the cause of non-response
DOCTRINE OF ASSUMPTION OF RISK
Predicated upon knowledge and informed consent, anyone who voluntarily
assumes the risk of injury from a known danger, if injured, is barred from
recovery
violenti non fit injuria, which means that a person who assents and was
injured is not regarded in law to be injured
DOCTRINE OF LAST CLEAR CHANCE
A physician who has the last clear chance of avoiding damage or injury but
negligently fails to do is liable
It implies thought, appreciation, mental direction and lapse of sufficient
time to effectually act upon impulse to save the life or prevent injury to
another
DOCTRINE OF FORESEEABILITY
A physician cannot be held accountable for negligence if the injury
sustained by the patient is on account of unforeseen conditions but if a
physician fails to ascertain the condition of the patient for want of the
requisite skill and training is answerable for the injury sustained by the
patient if injury resulted thereto
A physician owes duty of care to all persons who are foreseeably
endangered by his conduct, with respect to the risk which make the
conduct unreasonably dangerous
DOCTRINE OF RESCUE/FELLOW SERVANT
If a physician who went to rescue a victim of an accident was himself
injured, the original wrongdoer must be held liable for such injury
SOLE RESPONSIBILITY VS SHARED RESPONSIBILITY
Sole responsibility
o When the negligent act or omission which is the proximate cause of
the injury suffered by patient is attributed to the wrongful act of
person
Shared responsibility
o When the injury suffered by the patient is caused by the negligent act
of two or more persons, each of them acting concurrently and
successively in the production of injury
SPECIFIC ACTS OF OMISSIONS WHICH CONSTITUTE MEDICAL MALPRACTICE
Failure to take medical history
Failure to examine or make a careful and adequate examination
Non-referral of the patient to a specialist
Failure to consult prior physicians for previous management
Non-referral of patient to a hospital with equipment and trained personnel
Failure to use the appropriate diagnostic test
LM
Failure to diagnose infections
Treatment resulting to addiction
Abandonment of patients
Failure to give proper instructions
Failure to institute the proper prophylactic treatment
Errors in blood transfusion
Liabilities in administration of drugs
Product liabilities of manufacturer
Wrong baby cases
ABANDONMENT OF PATIENTS
Termination of the physician-patient relationship without the consent of
the patient and without giving the patient adequate notice and opportunity
to find another physician
Elements:
o There is a physician-patient relationship
o The relationship is terminated without mutual consent of both parties
o Unilateral termination of the contractual relationship by the physician
o Continuing need of the patient for further medical treatment
o Abandonment must have been the cause of the injury or death of the
patient
Some instances of abandonment:
o Refusal by a physician to treat a case after he has seen the patient
needing medical treatment but before treatment is commenced
o Refusal to attend to a case for which he has already assumed
responsibility
o Failure to provide follow-up attention
o Failure to arrange for a substitute physician during the time the
physician is absent or unavailable
The attending physician may be held liable for the acts of his substitute in
the following instances:
o The attending physician did not exercise due care and diligence in the
selection of the substitute
o If the substitute acts as agent of the attending physician in so far as
carrying out a certain course of treatment in which case masterservant relationship is created
Note: Non-payment of bill cannot be a defense for abandonment
LIABILITIES IN THE ADMINISTRATION OF DRUGS
Five basic rights:
o Right drug
o Right patient
o Right dose
o Right time
o Right route
NEGLIGENCE IN THE ADMINISTRATION OF A DRUG EHICH CAUSES INJURY TO
THE PATIENT MAY ATTRIBUTE TO
Drug reaction:
o Failure to note history of allergy
o Failure to test for signs of reaction
o Failure to stop treatment when the drug reaction has been observed
o Failure to provide adequate therapy to encounter a reaction
o Treatment with a drug not proper for the illness
Over-dosage
Failure to give warning of the side effects
Administering medicine on the wrong route
Administration of the wrong medicine
Administration of a drug on the wrong person
Infection following an injection
Injury to the nerves
Failure to administer the drug
DOCTRINE OF STRICT LIABILITY
A person injured by a defective product can recover compensation from his
injury from anyone in the distributive chain who sold the product while the
defect was present, even though the seller exercises every conceivable
caution to prevent and discover the defects
Negligence or carefulness is not in issue in a case under the doctrine nor is
any warranty or promise in issue
A drug manufacturer is liable if his product is contaminated by any
impurities which harm the user
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If the drug has side effects, it is the duty of the manufacturer to warn the
physician of it either through the literature attached or accompanying the
drug or through the services of the promoters
Once the physician has been forewarned, the manufacturer has no duty to
insure that the warning reaches the patient in normal circumstances
LIABILITIES OF HOSPITALS
Sec.2(a), RA 4226, Hospital Licensure Act
HOSPITAL means a place devoted primarily to the maintenance and
operation of facilities for the diagnosis, treatment, and care of
individuals suffering from illness, disease, injury or deformity, or in need
of obstetrical or other medical and nursing care.
The term hospital shall also be construed as any institution, building or
place where there are installed beds, cribs, bassinets for twenty-four
hour use or longer by patients in the treatment of diseases, ...
Classification, according to Control and Financial Support:
o Public/Government operated and maintained either partially or
wholly by the national, provincial, municipal, or city government or
other political subdivision, or by any department, division, board or
other agency thereof. (Sec. 2(b) RA 4226)
o Private privately owned, especially established and operated with
funds raised and contributed through donations, or private capital or
other means.(Sec. 2(C), RA4226)
For purposes of determining liability of private hospitals:
o Private charitable or eleemosynary established for the public
benefit and not conducted for the pecuniary gain of the management.
o Private pay established for profit and gain
Rationale why hospital cannot practice medicine:
o The hospital cannot be subjected to government licensure
examinations to determine whether it is qualified to practice
medicine
o A non-medical will be allowed to control a physician and through
circumvention practice medicine
o Breach of the confidential relationship in a physician-patient
relationship
PRIMARY DUTIES OF A HOSPITAL
To furnish a safe and well-maintained building and ground
To furnish adequate and safe equipment
To exercise reasonable care in the selection of the hospital staff
PERSONS COMING WITHIN THE PREMISES OF THE HOSPITAL
Trespasser one who enters the property of another without being
granted the privilege to do so. It is only required of a hospital to refrain
from taking positive steps to harm a trespasser.
Licensee one who is neither a customer, servant nor a trespasser. He has
no contractual relation with the hospital. He is permitted, expressly or
impliedly to be within the premises for his own interest and convenience.
His presence is merely tolerated.
Invitee one who is essential to the operation of a hospital or for whom
the hospital has a purpose.
LIABILITIES OF HOSPITALS FOR THE WRONGFUL ACTS OF THEIR AGENTS
Government or Public Hospitals
o A State cannot be sued without its consent.
o The immunity of the government from the official acts of its officers,
agents and employees is based on the legal principle that there can
be no legal right against the authority that makes the law which the
right depends.
o Rationale: Government funds should be spent for public purposes and
not diverted to compensate for private injuries and public service
should not be hindered. The government must not be sued because
the government derives no profit from its activity unlike a private
enterprise
o Those established to perform government functions; it is immune
from being sued
o Those performing proprietary function when it is established for
profit
o The government goes down to the level of any private hospital
Private Charitable, Voluntary or eleemosynary for charity
o A charity hospital is established and maintained from the donations,
contributions, philanthropic acts and pays no dividends
LM
o The determination whether a hospital was established for charity is
the articles of incorporation and the constitution and by-laws of the
corporation
Private Hospital Operating for profit
o May be held vicariously liable for the negligent acts of its employees
Note:
A hospital which allows the patient to pay if ever they have the capacity to
do so and serve others gratuitously does not change the fundamental
nature of the hospital as charity
The charging of the fee is not controlling but the purpose the fee will be
use is the measure of charity
The fact that a hospital refuses to accept certain persons and others to pay
in accordance with their means does not affect its charitable status, if it is
operated for no profit
A charitable hospital must not consist of rendering charitable acts to few
sporadic cases but must be extended to the public over a period of time
A hospital established for profit even though some beds are devoted for
charity is not deemed a charitable institution
DOCTRINES APPLIED TO CHARITABLE HOSPITALS IMMUNITY FOR THE ACTS
OF ITS EMPLOYEE
TRUST FUND DOCTRINE
Charitable hospitals derived support from voluntary contributions or
donations for the reception, care and treatment of charity patients
The contributions are held only in trust by the governing body of the
hospital
Diverting the money for the payment of damage will be utilizing the money
not intended by the donor.
IMPLIED WAIVER THEORY
A patient who enters a private hospital, knowing fully well that it is merely
supported by contributions, waives his right to claim damages
PUBLIC POLICY THEORY
It renders medical service without remuneration. It is doing an undertaking
of the obligation of State for the preservation of life and maintenance of
health
INDEPENDENT CONTRACTOR THEORY
A patient who enters a private charitable hospital does not have a contract
with the hospital but with the attending physician
Rules applied in determining the vicarious liability for the negligent acts of
the resident physicians, nurses and others employees
PRINCIPLES OF HOSPITAL LIABILITIES
Principle of administrative/ministerial as against professional/medical
duties
o The performance of all routinary duties which is the very reason why
he is appointed in the ordinary sense constitutes administrative
duties and any negligent acts committed by such employees in the
course of their employment which causes injury the patient, may
make the hospital vicariously liable
o Medical duties are by its nature beyond the ordinary routine in a
hospital. Any negligence of such hospital employees, the borrowed
servant doctrine must be applied and the hospital may not be held
vicariously liable
Power of Control
Contract of Service
o If the contract has been entered with hospital to render professional
services, the hospital may be held liable provided the negligent act
was committed within the scope of employment. But if entered with
the patient for contract of services, the principle of independent
contractor theory is applied
Independent Contractor Theory
Sole Responsibility vs Shared Responsibility
CORPORATE LIABILITIES OF HOSPITALS
Those arising from failure of the hospital to furnish accommodations and
facilities necessary to carry out its purpose or to follow in a given situation,
the established standard of conduct to which the corporation should
conform
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Recent decisions of the court have extended hospital liability to patient for
its failure to make careful selection, review, and supervision of
independent physicians who are permitted to practice in the hospital
VICARIOUS LIABILITIES FOR THE ACTS OF HOSPITAL EMPLOYEES
ADMISSION
A person has no absolute right to be admitted in a hospital or to avail of
hospital services. The relationship between the hospital and the patient is
contractual.
A government has no absolute privilege of choice of patients inasmuch as it
is established and maintained by public funds except for justifiable
grounds.
Attendance to emergency cases in hospitals
Sec. 1 RA 6615 substantially states that
hereby required to render immediate emergency medical assistance
and to provide facilities and medicine within its capabilities to patients in
emergency cases who are in danger of dying and/or who may have
suffered serious injuries.
TRANSFER OF PATIENTS
It must be premised on desire and consent of the patient and when the
condition of the patient would permit to do so
DISCHARGE OF PATIENTS
After evaluation of the patients condition, considers that further
hospitalization is no longer indispensable, a physician may order the
discharge with or without condition.
REFUSAL TO BE HOSPITALIZED
Refusal of the patient to remain in the hospital will not be a lawful ground
to detain him if he is of sound mind and of legal age
Related laws:
Art. 268, Revised Penal Code
1987 Philippine Constitution, Sec. 1 and 6
Refusal of the patient to leave the hospital
Premature discharge
The attending physician and the hospital any be held liable to the patient if
the latter is discharged from the hospital in spite of the fact that further
hospitalization is still necessary
DETENTION OF PATIENTSFOR NON-PAYMENT OF BILLS
A patient cannot be detained in a hospital for non-payment of the hospital
bill
The law provides a remedy for them to pursue by filling the necessary suit
in court for the recovery of such fee or bill
A hospital any legally detain a patient against his will when he is detained
or convicted prisoner, or when the patient is suffering from a very
contagious disease wherein his release is prejudicial to public health, or
when the patient is mentally ill, that his release will endanger public safety
LIABILITIES OF HOSPITALS FOR ITS ANCILLARY SERVICES
Whenever the hospital administration enters into contract with a
partnership of physicians to run the emergency room, the medical staffs
therein are not considered employees of the hospital
Consequently liability for negligence in the emergency room is shifted to
the medical partnership
Courts have held that even if contracts specify that physicians will be
considered independent contractors, the hospitals are responsible for their
action if they can exercise control over them
Patients are not bound by the secret limitations contained in a private
contract between the hospital and the physician
TWO ASPECTS OF EMERGENCY CARE
Examination of the patient to determine his condition and need for
emergency medical procedures
Performance of the specific medical or surgical procedure which are
required without delay to protect the patients health
LIABILITY IN THE ERGENCY ROOM ARISES FROM THE FOLLOWING:
LM
AMBULANCE
An AMBULANCE is a motor vehicle specifically designed, equipped and
used for the transportation of the sick, injured or wounded persons
operated by trained personnel for ambulance service
The criminal liability of an ambulance driver is the same as that of an
ordinary driver. However, the civil liability arising therefrom the hospital
must be held liable
HOSPITAL PHARMACY
Sec. 42, RA 5921
A PHARMACY is a place or establishment where drugs, chemical
products, active principles of drug, pharmaceuticals, proprietary
medicine of pharmaceutical specialties, devices and poison are sold at
retail and where medical and dental veterinary prescriptions are
compounded and dispensed
MEDICAL RECORDS
It is compilation of the pertinent facts of the patients life history, illness,
and treatment.
It is a compilation of scientific data derived from many sources,
coordinated into a document and made available for various uses to serve
the patient, the physician, the institution in which the patient has been
treated, the science of medicine and society as a whole.
PURPOSE OF MAINTAINANCE OF MEDICAL RECORDS
For convenience and necessity in consonance with the purpose
enumerated
As required by statutes (Hospital Licensure Law)
o The hospital may be held liable for injury resulting from a breach of
duty to maintain accurate records.
o Destruction of records is an evidence of negligence.
o An altered medical record may create suspicious intent to establish a
defense and such alteration may be a proof of negligence
o Removal of a certain portion of the record may raise
The inference that they are remove deliberately in order to
suppress evidence
Ownership of Medical Records
The guardian and owner of the medical records is the hospital
But ownership of the medical record is a limited one and
absolute and considered primarily custodial.
VIOLATIONS OF THE CONFIDENTIAL NATURE OF MEDICAL RECORDS
Sec. 6, Art. II, Code of Medical Ethics
The medical practitioner should guard as a sacred trust anything that is
confidential or private in nature that he may discover of that may be
communicated to him in his professional relation with the patient, even
after their death. He should never divulge this confidential information,
or anything that may reflect upon the moral character of the person
involved, except when it is required in the interest of justice, public
health or safety.
Sec. 17, Art. II, Comprehensive Dangerous Drug Act of 2002 (Maintenance
and Keeping of Original Records of Transactions on Dangerous Drugs
and/or Controlled Precursors and Chemicals)
The penalty of imprisonment ranging from 1 year to 6 years and a fine
ranging from 10,000.00 to 50,000.00 shall be imposed upon any
practitioner, who violates or fails to comply with the maintenance and
keeping of the original records of transactions on any dangerous
drugs
An additional penalty of revocation of license to practice his
profession
Sec. 60, Art. VIII, Comprehensive Dangerous Drug Act of 2002
(Confidentiality of Records Under the Voluntary Submission Program)
Judicial and medical records of drug dependents under the voluntary
submission program shall be confidential and shall not be used against
him for any purposes, except to determine how many time by himself or
through his parent, spouse guardian or relative within the fourth degree
of consanguinity or affinity, he voluntarily submitted himself to
confinement, treatment and rehabilitation in any center.
Failure to admit
Failure to examine and/or treat
Negligence in the application of management procedures
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Sec. 64. Art. VIII, Comprehensive Dangerous Drugs Act of
2002(Confidentiality of Records Under the Compulsory Submission
Program)
The records of a drug dependent who was rehabilitated and discharged
from the Center under the compulsory submission program, or who was
charged for violation of Sec. 15 of this act shall be covered under Sec 60
of this act. However, the records of a drug dependent who was not
rehabilitated, or who has escaped but did not surrender himself within
the prescribed period, shall be forwarded to the court and their use shall
be determined by the court, taking into consideration public interest and
the welfare of the drug-dependent.
Sec. 21 (c), Rule 130, Rules of Court (Privilege Communication)
A person authorized to practice medicine, surgery, obstetrics cannot in
civil case, without the consent of the patient, be examined as to any
information, which he may have acquired in attending such patient In a
professional capacity, which information was necessary to enable him to
act in that capacity, and which would blacken the character of the
patient.
INFORMATION FOR WHICH NO AUTHORIZATION IS NEEDED
Name of the patient and house officers associated with the treatment of a
patient
Personal circumstances of the patient which are not ordinarily related to
the treatment
WHEN MAY THE CONTENTS OF THE MEDICAL RECORDS BE DISCLOSED
When requested by the patient or by someone who could act in his behalf
which must be made in writing
When the law requires such disclosure
Upon a lawful order of the court
Note:
The attending patient has no legal right to determine who shall and who
shall not see the record. At the most, his approval or permission is only a
matter of courtesy.
Members of the resident staff, student and attending medical staff may
freely consult such records as pertain to their work.
Sec. 37, Rule 130, Rules of Court Entries in the Course of Business
Entries made at, or near the time of the transactions to which they
refer, by a person deceased, outside the Philippines or unable to testify,
who was in a position to know the facts therein stated, may be received
as prima facie evidence, if such person made the entries in his
professional capacity or in the performance of duty and in the ordinary
course of business or duty.
Patients record is admissible in evidence even if the person who made the
entry is dead or not available, as the records are entries in the course of
business.
EMERGENCIES IN MEDICAL PRACTICE
An emergency is an unforeseen combination of circumstances which calls for
an immediate action. It refers to a situation in which a patient has been
suddenly or unexpectedly endangered to such an extent that immediate
action is needed to save the life and limb or to avoid permanent damages.
A condition of emergency is usually an exception to the observance of the
standard ethical conducts
Related Provisions of the Code of Medical Ethics
Art. II, Sec. 2
A physician is free to choose whom he will serve. He may refuse
calls, other medical services for reasons satisfactory to his
professional conscience. He should, however, always respond to
any request for his assistance in an emergency
Art. II, Sec. 3
In case of emergency, wherein immediate action is necessary, a
physician should administer at least first aid treatment and then
refer the patient to a more qualified and competent physician if
the case does not fall within his particular line.
Art. IV, Sec. 15
A physician should never examine or treat a hospitalized patient
of another without the latters knowledge and consent except in
cases of emergency...
Art. IV, Sec. 16
A physician called upon to attend to a patient of another
physician because of an emergency, should attend only to the
patients immediate needs
LM
Art. IV, Sec. 17
Whenever in the absence of the family physician several
physicians have been simultaneously called in an emergency case
...the first to arrive should be considered as physician in charge,
unless the patient or his family has special
Preference for some other one among those who are present
Art. IV, Sec.20
When a physician is requested by a colleague to take care of a
patient because of an emergencyxxxThe physician should treat
the patient in the same manner and with the same delicacy as he
would have wanted his own patient cared for under similar
conditions
Other related provisions of the law
RA 6615
An act requiring government and private hospitals or clinics duly
licensed to extend medical assistance in emergency cases
RA 8344
An act penalizing the refusal of hospitals and medical clinics to
administer appropriate initial medical treatment and support in
emergency or serious cases, amending BP Blg. 702, otherwise
known as
An act prohibiting the demand or deposits or advance payments
for the confinement or treatment of patients in hospital and
medical clinics in certain cases
Abandonment of persons in danger and abandonment of
ones own victim
The penalty of arresto mayor shall be imposed upon:
- Anyone who shall fail to render assistance to any
person whom he shall find in an uninhabited place
wounded or in danger or dying, when he can render
such assistance without detriment to himself, unless
such omission shall constitute a more serious offense
- Anyone who shall fail to help or render assistance to
another which he has accidentally wounded or
injured
STANDARD OF CARE IN EMERGENCIES
A physician cannot be held to the same conduct as one who had an
opportunity to reflect, even though it later appears that he made a wrong
decision yet prudent at that time
EMERGENCY OPERATIONS WITHOUT CONSENT
When the situation is such that an immediate action is necessary to save
the life or preserve the health of the patient, and getting consent is
prejudicial to the patient, the physician can legally proceed with his
contemplated life-saving procedure
The law gives him the right to act under the Theory of Implied Consent or
that the physician is privileged to do whatever is sound for the benefit of
the patient
Instances:
o The injured person must be unconscious or otherwise unable to give a
valid consent
o The situation must be such as it would make it actually and
apparently necessary to act before there is an opportunity to obtain
consent
o The physician in the exercise of his best judgment that the medical
procedure is life-saving.
Note: The refusal of the patient who is of legal age and of sound mind to
submit to medical treatment shall prevail even if the danger to his life is
eminent
REFUSAL TO GIVE CONSENT DURING EMERGENCY
If the patient is conscious, or if unconscious or is not in a capacity to give
consent, but someone who could act on his behalf is present, then consent
must first be obtained before the commencement of a procedure
EXTENSION OF OPERATION IN CASES OF EMERGENCY
If during an operation, an accident occurs, or a condition maybe discovered
which requires immediate action, but which is not covered by the consent,
the surgeon is justified in extending the operation and be absolved of
liability.
The surgeon is authorized to extend the operation to any condition
discovered when it will redound to the welfare of the patient. In the
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absence of a clearly specific prohibition on the part of the patient, the
physician should be privileged to perform such surgery within the operative
field as is justified in the prevailing medical opinion.
Note:
Surgery cannot be extended if an emergency is not present
The law also implies an obligation on the part of the patient to pay
reasonable value of the emergency service; if no specified amount agreed
upon, the principle of quantum merit shall be applied
DELEGATION OF PHYSICIANS DUTIES
Requisites for a Valid Delegation
o When such duty can be delegated which will depend on the
circumstances of the case, nature of the duty to be delegated, and
the training and experience of the person to whom such duty is to be
delegated
o The person to whom such duty is delegated must be competent to
perform such duty;
o Proper instructions must be given to the person who will perform the
delegated duty
The patient consented, expressly or impliedly such delegation of duty
Liability for Injuries in the Negligent Performance of the Delegated Duties
The person performing the delegated duty cannot be held liable for any
untoward or unexpected effects of his act if he had complied with all the
requirements of a delegated duty and has exercised care and diligence in
such execution
DAMAGES
Are the pecuniary compensations that may be recovered for breach of some
duty or the violation of some rights recognized by law.
If a suit is filed against a physician for a professional liability claims, the
objective of the plaintiff is to recover damages.
If the physician is found negligent in the performance of his professional
services, he liable for the payment of damages for all the direct, natural
and logical consequences of his act.
Damages must be sufficiently proven by evidence, to permit the Court to
determine how much it must be
The proof must show the nature, extent, cause and probable duration of
the injury
Art. 20, Civil Code
Every person who, contrary to law, willfully or negligently causes
damage to another shall indemnify the latter for the same
Whoever, by act or omission causes damage to another, there being
fault or negligence, is obliged to pay for the damages done
Types of Damages
o Actual or Compensatory
o Moral
o Exemplary
o Nominal
o Temperate
o Liquidate
DOCTRINE OF CERTAINTY OF DAMAGE
Damages must be certain both in its nature and in respect to the cause
Recovery must not be contingent or speculative.
The injured patient has the right to recover medical and hospital expenses
from the wrongdoer even though the patient has been indemnified wholly
or partially by an insurance company
ACTUAL OR COMPENSATED DAMAGES
Kinds:
Dano emergente the loss already suffered by the patient
Lucro cesante failure to receive the benefit which would have
pertained to him
COMPENSATORY DAMAGES APPLIED TO MEDICAL MALPRACTICE
LM
o Loss of Service or Support
o Funeral Expenses
The amount of damages for the death caused by a crime or quasi-delict
shall be at least three thousand pesos (75,000.00), even though there
may have been mitigating circumstances.
MORAL DAMAGES
Kinds:
o Physical Suffering
o Mental Anguish
o Fright and Moral Shock
o Besmirched Reputation and Social
Moral damages include physical suffering, mental anguish, fright, serious
anxiety, besmirched reputation, wounded feelings, moral shock, social
humiliation, and similar injury. Though incapable of pecuniary
computation, moral damages may be recovered if they are the
proximate result of the defendants act or omission.
Moral damages may be recovered in the following and analogous cases:
A criminal offense resulting in physical injuries
Quasi-delict causing physical injuries
EXEMPLARY OR CORRECTIVE DAMAGES
Exemplary or corrective damages are imposed, by way of example or
correction for the public good, in addition to the moral, temperate,
liquidated or compensatory damages.
In criminal offense, exemplary damages as part of the civil liability may
be imposed when the crime was committed with one or more
aggravating circumstances. Such damages are separate and distinct from
fines and shall be paid to the offended party.
In quasi-delict, exemplary damages may be granted if the defendant
acted with gross negligence.
In contracts and quasi-contracts, the court may award exemplary
damages if the defendant acted in a wanton, fraudulent, reckless,
oppressive and malevolent manner.
Exemplary damages cannot be recovered as a matter of right; the court
will decide whether or not they should be adjudicated.
Punitive or exemplary damages are monetary compensation over and
above actual or compensatory damages awarded as punishment or
deterrence, because of the wanton, reckless, malicious or oppressive
nature of the wrong committed.
Punitive damages are recoverable from a physician in an action for
malpractice where there is evidence tending to show that he has acted
with malice, or that he acted with recklessness, oppression, or with utter
disregard to the effects of his act, or that he is guilty of gross negligence
in the performance of his profession.
NOMINAL DAMAGES
Nominal damages are adjudicated in order that a right of the plaintiff,
which has been violated or invaded by the defendant, may be vindicated
or recognized not for the purpose of indemnifying the plaintiff for any
loss suffered.
It is a trifling sum awarded to the plaintiff in an action where there is no
substantial loss or injury to be compensated.
It is awarded to plaintiff as a vindication of a right violated.
LIQUIDATED DAMAGES
Liquidated damages are those agreed upon by the parties to a contract,
to be paid in case of breach thereof.
Applies to:
o Death
o Physical Disability
o Loss of Earning Capacity
o Medical, Surgical, Hospital, and Related Expenses
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TEMPERATE OR MODERATE DAMAGES
Temperate or moderate damages, which are more than nominal but less
than compensatory damages, may be recovered when the court finds
that some pecuniary loss has been suffered but its amount cannot, from
the nature of the case, be proved with certainty.
OBLIGATIONS ON THE PART OF THE PLAINTIFF (PATIENT) TO MINIMIZE
DAMAGES
The party suffering from loss or injury must exercise the diligence of a
good father of a family to minimize the damages resulting from the act
or omission in question
DOCTRINE OF AVOIDABLE CONSEQUENCES
Where one person has, through wrongful act, caused personal injury to
another, it is incumbent upon the latter to use such means as are
reasonable under the circumstances to avoid or minimize the damages
The person wronged cannot recover for any item of damage which could
have been avoided
The burden of proof that the injured could have prevented or mitigated the
damages rests on the defendant
ATTORNEYS FEES
Art.2208, Civil Code
Attorneys fees and other related expenses in litigation, other than
judicial cost are not as rule recoverable except when the law specifically
provides.
When exemplary damages are awarded
When the defendants act or omission has compelled the plaintiff to litigate
with third persons or to incur expenses to protect his interest
In criminal cases of malicious prosecution against the plaintiff
In case of clearly unfounded civil action or proceeding against the plaintiff
Where the defendant acted in gross and evident bad faith in refusing to
satisfy the plaintiffs plainly valid, just and demandable claim
In actions for legal support
In actions for the recovery of wages of household helpers, laborers and
skilled workers
In actions for indemnity under the workmens compensation and
employers liability laws
In a separate civil action to recover civil liability
When at least double judicial costs are awarded
In any other case where the court deems it just and equitable that
attorneys fees and expenses of litigation should be recovered
THE MEDICAL WITNESS THE COURT
The court is an agency of the sovereign created directly or indirectly under its
authority, constituting one or more officers, established and maintained for
the purpose of hearing and determining issues of law and facts regarding legal
rights and alleged violations thereof, and of applying the sanction of the law,
authorized to exercise its power in the due course of law at times and places
previously determined by lawful authority.
Different Courts in the Philippines
o Supreme Court
o Court of Appeals
o Regional Trial Court
o Municipal or City Trial Court
o Military Commissions
Art. III, Sec. 2, Code of Medical Ethics
It is the duty of every physician, when called upon by the judicial
authorities, to assist in the administration of justice on matters which
are medico-legal in character.
PHYSICIAN AS AN ORDIANRY WITNESS
Rules of Court
o Sec. 20, Rule 130 - all persons who, having organs of sense, can perceive,
and perceiving can make known their perception to others maybe
witness
Requisites of an Ordinary Witness
o The person must have the organ and power of perception
LM
o The perception gathered by his organs of sense can be imparted to
others
o He does not fall in any of the exception or disqualifications provided
by the Rules of Court
REASONS FOR DISQUALIFICATION
Mental Incapacity or immaturity - Sec. 21, Rule 130, Rules of Court
o Those whose mental condition, at the time of their production for
examination, is such that they are incapable of intelligently making
known their perception to others
o Children whose mental maturity is such as to render them incapable
of perceiving the facts respecting which they are examined and of
relating them truthfully
Marriage - Sec. 22, Rule 130, Rules of Court
o During their marriage, neither the husband nor the
o wife may testify for or against the other without the consent of the
affected spouse, except in a civil case by one against the other, or in
any criminal case for a crime committed by one against the other or
the latters direct ascendants or ascendants
Death or Insanity - Sec. 23, Rule 130, Rules of Court
o Parties or assignors of parties to a case, or persons in whose behalf a
case is prosecuted, against an executor or administrator or other
representative of the deceased person, or against a person of
unsound mind, upon a claim or demand against the estate of such
deceased person or against such person of unsound mind, cannot
testify as to any matter of fact occurring before the death of such
deceased person or before such person become of unsound mind
Parental or filial Privilege - Sec. 25, Rule 130, Rules of Court
o No descendant can be compelled, in a criminal case To testify against
his parents and ascendants
DIQUALIFICATION BY PROVILAGED COMMUNICATION
The following persons cannot testify as to matters learned in confidence in
the following cases (Sec. 24, Rule 130, Rules of Court) :
o The husband or the wife, during or after the marriage, cannot be
examined without the consent of the other as to any communication
received in confidence by one from the other during the marriage
except in a civil case by one against the other, or for a crime
committed by one against the other or the latters direct descendants
and ascendants
o The attorney cannot, without the consent of his client, be examined
as to any communication made by the client to him or his advice
given thereon in the course of, or with a view to professional
employment; nor can an attorneys secretary, stenographer or clerk
be examined, without the consent of the client and his employer,
concerning any fact the knowledge of which has been acquired in
such capacity
o A person authorized to practice medicine, surgery or obstetrics
cannot in a civil case, without the consent of the patient, be examined
as to any information which he may have acquired in attending such
patient in a professional capacity, which information was necessary to
enable him to act in that capacity, and which would blacken the
reputation of the patient
o A minister or a priest cannot, without the consent of the person
making the confession, be examined as to any confession made to or
any advice given him in his professional character in the course of
discipline enjoined by the church to which he belongs
o A public officer cannot be examined during his term of office or
afterwards as to communications made to him in official confidence,
when the court finds that the public interest would suffer by the
disclosure
PRIVILEGED COMMUNICATION BETWEEN PHYSICIAN AND HIS PATIENT
Sec. 6, Art. II, Code of Medical Ethics
The medical practitioner should guard as sacred trust anything that is
confidential or private in nature that he may discover or that may be
communicated to him in his professional relation with his patients, even
after their death. He should never divulge this confidential information,
or anything that may reflect upon the moral character of the person
involved, except when it is required in the interest of justice, public
health, and public safety.
Sec. 24 (c), Rule 130, Rules of Court
A person authorized to practice medicine, surgery or obstetrics cannot
in a civil case, without the consent of the patient, be examined as to any
information which he may have acquired in attending such patient in a
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professional capacity, which information was necessary to enable him to
act in that capacity, and which would blacken the character of the
patient.
EXTENT OF THE PRIVILEGED COMMUNICATION
Interns
Confidential information obtained by one of the physicians practicing
medicine in partnership with another physician whereby the patients of
both are the patients of the firm
Nurses and attendants who were present and assisting the physician when
the communication was made
WHEN COMMUNICATION IS NOT A PRIVILEGED COMMUNICATION
When a person is examined at the instance of the law, for the purpose of
testifying to solely qualify the physician to testify
Information acquired by an autopsy on the body of a person who was not,
prior to his death, a patient of the physician performing the autopsy
Information obtained by a technician from a patient is not privileged
When the public interest so requires.
LM
ATTENDANCE OF A MEDICAL WITNESS IN COURT
Sec. 1, Rule 21, Rules of Court
Subpoena is a process directed to a person requiring him to attend and
to testify at the hearing or the trial of an action, or at any investigation
conducted by competent authority, or for the taking of his deposition. It
may also require him to bring with him books, documents, or other
things under his control, in which case it is called subpoena duces
tecum.
Kinds of Subpoena:
o Subpoena ad testificandum - a process requiring a person to appear
before a trial or hearing of an action or investigation conducted under
our laws or for the taking of a deposition at a certain definite date,
time and place to testify on some material issues.
o Subpoena duces tecum - a process which requires a person to
produce at the trial some documents or papers which are under his
control or possession that are pertinent to the issues of his
controversy, at a certain date, time and place.
Note: Failure to comply with a subpoena without justifiable reason is a
ground for reprimand, suspension or revocation of the certificate of
registration.
SCOPE OF PRIVILEGE
Oral testimony by the physician in court
Affidavits, certificates and reports made by the physician as exhibit in court
Hospital records
WAIVER OF PRIVILEGE
Patient may expressly or impliedly waive their right to privilege
communication
PHYSICIAN AS AN EXPERT WITNESS
Expert witness is one who has the capacity to draw inference from the
facts which a court would not be competent to draw.
To warrant the use of expert testimony, two elements are required:
o The subject of inference must be so distinctly related to some science,
profession, business or occupation as to be beyond the knowledge of
average layman
o The witness must have such skill, knowledge or experience in that
field or calling as to make it appear that his opinion or reference will
probably aid the trier of facts in his search for the truth
Opinion may be defined as the belief, judgment, inference, or sentiment
formed by the mind with regard to things, person or events perceived by a
witness. An opinion in the legal sense is something more than mere
speculation or conjecture.
RULES OF COURT FOR WITNESSES
Sec. 48, Rule 130
o General rule - The opinion of a witness is not admissible, except as
indicated by the Rules
Sec. 49, Rule 130
o Opinion of Expert Witness - The opinion of a witness on a matter
requiring special knowledge, skill, experience or training which he is
shown to possess, may be received in evidence
Sec. 50, Rule 130
o Opinion of Ordinary Witness The opinion of a witness for which
proper basis is given, may be received in evidence regarding to:
The identity of a person about whom he has adequate
knowledge
A handwriting with which he has sufficient familiarity
The mental sanity of a person with whom he is sufficiently
acquainted
o The witness may also testify on his impressions of: emotion, behavior,
condition or appearance of a person
Sec. 2, Art. III, Code of Medical Ethics

It is the duty of every physician, when called upon by the judicial
authorities, to assist in the administration of justice on matters which
are medico-legal in character.
Sec. 24, Art. III, Medical Act of 1959 as amended
Violation of any of the provisions of the Code of Medical Ethic shall
be sufficient ground for reprimanding or for suspending or revoking a
certificate of registration as physician
The penalties of arresto mayor, shall be imposed upon a public officer
who, upon demand from a competent authority, shall fail to lend his
cooperation towards the administration of justice or other public
service, if such failure shall result in serious damage to the public
interest, or to a third party.
WHEN A MEDICAL WITNESS NEED NOT COMPLY WQITH A SUBPOENA
The Court issuing the subpoena has no jurisdiction over the subject matter
of the case
When the place of residence is more than 100 kilometers from the court
issuing the subpoena
When the patient is attending to an emergency and no one is available and
competent enough to be his substitute to attend to such emergency
On account of illness incapacitating him to attend
Sec. 10, Art.21, Rules of Court
The provisions of sections 8 and 9 0f this rule (Compelling attendance
and Contempt) shall not apply to a witness who resides more than 100
km from his residence to the place where he is to testify by the ordinary
course of travel, or to a detention prisoner if no permission of the court
in which his case is pending was obtained.
Sec. 3, Rule 132, Rules of Court, Rights and Obligations of a Witness
A witness must answer questions, although his answers may tend to
establish a claim against him. However, it is the right of a witness:
To be protected from irrelevant, improper questions and from
harsh or insulting demeanor
Not to be detained longer than the interests of justice require
Not to be examined except only as to matters pertinent to the
issue
Not to give an answer which will tend to subject him to a
penalty for an offense unless otherwise provided by law
Not to give an answer which will tend to degrade his reputation,
unless it be to the very fact at issue or to a fact from which the
fact in issue would be presumed. But a witness must answer to
the fact of his previous final conviction of an offense
DISTINCETIONS BETWEEN AN ORDIANRY AND EXPERT WITNESS

An ORDINARY witness can only testify as a general rule, on those things
which he has perceived with his own organs of perception, while an EXPERT
witness may render his opinion, inference, conclusion or deduction on
what he and others perceived
An ORDINARY witness need not be skilled on the line he is testifying but an
EXPERT witness must be skilled on the art, science or trade he is testifying
INSTANCES WHEN THE MEDICAL WITNESS MAY NOT BE COMPELLED TO

ANSWER QUESTIONS IN COURT
It will tend to subject him to punishment for an offense
Incriminatory questions may subject the witness to punishment or
disclosure of which would form a necessary and essential part of a crime
It will degrade his character, except when such degradation of character is
the very fact at issue
A medical witness may refer to memoranda, notes or other pertinent
papers
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Sec. 17, Art. III, Phil Constitution
No person shall be compelled to be witness against himself
IMPEACHMENT OF MEDICAL TESTIMONY
By contradicting testimonies by others of his own class or by any other
competent witnesses
By showing that the medical witness is interested in the outcome of the
case or bias
By an inconsistent statement made at another time
By not expressing the opinion testified to at the time when such expression
might reasonably had been expected
When the scientific treatise which he relies on as the basis of his opinion
does not sustain him
HYPOTHETICAL QUESTIONS PROPOUNDED TO A MEDICAL WITNESS

A physician may be requested to draw his conclusions or opinions from
asset of facts which may or may not know to him.
He must answer the question provided those set of facts has the following
requisites:
o It must be framed as to fairly represent those facts and not give a
situation a false color by the way the statement was given
o The hypothetical question is based upon facts which are in evidence
and assumed facts within the limit of evidence
o The hypothetical question must not be unfair or misleading
Where the expert is familiar with the facts by personal
Observation and so testifies, he may be asked directly for his opinion,
without stating the facts upon which it is based
When the expert is not familiar with the facts upon which it is based, they
must be stated to him hypothetically, and upon the assumption of the facts
so stated, he must base his opinion
RATIONALE ON THE CORROBORATIVE PROBATIVE VALUE OF MEDICAL
EXPERT TESTIMONIES
The testimony however impartial, may unconsciously favor one of the party
litigants
The opinion of the medical expert is based on experience and treatise or
books which may be divergent from the observation of others
HEARSAY EVIDENCE
Not proceeding from personal knowledge of the witness, but from mere
repetition of what he had heard others say
It does not derive its value solely from the credit of the witness but its
value rests mainly in the veracity and competency of other persons
The very nature of the evidence shows its weakness, and it is admitted only
in special cases because of necessity
As a general rule, it is NOT admissible in evidence.
RULES OF COURT FOR EVIDENCES
Sec. 36, Rule 130
o Testimony generally confined to the personal knowledge of the
witness; hearsay excluded
o A witness can testify only to those facts which he knows of his own
knowledge; that is, which is derived from his own perception, except
as otherwise provided by these rules
Sec. 37, Rule 130
o The declaration of a dying person, made under a consciousness of an
impending death, may be received in a criminal case wherein his
death is the subject of inquiry, as evidence of the cause and
surrounding circumstances of such death
DYING DECLARATION
One of the exceptions in hearsay evidence rule
Is the statement made by a person who is at the point of death, and is
conscious of his impending death, in reference to the manner in which he
receives his injuries of which he is dying, or the immediate cause of his
death, and in reference to the person who inflicted such injuries or in
connection with such injuries of a person who is charged or suspected of
having committed them; which statements are admissible in evidence in a
trial where the killing of the declarant is the crime charged to the
defendant.
Grounds for Admissibility of Dying Declaration:
LM
o Necessity death of the declarant makes it impossible to obtain his
testimony in court
o Trustworthiness every motive of falsehood is silenced, and the
mind is induced by the most powerful consideration to tell the truth
Requisites of Dying Declaration:
o That the declaration must concern the cause and surrounding
circumstances of the declarants death
o That at the time the declaration was made, the declarant was under
the consciousness of impending death
o That the declarant is a competent witness
o That the 1declaration is offered in a criminal case in which the
declarant is the victim
PROBATIVE VALUE OF STANDARD MEDICAL BOOKS IN COURT
Medical textbooks are not admissible in evidence on account of the fact
that they are hearsay
The author of the books cannot be presented in court and be subjected to
cross-examination
Note:
Medical witness may have the right to base his opinion from standard
textbooks
In cross-examination, medical textbooks are admissible in evidence to
discredit a witness who has based his testimony upon it
LEARNED TREATISES
Sec. 46, Rule 130, Rules of Court
A published treatise, periodical or pamphlet on a subject of history,
science or art is admissible as tending to prove the truth of a matter
stated therein if the court takes judicial notice, or a witness expert in the
subject testifies that the writer of the statement in the treatise,
periodical or pamphlet is recognized in his profession or calling as expert
in the subject.
EFFECTS OF FALSE TESTIMONY
Art. 180, Revised Penal Code, False testimony against a defendant
Any person who shall give testimony against the defendant in any
criminal case shall suffer:
The penalty of reclusion temporal, if the defendant in said case
shall have been sentenced to death
The penalty of prision mayor, if the defendant shall have been
sentenced to reclusion temporal or perpetua
The penalty of prision correccional, if the defendant shall have
been sentenced to any other afflictive penalty
The penalty of arresto mayor, if the defendant shall have been
sentenced to a correctional penalty or a fine, or shall have been
acquitted
Art. 181, Revised Penal Code, False Testimony favorable to a defendant:
Any person, who shall give false testimony in favor of the defendant in
a criminal case, shall suffer the penalties of arresto mayor in its
maximum period to prision correccional, if the prosecution is for felony
punishable by an afflictive penalty.
Art. 182, Revised Penal Code, False Testimony in Civil Cases:
Any person found guilty of false testimony in civil cases shall suffer the
penalty of prision correccional, if the amount in controversy shall
exceed 5,000 pesos
Art. 183, Revised Penal Code, False testimony in other cases and perjury in
solemn affirmation:
The penalty of arresto mayor , knowingly making untruthful
statements and not being included in the provisions of the next
preceding articles, shall testify under oath, or make an affidavit, upon
ant material before a competent person authorized to administer an
oath in cases in which the law so requires.
Any person, who in case of a solemn affirmation made in lieu of an
oath, shall commit any of the falsehoods mentioned in this and the three
preceding articles of this section, shall suffer the respective penalties
provided therein.
PRINCIPLE OF FALSUS IN UNO, FALSUS IN OMNIBUS
False in one thing, false in everything
When a witness falsified the truth on one point, his testimony on other
points may be disregarded, unless corroborated by other unimpeached
evidences
Requisites:
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o That the witness deliberately or intentionally falsified the truth
o That the other portions of the testimony to be discredited, are not
corroborated by circumstances or other unimpeached evidence
o The false testimony must be on material point
When it is not applicable:
o When there are sufficient corroborations in many grounds of the
testimony
o When the mistake was not in a very material point
o When the error did not arise from the apparent desire to prevent the
truth, but from innocent mistakes and the desire of the witness to
exculpate himself though not completely
CONTEMPT
RULES OF COURT FOR CONTEMPT
Sec. 9, Rule 21
o Contempt Failure by any person without adequate cause to obey a
subpoena served upon him shall be deemed a contempt of court from
which the subpoena is issued. If the subpoena was not issued by a
court, the disobedience thereto shall be punished in accordance with
the applicable law or Rule.
Sec. 1, Rule 71
o Direct Contempt Punished Summarily A person guilty of
misbehavior in the presence of or so near a court as to obstruct or
interrupt the proceedings before the same, including disrespect
toward the court, offensive personalities toward others, refusal to be
sworn or to answer as witness, or to subscribe an affidavit or
deposition when lawfully required to do so, may be summarily
adjudged in contempt by such court.
Sec. 3, Rule 71
o Indirect contempt To Be Punished After Charged and Hearing After
a charge in writing has been filed, and an opportunity given to the
respondent to comment thereon within such period, a person guilty
of any of the following acts may be punished for indirect contempt:
Misbehavior of an officer of a court in the performance of his
official duties or in his official transactions
Disobedience of or resistance to a lawful writ, process, order, or
judgment of a court
Any abuse of or any unlawful interference with the process or
proceedings of a court not constituting direct contempt
Any improper conduct tending directly or indirectly to impede,
obstruct, or degrade the administration of justice
Assuming to be an attorney
The rescue of a person or property in the custody of an officer
by virtue of an order
o But nothing in this section shall be construed as to prevent the court
from issuing process to bring the respondent to the court, or from
holding him in custody pending such proceedings
RIGHT AGAINST SELF-INCRIMINATION
Sec. 17. Art. III, Philippine Constitution states that,
o No person shall be compelled to witness against himself
o The right is available not only in criminal prosecutions but also in all
other government proceedings, including civil actions and
administrative or legislative investigations. It may be claimed not only
by the accused but also by any witness to whom a question calling for
an incriminating answer is addressed
o In criminal actions, the accused may not be compelled to take the
witness stand, on the reasonable assumption that the purpose of the
interrogation will be to incriminate him
o The same principle shall apply to the respondent in an administrative
proceeding where the respondent may be subjected to sanctions of a
penal character, such as cancellation of his license to practice
medicine. (Pascual vs. Board of Medical Examiners, 28 SCRA 345)
Scope:
o The kernel of the right is not against all compulsion, but testimonial
compulsion only
o It is simply against the legal process of extracting from the lips of the
accused an admission of his guilt
o It does not apply where the evidence sought to be excluded is not an
incriminating statement but an OBJECT EVIDENCE (e.g. Fingerprinting,
photographing, paraffin testing, PE)
o The prohibition extends to the compulsion for the production of
documents, papers and chattels that may be used as evidence against
LM
the witness except where the State has the right to examine or
inspect under the police power of the State
o The right also protects the accused against any attempt to compel
him to furnish a specimen of his handwriting in connection with a
prosecution for falsification
CODE OF MEDICAL ETHICS
Art. I General Principles
o Primary objective of the practice of medicine is SERVICE to mankind
o Friend of Man
Art. II Duties of Physicians to their Patients
o To attend to his patients faithfully and conscientiously
o Free to choose whom to serve
o Immediate action in cases of emergency
o Proper consultation and referral
o He must exercise good faith and strict honesty in expressing his
opinion
o Sacred trust of information
o Practice of medicine is not a business
Art. III Duties of Physicians to the Community
o Cooperation with proper authorities, sanitation and health
o To assist in the administration of justice
o To protect the public from charlatans
o No solicitation and extravagant and false advertisements
o Gratuitous services to the indigents
Art. IV Duties of Physicians to their Colleagues and to the Profession
o Gratuitous services to a colleague
o Proper consultation and referral
o Uphold the honor and dignity of the profession
o Observe punctuality
o Observe utmost caution, tact and prudence as regards professional
conduct of another physician
o To refrain from making unfair and unwarranted criticisms of other
physicians
o To keep abreast to the advancements of medical science and
contribute to its progress
o He should be diligent, upright, sober, modest and well-versed in both
the science and art of medicine
o No advertising by means of untruthful or improbable statements in
newspapers or exaggerated announcements
o Should expose without fear or favor, before the proper medical or
legal tribunals corrupt and dishonest conduct of members of the
profession
o Should aid in safeguarding against the admission of those who are
unfit or unqualified because of deficiency in moral character
Art. V Duties of Physicians to Allied Professionals
o To cooperate with and safeguard the interest, reputation and dignity
of allied professional
o Not to allow being published any testimonial certifying the efficacy,
value and superiority and recommendation of drugs
o Non-payment of commissions to any person who refers cases to help
him acquire patients
PENAL PRIVISIONS
Violation of the provisions of this Code constitute unethical and
unprofessional conduct and therefore a sufficient ground for the reprimand,
suspension or revocation of the certificate of registration of the offending physician in accordance with the provisions of Sec. 24, par. 12 of the Medical
Act of 1959.
--------------------------------------------------------------------------------------------------END
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LEGAL/FORENSIC-MEDICINE- Atty.%Tony%D.

LACERATION / TEAR (PUTOK)

Transcribed & Edited by: P.G.Montao & J.Wang

Contusion/abrasion collar - would help determine the relative

COMPOUND / COMPLICATED LACERATION

MEDICAL JURIS PRUDENCE

ADVERSARIAL TRIAL SYSTEM

DUTIES AND OBLIGATIONS OF PHYSICIANS IN THE COURSE OF A PHYSICIANPATIENT RELATIONSHIP

FORMS OF PHYSICIAN-PATIENT RELATIONSHIP

by: P.G.Montanio & J.Wang

RIGHT TO LIMIT HIS MEDICAL PRACTICE

METHODS OF COLLECTION OF PAYMENTS FOR MEDICAL SERVICES

REQUISITES OF A VALID CONSENT

Ethical/Professional Confidential Information

QUANTUM OF INFORMATION NECESSARY TO FORM THE BASIS OD A VALID

In emergency cases the patient has the right to treatment

GROUNDS FOR ADMINISTRATIVE LIABILITIES

by: P.G.Montanio & J.Wang

Sec. 2, Art. III, Code of Medical Ethics

DISTINCETIONS BETWEEN AN ORDIANRY AND EXPERT WITNESS

by: P.G.Montanio & J.Wang

INSTANCES WHEN THE MEDICAL WITNESS MAY NOT BE COMPELLED TO

HYPOTHETICAL QUESTIONS PROPOUNDED TO A MEDICAL WITNESS

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