Legal Medicine

Guiding Principles in Medical Practice

Political boundary where limitation of practice is allowed

An MD who charges large amounts has limited practice of medicine limitation of practice that emanates
from other sources & are not self-imposed
Invoke self-limitation of practice of medicine based on religious belief a doctor in an RHU was tasked to
implement the governments program using artificial means of family planning, but since a devout
catholic, will only prescribe the natural family planning method
Issuance of false medical certificate criminal act considered as administrative liability of an MD
Tort refers to breech of legal duty
Doctrine of res ipsa loquitor applicable in a patient w/ burns during application of perineal heat after delivery
Last clear chance liability if after 1 week, the patient complained of a discharge due to retained pack
Any person who diagnoses & treats considered as practice of medicine
MDs from other countries during medical missions may be allowed limited practice of medicine w/o
certificate of registration
Illegaly practicing medicine any person who performs any of the acts constituting practice of medicine but is
not qualified to do so
Reciprocity Filipino MDs are allowed to practice medicine in Japan, Japanese MDs nay also practice in the
Philippines via this principle

PRC

PRC issues the certificate of registration

PRC body vested by law to have general supervision over the practice of medicine

Board of Medicine & Medical Education

Board of Medical Education determines & prescribes minimum required curriculum

Board of Medicine investigates administrative liability

Other Fields of Medical Practice

Chiropodist a person who treats diseases or malformations of both hands & feet
Naturopathist a person who heals by utilizing light, water, heat & the like

Rights of Physician & Patient

Right to privacy by refusing the medical student to examine her, the patient is practicing this right
Right to disclosure a woman diagnosed to have cervical cancer should be informed of her diagnosis
Patient waives confidentiality of information does not apply
A hospital has the discretion to choose MDs who can practice in the hospital true
MD may choose patient except in cases of emergency

Physician-Patient Relationship

MD-Patient relationship - commences when patient visits the clinic, the secretary takes his medical history
MD-Patient relationship - ends when the contract on a specified date has already expired
 In an MD-Patient relationship an MD is expected to possess average knowledge & skills
Active-Passive relationship when an MD treats an unconscious patient
Mutual trust a fiduciary MD-Patient relationship is based on this

Consent

Implied consent when a patient consulted an MD at his clinic, described his complaints & received treatment
Emergency case consent not necessary
Patient himself should give consent if the patient is a 19-year old, diagnosed to have appendicitis & was
scheduled for surgery
Exculpatory clause consent which states that the hospital/MD is not liable to any consequences
Mutual consent a consensual MD-Patient relationship is based on this

Type of Fees

Treatment result not considered in determining the amount of MDs professional fee
Simple contractual fee a professional fee agreed upon by the MD & Patient by treatment
Fee-splitting an MD referred patient to a specialist & is given a share in the consultants fee

Penalty & Liability

Penalty is fine and/or imprisonment criminal charges against MD

1-3 years of imprisonment penalty for an MD who failed to report treatment of physical injury to the proper
authority
Aggravating the educational attainment of an MD (being a medicine graduate) may be considered as this
circumstance to a criminal liability
Reckless imprudence act is done with lack of precaution
MD, nurse & hospital director held liable if an emergency case was brought to the hospital but was denied
attendance
Politely withdraw as attending MD if an MD cinsiders a process extremely necessary, but the patient refuses,
the MD may
30 days upon receipt of the decision, an MD may may file a petition for reconsideration after found guilty of
an administrative offense & was given penalty
PRC the decision of the Board of Medicine is final 30 days after promulgation, unless the doctor shall appeal
during the same period to
Income for the last month property of a physician shall exempt from execution by the court
Definite negligence not giving tetanus toxoid to a patient who stepped on a nail
Corporate liability of the hospital mother of a pediatric patient slipped on the floor of the hallway resulting
to injury
Vicarious liability of the hospital staff nurse failed to follow the order of the attending MD
1 3 years failure of physician to report treatment of physical injuries to proper authorities is punishable
by imprisonment for this number of years

Arresto menor

Arresto menor penalty for slight physical injury

Prision correccional
 Prision correccional punishment for falsification of documents to get a certificate of registration

Reclusion temporal

Reclusion temporal penalty for mutilation resulting to deprivation of organs of reproduction

Reclusion perpetua

Reclusion perpetua a person found guilty of parricidal death

Damages

General compensatory damages include loss of earning capacity

Special compensatory damages include expenses for hiring a helper
Exemplary damages damages imposed by way of example or correction for the public good

Abortion

No criminal abortion limitation of practice imposed by law

For criminal abortion a consent duly signed by the patient not considered valid
Participate in criminal abortion not a ground for administrative complaint against MD (immorality,
false advertisement, addiction to gambling)

Wound

Abrasion an open wound

Incised wound in one hand an injury considered example of defense wound
After 24 hours an incised wound shows proliferation of vascular epithelium
Clothing are not involved suggests that a stab wound is suicidal
Paddle will cause a lacerated wound
Horizontal below Adams apple an incised wound in the throat is considered homicidal

Post-mortem

Livor mortis is due to settling of blood

Heart organ that putrefies late
Post-mortem clot soft compared to ante-mortem clot
Marbolization prominent superficial veins
Floating of dead body in water is a result of gas formation
Emaciation delays decomposition of dead body after burial
After 1 month in tropical regions, a dead body is skeletonized
Very old person accelerates cooling of the body after death
Irritability first stage of muscular changes after death
4 hours (11 PM) last full meal was 7 PM; stomach is empty during post-mortem examination; earliest time
he could have died

Autopsy & Death Investigation

NBI chief authorized to make death investigation

Medical officer of NBI can do a medico-legal autopsy
Test

Magnus test uses ligature to examine peripheral circulation

Gettlers test detects chloride in the blood in heart after drowning

Drowning

Deep inspiration first phase of drowning

2 - 5 minutes average duration of death by drowning among people who do not swim
Gas accumulation causes floating of body in water
Suicidal drowning mentality of the victim
Homicidal drowning ligature on hands
Homicidal drowning destruction of clothing of victim
Accidental drowning condition of victim before death

Suicide

Hanging
- hyoid bone usually injured
- ligature at hyoid
- occludes jugular vein
Strangulation with ligature
- horizontal neck mark
- vertebral injury not observed
- occludes jugular vein

Gunshot Injury

Gunpowder detected by paraffin test

Firearm used determined by forensic ballistics
Velocity important determinant of kinetic energy
Smudging refers to smoke blackening
Less than 1 distance between the firearm and target in centimeter if there is burning & dense strong
tattooing in the wound entrance
Gunshot wound of entrance smaller than missile
Gunshot wound of exit
- everted edges
- contusion collar absent
- may be absent

Poisoning

60 90 mg of hydrogen cyanide considered fatal

2,000 minimum amount of hydrogen cyanide in ppm is immediately lethal
Hydrogen cyanide irritating to the respiratory passage
Carbon dioxide refrigerants
Sulfur dioxide volcanic eruption
 Hydrogen cyanide bamboo shoots
Carbon monoxide gasoline engines
Carbon monoxide considered the silent killer
Hydrogen sulfide rayon factory

Legal Medicine

2012 person on board, the vessel that sank in 2008 was not retrieved; can be presumed dead if still
missing by this year (4 years)
Mayor in the absence of an attending MD, can sign the death certificate for burial
25 meters distance of burial ground from dwelling houses under the code of sanitation
5 years exhumation of a dead person who died of dangerous communicable disease may be allowed after
a lapse of this number of years
40 % - loss of weight which may result to death
Extensive injury victim hit by falling rocks from 5th floor during an earthquake; suffered injuries on head,
chest, abdomen & extremities
More than 30 days physical injury considered serious if victim is incapacitated for this number of days
Removal of an extra finger form of mutilation
Women factor prolonging time of survival from starvation
Alpha rays composed of positively charged helium w/ poor penetrating power
2,500 usual muzzle velocity of a military rifle in feet per second
Lead, antimony & barium most common constituents of the primer within a cartridge of a gun
Anoxic form of asphyxia when one travels to Baguio city may cause difficulty in respiration
Tardieu spots find in the following causes of asphyxia: hanging, strangulation & suffocation
Caf coronary form of suffocation caused by bolus of food
Champignon docume signifies white foam in mouth
Histotoxic death type of death an alcohol can cause
Impact within the interior of the vehicle second collision in automotive crash
Any of abrasions, lacerations or fractures injuries can front occupants sustain in automotive crash

Malum prohibitum vs malum in se

Justifying circumstances, mitigating, alternative excempting

Different types of participation, participating principal

Principal by comiting a crime, principal by indispensable participation, principal by indispensable cooperation

Classification of laws

Enforceable by the state

Natural law, divine law, moral law

Substantive law remedial law

Sources of law
Laws that control the quality of medical services

Board of medicine standardization & regulation of medical education, gives exam for registration

Term of PRC commissioners 9 years

Admission to practice of medicine at least 21 years old

At least 15 subject in medicine

Philhealth

75 % average w/ score not lower than 50

Reciprocity phil will grant this privilege to any citizen of the country

Endorsement it will be the phil will be initiating the move

Grounds for non-issuance of certificate

Malpractice

Illegal practice w/o acquired necessary license

Constituting practice of medicine

Hippocratic & administrative oath

Juridical persons cannot practice medicine

Physician px relationship always contractual, basec on mutual consent & mutual trust

Mutual participation relation most common of pahysician-patient relationship

Military courts not included in the hierarchy

Ordinary witness testimony only limited on what you saw

Expert witness can make deductions & opinions

Dying declaration homicide, murder, parricide

Subpoena

Subpoena ad testificandum

Indirect contemot

Administrative penalty

State regulation

Safe regulation

Trespasser
Licensee

Invitee

Borrowed servant doctrine

Civil - 100

Criminal - 50