LEGAL MEDICINE

is the 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.

a branch of medicine which deals with the application of medical knowledge to the
purposes of law and in the administration of justice.

APPLICATION OF LEGAL MEDICINE TO LAW

1. CIVIL LAW

- the determination and termination of civil personality

- the limitation or restriction of a natural person’s capacity to act
- marriage and legal separation
- testamentary capacity of a person making a will
- paternity and filiation
- the right to hereditary succession

2. CRIMINAL LAW

- Felonies and circumstances which affect criminal liability

- Civil liability ex delictu
- Crimes relative to opium and prohibited drugs
- Crimes against civil status of persons
- Crimes against chastity
- Crimes against persons
- Quasi – offenses

3. REMEDIAL LAW

- Physical and Mental Examination of a person

- Hospitalization of insane persons
- Rules of Evidence

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4. SPECIAL LAWS

- Dangerous Drug Act

- Youth and Child Welfare Code
- Insurance law
- Sanitation Code
- Employees Compensation Law
- Labor Code

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.

WHAT IS FORENSIC MEDICINE?

Forensic medicine is the practice of medicine as it pertains to the Law. It involves areas
like determining the nature and cause of death, medical negligence and identification of
human remains. It can include medical examination of suspects and victims in support of the
investigation of crime such as medical examination of the victims of rape, for the purpose of
determining the nature and extent of any injuries and the taking of samples, fitness of
suspects to be interviewed where it may be in doubt for medical reasons, and determining
whether a person is acting under the influence of drugs.

There are various branches within the field of forensic medicine including Forensic
pathology that is concerned primarily with establishing the nature and cause of suspicious
death.

Forensic Odontology is the application of dentistry to legal matters. Amongst other

tasks the Forensic Odontologists can identify individuals using their dentition and through
bite marks.

Forensic Radiography is the application of science of diagnostic imaging to questions

of law. Forensic Radiography can be used to identify the individual, identify the cause of the
injury or death and to identify evidential material.

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WHAT IS MEDICAL 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.

In the Philippines, Legal Medicine is the appropriate name for Forensic Medicine.

What are the “Acts” which constitute Medical Practice?

- To physically examine and diagnose a patient.

- To physically examine and treat a patient
- To physically examine and perform surgery in a patient
- To physically examine and prescribe any remedy to a patient.

What are the “Rights” inherent in the practice of Medicine?

- The right to choose his patients

- The right to limit the practice of his profession
- The right to determine appropriate treatment procedures in the discretion
and judgment of the physician.
- The right to avail of hospital privileges after being qualified.
- The right to receive just and fair compensation from his patients.

Medical Negligence

specific term used when a medical practioner does not exercise due diligence and
standard care required of him thus resulting to injury to the patient. Usually connotes
accidental or unintentional injury.

Common complaints about doctors who commit malpractice include:

- Error in anesthesia
- Mistake during childbirth

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 - Surgical errors
- Unnecessary surgery
- Wrongful death
- Wrong diagnosis or misdiagnosis

Examples of medical negligence include:

- Failure to revise a diagnosis

- Failure to warn patients of the risks of treatment
- Failure to remove surgical instruments from the patient during surgery
- Failure to attend to or treat a patient
- Incompetence
- Failure to refer a patient to a specialist relevant to their disease or injury
- Wrongful diagnosis

Doctrine of Proximate Cause

“That cause, which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have
occurred.”

a legal concept of "cause-and-effect" relationships

determines whether an injury would have resulted from a particular cause.

In Malpractice - An element required to prove negligence; i.e., the plaintiff–Patient or

Patient's estate must prove that the Patient's injury is reasonably connected to the physician's
action.

What is the Degree of Care needed to be applied by Physicians?

Standard of care required is more than just ordinary care and diligence but a HIGHER
degree of care expected from an average physician or general practitioner.

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Doctrine of Res Ipsa Loquitur

Its function is to aid the plaintiff in proving the elements of negligence by

circumstancial evidence.

The doctrine can only be invoked when and only when, under the circumstances,
involved, direct evidence is absent and not readily available.

Medical malpractice can be established by the doctrine of res ipsa liquitur. It is

applicable to cases where the court, from its fund of knowledge, can determine the standard
of care or where an ordinary layman can conclude that there was negligence on the part of
the doctor.

Liabilities of Hospitals

The hospital’s liability is also anchored upon the following doctrines: agency principle of
apparent authority or agency by estoppel ; doctrine of corporate negligence/corporate
responsibility

which have gained acceptance in the determination of a hospital’s liability for negligent acts
of professionals because of the actions for a principal or an employer .

Doctrine of Apparent Authority

“Where it is shown that a hospital, by its actions, has held out a particular physician
as its agent and/or employee and that a patient has accepted treatment from that physician
in the reasonable belief that it is being rendered in behalf of the hospital, the hospital will be
liable for physician’s negligence.”

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

Doctrine of Corporate Responsibility

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 A hospital has the duty to see that it meets the standards of responsibilities for the
care of patients. Such duty includes the proper supervison of the members of its medical
staff.

If a hospital breached its duties to oversee or supervise all persons practicing medicine
within its walls and also failed to take an active step in fixing the negligence committed, it will
be vicariously liable for the negligence of the doctor under Art. 2180, and directly liable for its
own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

Doctrine of respondent Superior

A hospital has the duty to see that it meets the standards of responsibilities for the
care of patients. Such duty includes the proper supervison of the members of its medical
staff.

If a hospital breached its duties to oversee or supervise all persons practicing medicine
within its walls and also failed to take an active step in fixing the negligence committed, it will
be vicariously liable for the negligence of the doctor under Art. 2180, and directly liable for its
own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)

Liabilities of a Physician Which May Arise from His Negligent or Wrongful Acts or
Omissions

- 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.

- CRIMINAL LIABILITY- When an act or omission constitutes a crime, the physician can
be imprisoned or fined or both, as any other profession.

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 - CIVIL LIABILITY- The aggrieved party can be awarded
monetary damages for any wrongful or negligent act or omission, when the
professional is found guilty.

The most important goal of the medical profession is the preservation of life and health of
the people. But what happens when a medical professional causes bodily harm or even
death to his or her patient? What is the remedy available to the patient?

The remedy available is called a medical malpractice suit. In the Philippines, a medical
malpractice suit is primarily governed by the Civil Law concept of damages. In order to
successfully pursue a medical malpractice suit, the patient must prove the four (4) elements
of medical negligence. The four (4) elements are (1) duty; (2) breach; (3) injury; and (4)
proximate causation. Recent cases will illustrate how these 4 elements interact in order to
pursue a successful medical malpractice suit.

Standard of Breach

The breach referred to in medical malpractice cases is the breach of the standard of care
expected of other similarly trained medical professionals acting under the same
circumstances.

Let us take the example of Borromeo v. Family Care Hospital, Inc. (G.R. No. 191018, January
25, 2016). In Borromeo, the patient was complaining of acute pain and fever for two days.
The doctor suspected that the patient might be suffering from acute appendicitis. After
several inconclusive tests, the doctor decided to perform an exploratory laparotomy. After
the surgery, the patient’s blood pressure suddenly dropped. Furthermore, the patient
developed petechiae in various parts of her body. The doctor suspected that the patient has
Disseminated Intravascular Coagulation, which is a blood disorder. Unfortunately, attempts
to resuscitate the patient failed.

The Supreme Court held that there is no medical malpractice since the cause of the
uncontrollable bleeding was a medical disorder, Disseminated Intravascular Coagulation. In

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this case there is no proof that the doctor fell short of the expected standard required under
the circumstances.

Injury as a Result of Breach

The element of injury to the patient in medical malpractice cases is straightforward – it is

the direct result of the doctor’s breach.

The case of Rosit v. Davao Doctors Hospital (G.R. No. 210445, December 7, 2015) perfectly
illustrates how an injury to the patient can take place. In Rosit, the patient figured in a
motorcycle accident, which fractured his jaw. During the operation, the doctor used a metal
plate fastened to the jaw of the patient with metal screws to immobilize his mandible.
However, despite the doctor’s knowledge that the operation requires the smallest screws
available, the doctor simply cut the larger screws which were on hand. The doctor also knew
that the smaller screws were available in Manila, but he simply assumed that the patient
would not be able to afford the same.

Following the procedure, the patient could no longer properly open or close his mouth and
was in constant pain. X-rays done on the patient revealed that the modified screws placed
by the doctor reached the molar of the patient. The patient then had to seek the services of
another doctor to undo the damage. In this case, the Supreme Court held that the doctor is
liable for at least three types of damages, namely: actual, moral and exemplary damages.
First, the patient was able to claim actual damages since he was able to prove the definite
expenses that he incurred due to the negligence of the doctor. Second, the patient was
likewise able to claim moral damages because of the unnecessary physical suffering he
endured as a consequence of the doctor’ negligence. Third, the patient was entitled to
exemplary damages because the doctor acted in bad faith or in a wanton, fraudulent,
reckless, oppressive manner when he did not inform the patient of the risks of using large
screws for the operation.

Proximate Cause

Proximate causation refers to the relation between the negligence or breach of the doctor
and the resulting injury of the patient. The negligence or breach must have played an

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integral part in causing the injury or damage. In other words, the injury to the patient is
either a direct result or a reasonably probable consequence of the negligence or breach of
the doctor.

An illustration of proximate causation is provided for in the case of Casumpang v. Cortejo

(G.R. No. 171127, March 11, 2015). In Casumpang, the patient is an 11-year old boy who
initially complained of difficulty in breathing, chest pain, stomach pain and fever. The doctor
who examined the patient diagnosed him with bronchopneumonia. However, the mother of
the patient raised her doubts with the doctor’s diagnosis since her son had a high fever but
did not have any colds or cough.

The following day, the mother of the patient informed the doctor that there were traces of
blood in her son’s sputum. However, the doctor simply nodded and reassured them that it
was due to bronchopneumonia. Later that morning, the patient vomited phlegm with blood
streaks. He was attended to by one of the resident physicians. Several tests were ordered
done on the patient. When the tests came out, the results showed that the patient was
suffering from Dengue Hemorrhagic Fever.

The Supreme Court held that the doctor is liable for medical malpractice. In determining
whether or not the negligence of the doctor is the proximate cause for the patient’s death,
the court looked at the nature of Dengue. The court considered expert testimony stating
that with correct and timely diagnosis and proper medical management, dengue fever is not
a life threatening disease and could easily be cured. In fact, the mortality rate of dengue
fever should fall to less than 2%. Thus, the proximate cause of patient’ death is the failure of
the doctor to timely diagnose dengue, despite the presence of its characteristic symptoms.

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