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CHAPTER 1 LEGAL MEDICINE


Legal Medicine
Is that branch of medicine that applies, medical and
surgical concepts, scientific knowledge and skills to
medico legal issues, in order to assist the trier of
facts in the proper dispensation of justice.
Medical Jurisprudence
is the study of the Medical Law and its applicable
Jurisprudence that governs, regulates and defines
the practice of medicine.

Crimes against civil status of persons


Quasi offenses

3. Remedial Law
Physical and Mental Examination of a person
Hospitalization of insane persons
Rules of Evidence
4. Special Laws
- Dangerous Drug Act
- Youth and Child Welfare Code
- Sanitation Code
- Insurance law
- Labor Code
- Employees Compensation Law

In the Philippines, Legal Medicine is the appropriate name


for Forensic Medicine.
Modern Legal medicine has a broad range of applications,
it is used in civil cases such as paternity and filiation,
annulment of marriage, DNA testing , etc.
In all cases the medical examiner must conduct an
investigation of the crime scene and also an autopsy.

5. CORPUS DELICTI
- Is the body or substance of the crime and is
defined as the fact that a crime actually has been
committed. In all criminal prosecutions, the burden is on
the prosecution to prove the corpus delicti.

TECHNIQUES OF LEGAL MEDICINE:


Legal Medicine uses sophisticated laboratory
techniques to detect the presence of substances in
the victim, in the suspected criminal, or at the crime
scene.
Forensic examination of substances found at a crime
scene can often establish the presence of the
suspect at the crime scene.

QUANTUM OF PROOF
1. In Civil Cases the quantum of proof necessary to
prove a civil complaint is a PREPONDERANCE OF
EVIDENCE. The party filing or bringing a civil complaint
has the burden of proof and must establish the truth and
righteousness of his allegations by a preponderance of the
evidence admitted by a competent court.

LEGAL MEDICINE AND THE LEGAL SYSTEM


Courts routinely call upon physicians to give expert
testimony in a trial, especially concerning the findings
of an autopsy and the results of laboratory tests.
As an expert witness he is allowed to express an
opinion about the validity of the evidence in a case
and may quote the statements of other experts in
support of an opinion.
Ordinary testimony is restricted to statements
concerning what the witness actually saw or heard.
The evidence to be presented by the legal medicine
expert must signify a relation between the facts
called the Factum Probandum or proposition to be
established and the factum Probans which is the
material evidencing the proposition.
The Physician must present RELEVANT, MATERIAL
AND COMPETENT EVIDENCE.

2. In Criminal Cases
the quantum is proof beyond reasonable doubt.
In a criminal case the accused is entitled to an
acquittal, unless his guilt is shown beyond
reasonable doubt
Presumption of INNOCENCE is a conclusion drawn
by the constitution and the law in favor of the
accused , while REASONABLE DOUBT, is a
condition of mind produced by proof resulting from
evidence in the case.
3. To establish matters of defense
- The doctrine of reasonable doubt applies only
to incriminative facts.
4. To establish self defense
- One who sets up SELF DEFENSE must rely
on the strength of his own evidence and not on the
weakness of that of the prosecution.

HISTORY OF LEGAL MEDICINE:


Paulus Zacchias ( 1584 1659 ) is the Father of
Forensic Medicine. He was the first to describe the
importance and application of medicine to the proper
administration of justice.

5. To establish Alibi
- It must be proved by positive, dear and
satisfactory evidence. Oral Evidence of alibi is so easily
manufactured and usually unreliable that it can rarely be
given credence.

In the Phil. , the father of Legal Medicine can be


rightfully bestowed to Dr. Pedro P. Solis. His book on
Legal Medicine copyrighted in 1987, contains the
most extensive treatise and teachings in Philippine
Legal Medicine.
APPLICATION OF LEGAL MEDICINE TO LAW:
Legal Medicine is Applied to Law
1. Civil law
- the determination and termination of civil
personality
- the limitation or restriction of a natural persons
capacity to act
- marriage and legal separation
- paternity and filiation
- testamentary capacity of a person making a
will
- the right to hereditary succession

6. In Administrative Complaints
- In cases filed before administrative or quasi
judicial bodies, a fact maybe deemed established if it
supported by substantial evidence which means that
amount of relevant evidence which a reasonable mind
might accept as adequate to justify a conclusion.
CHAPTER 2 MEDICAL AND HOSPITAL
JURISPRUDENCE
Medical Jurisprudence:
Is the study of the Medical Law and its applicable
Jurisprudence, that governs, regulates, and defines
the practice of medicine.
It includes the rights, duties, obligations and liabilities
of both physician and patient to each other in a
physician patient professional contract.

2. Criminal Law
Felonies and circumstances which affect criminal
liability
Civil liability ex delictu
Crimes relative to opium and prohibited drugs
Crimes against persons
Crimes against chastity

The Following Acts Constitute the Practice of Medicine:


1. To physically examine and diagnose a patient.
2. To physically examine and treat a patient
3. To physically examine and perform surgery in a patient

4. To physically examine and prescribe any remedy to a


patient.

- The aggrieved party can be awarded monetary damages


for any wrongful or negligent act or omission, when the
professional is found guilty.

Any person who practice any of the above acts


enumerated, without any valid certificate of registration as
a physician, is practicing illegal medicine.

CASES ( Refer to Book )

Ex. Negligent or Wrongful Act

The Nature of the Physician Patient Professional Relationship


is
1. Consensual:
- based on mutual consent of both patient and physician.
- Contracts that are consensual in nature, are perfected
upon mere meetings of the minds

Medical malpractice is a particular form of negligence


which consists in the failure of a physician or surgeon to
apply to his practice of medicine that degree of care and
skill which is ordinarily employed by the profession
generally, under similar conditions, and in like surrounding
circumstances

2. Fiduciary:
- founded in trust, faith, and confidence reposed by one
person in the integrity and fidelity of another.

There are Four Elements involved in medical negligent


cases:
1. Duty
2. Breach
3. Injury
4. Proximate Causation It has been recognized that
expert testimony is usually necessary to support the
conclusion as to causation.

DUTIES AND OBLIGATIONS OF THE PHYSICIAN TOWARDS


HIS PATIENTS:
1. He must possess that knowledge and skill possessed by an
average physician.
2. He must use such knowledge and skill with ordinary care and
due diligence.
3. He is obliged to exercise his best judgment
in good faith.
4. He has the duty to keep the secrets and confidentialities of
his patients.

The Terms and Conditions not included in the Physician


Patient Professional Relationship Contract ( refer to book )

The only promise or guaranty that the law requires is that,


the physician will treat the patient in accordance with the
standards of medical care.

CHAPTER 3 DEATH
Legal Presumption of Death:
If absent without explanation from his or her usual or
last place of residence for a long continuous period.
Circumstantial proof of death
Ex. a passenger on an airplane that crashed is
considered to have died even if no remains can be
recovered.

PATIENTS RIGHTS RESPECTED BY PHYSICIANS:


1. The right to appropriate medical care and humane treatment.
2. The right to his religious belief.
3. The right to refuse treatment.
4. The right to Informed Consent.
5. The right to choose his physician.
6. The right to medical records.
7. The right to privacy and confidentiality.
8. The right to a second or third opinion.
9. The right to leave.
10. The right to information.
11. The right to self determination.
12. The right to refuse participation in medical research
13. The right to express grievance
14. The right to be informed of his rights and obligations.

Ex. Whether A Hospital may be Held Liable for the


Negligence of Physicians Consultants allowed to
Practice in its Premises.

Rules of Evidence in Rule 131, section 5 paragraph X,


paragraph JJ, and paragraph KK.
In common law the presumption of death does not arise
until the expiration of seven years of continuous absence.

DEATH IS THE COMPLETE CESSATION OF ALL THE VITAL


FUNCTIONS OF THE BODY WITHOUT POSSIBILITY OF
RESUSCITATION. THE ASCERTAINMENT OF DEATH IS A
MEDICAL AND NOT A LEGAL PROBLEM.
Death maybe
A. Brain Death occurs when there is a deeply irreversible coma,
and absence of electrical brain activity.
B. Cardio Respiratory Death occurs when there is continuous and
persistent cessation of heart action and respiration.

Obligations of the Patients to their Physicians ( Refer to


Book )

4 Kinds of Death:
1. Clinical or Somatic Death
2. Brain Death
3. Biological Death
4. Cellular Death

SOCIATAL RIGHTS OF THE PATIENTS FROM THE


GOVERNEMNT ( Refer to Book )
RIGHTS INHERENT IN THE PRACTICE OF MEDICINE:
1. The right to choose his patients
2. The right to limit the practice of his profession
3. The right to determine appropriate treatment procedures in
the discretion and judgment of the physician.
4. The right to avail of hospital privileges after being qualified.
5. The right to receive just and fair compensation from his
patients.

Clinical or Somatic Death


This particular kind of death occurs when in the
judgment of the physician with the use of his clinical
eye the bodys vital signs of life cease to exist
continuously and permanently.
The clinical death is verifiable only by a physician
after he observes that the patient no longer has a
heart beat no pulse rate, no spontaneous breathing
and movement, with the pupils of the eye widely
dilated and not reactive to light and accommodation.
When a clinically dead person is brought to the
morgue the generalized contraction of the muscles or
Rigor Mortis of the body within 3 to 6 hours, may
simulate a return to life, because of the motion or
movement of the body.

Liabilities of a Physician Which May Arise from His Negligent or


Wrongful Acts or Omissions:
1. Administrative Liability
- A complaint under oath can be filed before the
Professional Regulation Commission Board of Medicine, for
reprimand, of the license to practice medicine.
2. Criminal Liability
- When an act or omission constitutes a crime, the
physician can be imprisoned or fined or both, as any other
profession.
3. Civil Liability

BRAIN DEATH

This kind of death follows clinical death almost


immediately unless resuscitative procedures are
started promptly, because the human brain under
normal conditions cannot survive loss of oxygen for
more than 6 to 10 minutes.
Brain Death may occur in the
Stage 1 Cerebral Cortex- the highest center of the
brain that is most sensitive to changes in the supply
of oxygen and blood to the brain. When the cerebral
cortex dies, the patient is in cortical death.

4. Loss of motor power


5. Loss of sensory power
6. Changes in the skin
7. Changes in and about the eye
- There is loss of corneal reflex
CHANGES IN THE BODY FOLLOWING DEATH
1. Changes in the Muscle
a. Stage of primary flaccidity
b. Cadaveric rigidity or rigor mortis
- muscular contraction which develops
3 6 hours after death and may last
for 24 36 hours.
- may also be utilized to approximate
the length of time the body has been
dead from 3 to 36 hours
c. Stage of secondary flaccidity or
commencement of putrefaction

Stage 2 - Cerebellum It deals with the function of


equilibrium. It follows the death of the cerebral cortex.

Stage 3 Brainstem and Vital centers These


centers controlling respiration, heart rate and blood
pressure, ultimately die. When it does, the patient is,
Brain Stem Dead.
If the brain stem is damaged, then the vital centers in
the medulla maybe destroyed, causing the
respiratory center to fail.
The occurrence of brain stem death is equivalent to
Legal Death, so that Doctors can now issue a Death
Certificate, even though the heart is still beating, and
make arrangements to harvest donor organs and
tissues at this stage.
Further, in the presence of brain stem death, artificial
respirators only achieve the maintenance of an
oxygenated circulation through a corpse or cadaver.

Cadaveric Spasm- is the immediate or instantaneous spasm or


rigidity of the skeletal muscles occurring at the moment of death due
to exhaustion, etc.
Medico legal Importance of Cadaveric Spasm
( Refer to Book )
2. Changes in the Blood
a. Coagulation of the blood
b. Postmortem lividity or Livor Mortis
3. Autolytic or Auto Digestive Changes After Death
4. Putrefaction of the Body

CRITERIA FOR DIAGNOSING BRAIN STEM DEATH.


( refer to textbook )
Persistent Vegetative State ( PVS )
This condition exists, when irreversible destruction of
the Cortex of the brain occurs without damage to the
vital centers, and there are permanent eyes open
state of unconsciousness, but cardio respiratory
functions continue, sometimes without respiratory
assistance, but most often with respiratory support.
They do not however match the clinical criteria of
Brain Death, in as much as they have elicitable
reflexes, spontaneous respirations and reactions to
external stimuli.

PUTREFACTIVE CHANGES OCCURING AFTER DEATH ( Refer to


Book )
Kinds of Putrefaction:
1. Mummification
2. Saponification This is also called Adipocere Formation.
3. Maceration
Factors to Consider in Approximating the Duration of Death in a
Cadaver
1. Entomology The presence of maggots in the cadaver indicates
duration of death for more than 24 hours
2. Presence of live Fleas in clothing in death by drowning, a flea
can survive for about 24 hours submerged in water. After 24 hours
submersion in water the fleas die.
3. Blood vessel clots blood clotting occurs in 6 -8 hours after
death.
4. Post Mortem lividity develops in 3 to 6 hours after death.
5. Rigor Mortis- begins to develop in 3 to 6 hours after death and
may last for 24 to 36 hours after death.
6. Onset of decomposition Decomposition takes place within 24
48 hours after death.
7. Food in the stomach
8. Skeletal soft tissues soft tissues may disappear from 1.5 years
to 2 years after burial.

HARVARD CRITERIA OF WHOLE BRAIN DEATH:


1. Unreceptivity and Unresponsitivity
2. No spontaneous movements or breathing
3. No reflexes
4. Flat EEG of Confirmatory value
WHOLE BRAIN DEAD
When the brain ceased all functions, even though the
heart continues to beat. As a rule doctors can legally
declare whole brain death twelve hours after they
have corrected all treatable medical problems, but
the brain still doesnt respond even to induced pain ,
they eyes do not react to light and the person doesnt
breath without a respirator.

Position of the Body at the time of Death


1. Post Mortem lividity
2. Cadaveric spasm Death due to violence or inflicted physical
injuries, usually manifest the position of the body at the time of
death.
Ex. In suicide by gunshot wound, the gun maybe tightly grasped in
the hand of the deceased
In drowning, the victim maybe holding objects that come in
contact with his hands to cling to life.

BIOLOGICAL DEATH
All the components of the brain are dead
There is also permanent extinction of bodily life.
It is cardiorespiratory and brain death altogether with
permanent cessation of all the anatomic and
physiological functions of the body organs.
CELLULAR DEATH:
The death of the different parts of the body occurs at
different times and stages.
This is the reason why such organs as the corneas
and the kidneys can be removed immediately after
biological death and transplanted successfully.

MEDICOLEGAL IMPORTANCE OF RIGOR MORTIS AND


CADAVERIC SPASM:
Rigor mortis is utilized to approximate the time of death. Generalized
muscular contractions occur from 3 to 6 hours until 36 hours.
Cadaveric spasm occurs immediately after death and is useful to
ascertain the circumstances of death.

SIGNS OF DEATH:
1. Cessation of heart action and circulation
2. Cessation of respiration
3. Cooling of the body ( Algor Mortis )
- The temperature of 15 20 degrees
Fahrenheit is considered as a certain sign of death.

Medico Legal Investigation of Death


Deaths which are not obviously due to natural
causes, but are criminal, suspicious, accidental,

suicidal, murderous, homicidal, sudden or


unexpected, or unexplained, need medico legal
investigation.

Classification of Euthanasia:
1. Voluntary euthanasia is euthanasia conducted with consent

The Death Certificate


The death certificate is a legal document necessary
for burial of the dead, as it certifies the occurrence of
death. It is a document from the Office of the Civil
Registrar General, listing the particulars of an
individuals death.
It contains the Immediate Cause or Primary cause of
death, the antecedent causes and underlying cause
of death

2. Involuntary euthanasia
is euthanasia conducted without consent.
-is conducted where an individual makes a decision for another
person incapable of doing so.
- also known as physician assisted death, physician assisted suicide
or mercy killing.
3. Passive euthanasia entails withholding of common treatments
4. Active euthanasia entails the use of lethal substances or forces
to end life and is the most controversial means.

Immediate Cause or Primary Cause of Death


Ex. Suffocation due to drowning
Asphyxia
Cardio Respiratory Arrest

CHAPTER 4 REGIONAL TRAUMA


Trauma
is the leading cause of death in the first four decades of life and
the 3rd leading cause of death in all age groups today.
-Penetrating trauma particularly handguns is becoming common in
nearly all areas of the country.

Antecedent Cause of Death are events or conditions


that substantially contribute to the immediate cause
of death
Ex. Acute peritonitis, Acute Hypovolemic shock,
Acute Septic Shock,

Trimodal Distribution of Death from Trauma:


1. Seconds to minutes of injury due to the injury to the brain, high
spinal cord, heart, aorta and other large vessels. These patients can
rarely be salvaged.
2. Minutes to Few hours from injury ( The Golden Hour )
- It is in this period that Advanced Trauma Life Support9 ( ATLS )
techniques are important.
3. Several days to weeks of Injury these are due to sepsis or organ
failure.

Underlying Cause of Death is the basic cause or


bottom line cause of death. It is the diagnosis of the
patients or victims illness or sickness that resulted to
his death
Ex. Acute Appendicitis, Hepatocarcinoma, Pelvic
Fracture, Stab or Gunshot Wound to the chest.
Non Natural Causes of Death
Ex. Murder, Homecide, Suicide, Accident

SPECIFIC INJURIES
1. Head
a. Types of Head Injuries:
a.1 Hematoma
a.2 Contusions
a.3 Skull fractures
a.4 Hemorrhage
2. Spine and Spinal Cord Injuries
The most common causes of severe spinal trauma are
motor vehicular accidents, falls, diving accidents, and gunshot
wounds.
3. Chest
a. Life Threatening Injuries
Pnumothorax
Hemothorax
Flail chest as in multiple rib fractures Cardiac
tamponade due to penetrating injuries
b. Potentially Lethal Injuries
b.1. Pulmonary Contussion with or without flail
chest
b.2. Thoracic Aortic Tear or Rupture the most
common cause of sudden death after a
vehicular accident or fall ( major decelaration
injury )
c. Serious Chest Injuries
4. Abdomen
Types of Injuries:
a. Penetrating
- Gunshot wounds of the abdomen carry 95%
probability of significant visceral injury
- A bullet when it hits the abdomen will penetrate
the abdominal wall, enter the abdominal cavity
and most likely injure more than one organ.
- The incidence of abdominal injury is strikingly
higher in gunshot wounds than in stab wounds.
- The major cause of death is hemorrhage and
this occurs within the first 24 hours
- In stab wounds of the abdomen , only 2/3
penetrate the peritoneal cavity; of these only
cause significant visceral injury that requires
surgical repair.
b. Blunt
- The spleen and liver are the most commonly
injured organs due to blunt trauma.

Death Warrant is a warrant from the proper executive authority


appointing the time and place for the execution of the sentence of
death upon a convict judicially condemned to suffer death.
Manner of Death
Is the explanation as to how the cause of death
arose, and maybe either Natural Death or Violent
Death
Lazarus Syndrome
Is also called Lazarus Phenomenon is the
spontaneous return of circulation after failed attempts
at resuscitation.
Implications of Lazarus Syndrome
raise ethical and legal issues for doctors, who must
determine when medical death has occurred, when
resuscitation efforts should end, and post mortem
procedures such as autopsies and organ harvesting
may take place.
Lazarus Sign
Lazarus sign or Lazarus reflex is a reflex movement
in brain dead patients, which causes them to briefly
raise their arms and drop them crossed on their
chests.
The phenomenon has been observed to occur
several minutes after the removal of medical
ventilators used to pump air in and out of brain dead
patients to keep their bodies alive.
NEAR DEATH EXPERIENCE
Refers to a broad range of personal experiences
associated with impending death, encompassing
multiple possible sensations including detachment
from the body; feelings of levitation etc.
EUTHANASIA
Meaning good death ( well or good )
Refers to the practice of ending life in a painless
manner.
Deliberate intervention undertaken with the express
intention of ending life, to relieve intractable suffering

- Their frequent incidence also explains why the


mortality rate following blunt trauma is higher
than that of penetrating injury.

c. Article 264. Administering Injurious Substances or Beverages


d. Article 265. Less Serious Physical Injuries Any person who shall
inflict upon another physical injuries which shall incapacitate the
offended party for labor for 10 days or more, or shall require medical
attendance for the same period
e. Article 266. Slight Physical Injuries and Maltreatment.
- When the offender has inflicted physical injuries which shall
incapacitate the offended party for labor from one to nine days, or
shall require medical attendance during the same period.

5. Fractures and Dislocations


The word fracture comes from the Latin word fractura
which means a break in the continuity of the bone. It is also a
combination of a break in the bone and soft tissue injury
A. Open Fractures - 90% of open fractures are caused by
vehicular accident.
B. Hip fractures are very common in elderly people and
are usually caused by minor falls. It is the most common cause of
traumatic death after the age of 75.

Chapter 3, RAPE When and How rape is committed


1. By a man who shall have carnal knowledge of a woman under
any of the circumstances
a. Through force, threat, or intimidation
b. When the offended party is deprived of reason or
otherwise unconscious
c. By means of fraudulent machinations or grave abuse of
authority
d. When the offended party is under twelve ( 12 ) years of
age or is demented, even though none of the circumstances
mentioned above is present.

6. Urologic
- Hematuria following trauma
- Blunt kidney injury is usually due to motor
vehicular accidents which account for 70 90 %
of kidney trauma.
- Penile injury:
The erect penis is usually 6 8 inches long and
1 -2 inches in diameter.
- Avulsion of the prepuce this may follow
accidents where the foreskin called prepuce is
detached or lacerated by a blunt force.
- Fracture of the penis this is the traumatic
rupture of the corpora cavernosa penis resulting
from a forceful trauma to the flaccid organ.
- Amputated penis the penis of an avid
womanizer is sometimes intentionally cut or
amputated by a jealous derange wife or lover.

2. By any person who, under any of the circumstances mentioned in


paragraph 1 hereof, shall commit an act of sexual assault by
inserting his penis into another persons mouth or anal orifice or any
instrument or object into the genital or anal orifice of another person.
Classification of Wounds
2. AS TO THE DEPTH OF THE WOUND
a. Superficial When the wound involves only the layer of the skin
b. Deep When the wound involves the structures beyond the
layers of the skin.

7. Arterial trauma
8. Burns

b.1 Penetrating the wound enters the body but does not come out.
Punctured, stab and gunshot wounds usually belong to this type of
wound.
b.2 Perforating there is a communication between the outside,
inner and the outer side. There is both a point of entry and exit.

CLASSIFICATION OF WOUNDS
1.
AS TO LEGAL CLASSIFICATION
Chapter 1 DESTRUCTION
OF LIFE
a. Article 246. Parricide
b. Article 247. Death or Physical Injuries Inflicted Under Exceptional
Circumstances
c. Article 248. MURDER
- Any person who, not falling within the provisions of
Article 246 shall kill another, shall be guilty of murder and shall be
punished by Reclusion Perpetua, to death if committed with any of
the following attendant circumstances;
1. With treachery
2. In consideration of a price , reward or promise
3. By means of inundation etc.
4. On occasion of any of the calamities etc.
5. With evident premeditation
6. With cruelty etc

Classification of Wounds
3. AS TO MORTALITY
a. Deadly Wound- Death results immediately, after the infliction of
the wound. Deadly wounds though mortal, maybe prevented with
prompt medical treatment.
b. Non Deadly Wounds Does not result to death immediately, after
the wound is inflicted. A non deadly wound may cause death later,
due to complications i.e. tetanus, septicemia
Classification of Wounds:
4. AS TO THE WOUNDING INSTRUMENTS USED:
a. Sharp Instruments Ex. incised wound, punctured wound, stab
wound dagger or kitchen knife
b. Blunt Instruments A block of wood or iron produces contusion,
hematoma, abrasions, lacerated wound when used to strike, attack,
wound, beat or assault another

Article 249 HOMICIDE


Article 251. Death Caused in a Tumultous Affray
Article 252. Physical Injuries Inflicted In a Tumultuous Affray
Article 253. Giving Assistance to Suicide
Article 254. Discharge of Firearms
Article 255. Infanticide
Article 256. Intentional Abortion
Article 257. Unintentional Abortion who shall caused an abortion
by violence but not intentional.
Article 258. Abortion Practiced by the Woman Herself or By Her
Parents
Article 259. Abortion Practiced by a Physician or Midwife and
Dispensing of Abortives
Article 260. Responsibility of Participants in a Duel
Article 261. Challenging to a Duel

Classification of Wounds:
5. AS TO THE CONSEQUENTIAL INJURY AFTER THE
APPLOCATION OF FORCE
a. Coup Injury b. Coup Centre Coup Injury
c. Contre Coup Injury
d. Locus Minoris resistancia
e. Extensive injury
Classification of Wounds:
6. AS TO THE INTEGRITY OF THE SKIN
A. CLOSED WOUNDS Presents no break in the integrity or
continuity of the skin. There maybe only outward manifestations of
injury internally.
Ex. of closed wounds:
1. petechiae a circumscribe extravasation of blood in the
subcutaneous tissue.
2. contusion effusion of blood into the tissues underneath the skin
as a result of a blunt force. Ex. black eye
3. Hematoma
4. Blunt injury
5. Musculoskeletal injuries

CHAPTER 2
PHYSICAL INJURIES
a. Article 262. Mutilation Any person who shall intentionally
mutilate another by depriving him, either totally or partially , of some
essential organ of reproduction.
b. Article 263. Serious Physical Injuries Any person who shall
wound, beat, or assault another, shall be guilty of the crime of
serious physical injuries

Ex. Sprain, Dislocation, Fracture, Strain

7. Suicidal wounds these are wounds self inflicted by the victim on


himself, and usually seen on the temple, the roof of the mouth, and
other fatal body areas, accessible to the hand of the victim.

Cerebral Concussion there is a brief loss of consciousness and


sometimes memory after a head injury that doesnt cause obvious
physical damage.

CHAPTER 5 COMPREHENSIVE DANGEROUS DRUGS ACT OF


2002

Cerebral Contusion they are bruises to the brain, usually caused


by a direct, strong blow to the head. They are more serious than
concussions.

REPUBLIC ACT 9165


A DANGEROUS DRUG is a drug whose use is attended by risk and
therefore is unsafe, perilous and hazardous to people and society.

B. OPEN WOUNDS
- There is a break in the continuity of the skin
Examples:
1. Abrasion
2. Bruise
3. Incised wound
4. Stab wound
5. Punctured wound
6. Perforating wound
7. Lacerated wound
8. Bites
9. Gunshot wounds

A DRUG is any substance , vegetable, mineral or animal in origin,


used in the composition or preparation of medicines or any
substance used as medicines.
The Dangerous Drug Act of 1972, include the following Dangerous
Drugs as follows:
A. PROHIBITED DRUGS
1. Opium and its active components and derivatives such
as heroin and morphine.
2. Coca leaf and its derivatives, principally cocaine.
3. Hallucinogenic drugs such as mescaline, lysergic acid
diethylamide ( LSD ) and other substances producing
similar effects.
4. Other drugs whether natural or synthetic with the
physiological effects of a narcotic drug.

B. OPEN WOUNDS there is a break in the continuity of the skin


B.1. Abrasion Scratch, friction mark
B.2. Bruise cause by a blunt injury to the tissues which damage
blood vessels beneath the surface, allowing blood to extravasate or
leak into the surrounding tissues.
B.3. Incised wound
B.4. Stab wound
B.5. Punctured wound
B.6. Perforating wound
B.7. Lacerated wound result of an injury from a blunt instrument. In
cerebral laceration, the brain tissue is torn often with an
accompanying visible head wounds and skull fractures.
B.8. Bites they maybe abraded, bruised or rarely lacerated. They
are usually seen in sexual assaults and in child abuse and also by
animal bites
B.9. Gunshot wounds

B. REGULATED DRUGS
1. Self inducing sedatives such as secobarbital,
phenobarbital, pentobarbital, barbital and any drug which
contains salt or derivative of a salt of barbituric acid.
2. Any salt of amphetamine such as Benzedrine or any
drug which produces a physiological action similar to
amphetamine.
3. Hypnotic drugs, such as methaqualone producing
similar physiologic effects.
IMPORTANT TERMS in the DANGEROUS DRUG ACT
OF 2002
1. Drug Syndicate
2. Illegal Trafficking
3. Chemical Diversion
4. Planting Evidence
5. Drug Dependence

TEST FOR THE PRESENCE OF POWDER RESIDUES:


1. Paraffin test or Dermal Nitrate test present on the skin of the
hand dorsum or site of the wound of entrance. This test is not
conclusive because fertilizers, cosmetics, cigarettes, urine and other
nitrogenous compounds with nitrates will give a positive reaction. A
negative test is also not conclusive . The test usually gives a positive
result even after a lapse of 3 days or even if the hands are subjected
to ordinary washing

Two Classes of Drug Dependence:


a. Drug Addiction is a state of periodic or chronic
intoxication produced by the repeated consumption of a
drug, whether synthetic or natural and found to be
detrimental to the individual and to the society.

2. Use of Scanning Electron Microscope with a linked X ray


analyzer. This method appears to be more specific but seldom used
because the instrument is expensive.

Characteristics of Drug Addiction:


A. An overpowering desire or need to continue
taking the drug or to obtained it by any means.

SPECIAL TYPES OF WOUNDS


1. Assailants wounds these wounds are sustained by the assailant
from the victim, while the former is in the process of attacking,
wounding, assaulting, beating or killing his victim.
2. Defense wounds in the process of defending himself from the
attacks, assault, wounding, beating or violence of the assailant, the
victim sustains defensive wounds usually in the upper extremities.
3. Victims wounds these are wounds sustained by the victim, from
the assailant, the former not having the chance or opportunity to
defend himself. The victims wounds maybe located in any part of
the body.
4. Self Inflicted wounds these are wounds self inflicted by the
person on himself. The wounds are usually found on the accessible
parts of the body, usually with no intention to kill himself. Unless the
victim is insane, self inflicted wounds are for a fraudulent or self
serving purpose.
5. Homicidal wounds these are the serious wounds sustained by
the victim resulting to his death, from the criminal assailant. Usually
the wounds are situated in the areas of the neck, chest, the
abdomen and the skull.
6. Accidental wounds these wounds are sustained by the victim,
without any fault or intention whatsoever on the part of the accused
to inflict the wounds on the victim. The wounds are usually located
on any part of the victims body.

- a tendency to increase the dose.


-a psychological and physical dependence on
the effects of the drug.
- a detrimental effect to the society and to the
individual
B. Drug Habituation is the desire to have a continuous
use of the drug but with the capacity to refrain physically
from using it.
Characteristics of Drug Habituation:
- The desire to use the drug is not compulsive
but merely psychical.
- There is little or no tendency to increase the
dose
- The detrimental effect if any, is primarily on the
individual.
6. Protector
7. Pusher
8. Controlled Delivery

9. Den, Dive or Resort


10. PDEA The Philippine Drug Enforcement Agency,
which is the implementing arm of the Dangerous Drugs
Board.

Section 62. Compulsory Submission of a Drug Dependent


Charged with an Offense, to Treatment and Rehabilitation
Section 70. Probation or Community Service for a First
Time Minor Offender In Lieu of Imprisonment
Section 73. Liability of a Parent, Spouse or Guardian Who
refuses to Cooperate with the Board or any Concerned
Agency
Section 77. The Dangerous Drugs Board
Section 82. Creation of the Philippine Drug Enforcement
Agency ( PDEA )
Section 85. The PDEA Academy
Section 90. Jurisdiction
Section 91. Responsibility and Liability of Law
Enforcement Agencies and Other Government Officials
and Employees in Testifying as Prosecution Witnesses in
Dangerous Drug Cases
Section 92. Delay and Bungling in the Prosecution of Drug
Cases

UNLAWFUL ACTS AND PENALTIES IN THE


DANGEROUS DRUGS ACT OF 2002 ( R.A. 9165:
1. Importation of Dangerous Drugs and or Controlled
Precusors and Essential Chemicals.
2. Sale, Trading, Administration, Dispensation, Delivery,
Distribution and Transportation of Dangerous Drugs and
or Controlled Precursors and essential Chemicals.
3. Maintenance of a Den, Dive or Resort
4. Employees and Visitors of a Den, Dive or Resort
5. Manufacture of Dangerous Drugs and or Controlled
Precursors and Essential Chemicals
6. Illegal Chemical Diversion of Controlled Precursor and
Essential Chemicals
7.Manufacture or Delivery of Equipment , Instrument,
Apparatus and Other paraphernalia for Dangerous Drugs
and or Controlled Precursors and Essential Chemicals
8. Possession of Dangerous Drugs
9. Possession of Equipment, Instrument , Apparatus and
Other Paraphernalia for Dangerous drugs.
10. Possession of Dangerous D During Parties, Social
Gatherings or Meetings
11. Possession of Equipment, Instrument, Apparatus and
Other Paraphernalia for Dangerous Drugs During Parties,
Social Gatherings or Meetings
12. Use of Dangerous drugs
13. Cultivation or Culture of Plants
Classified
as
Dangerous Drugs or are Sources thereof
14. Failure to Maintain and Keep the Original Records of
transactions on Dangerous drugs and or Controlled
Precursors and Essential chemicals
15. Unnecessary Prescription of Dangerous Drugs
16. Unlawful Prescription of Dangerous drugs

PHARMACOLOGIC CLASIFICATION OF DANGEROUS


DRUGS
1.Hypnotics
2. Sedatives and Tranquilizers
3. Hallucinogens and Psychomimetics
4. Stimulants
5. Depressants
6. Deliriants and Intoxicants
A.Hypnotics:
Opiates and Their Derivatives Opium is obtained from
the milky exudates of the unripe seed capsules of the
poppy plant, Papaver Sornoiferum.
Derivatives of opium commonly used are morphine,
heroin, and codeine.
Its synthetic preparation are Demerol and Methadone.

THE CUSTODY AND DISPOSITION OF CONFISCATED,


SEIZED AND OR SURRENDERED DANGEROUS
DRUGS, PLANT SOURCES OF DANGEROUS DRUGS,
CONTROLLES
PRECURSORS AND
ESSENTIAL
CHEMICALS, INSTRUMENTS AND PARAPHERNALIA
AND OR LABORATORY EQUIPMENT The PDEA shall
take charge and have custody of all dangerous drugs,
plant sources of dangerous drugs, controlled precursors
and essential chemicals, as well as Instruments
paraphernalia and laboratory equipment so confiscated,
seized and or surrendered, for proper disposition in the
following manner ( Refer to Book ).

Narcotics that have a legitimate medical used as powerful


pain relievers are called Opioids, and include codeine,
oxycodone, meperidine, morphine and hydromorphone.
Heroin which is prohibited is a very strong pain reliever
and narcotic
Signs and Symptoms of Opium Administration:
1. Stage of Excitement
2. Stage of Stupor
3. Stage of Narcosis
B. SEDATIVES:
Barbiturates: - are the products of malonic acid and urea,
synthesized on St. Barbara day.
Used to treat anxiety and to induce sleep can cause
both psychologic and physical dependence.

IMPORTANT PROVISIONS OF R.A. 9165 OR THE


COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002
Section 22. Grant of Compensation, Reward and Award
Section 23. Plea Bargaining Provision
Section 36. Applicants for Drivers License
Section 38.
Laboratory Examination or test on
Apprehended / Arrested Offenders
Section 39. Accreditation of Drug Testing Centers and
Physicians
Section 40. A physician, dentist, veterinarian or
practitioner authorized to prescribe any dangerous drug
shall issue the prescription therefore in one original and 2
duplicate copies.
Section 54. Voluntary Submission of a Drug Dependent to
Confinement, Treatment and Rehabilitation
Section 55 Exemption from Criminal Liability
Under the Voluntary Submission Program
Section 56. Temporary Release from the Center; After
Care and Follow up Treatment Under the Voluntary
Submission Program
Section 58. Filing of Charges Against a Drug Dependent
who is not rehabilitated Under the Voluntary Submission
Program.
Section 61. Compulsory Confinement of a drug dependent
who refuses to apply under the Voluntary Submission
Program

C. HALLUCINOGENS OR PSYCHOMIMETIC DRUGS:


Marijuana ( Cannabis Sativa ) is a Mexican term for
pleasurable feeling. Marijuana is not addictive. Physical
dependence and dose tolerance do not develop with its
use. Psychic dependence may occur.
Subjective effects of Marijuana:
There is a feeling of lightness of the extremities
followed by rushes of warmth and well being that
eventually lead to a sense of relaxation, mild
euphoria and a dreamy state where ideas are
disconnected.
Objective Effects of Marijuana:
Moderate increase in resting pulse rate, reddening of
the eyes due to dilatation of the conjunctival blood
vessels. Difficulty of speech and of remembering of
the logical trend of what was being said.
Lysergic Acid Dsethylamide ( LSD )
These drugs are false hallucinogens.
It produces impaired judgement so that a user might
think that he can fly, and may even jump out a
window to prove it, resulting in severe injury or death.

Kinds of Ospresiophilia
1. Urolagnia
2. Coprolagnia
3. Mysophilia
a. Narcissism
b. Saboteur Fetish
c. Vampirism

D.STIMULANTS:
Amphetamines methamphetamines ( Shabu, speed );
methylenedioxymethamphetamine ( MDMA, ecstasy or
Adam )
Acts on the cerebral cortex causing alertness,
excessive self confidence and feeling of well being.
Physical performance may to some degree
temporarily improve.

D. As to the part of the body


1. Sodomy
2. Uranism
3. Frottage
4. Partialism
E. As to visual stimulus
1. Voyeurism
2. Scoptophilia
F. As to number
1. Troilism
2. Pluralism
G. Other sexual deviates.
1. Don Juanism
2. Indecent exposure
3. Coprolalia
H. Disorders of sexual function:
1. Premature ejaculation
2. Retarded ejaculation
3. Low sexual desire disorder
4. Sexual aversion disorder
5. Sexual arousal disorder in women
6. Inhibited orgasm
7. Dyspareunia
8. Vaginismus
I. Sexual reversal
1. Transvertism
2. Transexualism
3. Intersexuality

Untoward Effects:
They increase the blood pressure and heart rate.
Fatal heart attacks have occurred even in healthy,
young athletes. The blood pressure maybe so high
that a blood vessel in the brain ruptures causing a
stroke.
Coccaine is an alkaloid from the leaves of the coca
shrub cultivated in Bolivia and Peru.
It produces effects similar to amphetamines, but is a
much more powerful stimulant.
Is used to excite the undersexed.
Is a euphoriant and readily relieves fatigue
Untoward Effects:
Same as amphetamine
E. DEPRESSANTS:
Angel dust
Depresses the brain and abusers usually become
confused and disoriented shortly after taking the
drug.
Can be combative and because they dont feel the
pain they may continue fighting even when hit hard.
CHAPTER 6 SEXUAL DYSFUNCTIONS AND SEXUAL CRIMES

SEXUAL CRIMES:
Chaste An unmarried woman who has had no carnal knowledge
with men or that she never voluntarily had unlawful sexual
intercourse. These also denotes purity of mind and innocence of
heart.

SEXUALITY IS A NORMAL BIOLOGICAL URGE AND AN


IMPORTANT PART OF THE HUMAN EXPERIENCE.
4 Stages of a Sexual Response:
1. Desire
2. Arousal
3. Orgasm
4. Resolution

Virgin A woman who has had no carnal knowledge of man. Her


genital organs have not been altered by carnal connection.
Kinds of virginity
1. Moral virginity the state of not knowing the nature of sexual life
and not having experience sexual relation.
2. Physical virginity A condition whereby a woman is conscious of
the nature of sexual life but has not experienced sexual intercourse.
3. Demi virginity This term refers to a condition of a woman who
permits any form of sexual liberties as long as they abstain from
rupturing the hymen by sexual act. The woman allows sexual
intercourse, but only inter femora or even inter labia, but not to the
extent of rupturing the hymen.
4. Virgo intacta A truly virgin woman. There is no structural change
in her organ, notwithstanding the fact of a previous sexual
intercourse.

SEXUAL DYSFUNCTIONS ( Classification )


A. As to choice of sexual partners
1. Homosexual
2. Infanto sexual
3. Besto sexual
4. Auto sexual
5. Gerontophilia
6. Necrophilia
7. Incest
B. As to instinctual strength of the sexual urge:
1. Over sex
2. Under sex or sexual frigidity
a. Sexual anesthesia
b. Dyspareunia
c. Vaginismus
d. Old age
C. As to the mode of sexual expression
1. Oralism
a. Fellatio
b. Cunnilingus
c. Analism

DEFLORATION This is the laceration or rupture of the hymen, as a


result of sexual intercourse. All other lacerations which are not due
to coitus are not considered defloration.
SEMEN AND SPERMATOZOA:
ERECTILE DYSFUNCTION ( Impotence )
The diagnosis of Erectile Dysfunction is important
especially in complaints of rape. It must be proven
convincingly that the accused is permanently
impotent, so that the crime of rape cannot be proved
beyond reasonable doubt.

2. Sado masochism
a. Sadism
b. Masochism
3. Fetishism
a. Anatomic
b. Clothing

.
c. Necrophilic
d. Odor ( ospresiophilia )

Impotence usually results from vascular impairment,


neurologic disorders, drugs, abnormalities of the
penis or psychological problems that interfere with
sexual arousal.

These includes injury, diabetes mellitus, stroke and


drugs like all antihypertensive and psychotics,
antidepressants and some sedatives.
Alcohol can also cause impotence and also low
levels of testosterone

3. Generalized Anxiety Disorders


4. Panic Attacks and Panic Disorder
5. Phobic Disorders
a. Agoraphobia
b. Specific phobias
c. Social phobia
6. Obsessive Compulsive Disorder
7. Post Traumatic Stress Disorder
8. Depression and Mania
9. Bipolar Disorder
10. Suicidal Behavior
11. Eating Disorders
a. Anorexia nervosa
b. Bulimia nervosa
c. Binge eating disorder
12. Personality Disorders
a. Paranoid
b. Schizoid
c. Histrionic
d. Narcissistic
e. Antisocial
f. Borderline
g. Avoidant
h. Dependent

SEX CRIMES IN THE REVISED PENAL CODE:


A. Rape
B. Carnal Knowledge
- is the act of a man in having sexual bodily
connection with a woman. There is carnal knowledge
if there is the slightest penetration in the sexual organ
of the female by the sexual organ of the male.
C. Seduction
- is the art of a man enticing women to have
unlawful intercourse with him by means of
persuasion, solicitation, promises, bribes or other
means without employment of force
D. Acts of Lasciviosness
E. Acts of Lasciviousness with Consent of the
Offended Party
F. Abduction
1. Forcible Abduction
2. Consensual Abduction
G. Adultery
H. Concubinage
I. Bigamy
J. Marriage Contracted Against the Provisions of Law
K. Premature Marriage
L. Performance of Illegal Marriage Ceremony
M. Prostitution
N. Corruption of Minors
O. White Slave Trade
P. Abuse Against Chastity
PROVISIONS OF THE REVISED PENAL
APPLICABLE TO UNNATURAL SEXUAL OFFENSES

i. Obsessive Compulsive
j. Passive Aggressive
k. Dissociative
13. Schizophrenia a serious mental disorder characterized by loss
of contact with reality ( psychosis ) , hallucinations, delusions ( false
beliefs ) , abnormal thinking, disrupted work and social functioning
Types of Schizophrenia:
a. Paranoid
b. Hebephrenic
c. Catatonic

CODE

14. Delusional Disorder


15. Psychological Incapacity a waste basket diagnosis because it
is so broad a term, that it covers all possible Mental Disorders.

1. Grave Scandal ( Art. 200 )


2. Immoral Doctrines, Obscene Publications and Exhibitions ( Art.
201 )
3. Vagrants and Prostitutes ( Art. 202 )
4. Grave Threats ( Art. 282 )
5. Light Threats ( Art. 283 )
6. Other Light Threats ( Art. 285 )
7. Grave Coercions
8. Unjust Vexation or Any Other Coercion ( Art. 287 )

SOME MANIFESTATIONS OF MENTAL DISORDERS:


1. Disorders of Cognition ( Knowing )
a. Illusion
b. Hallucination
2. Disorders of Memory
a. Dementia
3. Disorders in the Content of Thought
A. Delusion
a. Delusion of grandeur
b. Delusion of persecution
c. Delusion of reference
d. Delusion of Self Accusation
e. Delusion of infidelity
f. Nihilistic delusion
g. Delusion of poverty
h. Delusion of control
i. Delusion of depression
B. Obsession
4. Disorders in the trend of thought
Types:
a. Mania
b. Melancholia

CHAPTER 7 MENTAL HEALTH DISORDERS


Mental Health Disorders include disturbances in thinking, emotion,
and behavior. There is a complex interaction between the physical,
psychologic, social, cultural and hereditary influences.
Factors that Contribute to the Development of Mental Disorders:
1. Heredity the most frequent factor that contributes to insanity and
a good history will reveal the ascendants afflicted with the same.
2. Incestous Marriage The mental illness is accentuated when they
are blood relatives.
3. Impaired Vitality Stress, tension, worry, grief may predispose to
insanity
4. Poor Moral Training and Breeding Corrupt moral upbringing in
the family due to immorality of the parents
5. Psychic Factors Factors like love, hate, rage, anger, passion
disappointments
6. Physical Factors
a. Non toxic factors exhaustion resulting from severe
physical and mental strain and traumatic injuries to the head.
b. Toxic factors drug addiction, infections of the brain

5. Disorders of Emotions or Feelings a disorder in the state of


mind, fervor, or sensibility, not in accord with reality.
6. Disorders of volition or conation ( doing )
Kinds of Conation:
A. Impulsion or Impulse ( Compulsion ) a sudden and
irresistible force compelling a person to the conscious
performance of some action without motive or forethought.

KINDS OF MENTAL HEALTH DISORDERS:


1. Psychosomatic disorders physical disorders caused by
psychologic factors.
2. Somatiform disorders encompasses several psychiatric
disorders in which people report physical symptoms but deny having
psychiatric problems.

Types of Compulsion:
a. Pyromania
b. Kleptomania
c. Dipsomania
d. Homicidal impulse

e. Sex impulse
f. Suicidal impulse

1. Idiot The idiots intelligence never exceeds that of a


normal child over 2 years old. The IQ is between 0 20.
This is usually congenital.
2. Imbecile the imbeciles intelligence is compared to a
normal child from 2 7 years old and the IQ is 20 40.
3. Feeble Minded his mentality is similar to that of a
normal child between 7 12 years old and an IQ of 40
70.

DISTINCTIONS BETWEEN TRUE AND FALSE


INSANITY:
1. True insanity develops insidiously usually with the
existence of some predisposition to an exciting cause if
careful history is taken, while false insanity develops
suddenly with no existing predisposition.

The Legal Importance of determining the persons state of


mind are the following

2. In true insanity, there is a peculiar facial expression,


which is absent in false insanity

In Criminal law, insanity exempts a person from criminal


liability

3. In true insanity, there is a continuous and persistent


manifestation of insanity, which is only present in false
insanity when the pretender is under observation, and
absent when not under observation.

In Civil law, Insanity is a restriction of the capacity of a


natural person to act as provided in Article 38 of the Civil
Code.

4. In true insanity, there is a clinical entity of a specific


mental disorder, which is absent in false insanity.

Insanity modifies or limits the capacity of a natural person


to act as providedin Article 39, also of the Civil Code.

5. In true insanity, the patient can endure a violent or


stressful activity without fatigue, which is not present in
false insanity

Insanity at the time of marriage of any or both parties is a


ground for the annulment of marriage.

6. In true insanity, the patient does not observe personal


hygiene, in false insanity, the pretender observes hygiene
Insanity or Mental Illness is an exempting or mitigating
circumstance to Criminal Liability as provided in the
following:
1. As an exempting Circumstance
Article 12 of the Revised Penal Code provides,
When the imbecile or an insane person has committed an
act which the law defines as felony, the court shall order
his confinement in one of the hospitals or asylums
established for persons thus afflicted and he shall not be
permitted to leave without first obtaining the permission of
the same court.
2. As a mitigating Circumstance
Article 13, of the Revised Penal Code provides,
the following are mitigationg circumstances:
a. That the offender is deaf and dumb, blind or
otherwise suffering from physical defect which thus
restricts his means of action, defense or communication
with his fellow beings
The American Law Institute formulated the following Rules
on Criminal Responsibility and states that;
1. A person is not responsible for his criminal conduct if at
the time of such conduct as a result of mental illness or
defect, he lacks essential capacity to appreciate the
criminality of his conduct or to conform his conduct to the
requirement of the law.
2. The term mental disease or defect does not include
an abnormality manifested only by repeated criminal or
otherwise anti social conduct
Fundamental Principles of Insanity and Criminal
Responsibility:
1. A sane man is assumed to be wholly responsible for the
consequence of his crime.
2. A person who commits a criminal act is presumed to be
sane.
3. Crime is always considered as an affair of the mind as
well as the body and to make an act or omission a crime,
there must be a criminal act ( actus reus ) and an criminal
mind ( mens rea ) . Actur facit reum, nisi mens sit rea.
Mental Deficiency or mental retardation, is sub average
intellectual ability present from birth or early infancy.
Intelligence is both determined by heredity and
environment. In most cases of mental deficiency, the
cause is unknown.
Classification of mental deficiency:

10