Legal Medicine

Legal Medicine Guiding Principles in Medical Practice   

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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 government’s 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

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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 consultant’s 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

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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 Adam’s 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 Gettler’s 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 

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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

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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 Café coronary – form of suffocation caused by bolus of food Champignon d’ocume’ – 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