General General ConsiderationsConsiderations

Atty Molly Cr Abiog, Atty Molly Cr Abiog, MD, LlBMD, LlB

University of the University of the CordillerasCordillerasBaguio CityBaguio City

Lecture 1:

Definition of TermsDefinition of Terms• Legal MedicineLegal Medicine

• Branch of Medicine which deals with Branch of Medicine which deals with the application of medical knowledge the application of medical knowledge to the purposes of law and in the to the purposes of law and in the administration of justiceadministration of justice

• Legal Medicine, Forensic Medicine and Legal Medicine, Forensic Medicine and Medical Jurisprudence Medical Jurisprudence -- synonymous synonymous with each other, and in common with each other, and in common practice are used interchangeably practice are used interchangeably

Definitions & Definitions & DifferencesDifferences

• Strictly speakingStrictly speaking• Legal MedicineLegal Medicine is primarily the is primarily the

application of medicine to legal cases application of medicine to legal cases • Forensic MedicineForensic Medicine concerns with concerns with

the application of medical knowledge the application of medical knowledge to elucidate legal problems.to elucidate legal problems.

Differences in Scopes Differences in Scopes • William J. CurranWilliam J. Curran

• a prominent Harvard professor of legal a prominent Harvard professor of legal medicine definesmedicine defines• Legal MedicineLegal Medicine as encompassing those as encompassing those

specialty areas of medicine concerned with specialty areas of medicine concerned with relations to substantive law and legal relations to substantive law and legal institutions institutions

• Forensic MedicineForensic Medicine deals with investigation , deals with investigation , preparation, preservation and presentation of preparation, preservation and presentation of evidence and medical opinion in courts and evidence and medical opinion in courts and other legal, correctional and other law-other legal, correctional and other law-enforcement settingsenforcement settings

According to Dr Henry According to Dr Henry C. LeeC. Lee

• an eminent U.S. forensic expert who claims an eminent U.S. forensic expert who claims that that Forensic MedicineForensic Medicine has a broader has a broader definition than Ldefinition than Legal Medicineegal Medicine• FM encompasses a variety of fields in forensic FM encompasses a variety of fields in forensic

science such as, pathology, anthropology, science such as, pathology, anthropology, odontology, toxicology, entomology, et alodontology, toxicology, entomology, et al

• Its application is limited not only to legal issues Its application is limited not only to legal issues but also covers historical, environmental and but also covers historical, environmental and social political issuessocial political issues

• Legal MedicineLegal Medicine refers to substantive law refers to substantive law defining the relationship between and among defining the relationship between and among hospitals, doctors, patients, whereas Forensic hospitals, doctors, patients, whereas Forensic Medicine deals with activities or acts punishable Medicine deals with activities or acts punishable under our local lawsunder our local laws

• Dr. Henry C. LeeDr. Henry C. Lee, , • Medical JurisprudenceMedical Jurisprudence denotes the denotes the

knowledge of law in relation to the knowledge of law in relation to the practice of medicinepractice of medicine

• It concerns with the study of the It concerns with the study of the rights, duties and obligations of a rights, duties and obligations of a medical practitioner with particular medical practitioner with particular reference to those arising from a reference to those arising from a doctor-patient relationshipdoctor-patient relationship

Nature of the Study of Legal Nature of the Study of Legal MedicineMedicine::

• Knowledge of legal medicine means:Knowledge of legal medicine means:• ability to acquire factsability to acquire facts• power to arrange those facts in their power to arrange those facts in their

logical orderlogical order• draw a conclusion from the facts which draw a conclusion from the facts which

may be useful in the administration of may be useful in the administration of justicejustice

• power to impart to others verbally or in power to impart to others verbally or in writing all those he has observed.writing all those he has observed.

Facts & FallaciesFacts & Fallacies• Misconceptions among the Misconceptions among the

publicpublic• Medicolegal practitioners must Medicolegal practitioners must

also be lawyersalso be lawyers • One has to be a pathologist to be One has to be a pathologist to be

involved in this line of workinvolved in this line of work

Who is who?Who is who?• A physician who specializes or is involved A physician who specializes or is involved

primarily with medico-legal duties is known as primarily with medico-legal duties is known as a a Medical Jurist Medical Jurist ((akaaka “Medical Examiner”, “Medical Examiner”, “Medico-legal Officer”, “Medico-legal “Medico-legal Officer”, “Medico-legal Expert”)Expert”)• e.g. Dr V.V. Villasenor (PNP Crime Laboratory) e.g. Dr V.V. Villasenor (PNP Crime Laboratory)

Dr. Ronaldo Bandonill (NBI)Dr. Ronaldo Bandonill (NBI)

• Atty. Molly Cr. Abiog, M.D. Atty. Molly Cr. Abiog, M.D. is a doctor and is a doctor and a lawyer, buta lawyer, but not not aa Medico-legal Officer! Medico-legal Officer!

Who are the Medico-Legal Who are the Medico-Legal Practitioners?Practitioners?

• Can either be in the service of the government Can either be in the service of the government or in private practice. or in private practice. • In governmentIn government

• Connected with law enforcement agencies such as the Connected with law enforcement agencies such as the police departments police departments

• Legitimate investigative bodies such as the PNP Crime Legitimate investigative bodies such as the PNP Crime Laboratory Laboratory

• Medicolegal division of the National Bureau of InvestigationMedicolegal division of the National Bureau of Investigation• Physicians employed by the government as they are Physicians employed by the government as they are

mandated by law to perform autopsies on medicolegal casesmandated by law to perform autopsies on medicolegal cases• Municipal Health OfficerMunicipal Health Officer• Provincial Health OfficersProvincial Health Officers

Who are the Medico-Legal Who are the Medico-Legal Practitioners?Practitioners?

• As private practitionersAs private practitioners• Consultants in private hospitals to whom Consultants in private hospitals to whom

are referred medicolegal patients.are referred medicolegal patients.• As part of the Hospital Team that monitors the As part of the Hospital Team that monitors the

patient’s condition while confined at the patient’s condition while confined at the Hospital. When the patient’s case goes to Hospital. When the patient’s case goes to court, the medicolegal practitioner is called to court, the medicolegal practitioner is called to testify on the fact of the injury, the treatment testify on the fact of the injury, the treatment the patient received in the Hospital, his expert the patient received in the Hospital, his expert opinion as to the cause of the patienty’opinion as to the cause of the patienty’

Who are authorized by law Who are authorized by law to perform autopsiesto perform autopsies??

• Sec. 95, P.D. 856, Code of Sanitation:Sec. 95, P.D. 856, Code of Sanitation:• Health OfficersHealth Officers• Medical Officers of Law enforcement agenciesMedical Officers of Law enforcement agencies• Members of the Medical Staff of Accredited hospitals Members of the Medical Staff of Accredited hospitals

• Code of Medical Ethics of the Medical Profession Code of Medical Ethics of the Medical Profession of the Philippines. Sec. 2. Art. III states:of the Philippines. Sec. 2. Art. III states:• ““However, it is the duty of every physician, when However, it is the duty of every physician, when

called upon by the judicial authorities, to assist in the called upon by the judicial authorities, to assist in the administration of justice on matters which are medico-administration of justice on matters which are medico-legal in character” legal in character”

Distinction between an Distinction between an ordinary physician and a ordinary physician and a

medical jurist:medical jurist: Ordinary PhysicianOrdinary Physician

1.1. Sees an injury or Sees an injury or illness on the point of illness on the point of view of TREATMENT view of TREATMENT

2.2. Purpose in Purpose in examining patient examining patient is to arrive at a is to arrive at a definite Diagnosis-definite Diagnosis-Rx RxRx Rx

Medical JuristMedical Jurist 1.1. Sees an injury or Sees an injury or

illness on the point of illness on the point of view of CAUSEview of CAUSE

2.2. include those include those bodily lesions in his bodily lesions in his report and testify report and testify before the court before the court before an before an investigation body investigation body result: justice result: justice where justice is where justice is due-given.due-given.

Ordinary PhysicianOrdinary Physician3. Minor or trivial 3. Minor or trivial

ignored –they do ignored –they do not requirenot require

Medical JuristMedical Jurist 3. Medical jurists must 3. Medical jurists must

record all bodily record all bodily injuries even if they injuries even if they are minor because are minor because these injuries may these injuries may be proofs to qualify be proofs to qualify the crime or to the crime or to justify an actjustify an act

What are these so-called What are these so-called MEDICOLEGAL CASES?MEDICOLEGAL CASES?

• Injuries or deaths involving persons who have no Injuries or deaths involving persons who have no means of being identifiedmeans of being identified

• Persons pronounced as “dead on arrival” (DOA)Persons pronounced as “dead on arrival” (DOA)• Deaths under the following circumstances:Deaths under the following circumstances:• Death occurring within 24 hours of admission when the Death occurring within 24 hours of admission when the

clinical cause of death is unknown or undeterminable;clinical cause of death is unknown or undeterminable;• Unexpected sudden death especially when the Unexpected sudden death especially when the

deceased is in apparent good health;deceased is in apparent good health;• Death due to natural disease but associated with Death due to natural disease but associated with

physical evidence suspicious of foul play;physical evidence suspicious of foul play;• Death as a result of violence, accident, suicide or Death as a result of violence, accident, suicide or

poisoning;poisoning;• Death due to improper of negligent act of another Death due to improper of negligent act of another

person;person;

• Victims of physical injuries caused by Victims of physical injuries caused by the following:the following:• Physical violence such as gunshot wound, Physical violence such as gunshot wound,

stab wound, mauling, etc.;stab wound, mauling, etc.;• Vehicular accident Vehicular accident • Asphyxia Asphyxia • ElectrocutionElectrocution• Chemical or thermal insultChemical or thermal insult• AccidentAccident• Attempted Homicide or suicide Attempted Homicide or suicide • PoisoningPoisoning

• Cases of child abuse, domestic violence, Cases of child abuse, domestic violence, rape, alcoholism and drug addiction;rape, alcoholism and drug addiction;

• Cases involving the mental competency Cases involving the mental competency of the patient;of the patient;

• Iatrogenic causes brought about by Iatrogenic causes brought about by negligent acts or omissions of the negligent acts or omissions of the hospital staff resulting in violation of hospital staff resulting in violation of rights of patients or leading to his rights of patients or leading to his physical and mental incapacitation, physical and mental incapacitation, physical injury and death.physical injury and death.

• Under Philippine laws, medico-legal Under Philippine laws, medico-legal deaths must undergo mandatory deaths must undergo mandatory autopsyautopsy

• No consent is required for the autopsy No consent is required for the autopsy although the next of kin is informed of although the next of kin is informed of this requirement and his signed this requirement and his signed consent obtained as a matter of consent obtained as a matter of courtesycourtesy

• Death certificate cannot be completed Death certificate cannot be completed without the autopsy.without the autopsy.

• If the hospital has no authority to conduct If the hospital has no authority to conduct autopsy, it refers the case to a government autopsy, it refers the case to a government body which can do it—either to the PNP or the body which can do it—either to the PNP or the NBI or top a Municipal or Provincial Heath NBI or top a Municipal or Provincial Heath OfficerOfficer

• If the Hospital has the authority to conduct If the Hospital has the authority to conduct autopsy but the relatives refuse to cooperate, autopsy but the relatives refuse to cooperate, the death certificate is merely filled up by the death certificate is merely filled up by putting as the cause of death “undetermined” putting as the cause of death “undetermined” • In effect, it is also as if no death certificate has been In effect, it is also as if no death certificate has been

issued because legally the body cannot be buried issued because legally the body cannot be buried without a cause of death without a cause of death

Major capabilities of a Major capabilities of a medico-legal officer:medico-legal officer:

• Conducts Conducts • autopsyautopsy• examination of victims of sexual crimesexamination of victims of sexual crimes• examination of victims of Physical injuriesexamination of victims of Physical injuries• examination of skeletal remainsexamination of skeletal remains• blood and blood stain, seminal fluid/stain-blood and blood stain, seminal fluid/stain-

examination of body fluidsexamination of body fluids• Exhumation of bodiesExhumation of bodies• Histopathological examinationsHistopathological examinations

Branches of Law where Legal Branches of Law where Legal Medicine maybe applied:Medicine maybe applied:

• Civil LawCivil Law• Paternity and filiations;Paternity and filiations;• Determination of or change in Civil Personality/Status of Determination of or change in Civil Personality/Status of

persons;persons;• Adoption, Declaration of Nullity of Marriage, Legal Separation, Adoption, Declaration of Nullity of Marriage, Legal Separation,

etc. etc. • Criminal LawCriminal Law

• Circumstances affecting criminal liabilityCircumstances affecting criminal liability• Crimes against personsCrimes against persons• Crimes against chastityCrimes against chastity

• Remedial LawRemedial Law• Rules on evidenceRules on evidence• Proceedings for hospitalizationProceedings for hospitalization• Physical/mental examination of a personPhysical/mental examination of a person

Autopsies shall be performed Autopsies shall be performed in the following cases:in the following cases:

• Whenever required by special lawsWhenever required by special laws• Upon order of a competent court, mayor Upon order of a competent court, mayor

and a provincial or city fiscaland a provincial or city fiscal• Upon written request by police authoritiesUpon written request by police authorities• Whenever the Solicitor General, provincial Whenever the Solicitor General, provincial

or city fiscal deem it necessary to dissenter or city fiscal deem it necessary to dissenter and take possession of the remains for and take possession of the remains for examination to determine cause of deathexamination to determine cause of death

• Whenever the nearest kin shall request in Whenever the nearest kin shall request in writing the authorities concerned to writing the authorities concerned to ascertain the cause of deathascertain the cause of death

FORENSIC Science FORENSIC Science Disciplines:Disciplines:

• Hair AnalysisHair Analysis DNA AnalysisDNA Analysis• Fiber AnalysisFiber Analysis Forensic AnthropologyForensic Anthropology• Glass fragments and paint chipsGlass fragments and paint chips Forensic Forensic

ArchaeologyArchaeologyanalysesanalyses Forensic PathologyForensic Pathology

• Ballistics and Tool marksBallistics and Tool marks Forensic OdontologyForensic Odontology• FingerprintsFingerprints Questioned Document analysisQuestioned Document analysis• FootwearFootwear Forensic Psychiatry & PsychologyForensic Psychiatry & Psychology• Tire ImpressionsTire Impressions Blood Splatter AnalysisBlood Splatter Analysis

ASSIGNMENT:ASSIGNMENT:• Bring to class next meetingBring to class next meeting

• Medico-legal certificate Medico-legal certificate • Autopsy ReportAutopsy Report

Case Discussion:Case Discussion:• An 18 year old female, single, came to a medical clinic An 18 year old female, single, came to a medical clinic

complaining that she has been raped.complaining that she has been raped.• History of the Present Complaint:History of the Present Complaint:

• One (1) month PTC, Mr. X by use of force and intimidation had One (1) month PTC, Mr. X by use of force and intimidation had carnal knowledge with her at Burnham Park @ 2:00 p.m. For fear carnal knowledge with her at Burnham Park @ 2:00 p.m. For fear of her parent’s wrath, she kept what happened to herself and of her parent’s wrath, she kept what happened to herself and came for medical examination only today.came for medical examination only today.

• Examination results:Examination results:• Recently healed hymeneal lacerations at 4 and 6 o’clock;Recently healed hymeneal lacerations at 4 and 6 o’clock;• No signs of recent application of force at the perineal area;No signs of recent application of force at the perineal area;• Internal Examination, admits 2 examining fingers with ease; Internal Examination, admits 2 examining fingers with ease;

shallow vaginal rugosities;shallow vaginal rugosities;• Laboratory Examinations: Positive for spermatozoa, no gram Laboratory Examinations: Positive for spermatozoa, no gram

negative cocci.negative cocci.• Conclusions:Conclusions: -non-virgin state;-non-virgin state;

-healed lacerations at 4 and 6 o’clock-healed lacerations at 4 and 6 o’clock-presence of Spermatozoa, -presence of Spermatozoa,

• Conclusion: recent sexual intercourse within the last 24 hrs.Conclusion: recent sexual intercourse within the last 24 hrs.