C2017 Med Jur Finals Reviewer

MEDICAL
JURISPRUDENCE
FINAL EXAM REVIEWER
(Updating the B2015 Midterms Reviewer)
Module 8: Child Abuse p. 1

Module 9: Physical Injuries p. 8
Module 10: Gender & Sexuality p. 23
Module 11: Insanity p. 27
Module 12: Drugs p. 38
Module 13: Medical Malpractice p. 42
Module 14: Death & Dying p. 50
VILLARAMA C2017 MED JUR FINALS REVIEWER | 1
MODULE 8: CHILD ABUSE

1. Growth and Development
Let-Down Reflex - By sucking at the breast, the baby triggers tiny nerves in the nipple. These nerves cause hormones to be
released into the bloodstream. One of these hormones (prolactin) acts on the milk-making tissues. The other hormone
(oxytocin) causes the breast to push out or ‘let down’ the milk. Cells around the alveoli contract and squeeze out the milk,
pushing it down the ducts towards the nipple. Oxytocin also makes the milk ducts widen, making it easier for the milk to flow
down them. The let-down may happen if the mother sees or hears the baby or even just thinks about the baby. The let-down
can also be triggered by touching the breast and nipple area with the fingers or by using a breast pump.
Breastfeeding- the method of feeding an infant directly from the human breast. In order to produce milk, hormones are
needed. The two main hormones are prolactin and oxytocin.
1. Prolactin is produced by the adenohypophysis (anterior pituitary) and released into the circulation. The regulation of prolactin
levels in the plasma is controlled by the dopaminergic system. Prolactin acts on the human breast to produce milk. This occurs
by binding to mammary epithelial cell receptors, which stimulates synthesis of mRNA of milk proteins . It takes several minutes
of the infant sucking at the breast to cause prolactin secretion. Prolactin is also important in inhibiting ovulation.
2. Oxytocin is produced by the neurohypophysis (posterior pituitary). Suckling at the breast stimulates the neurohypophysis to
produce and release oxytocin in an intermittent manner. Oxytocin acts on the breast to produce milk ejection or "milk let
down." Oxytocin also causes uterine contractions. Opiates and B endorphins released during stress can block the release of
oxytocin. Lack of release of oxytocin inhibits the "milk let down" and the milk cannot be removed from the breast Other
hormones necessary for the production of breast milk include: insulin, cortisol, thyroid hormone, parathyroid hormone,
parathyroid hormone-related protein, and human growth hormone.
Anatomy and physiology of the breast

The nipple and the areola are the darker part of the breast. The nipple is the central area through which the milk
ducts open. The areola is the circular dark area around the nipple. The "bumps" on the areola and nipple are Montgomery's
tubercles. These contain the opening of sebaceous and sweat glands (Montgomery glands) that secrete lubricating
substances for the nipple.
Milk is produced in the alveolus. The alveolus is made up of gland cells around a central duct. The milk is produced by
the gland cells. Surrounding the gland cells are the myoepithelial cells which contract to cause milk ejection into the milk duct.
The milk then travels down the lactiferous ducts. Milk is stored largely in the alveoli with little storage in the ducts between
breastfeedings. Mothers continue to make milk between feedings and they make more milk during feedings
Expanded Breastfeeding Promotion Act of 2009 (RA 10028)

The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It
shall create an environment where basic physical, emotional, and psychological needs of mothers and infants are fulfilled
through the practice of rooming-in and breastfeeding.
The State shall promote and encourage breastfeeding and provide the specific measures that would present
opportunities for mothers to continue expressing their milk and/or breastfeeding their infant or young child
Rooming-in — the practice of placing the newborn in the same room as the mother right after delivery up to
discharge to facilitate mother-infant bonding and to initiate breastfeeding. The infant may either share the mother’s bed or be
placed in a crib beside the mother.
Age of gestation — the length of time the fetus is inside the mother’s womb.
Low birth weight infant — a newborn weighing less than two thousand five hundred (2,500) grams at birth.
Right of the Mother to Breastfeed. — It shall be the mother’s right to breastfeed her child who equally has the
right to her breastmilk. Bottlefeeding shall be allowed only after the mother has been informed by the attending health
personnel of the advantages of breastfeeding and the proper techniques of infant formula feeding and the mother has opted
in writing to adopt infant formula feeding for her infant.
WHO: 10 Facts on Breastfeeding
1. WHO recommends exclusive breastfeeding for the first six months of life.
At six months, solid foods, such as mashed fruits and vegetables, should be introduced to complement breastfeeding for up to
two years or more. In addition:
1. breastfeeding should begin within one hour of birth
2. breastfeeding should be "on demand", as often as the child wants day and night; and
3. bottles or pacifiers should be avoided.
2. Health benefits for infants Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need
for healthy development. It is safe and contains antibodies that help protect infants from common childhood illnesses such as
diarrhoea and pneumonia, the two primary causes of child mortality worldwide. Breast milk is readily available and affordable,
which helps to ensure that infants get adequate nutrition
3. Benefits for mothers Breastfeeding also benefits mothers. Exclusive breastfeeding is associated with a natural (though not
fail-safe) method of birth control (98% protection in the first six months after birth). It reduces risks of breast and ovarian cancer
later in life, helps women return to their pre-pregnancy weight faster, and lowers rates of obesity.
4. Long-term benefits for children Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good
health. Adolescents and adults who were breastfed as babies are less likely to be overweight or obese. They are less likely to
have type-2 diabetes and perform better in intelligence tests.
5. Why not infant formula? Infant formula does not contain the antibodies found in breast milk. When infant formula is not
properly prepared, there are risks arising from the use of unsafe water and unsterilized equipment or the potential presence of
bacteria in powdered formula. Malnutrition can result from over-diluting formula to "stretch" supplies. While frequent feeding
maintains breast milk supply, if formula is used but becomes unavailable, a return to breastfeeding may not be an option due
to diminished breast milk production.
6. HIV and breastfeeding

An HIV-infected mother can pass the infection to her infant during pregnancy, delivery and through breastfeeding.
Antiretroviral (ARV) drugs given to either the mother or HIV-exposed infant reduces the risk of transmission. Together,
breastfeeding and ARVs have the potential to significantly improve infants' chances of surviving while remaining HIV
uninfected. WHO recommends that when HIV-infected mothers breastfeed, they should receive ARVs and follow WHO
guidance for infant feeding.
7. Regulating breast-milk substitutes

An international code to regulate the marketing of breast-milk substitutes was adopted in 1981. It calls for:
1. all formula labels and information to state the benefits of breastfeeding and the health risks of substitutes;
2. no promotion of breast-milk substitutes;
3. no free samples of substitutes to be given to pregnant women, mothers or their families; and
4. no distribution of free or subsidized substitutes to health workers or facilities.
8. Support for mothers is essential Breastfeeding has to be learned and many women encounter difficulties at the beginning.
Nipple pain, and fear that there is not enough milk to sustain the baby are common. Health facilities that support
breastfeeding—by making trained breastfeeding counsellors available to new mothers—encourage higher rates of the
practice. To provide this support and improve care for mothers and newborns, there are "baby-friendly" facilities in about 152
countries thanks to the WHO- UNICEF Baby-friendly Hospital initiative.
9. Work and breastfeeding Many mothers who return to work abandon breastfeeding partially or completely because they do
not have sufficient time, or a place to breastfeed, express and store their milk. Mothers need a safe, clean and private place in
or near their workplace to continue breastfeeding. Enabling conditions at work, such as paid maternity leave, part-time work
arrangements, on-site crèches, facilities for expressing and storing breast milk, and breastfeeding breaks, can help.
10. The next step: phasing in solid foods To meet the growing needs of babies at six months of age, mashed solid foods
should be introduced as a complement to continued breastfeeding. Foods for the baby can be specially prepared or modified
from family meals. WHO notes that:
a. breastfeeding should not be decreased when starting on solids;
b. food should be given with a spoon or cup, not in a bottle;
c. food should be clean, safe and locally available; and
d. ample time is needed for young children to learn to eat solid foods
Men Can Lactate

Medical disruptions involving prolactin, the hormone necessary to produce milk, have resulted in spontaneous
lactation. Thorazine, a popular antipsychotic used in the mid-20th century, impacted the pituitary gland—the pea-size
endocrine gland located near the base of the brain—often causing it to overproduce prolactin. If prolactin levels remained
high, milk could follow. According to Dr. Newman, lactation is listed as a possible side effect of the heart medication digoxin. A
pituitary tumor could also induce milk production: "It would be the same reason—increased prolactin levels – the one case
drug-induced, in the other due to a tumor or some other sort of neurological problem." Males of many different mammalian
species have the potential to lactate, although only one, the Dayak fruit bat of Southeast Asia, does so spontaneously.
2. Infant & childhood injuries and deaths
RPC, Art. 246. Parricide. — Any person who shall kill his father, mother, or child, whether legitimate or illegitimate, or any of
his ascendants, or descendants, or his spouse, shall be guilty of parricide and shall be punished by the penalty of reclusion
perpetua to death.
i. (1) A person is killed
ii. (2) The deceased is killed by the accused
iii. (3) The deceased is the father, mother or child whether legitimate or illegitimate, or a legitimate other ascendant or other
descendant, or the legitimate spouse, of the accused
RPC, Art. 255. Infanticide. — The penalty provided for
parricide in Article 246 and for murder in Article 248
shall be imposed upon any person who shall kill any
child less than three days of age. If the crime penalized
in this article be committed by the mother of the child
for the purpose of concealing her dishonor, she shall
suffer the penalty of prision correccional in its medium
and maximum periods, and if said crime be committed
for the same purpose by the maternal grandparents or
either of them, the penalty shall be prision mayor
(1) A child was killed
(2) The deceased child was less than 3 days old or 72 hours
old
(3) The accused killed the said child
Note: Neonaticide is not a legal term; it is used for medical

purposes.
Case: PEOPLE v. MORALES, G.R. No. L-44096 April 20, 1983.

Summary: Accused raped his daughter who gave birth to a healthy child. Accused got the baby and buried her alive. Accused
was convicted of rape (reclusion perpetua) and infanticide (death) with evident premeditation, abuse of superior strength and
by nocturnity. SC: guilty of infanticide but without evident premeditation. Testimonies of Maria, neighbor, station commander
and medico legal showed that the child was buried alive. Accused also extra-judicially confessed to the crime.
According to medico-legal officer Dr. Mercedes Alamar: there were evidence of life i.e. arching of the chest, lungs filled the
thoracic cavity and overlaps the heart = respiration established; edges are rounded and vermillion pink = lungs expanded; A
piece of lung was floated on water showing that air had probably entered in the lungs air sacs; Stomach and intestines
contains mucus and air bubbles and saliva; thus death due to MOST PROBABLY CARDIO-RESPIRATORY FAILURE DUE TO
ASPHYXIATION CAUSED THE DEATH OF THE CHILD".
RA 7610 Anti-Child Abuse Law

"Child abuse" refers to the maltreatment, whether habitual or not, of the child which includes any of the following:
• Psychological and physical abuse, neglect, cruelty, sexual abuse and emotional maltreatment;
• Any act by deeds or words which debases, degrades or demeans the intrinsic worth and dignity of a child as a human
being;
• Unreasonable deprivation of his basic needs for survival, such as food and shelter; or
• Failure to immediately give medical treatment to an injured child resulting in serious impairment of his growth and
development or in his permanent incapacity or death.
"Circumstances which gravely threaten or endanger the survival and normal development of children" include, but are
not limited to, the following:
• Being in a community where there is armed connect or being affected by armed conflict-related activities;
• Working under conditions hazardous to life, safety and morals which unduly interfere with their normal development;
• Living in or fending for themselves in the streets of urban or rural areas without the care of parents or a guardian or any
adult supervision needed for their welfare;
• Being a member of an indigenous cultural community and/or living under conditions of extreme poverty or in an area
which is underdeveloped and/or lacks or has inadequate access to basic services needed for a good quality of life;
• Being a victim of a man-made or natural disaster or calamity; or
• Circumstances analogous to those above stated which endanger the life, safety or normal development of children.
Case: SANCHEZ v. PEOPLE, G.R. No. 179090, June 5, 2009

Summary: After an altercation with VVV’s family, she was hit by Sanchez thrice in the upper part of her legs with a wood. The
wood broke into several pieces. VVV is a 16 y/o minor. Medical report said VVV suffered a contusion with a hematoma. An
information was filed against Sanchez alleging that the acts committed by Sanchez are prejudicial to the child-victim's
development which acts are not covered by the Revised Penal Code, as amended, but the same are covered by Art. 59,
par. 8 of P.D. No. 603 as amended. RTC: Sanchez guilty of violating paragraph (a) section 10 of RA 7610. Sanchez argued
that if ever he would be liable, it will only be for slight physical injuries. He was charged with child abuse only to make him
suffer a greater penalty. CA affirmed but removed civil damages. SC upheld the CA ruling but modified the application of ISl.
DOCTRINE: Child abuse includes physical abuse of the child, whether the same is habitual or not. As gleaned from the
provision of Section 10 RA 7610, the provision punishes not only those enumerated under Article 59 of Presidential Decree No.
603, but also four distinct acts, i.e., (a) child abuse, (b) child cruelty, (c) child exploitation and (d) being responsible for
conditions prejudicial to the child's development.
Anti-Child Pornography Law & IRR

Unlawful or Prohibited Acts. — It shall be unlawful for a person to commit any of the following acts:
a. To hire, employ, use, persuade, induce or coerce a child to perform in the creation or production of any form of child
pornography;
b. To produce, direct, manufacture or create any form of child pornography;
c. To publish, offer, transmit, sell, distribute, broadcast, advertise, promote, export or import any form of child pornography;
d. To possess any form of child pornography with the intent to sell, distribute, publish or broadcast: Provided, That possession of
three (3) or more articles of child pornography of the same form shall be prima facie evidence of the intent to sell, distribute,
publish or broadcast;
e. To knowingly, willfully and intentionally provide a venue for the commission of prohibited acts such as, but not limited to,
dens, private rooms, cubicles, cinemas, houses or in establishments purporting to be a legitimate business;
f. For film distributors, theaters and telecommunication companies, by themselves or in cooperation with other entities, to
distribute any form of child pornography;
g. For a parent, legal guardian or person having custody or control of a child to knowingly permit the child to engage, participate
or assist in any form of child pornography;
h. To engage in the luring or grooming of a child;
i. To engage in pandering of any form of child pornography;
j. To willfully access any form of child pornography;
k. To conspire to commit any of the prohibited acts stated in this section. Conspiracy to commit any form of child pornography
shall be committed when two (2) or more persons come to an agreement concerning the commission of any of the said
prohibited acts and decide to commit it; and
l. To possess any form of child pornography.
Anti-Bullying Law & IRR

Acts of Bullying . – For purposes of this Act, “bullying” shall refer to any severe or repeated use by one or more students of a
written, verbal or electronic expression, or a physical act or gesture, or any combination thereof, directed at another student
that has the effect of actually causing or placing the latter in reasonable fear of physical or emotional harm or damage to his
property; creating a hostile environment at school for the other student; infringing on the rights of the other student at school;
or materially and substantially disrupting the education process or the orderly operation of a school; such as, but not limited
to, the following:
a. Any unwanted physical contact between the bully and the victim like punching, pushing, shoving, kicking, slapping, tickling,
headlocks, inflicting school pranks, teasing, fighting and the use of available objects as weapons;
b. Any act that causes damage to a victim’s psyche and/or emotional well-being;
c. Any slanderous statement or accusation that causes the victim undue emotional distress like directing foul language or
profanity at the target, name-calling, tormenting and commenting negatively on victim’s looks, clothes and body; and
d. Cyber-bullying or any bullying done through the use of technology or any electronic means.
SIDS
Sudden infant death syndrome (SIDS) also known as cot death or crib death is the sudden death of an infant that is
not predicted by medical history and remains unexplained after a thorough forensic autopsy and detailed death scene
investigation. Infants are at the highest risk for SIDS during sleep. Typically the infant is found dead after having been put to
bed, and exhibits no signs of having struggled. SIDS is the leading cause of death among infants 1 month to 1 year old, and
claims the lives of about 2,500 each year in the United States. It remains unpredictable despite years of research.
Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather. African-
American infants are twice as likely and Native American infants are about three times more likely to die of SIDS than caucasian
infants. More boys than girls fall victim to SIDS.
Shaken Baby Syndrome

A baby’s head can weigh one fourth of its total body weight and because the neck muscles are still weak, any violent
shakes will cause the head to fling out of control. The impact on the brain can be up to 30 times the force of gravity and cause
permanent or fatal damage to the baby. Because damage is internal, signs of danger may not be seen until it’s too late
a. 1,000 to 1,500 infants/year
b. 2,000 children die from abuse or neglect each year, SBS accounts for 10%--- 12%
c. victims commonly between 3 and 8 months old; however, it has been reported in newborns and in children up to 4 years of
age.
d. 1 out of 4 of all children diagnosed with shaken baby syndrome die from their injuries.
e. Injuries may not be immediately noticeable
These symptoms are caused by the developing increased pressure within the brain (intracranial pressure) caused by brain
hemorrhages and swelling:
· Irritability
· Pale or Blue Skin
· Vomiting
· Lethargy
· Breathing difficulties
· Seizure
Other potential risk factors include:
· smoking, drinking, or drug use during pregnancy
· poor prenatal care
· prematurity or low birth weight
· mothers younger than 20
· tobacco smoke exposure following birth
· overheating from excessive sleepwear and bedding
Forms of Child Abuse in the Philippines
· prostitution
· pornography
· agriculture
· mining
· fishing
· domestic works
· child soldiering
· criminal activities (drugs, theft, robbery etc.)
SIGNS
Child Parents/ Caregivers
· Sudden changes in behaviour
· Shows little concern for the child
· Unexplained sudden deterioration of school performance
· Denies or blames the child for the child’s
· Has not received help for physical or medical problems
problems in school or at home
brought to parents’ attention
· Asks teachers or other caregivers to use harsh
· Has learning problems (or difficulty concentrating) that
physical discipline if the child misbehaves
cannot be attributed to specific physic physical or psychological causes
· Sees the child as entirely bad, worthless, or
· Lacks adult supervision
burdensome
· Child is overly compliant, passively, or withdrawn
· Demands a level of physical or academic
· Comes to school or other activities early, stays late, and does
performance the child cannot achieve
not want to go home
· Looks primarily to the child for care, attention,
· Seems frightened of the parents and caregivers and protests
and satisfaction of emotional needs
or cries when it is time to go home
· Demands a level of physical or academic
· Shrinks at the approach of adults
performance the child cannot achieve
· Reports injury by a parent or another adult caregiver Physical
· Looks primarily to the child for care, attention and
Signs
satisfaction of emotional needs
· Has unexplained burns, bites, bruises, broken bones, or black
· Rarely touch or look at each other
eyes
· Consider their relationship entirely negatively
· Has fading bruises or other marks noticeable after from
· State that they do not like each other
school
Effects of Child Abuse

· depression
· eating disorders (anorexia; bulimia)
· poor self--- esteem
· dissociative disorders
· anxiety disorders
· general
· psychological
· distress
· somatization
· neurosis
· chronic pain
· school/learning problems
· behaviour problems
· substance abuse
· self- destructive behaviour
· animal cruelty
· crime in adulthood
· propensity to further victimization in adulthood
· suicide
· physical injury to the child
· sexualized behavior
· sexual abuse by a family member can result in more serious and long-- - term psychological trauma, especially in
the case of parental incest
MODULE 9: PHYSICAL INJURIES

Wounds- Break in the continuity of or damage to tissues.
Tissues
1. Skin
2. Mucous membranes
3. Muscles
4. Bones and joint tissues
5. Brain & nervous tissues
6. Gastrointestinal tract
7. Connective tissues
8. Heart and blood vessels
9. Lungs and organs of respiration
Type of wounds based on skin integrity

OPEN WOUNDS – break in the skin or mucous membranes
CLOSED WOUND – deep wounds without break in the skin or mucous membranes
WOUNDING AGENTS TYPE OF WOUNDS

• Sharp instruments • incision, cuts, slash, amputations
• Blunt instruments • lacerations, contusion,
• Pointed instruments • hematoma, macerations,
• Rough surface • fractures
• Bullets • puncture, stabs
• Electricity • abrasions
• chemical, poisons • gunshot wounds (GSW)
• explosives • electrical burns
• radiation • chemical burns
• sound waves • burns
• electromagnetic
waves • radiation burns
• gravitational force • sound wave injuries
• heat • EMW Injuries
• cold • contusion, hematoma,
• forcible detachment • macerations, fractures
• biological agents • thermal burns
• cold burns
• avulsion
• varies with bacteria or viruses used
1. Incised Wounds
- caused by sharp instruments (e.g., knives, blades, cutters, glass splinters, aluminum or metal sheets)
-smooth edges generally, length is greater than width
-generally not life threatening except when major blood vessels or organs are involved
-tends to gape depending on the elasticity of the skin
i.e. Suicide Injuries

• throat, wrists, front of chest
• often multiple
• there are deep cuts
Wrist incision
Multiple Incisions
2. Defense Wounds
• Sustained to avoid or minimize a blow or slashing
• May be active or passive
i.e. Outer Part of Forearm
i.e. Back of hands
Palms and fingers

Outer part of thigh
3. Lacerations
• Caused by tearing of tissues (e.g., barb wires, saw)

• Jagged edges
• Generally limited to skin and subcutaneous tissues
• Often more contaminated with bacteria and debris from whatever instrument caused the lacerations
i.e. Right Ocular Lacerations

i.e. leg lacerations
i.e. barb-wire lacerations
4. Stab wounds, puncture
• Length (depth) usually greater than width (diameter)

• Generally more fatal due to involvement of internal organs
• Extent of injury not easily observable on ocular inspection
• Infection may go deeper

• Generally less bloody because the bleeding is internal and the entrance is small for drainage
• Clean cut edges
• One or both ends pointed
• non-pointed end may be squared off or split (fish tail or boat shaped defect)
• often gape (related to skin elasticity and Langer’s lines)
• cross section of weapon may be illustrated when edges of wounds opposed
• underlying bone may be scored by blade
• frequently shows notching or a change in direction (caused by relative movement of the knife and body)
i.e. Single blade
Double edge knife
Screw drivers
Serrated blade
Nail puncture
Pencil puncture
Back stab wound

5. Gunshot wounds (GSW)

• Magnitude and character of injury in GSW
1. Frontal Area (FA)
2. Velocity
3. Distance
Frontal Area
• Surface area of the bullet that strikes an object
• Factors that increase frontal area are:
A. Profile
B. Tumble-bullet’s center of gravity
C. Fragmentation
• Bullets with soft noses or vertical cuts increase damage by breaking apart on impact.
• The mass of fragments produced creates a larger frontal area than a solid bullet and energy is dispersed rapidly
into the tissues.
• A shot gun injury is the ultimate example of fragmentation.
Velocity
kinetic energy = massx velocity2
KE ∝ m KE ∝ v2
Firearms velocity
a. medium velocity
b. high velocity
assault and hunting rifles
• velocity > 1500 ft / s

• These weapons use larger cartridges
• gunpowder in the cartridge ∝ bullet speed
• missiles create a permanent track
• much larger temporary cavity with the cavity expanding well beyond of the actual bullet track hunting rifles
• high velocity weapons
• high velocity bullets
Distance
d ∝ air resistance d 1/∝ v
KE ∝ v2
↑d ↓KE ↓ tissue damage
Thoracic injuries
• pneumothorax
• internal/external hemorrhage
• myocardial rupture
• pericardial tamponade
• vessel rupture
• liver damage
• rib fracture
Abdominal Trauma
• rupture of spleen, stomach or intestines, kidneys
• vessel rupture
• spinal fracture
Extremity Trauma
• muscle rupture
• vessel rupture
• bone fracture
GSW Injuries
• Contact GSW
• Hard Contact Gunshot Wound
• Near contact GSW
• Intermediate GSW
• Distant GSW
• Oblique GSW entrance
Distant GSW high velocity rifle
Intermediary target effect
Shotgun Wounds
Shotgun
• Bullets contain numerous pellets

• At contact range up to a few feet, the entrance wound is a single round
defect
• At a range of 3--- 4 feet, the pellets begin to spread out before reaching the body, producing one large entry wound
surrounded by scalloping or several smaller defects due to penetration by individual pellets
• As the range increases, the central defect becomes smaller and the number of surrounding pellet holes increases
Shotgun pellets
Shotgun wounds
Distant GSW
Buckshot superficial perforating
Graze wound
Exit Wounds
• Usually more irregular in shape than entry wounds

• Do not show soot deposition, muzzle imprint, stippling, or blackening of the skin edges
• A shored exit wound is one in which the skin is in contact with another object when the bullet exits; this causes
an irregular area of abrasion on the skin, which can be confused with the abrasion ring of an entrance wound
Exit wound (High velocity rifle)
Keyhole wound
Lead snowstorm Pattern
Re-entrant GSW
Bullet wipe on clothing
Case: PEOPLE v. MAYINGQUE, G.R.No. 179709, July 6, 2010

Summary: Appellants were found guilty along with Edwin Macas for murdering Edgardo. They were at a drinking session when
Edgardo admonished them, saying they should not be so noisy. Later on, when Edgardo and his wife were resting in front of
their house, Toribio arrived and stabbed him multiple times. He was then accompanied by three others who proceeded to
stab and assault him. One of the defenses of the accused was that Toribio attacked Edgardo only in self-defense. RTC and CA:
guilty. The SC affirmed this as Toribio’s theory of self-defense is belied by the 12 wounds incurred by Edgardo which were of
varying sizes. The wounds were of the nature that an intent to kill was obvious when they were made upon his body.
Doctrine: Essential elements of self-defense are: (a) unlawful aggression; (b) reasonable necessity of the means employed to
prevent or repel it; and (c) lack of sufficient provocation on the part of the person defending himself. By invoking self-defense,
the accused must prove by clear and convincing evidence the elements of self-defense. The plea of self-defense can be belied
by the number and the different sizes of the wounds inflicted. The presence of a large number of wounds on the victim’s body
negated self-defense, and indicated, instead, a determined effort to kill the victim.
Case: PEOPLE v. REFORMA, G.R. No. 133440, June 7, 2004

Summary: Virgilio allegedly stabbed Nazario in a fight and this was witnessed by Zenaida and Roger who testified to the same
in court. Virgilio denied this. Balingit, Virgilio’s helper, testified that it was Rolando (one of the Damian brothers) who started
the fight by throwing a bottle at Virgilio. Jaime and Nazario who are brothers of Rolando arrived and helped him maul Virgilio,
hitting him with a lead pipe. Rolando tried to stab him in his left thigh upon assisting Virgilio back to his stall. He was able to
evade the blow and Nazario was hit instead. Virgilio was convicted of murder by the lower court. SC held that the qualifying
circumstances for murder were not present in the crime, thus, it should only be homicide. The appellant’s and Balingit’s
testimony, that the appellant was mauled with a lead pipe and that Rolando stabbed Nazario once when he attempted to stab
the appellant, is belied by the medico-legal report of Dr. Baltazar that the victim sustained one penetrating stab wound on the
anterior left thorax and 4 incised wounds and multiple abrasions. Balingit has not adduced in evidence any medical certificate
that he sustained a stab wound on his left hand.
Doctrine: Between the testimony of a presented witness and the physical evidence upheld by the findings of a medico-legal,
the latter will be given greater credence.
Case: PEOPLE v. LEE, G.R. No. 139070. May 29, 2002
Summary: Herminia (mother) and Joseph (son) were watching TV in their living room, sitting across each other. Joseph was
sitting on a sofa against the window. Herminia witnessed a hand holding a gun coming through of the open window, and
before she could warn him. Joseph was shot on the head by accused Noel Lee. A post-mortem examination was made on
Joseph’s body. Dr. Rosaline Cosidon, a medico-legal officer of the PNP Crime Laboratory, made a Conclusion that the “cause of
death is intracranial hemorrhage as a result of (2) gunshot wounds. As defense, accused testified on the bad reputation of the
victim as a thief and drug addict, and he might have been shot by any of the persons from whom he had stolen. SC upheld
the findings of the RTC and found him guilty of murder.
Doctrine: For crimes of murder, such as this case, the proof of the bad moral character of the victim is irrelevant to determine
the probability or improbability of his killing. No allegation that victim was the aggressor or that the killing was made in self-
defense. There is no connection between the deceased’s drug addiction and thievery with his violent death in the hands of
accused-appellant.
Major Arteries and Veins

MODULE 10: GENDER AND SEXUALITY

GENDER
Legal implications of gender

• Marriage
• Use of surnames
• Damages
• Crimes committed only against women/ men
• Crimes committed only by women/ men
• Special laws which are gender-related
Dictionary definition of “male”

1. A member of the sex that begets young by fertilizing ova. (capability of fertilizing)
2. Sex that produces spermatozoa. (ability to produce spermatozoa)
3. a person bearing an X and Y chromosome pair in the cell nuclei (genetic basis) and normally having a penis, scrotum, and
testicles, and developing hair on the face at adolescence. (secondary male characteristics)
Dictionary definitions of “female”
1. an individual organism of the sex that bears young or produces ova or eggs (capability)
2. pertaining to the sex that has the ability to become pregnant and bear children (ability)
Sex Differentiation
• Visible differentiation of the gross anatomy does not appear until late in the second month of embryonic life.
• Testosterone causes the differentiation of the foetus to a male.
• The foetal genital tract will always develop into female genitals, if unexposed to embryonic testicular secretion.
• The genital sex is a phenotypic female.
• If testosterone is present, male external sex organs develop and the genital tubercle elongates to form the male phallos.
• If testosterone is absent, female organs develop instead.
• It is the action of testosterone and 5-a- dihydrotestosterone on the urogenital sinus that is behind the normal development
of the male external genitalia.
• In the last months of gestation the growth of the external genitalia depends upon foetal pituitary LH.
• The presence of normal ovaries or testes determines the gonadal sex. Without normal ovaries or testes any genetic sex will
develop into an apparent female.
• Female is the default path.
Hypogonadism – Male hypogonadism is a condition in which the body doesn't produce enough testosterone, the hormone
that plays a key role in masculine growth and development during puberty.
Cryptochirdism – absence of one or both testes from the scrotum.

• the most common birth defect regarding male genitalia.
• in unique cases, cryptorchidism can develop later in life, often as late as young adulthood.
• About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis.
• about 80% of cryptorchid testes descend by the first year of life (the majority within three months), making the true incidence
of cryptorchidism around 1% overall.
• Cryptorchidism is distinct from monorchism the condition of having only one testicle.
Risk Factors:
• low-birth weight infants (under 2.5 kg)
• preterm infants
• twins
• maternal exposure to estrogens during pregnancy
• alcohol use by the mother during pregnancy
• cigarette smoking by the mother or exposure to secondhand smoke
• obesity in the mother
• diabetes in the mother
• parents' exposure to some pesticides

• congenital & familial
Ambiguous genitalia
HERMAPHRODITISM
• presence of both testicular and ovarian tissue
• having ambiguous-looking external genitalia
• external genitalia are often ambiguous, the degree depending mainly on the amount of testosterone produced by the
testicular tissue between 8 and 16 weeks of gestation.
• there may be an ovary underneath each testicle on the other
• more commonly one or both gonads is an ovotestis containing both types of tissue.
• It is rare—so far undocumented—for both types of gonadal tissue to function.
• Encountered karyotypes are 46XX/46XY, or 46XX/ 47XXY, and various degrees of mosaicism (with one interesting case of a XY
predominant (96%) mosaic giving birth).
• Fertility is possible in true hermaphrodites (as of 2008 there have been at least 11 reported cases of fertility in the literature)
• NO documented case where both gonadal tissues function
• contrary to folk rumors of hermaphrodites being able to impregnate themselves.
Case: PEOPLE v. CAGANDAHAN, G.R.No. 166676, September 12, 2008

Summary: Jennifer Cagandahan filed a Petition for Correction of Entries in Birth Certificate of her name from Jennifer C to Jeff
and her gender from female to male. Jennifer is suffering from Congenital Adrenal Hyperplasia, a rare medical condition where
afflicted persons possess both male and female characteristics. Jennifer grew up with secondary male characteristics. She
presented in court the medical certificate evidencing that she is suffering from CAH, issued by Dr. Sionzon of the Department
of Psychiatry, UP PGH. Sionzon explained that Jennifer genetically is female but because her body secretes male hormones,
her female organs did not develop normally, thus has organs of both male and female. RTC granted her petition, but the OSG
appealed before the SC, stating that Rule 108 does not allow change of sex or gender in the birth certificate and her claimed
medical condition known as CAH does not make her a male. SC: AFFIRMED RTC. Based on medical testimony and scientific
development, Jennifer was “other than female”, hence a change in her birth certificate entry was in order.
Jennifer’s CAH causes the early or inappropriate appearance of male characteristics. A person, like respondent, with this
condition produces too much androgen, a male hormone. A newborn who has XX chromosomes coupled with CAH usually
has a (1) swollen clitoris with the urethral opening at the base, an ambiguous genitalia often appearing more male than
female; (2) normal internal structures of the female reproductive tract such as the ovaries, uterus and fallopian tubes; as the
child grows older, some features start to appear male, such as deepening of the voice, facial hair, and failure to menstruate at
puberty. About 1 in 10,000 to 18,000 children are born with CAH.
CAH is one of many conditions that involve intersex anatomy. During the twentieth century, medicine adopted the term
intersexuality to apply to human beings who cannot be classified as either male or female. The term is now of widespread use.
According to Wikipedia, intersexuality is the state of a living thing of a gonochoristicspecies whose sex chromosomes,
genitalia, and/or secondary sex characteristics are determined to be neither exclusively male nor female. An organism with
intersex may have biological characteristics of both male and female sexes.
The SC held that where the person is biologically or naturally intersex the determining factor in his gender classification would
be what the individual, like respondent, having reached the age of majority, with good reason thinks of his/her sex. As Jennifer
thinks of himself as a male and considering that his body produces high levels of male hormones (androgen) there is
preponderant biological support for considering him as being male. Sexual development in cases of intersex persons makes
the gender classification at birth inconclusive. It is at maturity that the gender of such persons is fixed.
Jennifer here has simply let nature take its course and has not taken unnatural steps to arrest or interfere with what he was
born with. He has already ordered his life to that of a male. Jennifer could have undergone treatment and taken steps, like
taking lifelong medication, to force his body into the categorical mold of a female but he did not. He chose not to do so.
Nature has instead taken its due course in respondents development to reveal more fully his male characteristics.
ANEUPLOIDY
• abnormal number of chromosomes (extra or missing chromosome) is a common cause of genetic disorders (birth defects)
• occurs during cell division when the chromosomes do not separate properly between the two cells.
• occur in 1 of 160 live births
• Most cases of aneuploidy result in termination of the developing fetus, but there can be cases of live birth
KLINEFELTER’S SYNDROME
• congenital abnormality where two or more X chromosomes are present in addition to one Y chromosome. (=/>)2X + Y
• the extra X chromosome causes abnormal development of the testicles, which in turn results in underproduction of
testosterone.
• 1:500 to 1:1000 live male births
• principal effects is hypogonadism and infertility
TURNER’S SYNDROME
• Turner syndrome is caused by a missing or incomplete Xchromosome.
• People who have Turner syndrome develop as females.
• The genes affected are involved in growth and sexual development, which is why girls with the disorder are shorter than
normal and have abnormal sexual characteristics.
• 1 in 2000 – 1 in 5000 phenotypic females,
XXX
• females
• karyotype of 47,XXX.
• approximately 1 in 1000 liveborn females • no characteristic abnormal physical features
• usually within the normal range of intelligence, their IQ scores may be lower than those of their normal siblings
XYY
• karyotype result of 47,XYY.
• incidence is 1 in 840 among liveborn males.
• tend to be tall in comparison with their own family members
• generally their phenotypic appearance is normal
• IQ is usually within the normal range but may be lower than that of siblings.
XYY
• Affected boys often come to medical attention because of problems with fine motor coordination, speech disorders, and
learning disabilities.
• Early reports raised concerns about significant behavioral problems; however, long-term prospective studies now suggest
that these boys do not have any greater incidence of problem behaviors than the general population.
GONADAL DYSGENESIS
• any inherited developmental disorder of the reproductive system characterized by a progressive loss of primordial germ cells
on the developing gonads of an embryo.
• This loss leads to extremely hypoplastic (underdeveloped) and dysfunctioning gonads mainly composed of fibrous tissue,
hence the name streak gonads
• The accompanying hormonal failure also prevents the development of secondary sex characteristics in either sex, resulting in
a sexually infantile female appearance and infertility.
• The first type of gonadal dysgenesis discovered was Turner syndrome.
• During embryogenesis, without any external influences for or against, the human reproductive system is intrinsically
conditioned to give rise to a female reproductive organisation.
• As a result, if a gonad cannot express its sexual identity via its hormones—as in gonadal dysgenesis—then the affected
person, no matter whether genetically male or female, will develop external female genitalia.
• Internal female genitalia, primarily the uterus, may or may not be present depending on the etiology of the disorder.
• In both sexes, the commencement and progression of puberty require functional gonads that will work in harmony with the
hypothalamic and pituitary glands to produce adequate hormones.
• For this reason, in gonadal dysgenesis the accompanying hormonal failure also prevents the development of secondary sex
characteristics in either sex, resulting in a sexually infantile female appearance and infertility.
MIXED GONADAL DYSGENESIS

• a condition of unusual and asymmetrical gonadal development leading to an unassigned
sex differentiation.
• A number of differences have been reported in the karyotype, most commonly a mosaicism 45,X/ 46, XY.
• The phenotypical expression may be ambiguous, intersex, or male, or female depending the extent of the mosaicism.
MODULE 11: INSANITY AND PSYCHOLOGICAL INCAPACITY

CC, Art. 800: The law presumes that every person is of sound mind, in the absence of proof to the contrary.
The burden of proof that the testator was not of sound mind at the time of making his dispositions is on the person who
opposes the probate of the will; but if the testator, one month, or less, before making his will was publicly known to be insane,
the person who maintains the validity of the will must prove that the testator made it during a lucid interval. (n)
RPC, Art. 12. Circumstances which exempt from criminal liability. — the following are exempt from criminal liability:
1. An imbecile or an insane person, unless the latter has acted during a lucid interval.
When the imbecile or an insane person has committed an act which the law defines as a felony (delito), the court shall order
his confinement in one of the hospitals or asylums established for persons thus afflicted, which he shall not be permitted to
leave without first obtaining the permission of the same court.
1. Brain Anatomy and function
The brain is one of the largest and most complex organs in the human body. It is made up of more than 100 billion nerves that
communicate in trillions of connections called synapses. The brain, with the spinal cord, comprises the body's central nervous
system. This is the major control network for the body's functions and abilities: conscious communication with our body and
automatic operation of vital organs
The brain is made up of many specialized areas that work together:
• The cortex (outermost) is the layer of brain cells. Thinking and voluntary movements begin in the cortex.
• The brain stem is between the spinal cord; the rest functions like breathing and sleep are controlled here.
• The basal ganglia are structures in the center of the brain which coordinate messages between multiple other brain areas.
• The cerebellum is at the base and the back of the brain, and is responsible for coordination and balance.
The brain is also divided into several lobes:
• The frontal lobes are responsible for problem solving and motor functions.
• The parietal lobes manage sensation and handwriting
• The temporal lobes are involved with memory and hearing
• The occipital lobes contain the brain's visual processing
Much of the brain's job involves receiving information from the rest of the body, interpreting that information, and then
guiding the body's response to it. Types of input the brain interprets include odors, light, sounds, and pain. The brain also
helps perform vital operations such as breathing, maintaining blood pressure, and releasing hormones.
The brain is divided into sections. These sections include the cerebrum, the cerebellum, the diencephalon, and the brain stem.
Each of these parts is responsible for portions of the brain's overall job. The larger parts are, in turn, divided into smaller areas
that handle smaller portions of the work. Different areas often share responsibility for the same task.
The cerebrum is the largest part of the brain. It handles memory, speech, the senses, emotional response, and more. It is
divided into several sections called lobes. These lobes are the frontal, temporal, parietal, and occipital; each handles portions of
the cerebrum's jobs.
The cerebellum is below and behind the cerebrum and is attached to the brain stem. It controls motor function, the body's
ability to balance, and its ability to interpret information sent to the brain by the eyes, ears, and other sensory organs.
The functions the brain stem governs include respiration, blood pressure, some reflexes, and the changes that happen in the
body during “flight” response. The brain stem is also divided into distinct sections: the midbrain, pons, and medulla oblongata.
The diencephalon is inside the cerebrum above the brain stem. Its jobs include sensory function, food intake control, and the
body's ability to sleep. As with the other parts of the brain, it is divided into sections. These include the thalamus,
hypothalamus, and epithalamus.
The brain is protected from damage by several layers of defenses. Outermost are the bones of the skull. Beneath the skull are
the meninges, a series of sturdy membranes that surround the brain and spinal cord. Inside the meninges the brain is
cushioned by fluid.
Brain Conditions
• Headache: There are many types of headaches; some can be serious but most are not and are generally treated with
analgesics/painkillers.
• Stroke (brain infarction): Blood flow and oxygen are suddenly interrupted to an area of brain tissue, which then dies. A blood
clot, or bleeding in the brain, are the cause of most strokes.
• Brain aneurysm: An artery in the brain develops a weak area that swells, balloon-like. A brain aneurysm rupture can causes a
stroke.
• Subdural hematoma: Bleeding within or under the dura, the lining inside of the skull. A subdural hematoma may exert
pressure on the brain, causing neurological problems.
• Epidural hematoma: Bleeding between the tough tissue (dura) lining the inside of the skull and the skull itself, usually shortly
after a head injury. Initial mild symptoms can progress rapidly to unconsciousness and death, if untreated.
• Intracerebral hemorrhage: Any bleeding inside the brain.
• Concussion: A brain injury that causes a temporary disturbance in brain function. Traumatic head injuries cause most
concussions.
• Cerebral edema: Swelling of the brain tissue in response to injury or electrolyte imbalances
• Brain tumor: Any abnormal tissue growth inside the brain. Whether malignant (cancer) or benign, brain tumors usually cause
problems by the pressure they exert on the normal brain.
• Glioblastoma: An aggressive, malignant brain tumor (cancer). Brain glioblastomas progress rapidly and are very difficult to
cure.
• Hydrocephalus: An abnormally increased amount of cerebrospinal (brain) fluid inside the skull. Usually this is because the
fluid is not circulating properly.
• Normal pressure hydrocephalus: A form of hydrocephalus that often causes problems walking, along with dementia and
urinary incontinence. Pressures inside the brain remain normal, despite the increased fluid.
• Meningitis: Inflammation of the lining around the brain or spinal cord, usually from infection. Stiff neck, neck pain, headache,
fever, and sleepiness are common symptoms.
• Encephalitis: Inflammation of the brain tissue, usually from infection with a virus. Fever, headache, and confusion are
common symptoms.
• Traumatic brain injury: Permanent brain damage from a traumatic head injury. Obvious mental impairment, or more subtle
personality and mood changes can occur.
• Parkinson's disease: Nerves in a central area of the brain degenerate slowly, causing problems with movement and
coordination. A tremor of the hands is a common early sign.
• Huntington's disease: An inherited nerve disorder that affects the brain. Dementia and difficulty controlling movements
(chorea) are its symptoms.
• Epilepsy: The tendency to have seizures. Head injuries and strokes may cause epilepsy, but usually no cause is identified.
• Dementia: A decline in cognitive function resulting from death or malfunction of nerve cells in the brain. Conditions in which
nerves in the brain degenerate, as well as alcohol abuse and strokes, can cause dementia.
• Alzheimer’s disease: For unclear reasons, nerves in certain brain areas degenerate, causing progressive dementia. Alzheimer’s
di common form of dementia.
• Brain abscess: A pocket of infection in the brain, usually by bacteria. Antibiotics and surgical drainage of the area are often
necessary.
2. Mental and Personality Disorders
TWO CLASSIFICATIONS SYSTEMS FOR MENTAL DISORDERS

ICD-10: International Statistical Classification of Diseases and Related Health Problems
DSM-5: Diagnostic & Statistical Manual of Mental Disorders
According to ICD-10
(F00–F99) Mental and behavioral disorders
(F00–F09) Organic, including symptomatic, mental disorders
(F10–F19) Mental and behavioral disorders due to psychoactive substance use
(F20–F29) Schizophrenia, schizotypal and delusional disorders
(F30–F39) Mood (affective) disorders
(F40–F48) Neurotic, stress-related and somatoform disorders
(F50–F59) Behavioral syndromes associated with physiological disturbances and physical factors
(F60–F69) Disorders of adult personality and behavior
(F70–F79) Mental retardation
(F80–F89) Disorders of psychological development
(F90–F98) Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
(F99) Unspecified mental disorder
According to DSM-5
31 - Neurodevelopmental disorders
87- Schizophrenia spectrum and other psychotic disorders
123- Bipolar and related disorders
155- Depressive disorders
189- Anxiety disorders
235- Obsessive-compulsive and related disorders
265- Trauma and stressor-related disorders
291- Dissociative disorders
309- Somatic symptom and related disorders
329- Feeding and eating disorders

355- Sleep–wake disorders
423- Sexual dysfunctions
451- Gender dysphoria
461- Disruptive, impulse-control, and conduct disorders
481- Substance-related and addictive disorders
591- Neurocognitive disorders
685- Paraphilic disorders
645- Personality disorders
Dementia praecox/schizophrenia
• fundamental and characteristic distortions of thinking and perception, and affects that are
inappropriate or blunted.
• Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the
course of time.
• thought echo;
• thought insertion or withdrawal;
• thought broadcasting;
• delusional perception and delusions of control;
• influence or passivity
• hallucinatory voices commenting or discussing the
• patient in the third person
• thought disorders and
• negative symptoms
• The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be
one or more episodes with complete or incomplete remission. (ICD 10)
Manic-depressive/bipolar
• mood disorder (affective)
• two or more episodes in which the patient's mood and activity levels are significantly disturbed
• this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or
mania) and on others of a lowering of mood and decreased energy and activity (depression)
Mania-possible causes (genetic)

• familial (50%)
• bipolar parent (15-25% chance)
• bipolar monozygotic twin (8X risk to other twin)
• dysfunction of certain neurotransmitters, or
• chemical messengers, in the brain
o norepinephrine
o serotonin and probably many others
• psychological or social stresses
• altered eating habits
• substance abuse
○ alcohol
○ cocaine
○ amphetamine, ecstasy
• excessive caffeine
• medications
o anti-depressants
o appetite-suppressants
o steroids
o thyroid drugs
o cough-cold preparations
Historical classification of mental deficiency

Mental deficiency - encompassed all degrees of educational and social deficiency.
• feeble-mindedness-high functionality
• imbecility-median
• idiocy-highest severe form
F70 Mild mental retardation

• approximate IQ range of 50 to 69 in adults, mental age from 9 to under 12 years
likely to result in some learning difficulties in school
• many adults will be able to work and maintain good social relationships and contribute to
society.
Incl: feeble-mindedness
mild mental subnormality
F71 Moderate mental retardation

• approximate IQ range of 35 to 49 in adults, mental age from 6 to under 9 years likely to result in marked developmental delays
in childhood
• most can learn to develop some degree of independence in self-care and acquire adequate communication and academic
skills
• adults will need varying degrees of support to live and work in the community.
F72 Severe mental retardation

• approximate IQ range of 20 to 34
• in adults, mental age from 3 to under 6 years
• likely to result in continuous need of support
F73 Profound mental retardation

• IQ under 20
• in adults, mental age below 3 years
• results in severe limitation in self-care, continence, communication and mobility
INTELLECTUAL DISABILITY
Assessed via:
• IQ tests
• adaptive functioning tests
Causes
• Genetic conditions
• Down syndrome and
• Fragile X syndrome etc.
• Problems during pregnancy:

• alcohol or drug use
• malnutrition
• certain infection
• or preeclampsia.
• Problems during childbirth.
• baby is deprived of oxygen during childbirth or
• born extremely premature.
• Illnesses
• meningitis
• whooping cough
• measles
• Injury
• severe head injury
• near-drowning
• extreme malnutrition
• exposure to toxic substances
• 2/3 unknown cause
SCHIZOPHRENIA SPECTRUM
• Schizophrenia
• Other psychotic disorders
• Schizotypal personality disorders
At least one of the following:

• delusions
• hallucinations
• disorganized
• thinking (speech)
• grossly disorganized or abnormal motor behavior (including catatonia), and
• negative symptoms
Delusions
1. Fixed beliefs that are not amenable to change in light of
conflicting evidence.
• persecutory
• referential
• somatic
• religious
• erotomanic
• nihilistic
• grandiose
2. Deemed “bizarre” if they are clearly implausible and not understandable to same-culture peers and do not derive
from ordinary life experiences.
• though withdrawal
• thought insertion
• delusions of control
Hallucinations
• perception-like experiences that occur without an external stimulus.
• vivid and clear, with the full force and impact of normal perceptions
• not under voluntary control
• must occur in the context of a clear sensorium; those that occur while falling asleep (hypnagogic) or waking up
(hypnopompic) are considered to be within the range of normal experience.
• may occur in any sensory modality
• visual
• auditory (most common)
• tactile
• olfactory
• gustatory
Disorganized Thinking (Speech)

• Derailment or loose association
• Tangentiality
• Incoherence or “word salad”
Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)

• Ranges from childlike-silliness to unpredictable agitation
• difficulty in performing activities of daily occurrence
Catatonia
A marked decrease in reactivity to the environment:
• resistance to instructions (negativism)
• maintaining a rigid, inappropriate or bizarre posture
• complete lack of verbal and motor responses (mutism and stupor)
• purposeless and excessive motor activity without obvious cause (catatonic excitement)
• repeated stereotyped movements
• staring
• grimacing
• mutism, and
• echoing of speech.
Negative symptoms of catatonia

• diminished emotional expression
• avolition
• alogia
• anhedonia
• ansociality
SCHIZOPHRENIA
• from the Greek roots skhizein ("to split") and phrēn ("mind")
• symptoms for at least 6 months
• at least 1 month of active-phase symptoms
• No cure
• anti-psychotic medications
• psycho-social therapies
• high cost- $62 billion (US)
• 285,000 people in Australia
• Over 280,000 people in Canada
• Over 250,000 diagnosed cases in Britain
Causes for schizophrenia: fetal development stage

• brain cell migration deranged during fetal development
o viral infection
o lack of vital nutrients during pregnancy
Ø folic acid
Ø choline
Ø vitamin D and
Ø omega 3 fatty acid
• smoking mothers; secondary smoke
• early childhood
o lack of vital nutrients
Ø failure to breastfeed for at least 6 months
Ø choline
Ø vitamin D and
Ø omega 3 fatty acid
ORGANIC MENTAL DISORDERS

I. DUE TO STROKE
DSM 5 (621) Major or Mild Vascular Neurocognitive Disorder
ICD 10 (F01) Vascular dementia
TYPES BASED ON ORGANS AFFECTED

PRIMARY –diseases and injuries that affect the brain directly and selectively
SECONDARY-systemic diseases and disorders that attack the brain only as one of the multiple
organs or systems of the body that are involved
PRIMARY
DEMENTIA
• Dementia due to Alzheimer’s disease
• Vascular dementia (stroke)
o hypertension is the most common cause
Ø due to embolism
Ø aneurysm
• Others
o Pick’s Disease
o Creutzfeldt-Jakob disease
o Huntington disease
o Parkinson’s disease
o HIV
ORGANIC MENTAL DISORDER WITH PSYCHOSIS

DSM 5 (641) Major Neurocognitive Disorder Due to Another Medical Condition
ICD 10 (F03) Unspecified dementia
Case: PEOPLE v. BONOAN

Summary: Celestino Bonoan is charged with the crime of murder for stabbing Carlos Guison with a knife, which caused his
death three days afterwards. An arraignment was then called, but the defense objected on the ground that Bonoan was
mentally deranged and was at the time confined at the Psychopatic Hospital. After several months of summons for doctors,
pro record of mental condition from the hospital and his admission to the hospital for personal observation, assistant alienist
Dr. Fernandez finally reported to the court that Bonoan may be discharged for being a “recover court found Bonoan guilty and
sentenced him to life imprisonment. SC acquitted Bonoan after a finding that he was indeed suffering from dementia præcox,
appreciating (a) the fact that Bonoan was confined in San Lazaro during certain periods before the commission of the offense
charged, and (b) the findings of Dr. Joson and Dr. Fernandez.
Doctrine: US COURTS proceed upon three different theories re: insanity in criminal cases.
1. Insanity as a defense in a confession and avoidance and must be proved beyond reasonable doubt when the commission of a
crime is established, and the defense of insanity is not made out beyond a reasonable doubt, conviction follows. Proof of
insanity at the time of committing the criminal act should be clear and satisfactory in order to acquit the accused on the
ground of insanity. (the Philippines follows this view)
2. An affirmative verdict of insanity is to be governed by a preponderance of evidence, and insanity is not to be established
beyond a reasonable doubt. Prosecution must prove sanity beyond a reasonable doubt. This liberal view is premised on the
proposition that while it is true that the presumption of sanity exists at the outset, the prosecution affirms every essential
ingredients of the crime charged, and hence affirms sanity as one essential ingredients, and that a fortiori where the accused
introduces evidence to prove insanity it becomes the duty of the State to prove the sanity of the accused beyond a reasonable
doubt.
Case: PEOPLE v. FORMIGONES
Summary: Abelardo Formigones is a farmer who had a wife and 5 children. He stabbed his wife under the suspicion that she
had an illicit relationship with his brother. He was charged of parricide. His defense was that he was an imbecile and that this
exempts him from criminal liability. His counsel submitted the testimony of jail guards indicating that he behaved like an
insane person and that he would remove his clothes, refuse to take a bath, or sing alone. SC: he is not an imbecile. During his
marriage of 16 years, he has not done anything so as to warrant an opinion that he was or is an imbecile. He regularly and
dutifully cultivated his farm, raised five children, and supported his family and even maintained in school his children of school
age. A man who could feel the pangs of jealousy to take violent measure to the extent of killing his wife could hardly be
regarded as an imbecile. As to his strange behavior during his confinement, it may be attributed either to his being
feebleminded or eccentric, or to a morbid mental condition produced by remorse at having killed his wife. Hence, he is liable
for parricide.
Doctrine: In order that a person could be regarded as an imbecile within the meaning of RPC Art 12, so as to be exempt from
criminal liability, he must be deprived completely of reason or discernment and freedom of the will at the time of committing
the crime. It is necessary that there be a complete deprivation of intelligence in committing the act. The imbecility or insanity
at the time of the commission of the act should absolutely deprive a person of intelligence or freedom of will—mere
abnormality of mental faculties does not exclude imputability.
Case: PEOPLE v. MADARANG
Summary: Madarang is accused of killing his wife. He was invoking insanity and claiming exemption from liability for the crime
he committed. The accused was found to be suffering from insanity or psychosis, classified as schizophrenia, and was
committed to a mental facility until he was fit to stand trial. The TC held that he evidence failed to refute the presumption of
sanity at the time he committed the offense. The Court held agreed that he is liable.
Doctrine: In the Philippines, the courts have established a more stringent criterion for insanity to be exempting as it is required
that there must be a complete deprivation of intelligence in committing the act, i.e., the accused is deprived of reason; he
acted without the least discernment because there is a complete absence of the power to discern, or that there is a total
deprivation of the will. Mere abnormality of the mental faculties will not exclude imputability.
Case: PEOPLE v. AQUINO
Summary: Juanito Aquino was charged with the crime of rape with homicide by the RTC. It was found that he raped Carmelita
Morado and struck her in the head with a stone. The defense pleaded insanity on the part of Aquino. The RTC found him guilty
and did not believe his defense of insanity. The SC affirmed the same.
Doctrine: The presumption is in favor of sanity. The defense has the burden of proving that the accused was insane at the time
he committed the crime. The inquiry into the mental state of the accused shall be directed at that transpiring immediately
before and/or at the very moment of the acts or acts under prescription. Insanity itself is a condition, not a thing. Insanity may
be proven only by outward acts. The court reads the thoughts, the motives and emotions of a person and come to determine
whether his acts conform to the practice of people of sound mind. In interpreting these physical manifestations, scientific
knowledge and experience have been resorted to by judicial agencies.
Case: PEOPLE v. DUNGO
Summary: Dungo went to the place where Mrs. Sigua was holding office at the DAR in Apalit, Pampanga. After a brief talk,
Dungo drew a knife from the envelope he was carrying and stabbed Mrs. Sigua several times. He went down the staircase and
out of the office with bloodstained clothes, carrying a bloodied bladed weapon. The autopsy report reveals that the victim
sustained 14 wounds, 5 of which were fatal. Rodolfo Sigua, the husband of the deceased, manifested that prior to the act,
Dungo inquired from him concerning the actuations of his wife in requiring so many documents from Dungo. Rodolfo
explained to him the procedure, but Dungo just said "never mind, I could do it my own way." Dungo’s defense was insanity.
SC: to be able to use insanity as a defense, such must be present during the commission of the act. In this case, although
doctors testified that he was insane 3 months before the commission of the act, the testimony of the husband of the victim
that the accused talked to him regarding his wife and the fact that the accused shouted “Napatay ko si Mrs. Sigua” showed
awareness of the commission of the crime.
Doctrine: One who suffers from insanity at the time of the commission of the offense charged cannot in a legal sense entertain
a criminal intent and cannot be held criminally responsible for his acts. His unlawful act is the product of a mental disease or a
mental defect. In order that insanity may relieve a person from criminal responsibility, it is necessary that there be a complete
deprivation of intelligence in committing the act, that is, that the accused be deprived of cognition; that he acts without the
least discernment; that there be complete absence or deprivation of the freedom of the will.
PSYCHOLOGICALINCAPACITY
1. ANTI-SOCIAL PERSONALITY DISORDER (BORDERLINE PERSONALITY DISORDER)
Diagnostic criteria
• A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or
more) of the following:
o Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are
grounds for arrest.
o Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
o Impulsivity or failure to plan ahead.
o Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
o Reckless disregard for safety of self or others
o Consistent irresponsibility, as indicated by repeated
o failure to sustain consistent work behavior or honor financial obligations
o Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
2. DEPENDENT PERSONALITY DISORDER
Diagnostic Criteria
• A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation,
beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
o Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
o major areas of his or her life.
o Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include
realistic fears of retribution.)
o Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities
rather than a lack of motivation or energy).
o Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are
unpleasant.
o Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
o Urgently seeks another relationship as a source of care and support when a close relationship ends.
o Is unrealistically preoccupied with fears of being left to take care of himself or herself.
3. HISTRIONIC PERSONALITY DISORDER
Diagnostic Criteria
• A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
o Is uncomfortable in situations in which he or she is not the center of attention
o Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
o Displays rapidly shifting and shallow expression of emotions.
o Consistently uses physical appearance to draw attention to self.
o Has a style of speech that is excessively impressionistic and lacking in detail.
o Shows self-dramatization, theatricality, and exaggerated expression of emotion.
o Is suggestible (i.e., easily influenced by others or circumstances).
o Considers relationships to be more intimate than they actually are.
4. NARCISSISTIC PERSONALITY DISORDER
Diagnostic Criteria
• A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early
adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
o Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior
without commensurate achievements)
o Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
o Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-
status people (or institutions).
o Requires excessive admiration.
o Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his
or her expectations).
o Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
o Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
o Is often envious of others or believes that others are envious of him or her.
o Shows arrogant, haughty behaviors or attitudes.
Case: REYES v. REYES

Summary: Maria Camacho and Ramon Reyes met in UP, fell in love, and got married. However, due to financial difficulties
Ramon started a business in Mindoro. Their marriage started to fall apart when he did not even exert any effort to
communicate with his family in Manila. The last straw was when he played dumb when Maria requested him to accompany
her when she was being wheeled in an operation room for surgery. Maria filed for declaration of nullity of marriage on the
ground of psychological incapacity. SC eventually nullified their marriage. SC cited the unanimous findings of 3 experts that
Ramon was suffering from Antisocial Personality Disorder.
Doctrine: Patients with antisocial personality disorder can often seem to be normal and even charming and ingratiating. Their
histories, however, reveal many areas of disordered life functioning. Lying, truancy, running away from home, thefts, fights,
substance abuse, and illegal activities are typical experiences that patients report as beginning in childhood. Their own
explanations of their antisocial behavior make it seem mindless, but their mental content reveals the complete absence of
delusions and other signs of irrational thinking. In fact, they frequently have a heightened sense of reality testing and often
impress observers as having good verbal intelligence. Those with this disorder do not tell the truth and cannot be trusted to
carry out any task or adhere to any conventional standard of morality. A notable finding is a lack of remorse for these actions;
that is, they appear to lack a conscience. All these show that they are psychologically incapacitated under Art 36.
Case: YAMBAO v. YAMBAO
Summary: After 35 years of marriage, Cynthia filed a petition for the declaration of nullity of her marriage with Patricio under
Art. 36 (Psychological Incapacity). She alleged many things, among them being that she got tired of Patricio’s laziness and
failure to provide for the family. As evidence of his Dependent Personality Disorder, she presented an expert witness, Dr.
Tolentino, to testify. All the courts dismissed the petition and upheld the marriage. SC: Even assuming that respondent’s faults
amount to psychological incapacity, it has not been established that the same existed at the time of the celebration of the
marriage. Although the evidence tended to show that respondent would unduly rely upon petitioner to earn a living for the
family, there was no evidence to show that the latter resented such imposition or suffered with the additional financial
burdens passed to her by her husband.
Doctrine: Article 36 contemplates incapacity or inability to take cognizance of and to assume basic marital obligations and not
merely difficulty, refusal, or neglect in the performance of marital obligations or ill will.
This incapacity consists of the following: (a) a true inability to commit oneself to the essentials of marriage; (b) this inability to
commit oneself must refer to the essential obligations of marriage: the conjugal act, the community of life and love, the
rendering of mutual help, the procreation and education of offspring; and (c) the inability must be tantamount to a
psychological abnormality. It is not enough to prove that a spouse failed to meet his responsibility and duty as a married
person; it is essential that he must be shown to be incapable of doing so due to some psychological illness.
Case: LIM v. LIM
Summary: Petitioner and respondent were a married couple. The respondent wife didn’t like living with her husband’s in-laws.
She also caught him cheating on her with the caregiver. He filed a petition and sought the declaration of nullity of his
marriage to her on the ground of her psychological incapacity under Article 36 of the Family Code, including an allegation of
his own psychological incapacity, as both he and his wife were diagnosed with personality disorders (dependent personality
disorder and histrionic personality disorder, respectively). RTC granted nullity but CA and SC reversed as it was not established
through testing and interviews that couple’s behavior could be linked to said personality disorders – histrionics (wife) and
dependency (husband).
Doctrine: The ruling in Santos v. Court of Appeals cites three (3) factors characterizing psychological incapacity to perform the
essential marital obligations: (1) gravity, (2) juridical antecedence, (3) incurability. The incapacity must be grave or serious
such that the party would be incapable of carrying out the ordinary duties required in marriage; it must be rooted in the
history of the party antedating the marriage, although the overt manifestations may emerge only after the marriage; and it
must be incurable or, even if it were otherwise, the cure would be beyond the means of the party involved. Given the
requisites, the party alleging his own psychological incapacity and that of his spouse, had the special burden to prove that he
and his wife were suffering from the most serious cases of personality disorders clearly demonstrative of an utter insensitivity
or inability to give meaning and significance to the marriage.
Case: TORING v. TORING
Summary: Ricardo filed a petition for annulment of his marriage to Teresita on the ground of psychological incapacity. Ricardo
alleged various instances of Teresita’s incapacity. He also presented the psychological evaluation of Dr. Albaran's testimonies.
Dr. Albaran testified that Teresita has Narcissistic Personality disorder. Her diagnosis was based on the information from her
psychological evaluation on Ricardo and Richardson. Teresita was not personally observed and examined. SC held that his
petition for annulment of must fail. The Court applied the Santos v. CA case and the Molina guidelines. The Court is not
convinced that a mere narration of the statements of Ricardo and Richardson, coupled with the results of the psychological
tests administered only on Ricardo, without more, already constitutes sufficient basis for the conclusion that Teresita suffered
from Narcissistic Personality Disorder.
Doctrine: The law does not require that the allegedly incapacitated spouse be personally examined by a physician or by a
psychologist as a condition sine qua non for the declaration of nullity of marriage under Article 36 of the Family Code. This,
however, does not signify that the evidence should be any less than the evidence that an Article 36 case, by its nature,
requires. It is still essential - although from sources other than the respondent spouse - to show his or her personality profile, or
its approximation, at the time of marriage; the root cause of the inability to appreciate the essential obligations of marriage;
and the gravity, permanence and incurability of the condition.
MODULE 12: DRUGS AND POISONS

Laws related to drugs
RA 6675 (Generics Drugs Act of 1998)

• "Generic Name or Generic Terminology" is the identification of drugs and medicines by their scientifically and internationally
recognized active ingredients or by their official generic name as determined by the Bureau of Food and Drugs of the
Department of Health.
• "Brand Name" is the proprietary name given by the manufacturer to distinguish its product from those of competitors.
• "Generic Drugs" are drugs not covered by patent protection and which are labeled solely by their international non-
proprietary or generic name.
• Provision on Quality, Manufacturer's identity and Responsibility. — In order to assure responsibility for drug quality in all
instances, the label of all drugs and medicines shall have the following: name and country of manufacture, dates of
manufacture and expiration. The quality of such generically labeled drugs and medicines shall be duly certified by the
Department of Health.
RA 9502 (Universally Accessible Cheaper and Quality Medicines Act of 2008)

Pursuant to the attainment of this general policy, an effective competition policy in the supply and demand of quality
affordable drugs and medicines is recognized by the State as a primary instrument. In the event that full competition is not
effective, the State recognizes as a reserve instrument the regulation of prices of drugs and medicines, with clear
accountability by the implementing authority as mandated in this Act, as one of the means to also promote and ensure access
to quality affordable medicines.
Sec. 17. Drugs and Medicines Price Regulation Authority of the President of the Philippines. — The President of the
Philippines, upon recommendation of the Secretary of the Department of Health, shall have the power to impose maximum
retail prices over any or all drugs and medicines as enumerated in Section 23.
The power to impose maximum retail prices over drugs and medicines shall be exercised within such period of time
as the situation may warrant as determined by the President of the Philippines. No court, except the Supreme Court of the
Philippines, shall issue any temporary restraining order or preliminary injunction or preliminary mandatory injunction that will
prevent the immediate execution of the exercise of this power of the President of the Philippines.
RA 9165 (Dangerous Drugs Act)
(v) Cannabis or commonly known as "Marijuana" or "Indian Hemp" or by its any other name. - Embraces every kind,
class, genus, or specie of the plant Cannabis sativa L. including, but not limited to, Cannabis americana, hashish, bhang, guaza,
churrus and ganjab, and embraces every kind, class and character of marijuana, whether dried or fresh and flowering,
flowering or fruiting tops, or any part or portion of the plant and seeds thereof, and all its geographic varieties, whether as a
reefer, resin, extract, tincture or in any form whatsoever.
(w) Methylenedioxymethamphetamine (MDMA) or commonly known as "Ecstasy", or by its any other name. - Refers
to the drug having such chemical composition, including any of its isomers or derivatives in any form.
(x) Methamphetamine Hydrochloride or commonly known as "Shabu", "Ice", "Meth", or by its any other name. - Refers
to the drug having such chemical composition, including any of its isomers or derivatives in any form.
(y) Opium. - Refers to the coagulated juice of the opium poppy (Papaver somniferum L.) and embraces every kind,
class and character of opium, whether crude or prepared; the ashes or refuse of the same; narcotic preparations thereof or
therefrom; morphine or any alkaloid of opium; preparations in which opium, morphine or any alkaloid of opium enters as an
ingredient; opium poppy; opium poppy straw; and leaves or wrappings of opium leaves, whether prepared for use or not.
(z) Opium Poppy. - Refers to any part of the plant of the species Papaver somniferum L., Papaver setigerum DC,
Papaver orientale, Papaver bracteatum and Papaver rhoeas, which includes the seeds, straws, branches, leaves or any part
thereof, or substances derived therefrom, even for floral, decorative and culinary purposes.
Dangerous Drugs Board Regulation No. 1, Series of 2002
Administrative Order No. 62, Series of 1989 dated March 9, 1989
Case: DEL ROSARIO V. SECRETARY OF HEALTH, G.R. No. 88265, December 21,1989
Summary: RA 6675 requiring the use of generic names in all transactions related to purchasing, prescribing, dispensing and
administering of drugs and medicines. Petitioners, officers of Philippine Medical Association assailed the constitutionality of
the said statute and petitioned for declaratory relief. Court treated it as petition for prohibition. Petitioner’s argument of the RA
favouring private sector and giving the act of prescribing the correct medicine a duty of the salesgirl were all stricken down as
misinterpretation of the RA. Petition dismissed for lack of merit. Generics Act of 1988 constitutional. RA 6675 secures the
patient the right to choose between the brand name and its generic equivalent since his doctor is allowed to write both the
generic and the brand name in his prescription form. The respondent is implementing the constitutional mandate of the State
“to protect and promote the right to health of the people” and “to make essential goods, health and other social services
available to all the people at affordable cost.
Case: PEOPLE V. CARDENAS, G. R. No. 190342, March 21, 2012
Summary: : After a buy-bust operation in QC, an Information was filed against accused Cipriano Cardena for
violation of Sec.5,Art.II of RA9165 or for selling 0.05g of white crystalline substance containing
methylamphetamine hydrochloride (“shabu”) to a police officer as a poseur-buyer. Defense contends
however, that accused is entitled to an acquittal as the arresting officers did not follow the required
procedure for the handling of seized drugs in a buy-bust operation, particularly that they did not conduct a
physical inventory of the items seized and failed to photograph them in the presence of the accused and
other personalities specified by Sec.21(a), Art.II of the IRR of RA9165. SC DENIED THE APPEAL. It held
that strict compliance with the chain of custody rule is not required. Although the police officers did not
strictly comply with the requirements of Sec.21, the noncompliance did not affect the evidentiary weight
of the drugs seized from the accused, because the chain of custody of the evidence was shown to
be unbroken under the circumstances of the case.
Poisons & Hazardous substances

Sarin - RA 6969 (The Toxic Substances and Hazardous and Nuclear Wastes Act of 1990)
• Colorless, odorless
• Used as a weapon of mass destruction
Alcohol intoxication – RA 10586 (Anti-Drunk and Drugged Driving Act of 2013; took effect 2015)
(e) Driving under the influence of alcohol refers to the act of operating a motor vehicle while the driver’s blood alcohol
concentration level has, after being subjected to a breath analyzer test, reached the level of intoxication, as established jointly
by the Department of Health (DOH), the National Police Commission (NAPOLCOM) and the Department of Transportation and
Communications (DOTC).
(f) Driving under the influence of dangerous drugs and other similar substances refers to the act of operating a motor
vehicle while the driver, after being subjected to a confirmatory test as mandated under Republic Act No. 9165, is found to be
positive for use of any dangerous drug.
(g) Field sobriety tests refer to standardized tests to initially assess and determine intoxication, such as the horizontal
gaze nystagmus, the walk-and-turn, the one-leg stand, and other similar tests as determined jointly by the DOH, the
NAPOLCOM and the DOTC.
(h) Motor vehicle refers to any land transportation vehicle propelled by any power other than muscular power.
Arsenic
• Can come from natural sources in the environment
• Taken through inhalation and ingestion
Lead
• Inhibits/ mimics the action of calcium
Mercury
• Minimata disease - a neurological syndrome caused by severe mercury poisoning. Symptoms include ataxia,
numbness in the hands and feet, general muscle weakness, loss of peripheral vision, and damage to hearing and
speech. In extreme cases, insanity, paralysis, coma, and death follow within weeks of the onset of symptoms. A
congenital form of the disease can also affect fetuses in the womb.
Derivatives of Opium
• Codeine
• Morphine – treatment of acute and chronic pain; pain due to cancer; labor pains; myocardial infarct
o Physical signs
§ blurred vision
§ •double vision
§ •involuntary movement of the eyeball
§ •“pinpoint” pupils
§ •slurred speech
§ •fainting/faintness
§ •uncoordinated muscle movements
§ •tremors or seizures
§ •needle marks (if injecting drugs)
§ •memory loss
o Behavioral signs
§ prescription abuse: needing refills too often for alleged lost or stolen prescription
§ •Multiple providers: seeking prescriptions from different healthcare providers
§ •Changes in social behavior with friends, colleagues and family members
§ •Changes in mood or behaviors, including signs of lying or stealing
o Emotional signs
§ Hallucinations
§ •Exaggerated sense of well-being
§ •Abnormal thinking
§ •Extreme agitation
o Morphine withdrawal symptoms
§ •Aches and pains
§ •Cold- or flu-like symptoms
§ •Gooseflesh
§ •Headaches
§ •Lacrimation (eyes tearing)
§ •Loss of appetite
§ •Mood swings
§ •Nasal discharge
§ •Nausea
§ •Restlessness
§ •Runny nose
§ •Sleeping difficulties
§ •Sweating
§ •Yawning
§ •Strong drug craving (in some cases)
Methamphetamine
• Synthesized from ephedrine
• Chemical name: N-methyl-1-phenylpropan-2-amine Brand names: Pervitin, Anadrex, Methedrine, Syndrox Desoxyn
• Actions
o •increases alertness
o •concentration
o •energy
o •in high doses, can induce euphoria
o •enhance self-esteem
o •increase libido.
• Physical signs
o •anorexia
o •hyperactivity, restlessness
o •dilated pupils
o •flushing, dry mouth
o •headache
o •tachycardia, bradycardia
o •tachypnea
o •hyperthermia
o •diaphoresis, diarrhea, constipation
o •blurred vision, dizziness, twitching
o •insomnia, numbness, palpitations, arrhythmias, tremors •dry and/or itchy skin, acne, pallor
o •convulsions
o •heart attack stroke and death
• Psychological signs
o •euphoria
o •anxiety
o •increased libido
o •alertness, concentration, increased energy
o •increased self-esteem, self-confidence •sociability
o •irritability, aggressiveness
o •psychosomatic disorders
o •psychomotor agitation, dermatillomania,
o •delusions of grandiosity
o •hallucinations
o •excessive feelings of power and invincibility
o •repetitive and obsessive behaviors •paranoia, and with chronic and/or high doses, amphetamine psychosis
can occur
• Withdrawal
o •fatigue, depression
o •increased appetite
o •anxiety, irritability, headaches,
o •agitation
o •akathisia
o •hypersomnia (excessive sleeping)
o •vivid or lucid dreams

o •deep REM sleep and
o •suicidal ideation
Marijuana
• Psychological effects
o Relaxation
o Euphoria
o Alteration in perception of time, color and space
o Short-term memory loss
o Irritability
• Physical effects
o Dry mouth
o Dry eyes
o Bloodshot eyes
o Increased heart rate
Ecstasy (MDMA) - methylenedioxymethamphetamine—a substituted amphetamine drug

• Psychological effects
o A perceived increase in energy levels.
o A euphoric state of being.
o Distorted perception of time.
o Higher pleasure from and desire for physical touch.
o Increased levels of sexuality and sexual arousal.
o Elevated alertness.
o Increased energy and focus.
• Physical effects
o Nausea.
o Muscle cramping.
o Fever.
o Sweating and chills.
o Shaking and tremors.
o Hallucinations.
o Blurred vision.
o Higher heart rate.
o Increase blood pressure.
o Tension in mouth, face, and jaw.
o Feeling faint.
MODULE 13: MEDICAL MALPRACTICE

1. Elements of medical malpractice
• Duty to patient
- to possess knowledge and skill
- to utilize such knowledge and skill with care and diligence
• Dereliction of duty which may be due to:
- violation of law
- negligence
- ignorance
- departure from accepted practice
• Direct (proximate) cause of damage is negligence
- direct physical connection between act (or omission) and injury

- wrongful act (or omission) must be efficient, effective and must not be too remote
- injury must be the natural and probable consequence of the act (or omission)
• Damage sustained
- condition worsens
- diminished chances of recovery (prolonged illness)
- increased suffering
Medical Act of 1959
SEC. 10. Acts constituting practice of medicine.—A person shall be considered as engaged in the practice of
medicine (a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or through another, or even
without the same, physically examine any person, and diagnose, treat, operate or prescribe any remedy for any human
disease, injury, deformity, physical, mental or physical condition or any ailment, real or imaginary, regardless of the nature of
the remedy or treatment administered, prescribed or recommended; or (b) shall, by means of signs, cards, advertisements,
written or printed matter, or through the radio, television or any other means of communication, either offer or undertake by
any means or method to, diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical,
mental or psychical condition; or (c) who shall use the title M.D. after his name.
SEC. 11. Exemptions.—The preceding section shall not be construed to affect (a) any medical student duly enrolled in
an approved medical college or school under training, serving without any professional fee in any government or private
hospital, provided that he renders such service, under the direct supervision and control of a registered physician; (b) any
legally registered dentist engaged exclusively in the practice of dentistry; (c) any duly registered masseur or physiotherapist,
provided that he applies massage or other physical means upon written order or prescription of a duly registered physician, or
provided that such application of massage or physical means shall be limited to physical or muscular development; (d) any
duly registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or other similar appliances or who is
engaged in the mechanical examination of eyes for the purpose of constructing or adjusting eye glasses, spectacles and
lenses; (e) any person who renders any service gratuitously in cases of emergency, or in places where the services of a duly
registered physician, nurse or midwife are not available; (f) any person who administers or recommends any household
remedy as per classification o existing Pharmacy Laws; and (g) any psychologist or mental hygienist in the performance of his
duties, provide such performance is done in conjunction with a duly registered physician.
Duty of physicians to patients – Code of Ethics
Section 1. A physician should be dedicated to provide competent medical care with full professional skill in
accordance with the current standards of care, compassion, independence and respect for human dignity.
Section 2. A physician should be free to choose patients.
Section 3. In an emergency, provided there is no risk to his or her safety, a physician should administer at least first aid
treatment and then refer the patient to the primary physician and/or to a more competent health provider and appropriate
facility if necessary.
Section 4. In serious/difficult cases, or when the circumstances of the patient or the family so demand or justify, the
attending physician should seek the assistance of the appropriate specialist.
Section 5. A physician should exercise good faith and honesty in expressing opinion/s as to the diagnosis, prognosis,
and treatment of a case under his/her care. A physician shall respect the right of the patient to refuse medical treatment.
Timely notice of the worsening of the disease should be given to the patient and/or family. A physician shall not conceal nor
exaggerate the patient’s condition except when it is to the latter’s best interest. A physician shall obtain from the patient a
voluntary informed consent. In case of unconciousness or in a state of mental deficiency the informed consent may be given
by a spouse or immediate relatives and in the absence of both, by the party authorized by an advanced directive of the
patient. Informed consent in the case of minor should be given by the parents or guardian, members of the immediate family
that are of legal age.
Section 6. The physician should hold as sacred and highly confidential whatever may be discovered or learned
pertinent to the patient even after death, except when required in the promotion of justice, safety and public health.
Section 7. Professional fees should be commensurate to the services rendered with due consideration to the patient’s
financial status, nature of the case, time consumed and the professional standing and skill of the physician in the community.
RA 8344: In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer,
and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any
other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or
medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent
death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical
clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient
or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided,
however, That when the patient is unconscious, incapable of giving consent and/ or unaccompanied, the physician can
transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary
emergency treatment and support have been administered to stabilize the patient and after it has been established that such
transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after
being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or
his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on
transfer shall not be construed as a refusal made punishable by this Act.
2. Essential elements to prove malpractice action based upon the doctrine of informed consent:
• duty to disclose material risks
• failure to disclose or inadequately disclosure of those risks
• as a direct and proximate result of the failure to disclose, the patient
• consented to treatment she otherwise would not have consented to; and
• plaintiff was injured by the proposed treatment
3. Doctrines & principles in medical malpractice
A. Doctrine of vicarious liability -The tort doctrine that imposes responsibility upon one person for the failure of another,
with whom the person has a special relationship (such as parent and child, employer and employee, or owner of vehicle and
driver), to exercise such care as a reasonably prudent person would use under similar circumstances
• Ostensible agent doctrine- -person who has been given the appearance of being an employee or acting (an agent)
for another (principal), which would make anyone dealing with the ostensible agent reasonably believe he/she was
an employee or agent.
• Borrowed servant doctrine- An employee (e.g., a nurse) paid by a person or organisation (e.g., a hospital) who is
temporarily responsible to another person (e.g., a surgeon).
• Captain of the ship doctrine- assistants who are under the surgeon's control but who are employees of the hospital.
The surgeon as "the captain of the ship," is directly responsible for an alleged error or act of alleged negligence
because he or she controls and directs the actions of those in assistance. This common law doctrine is often used in
operating room situations
B. Res ipsa loquitur -is a Latin term meaning "the thing speaks for itself". It is a doctrine of law that one is presumed to be
negligent if he/she/it had exclusive control of whatever caused the injury even though there is no happened without
negligence. The traditional elements needed to prove negligence through the doctrine of res ipsa loquitur include:
• The harm would not ordinarily have occurred without someone's negligence
• The instrumentality of the harm was under the exclusive control of the defendant at the time of the likely negligent
act
• The plaintiff did not contribute to the harm by his own negligence.
C. Doctrine of common knowledge -common-knowledge exception is an exception to the requirement of expert

testimony. It is invoked in a situation where the evidence and the circumstances are such that the recognition of the alleged
negligence may be presumed to be within the comprehension of laymen.
D. Doctrine of contributory negligence -a doctrine of common law that if a person was injured in part due to his/her own
negligence (his/her negligence "contributed" to the accident), the injured party would not be entitled to collect any damages
(money) from another party who supposedly caused the accident. The possible unfair results have led some juries to ignore
the rule and, in the past few decades, most states have adopted a comparative negligence test in which the relative
percentages of negligence by each person are used to determine damage recovery.
E. Doctrine of continuing negligence -continuing negligence exception states that if there were repeated acts of
negligence, one or more of which occurred within three years of bringing suit, and if all the negligent acts contributed to the
harm, the medical provider can be held liable for all the negligent acts.
F. Doctrine of assumption of risk -the precept that denotes that a person who knows and comprehends the peril and
voluntarily exposes himself or herself to it, although not negligent in doing so, is regarded as engaging in an ASSUMPTION OF
THE RISK and is precluded from a recovery for an injury ensuing therefrom.
G. Doctrine of last clear chance -provides that if the plaintiff (the party suing for damages) is negligent, that will not matter if
the defendant (the party being sued for damages caused by his/her negligence) could have still avoided the accident by
reasonable care in the final moments (no matter how slight) before the accident.
H. Doctrine of foreseeability -a concept used in tort law to limit the liability of a party to those acts which carry a risk of
foreseeable harm, meaning that a reasonable person would be able to predict or expect the ultimately harmful result of their
actions. Under negligence law, the duty to act reasonably to avoid foreseeable risks of physical injury extends to any person.
I. Fellow servant doctrine -is a common law doctrine that barred or reduced the amount of money an injured employee
could recover against an employer if an injury was caused solely by the negligence of a fellow worker. An injured employee
had to bring a cause for action against the fellow employee causing the injury, not the employer. It absolves an employer from
liability to one engaged in his/her employment for injuries incurred or suffered solely as the result of the negligence,
carelessness, or misconduct of others who are in the service of the employer and who are engaged in the same common or
general employment as the injured employee.
J. Rescue doctrine -the principle that one who has, through her negligence endangered the safety of another can be held
liable for injuries sustained by a third person who attempts to save the imperiled person from injury.
Case: REYES v. SISTERS OF MERCY

Summary: Jorge had a recurring fever with chills. Dr. Rico and Dr. Blanes concluded that Jorge was suffering from Typhoid
Fever and chloromycetin was administered. He was also subjected to several tests. Jorge still died. Petitioners filed an action
for medical malpractice for the wrongful administration of chloromycetin, allegedly causing Jorge’s death. RTC and CA
dismissed the complaint. SC affirmed, stating that petitioners failed to prove that the respondents were negligent.
Doctrine: The standard contemplated for medical practitioners is not what is actually the average merit among all known
practitioners from the best to the worst and from the most to the least experienced, but the reasonable average merit among
the ordinarily good physicians. There is no need to expressly require of doctors the observance of extraordinary diligence.
Garcia-Rueda v. Pacasio
Assumptions
Case: GARCIA-RUEDA v. PASCASIO
Summary: Leonila Garcia-Rueda’s husband underwent a surgical operation at the UST hospital. Six hours after his surgery, the
latter died of complications due to an “unknown cause.” Leonila requested an autopsy from the NBI which recommended that
Dr. Domingo and Dr. Reyes be charged with homicide through reckless imprudence. A series of events ensued during
preliminary investigation – prosecutors inhibiting, re-raffling, etc. Senior State Prosecutor Arrizala issued a resolution
exonerating Dr. Reyes. Garcia-Rueda filed graft charges against the prosecutors with the Ombudsman. Ombudsman dismissed
such for lack of evidence. SC held that the prosecutors are only charged to determine probable cause and are not required to
base their findings on sufficient evidence to procure a conviction – which ultimately is proven during actual trial. The fact that
Garcia-Rueda is able to prove that there exists medical negligence on the part of the attending physicians, does not
automatically warrant a cause of action against the prosecutors under RA 3019. She should have appealed the prosecutor’s
resolutions instead to the Secretary of Justice who would, in turn, resolve the existence of probable cause.
Doctrine: Determination of causation is divided into two inquiries: (1) whether the doctor’s actions in fact caused the harm to
the patient; and (2) whether these were the proximate cause of the patient’s injury. In order to successfully pursue such a
claim, a patient must prove that a health care provided, either (1) failed to do something which a reasonably prudent health
care provider would have done, or (2) that he or she did something that a reasonably prudent provider would not have done;
and that failure or action caused the injury.
In accepting a case, doctors represent that they have the needed training and skill possessed by physicians and surgeons
practicing in the same field, and that they will employ such training, care, and skill in the treatment of their patients. They have
a duty to at least use the same level of care that other reasonably competent doctor would use to treat a condition under the
same circumstances.
Nature of a physician-patient relationship

Case: CAYAO-LASAM v. RAMOLETE
Summary: Due to profuse vaginal bleeding, Editha, then 3 months pregnant, underwent a Dilatation and Curettage Procedure
(D&C), upon advice of and performed by Dr. Fe. She was discharged but was told to return for check-up after 4 days. Editha
only returned 1 ½ months after, due to her suffering from vomiting and severe abdominal pains. She was informed that there
was a dead fetus in her womb; she had to undergo hysterectomy, thus, preventing her from bearing children. Editha and
husband filed a medical malpractice suit against Dr. Fe. Court held that the D&C procedure was not the proximate cause of her
injury; rather, it was Editha’s omission – failure to return for follow-up evaluation as advised. Court noted that expert testimony
is required in medical malpractice cases to determine the reasonable level of care required of doctors, the breach thereof, and
the causation between the negligence and the injury. Such testimony was not presented by Sps. Ramolete.
Doctrine: In a physician-patient relationship, the physician is duty-bound to use at least the same level of care that any
reasonably competent doctor would use to treat a condition under the same circumstances. Proximate cause is that which, in
natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result
would not have occurred.
Case: OSBORNE v. FRAZOR
Summary: Mrs. Effie Frazor filed suit against J.W. Osborne, M.D. but died shortly after. Her children we substituted as plaintiffs.
Effie Frazor suffered from a broken hip and in one of the surgeries performed on her by a specialist, with Osborne’s assistance,
a sponge was left inside. The incision failed to heal and produced pain, foul odor and drainage. It took about eight years before
it was found, and removed. Effie was under Osborne’s care the entire time. The hospital and the surgeon were found not liable
due to prescription. Osborne, however, was found liable for violating his duty of care to Effie Frazor. That he did not refer Effie
Frazor to a specialist for her condition constituted a breach of his duty to her as her physician.
Doctrine: Where a physician sets his own standard of professional competence and testifies that he measured up to that
standard, but the jury finds from other evidence that the physician failed to do that which he himself considered proper and
necessary, the physician cannot complain that the plaintiff has not proven negligence.
Case: JARCIA v. CA
Summary: Belinda Santiago lodged a complaint with the NBI against Dr. Emmanuel Jarcia, Jr. and Dr. Marilou Bastan, for their
alleged neglect of professional duty which caused her son, Roy Alfonso, to suffer serious physical injuries. Upon investigation,
the NBI found that Roy Jr. was hit by a taxicab; that he was rushed to the Manila Doctors Hospital; that an X-ray of the victim’s
ankle was ordered; that the X-ray result showed no fracture as read by Dr. Jarcia; that Dr. Bastan entered the emergency room
and, after conducting her own examination, informed Mrs. Santiago that since it was only the ankle that was hit, there was no
need to examine the upper leg. despite Mrs. Santiago's protest the doctors did not examine the upper portion of the leg of
Roy. 11 days later, Roy Jr. developed fever, swelling of the right leg and misalignment of the right foot; that Mrs. Santiago
brought him back to the hospital; and that the X-ray revealed fractures in the shaft of the bone. SC: there is a physician-patient
relationship in this case since the petitioner obliged themselves and examined the victim, and later assured the mother that
everything was fine and that they could go home. Their assurance that everything is fine deprived the victim of seeking
medical help.
Doctrine: In accepting a case, the physician, for all intents and purposes, represents that he has the needed training and skill
possessed by physicians and surgeons practicing in the same field; and that he will employ such training, care, and skill in the
treatment of the patient. Thus, in treating his patient, a physician is under a duty to exercise that degree of care, skill and
diligence which physicians in the same general neighborhood and in the same general line of practice ordinarily possess and
exercise in like cases. Stated otherwise, the physician has the obligation to use at least the same level of care that any other
reasonably competent physician would use to treat the condition under similar circumstances.”
Duty of a physician
Case: CARILLO v. PEOPLE
Summary: Dr. Leandro Carillo filed a petition for review on certiorari on the decision of the Court of Appeals affirming his
conviction by the RTC of the crime of simple negligence resulting in homicide, for the death of his 13 year old patient
Catherine Acosta after an appendectomy procedure conducted on the patient. SC RULING: Petitioner guilty, considering the
chain of circumstances, including failure to appreciate the serious post-surgery condition of their patient and to monitor her
condition and provide close patient care to her; the low level of care and diligence exhibited by petitioner in failing to correct
Dr. Madrid's prescription of Nubain for post-operative pain; and the extraordinary failure or refusal of petitioner and Dr. Madrid
to inform her parents of her true condition after surgery, in disregard of the requirements of the Code of Medical Ethics.
Doctrine: Simple negligence, penalized under what is now RPC Art. 365, is defined as "a mere lack of prevision in a situation
where either the threatened harm is not immediate or the danger not openly visible." The gravamen of the offense of simple
negligence is the failure to exercise the diligence necessitated or called for the situation which was not immediately life-
destructive but which culminated, in the present case, in the death of a human being 3 days later.
Case: LUCAS v. TUAÑO
Summary: Peter Lucas consulted with Dr. Tuaño for his “sore eyes” which eventually developed into Epidemic Kerato
Conjunctivitis (EKC). Dr. Tuaño prescribed Maxitrol, a steroid-based eye drop, which Peter used until being diagnosed with
glaucoma and losing vision in his right eye. Peter filed a complaint for damages against Dr. Tuaño alleging that as a direct
consequence of prolonged use of Maxitrol, he suffered from steroid-induced glaucoma. The RTC and the CA both dismissed
the case for insufficiency of evidence. The SC affirmed the decision stating that there was absolute failure to present any expert
testimony to establish: (1) the standard of care to be implemented by competent physicians in treating the same condition as
Peter’s under similar circumstances; (2) that, in his treatment, Dr. Tuaño failed in his duty to exercise said standard of care that
any other competent physician would use in treating the same condition as Peter’s under similar circumstances; and (3) that
the damage to Peter’s right eye was the result of his use of Maxitrol,
Doctrine: In treating his patient, a physician is under a duty to the former to exercise that degree of care, skill and diligence
which physicians in the same general neighborhood and in the same general line of practice ordinarily possess and exercise in
like cases. This standard level of care, skill and diligence is a matter best addressed by expert medical testimony, because the
standard of care in a medical malpractice case is a matter peculiarly within the knowledge of experts in the field.
Case: CRUZ v. CA
Summary: Lydia Umali was found to have myoma in her uterus and was scheduled for a hysterectomy operation by Dr.
Ninevetch Cruz. On the day of the operation, her daughter Rowena noticed that the clinic was untidy and advised her mother
not to continue with the operation, but the latter insisted. During the operation, Dr. Ercillo (the anesthesiologist) came out of
the operating room to instruct the family to buy Tagamet ampules and later on, blood. Lydia had to be transferred to San
Pablo District Hospital so that she could be connected to a respirator. Upon getting there, she was reoperated on but she
could no longer be saved. Death certificate indicated that the immediate cause of death was shock, while the antecedent
cause was DIC or Disseminated Intravascular Coagulation. A criminal charge for reckless imprudence resulting in homicide was
filed against Dr. Cruz and Dr. Ercillo. Lower courts acquitted Dr. Ercillo but convicted Dr. Cruz. SC acquitted her from the
criminal liability but imposed on her civil liability.
Doctrine: Expert testimony is essential to establish 2 aspects in a medical malpractice suit: 1.) Standard of care of the profession
but also that the physician's conduct in the treatment and care falls below such standard; 2.) To support conclusion as to
causation.
Case: RAMOS v. CA
Summary: Erlinda underwent a surgery to remove a stone in her gall bladder. The surgeon was 3 hours late for the scheduled
time of operation. Upon intubation, her sister-in- law heard the anesthesiologist utter: “Ang hirap ma-intubate nito, mali yata
ang pagkakapasok. O lumalaki ang tiyan.” Cruz noticed a bluish discoloration of Erlinda’s nail beds on her left hand. Erlinda
stayed in the ICU for a month. She was released from the hospital only four months. Since the ill-fated operation, Erlinda
remained comatose condition until she died.SC: Dr. Gutierrez, anesthesiologist is liable under res ipsa loquitor, while surgeon
liable under captain of the ship doctrine; DLSMC not liable since no employer-employee relationship between doctor and
hospital.
Doctrine: A hospital does not hire or engage the services of a consultant, but rather, accredits the latter and grants him or her
the privilege of maintaining a clinic and/or admitting patients in the hospital upon a showing by the consultant that he or she
possesses the necessary qualifications, such as accreditation by the appropriate board, evidence of fellowship and references.
It is not the hospital but the patient who pays the consultant’s fee for services rendered by the latter. A hospital does not
dismiss a consultant; instead, the latter may lose his or her accreditation or privileges granted by the hospital.
Negligence per se
Case: AÑONUEVO v. CA
Summary: Añonuevo, while driving, collided with Villagracia, who was on his bike at an intersection. RTC and CA: in favor of
Villagracia. Añonuevo argued that Villagracia violated a municipal ordinance by not registering his vehicle with the Municipal
Treasurer and that the bicycle had no safety gadgets such as a horn or bell, or headlights. Applying Art 2185, which presumes
the driver of a motor vehicle negligent if he was violating a traffic regulation at the time of the mishap, should apply by
analogy to non-motorized vehicles, Villagracia should be the one negligent. The SC affirmed RTC and CA. Añonuevo admitted
having seen Villagracia from 10 m away, thus he could not claim having insufficient warning. The fact that Añonuevo was
recklessly speeding as he made the turn meant that even if the bicycle had been equipped with brakes, the cyclist would not
have had time to brake in time to avoid the car. It was incumbent on Añonuevo to have established that Villagracia’s failure to
have installed the proper brakes contributed to his own injury. Añonuevo had the burden of clearly proving that the alleged
negligence of Villagracia was the proximate or contributory cause of the latter’s injury.
Doctrine: The general rule of negligence per se is that violation of a statutory duty constitutes negligence as a matter of law or
negligence per se. However, the doctrine should not be rendered inflexible so as to deny relief when in fact there is no causal
relation between the statutory violation and the injury sustained. Negligence per se, arising from the mere violation of a traffic
statute, need not be sufficient in itself in establishing liability for damages. He must show that the violation of the statute was
the proximate or legal cause of the injury or that it substantially contributed thereto.
Case: GARCIA v. SALVADOR
Summary: The Community Diagnostic Center conducted a Hepatitis B Surface Antigen test on Salvador for her work at a
company. CDC erroneously indicated in her test result she was reactive. This caused her employment to be terminated and
her father to suffer a heart attack from the news. When she had gotten several HBs Ag tests done again, the results came out
negative. She was rehired and she subsequently filed a complaint for damages, along with her father, against Garcia, (the
medtech), and Castro (pathologist). The SC held Garcia liable for damages by virtue of CC Art. 20, ruling that all the elements of
actionable conduct are present in the case.
Doctrine: Test of the existence of negligence: did the health care provider either fail to do something which a reasonably
prudent health care provider would have done, or that he or she did something that a reasonably prudent health care
provider would not have done; and that failure or action caused injury to the patient; if yes, then he is guilty of negligence.
Elements of an actionable conduct: duty, breach, injury, and proximate causation.
Case: PROFESSIONAL SERVICES v. AGANA
Summary: The Aganas filed a case against Professional Services (owner of Medical City) and its physicians Dr. Ampil and Dr.
Fuentes from the injury suffered by Natividad Agana resulting from pieces of gauze left in her body after an operation. Dr.
Ampil was her lead surgeon while Dr. Fuentes was merely requested by him to perform a hysterectomy. Subsequently,
Natividad experienced excruciating pains in her anal region and found 2 gauzes in the area where the surgery was performed.
Removal of the 2nd gauze necessitated surgery since the area where it was left became severely infected. RTC: All of them are
liable. SC: Only Dr. Ampil and PSI are liable. Dr. Fuentes cannot be held liable as there was no evidence to show he was the one
who left the gauzes and that he knew of it but failed to inform the patient. Res ipsa loquitur does not apply as the element of
control and management is lacking. Dr. Ampil is guilty of medical negligence. PSI is liable under CC Art. 2180 under the
principle of respondeat superior. PSI’s liability is also anchored upon the agency principle of apparent authority or agency by
estoppel and the doctrine of corporate negligence.
Doctrine: Present day hospitals are increasingly taking active role in supplying and regulating medical care to patients. Hence,
there is no reason to exempt hospitals from the universal rule of respondeat superior. According to Ramos v. CA, an employer-
employee relationship in effect exists between hospitals and their attending and visiting physicians.
Captain of the ship

Case: A v. B
Summary: Plaintiff parents filed an action against defendant physician after her child was partially blinded by use of excess
silver nitrate by a hospital intern. At the end of the parent’s case, the Court of Common Pleas (Pennsylvania) entered a nonsuit
and the parent challenged that decision. The SC of Pennsylvania held the court erred in entering a nonsuit. It is for the jury to
decide whether the relationship between the physician and intern, at the time the child’s eyes were injured, was that of
master and servant.
Doctrine: Following the “captain of the ship” principle in surgeries, if it is shown that a doctor had supervisory control and the
right to give orders to the intern in regard to the very act in the performance of which the intern was negligent, it would
follow, according to the classical test of agency, that a jury would be justified in concluding that the temporary relationship
between doctor and the intern was that of master and servant, and that consequently a doctor is legally liable for the harm
caused by any negligence on the part of the intern.
Case: CANTRE v. SPS. GO
Summary: Nora Go gave birth to her 4th child. Later, she suffered profuse bleeding inside her womb due to some placenta
parts which were not completely expelled after delivery. Her BP dropped. Dr. Cantre, her attending physician performed
procedures to stop the bleeding and to restore Nora's BP. While Dr. Cantre was massaging Nora's uterus, she ordered a
droplight to warm Nora and her baby. At that time, she was unconscious. Nora's husband noticed a fresh gaping wound in the
inner portion of Nora’s left arm. Cantre said that what caused the injury was the BP cuff. John David brought Nora to the NBI
for a physical exam. The medico-legal said the injury appeared to be a burn. Sps. Go filed a complaint for damages against Dr.
Cantre. SC: affirmed CA, stating that the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a
presumption of negligence on the part of the person who controls the instrument causing the injury.
Doctrine: The doctrine of res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the
part of the person who controls the instrument causing the injury, provided that the following requisites concur: accident is of
a kind which ordinarily does not occur absent someone's negligence; caused by an instrumentality within defendant's
exclusive control; possibility of contributing conduct which would make plaintiff responsible is eliminated.
Borrowed servant doctrine

Case: DAVIS v. GLAZE
Summary: Kory, infant son of Kirby and Deborah Glaze, was severely burned as the result of the malfunction of an
electrocautery grounding pad during the course of a tonsillectomy-adenoidectomy performed by Edwin Davis in facilities
owned and operated by appellant Clayton County Hospital Authority. The evidence showed that the pad was placed on Kory’s
thigh and it malfunctioned due to a defect in the product; and that the malfunction of the grounding pad, allegedly in
combination with negligent acts or omissions on the part of Davis or the hospital or its agents, was the proximate cause of the
injury. His parents brought a malpractice suit against Davis and the hospital, and an action for negligence and products liability
against MPI Davis (pad manufacturer) while the Hospital Authority cross-claimed against MPI for indemnity on the theory of
passive active negligence.
Doctrine: The "borrowed servant" doctrine provides that, once the surgeon enters the operating room and takes charge of the
proceedings, the acts or omissions of operating room personnel, and any negligence associated with such acts or omissions,
are imputable to the surgeon.
Case: NOGALES v. CAPITOL MEDICAL CENTER
Summary: Corazon, who was pregnant, was under the care of Dr. Estrada. She was found to have an increase of blood pressure
and development of leg edema indicating preeclampsia, which made her pregnancy dangerous. Upon labor, Dr. Estrada
advised that she be admitted to CMC so he can properly perform the surgery. During the operation, Corazon died. Dr. Estrada
misapplied the forceps in causing the delivery, which resulted in a large cervical tear causing the profuse bleeding. He also
failed to control the application of injection of magnesium sulfate by his assistant. Also failed to notice the erroneous
administration by the nurse of hemacel by way of side drip, instead of direct intravenous injection. SC ruled that CMC is liable
for Dr. Estrada’s actions based on the doctrine of apparent authority.
Doctrine: This case falls under an exception to the general rule that applies when hospitals hire independent contractor-
physicians. As a general rule, the hospital is not liable for the negligence of an independent contractor-physician. The
exception is that a hospital may be held liable if the physician is its “ostensible” agent, which is also known as the “doctrine of
apparent authority”, which has two factors: 1) Manifestations - hospital’s manifestations which would lead a reasonable person
to conclude that the negligent party was an employee or agent of the hospital. This manifestation may be express or implied;
2) Reliance - patient’s reliance on the conduct of the hospital or its agent.
Case: YBARRA v. SPANGARD
Summary: Ybarra was diagnosed with appendicitis. He underwent surgery where he was under anesthesia and was
unconscious. After the operation, he felt a sharp pain about half way between the neck and the point of the right shoulder. He
was unable to rotate or lift his arm, and developed paralysis and atrophy of the muscles around the shoulder. Upon
examination by other doctors, they found that the pain was caused by paralysis of traumatic origin, not arising from
pathological causes, and not systemic. SC: held that res ipsa loquitur applies in this case and that the attending physician and
other defendants are liable.
Doctrine: Res Ipsa Loquitur has three conditions: (1) the accident must be of a kind which ordinarily does not occur in the
absence of someone's negligence; (2) it must be caused by an agency or instrumentality within the exclusive control of the
defendant; (3) it must not have been due to any voluntary action or contribution on the part of the plaintiff. Where a plaintiff
receives unusual injuries while unconscious and in the course of medical treatment, all those defendants who had any control
over his body or the instrumentalities which might have caused the injuries may properly be called upon to meet the
inference of negligence by giving an explanation of their conduct.
Proximate causation
Case: OCEAN BUILDERS v. SPS. CUBACUB
Summary: Bladimir, a maintenance man at Ocean Builders, contracted chicken pox and later died due to complications. His
parents sued the GM, Hao. RTC held that Hao was not negligent. CA reversed. SC upheld RTC, holding that Hao observed the
standard required by law in instructing Bladimir to rest for 3 days and in having him brought to the nearest hospital. The
alleged negligence of Hao cannot be considered the proximate cause of Bladimir’s death.
Doctrine: Proximate cause is that which, in natural and continuous sequence, unbroken by an efficient intervening cause,
produces injury, and without which, the result would not have occurred. An injury or damage is proximately caused by an act
or failure to act, whenever it appears from the evidence in the case that the act or omission played a substantial part in
bringing about or actually causing the injury or damage, and that the injury or damage was either a direct result or a
reasonably probable consequence of the act or omission
Hospital facilities
Case: MANILA DOCTORS HOSPITAL v. SO UN CHUA
Summary: So Un Chua (mother of Vicky Ty), and Judith (sister of Vicky), were confined. Judith was discharged, but So Un Chua
remained in confinement even though there were no serious findings by the doctors necessitating her stay. The hospital bill
was only partially paid and still kept accumulating so the hospital removed facilities like the air conditioning, changed
beddings late and delivered food late. Respondents allege that this caused the condition of So Un Chua to deteriorate, giving
her hypertension and bed sores. RTC and CA: in favor of So Un Chua. SC reversed, saying that the facilities were non-essential. If
found to not cause any negative effect on the patient, hospitals can remove them as a cost-cutting measure.
Doctrine: Operation of private pay hospitals and medical clinics is impressed with public interest, but is also a business with a
right to institute all measures of efficiency commensurate to ends for which it is designed, especially to ensure economic
viability and survival. In the institution of cost-cutting measures, the hospital has a right to reduce the facilities and services
that are deemed to be non-essential, such that their reduction or removal would not be detrimental to the medical condition
of the patient.
MODULE 14: DEATH AND DYING

Legal definition (RA 7170)- "Death" - the irreversible cessation of circulatory and respiratory functions or the irreversible
cessation of all functions of the entire brain, including the brain stem. A person shall be medically and legally dead if either:
(1) In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of
natural respiratory and cardiac functions and, attempts at resuscitation would not be successful in restoring those functions. In
this case, death shall be deemed to have occurred at the time these functions ceased; or
(2) In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable
standards of medical practice, there is an irreversible cessation of all brain functions; and considering the absence of such
functions, further attempts at resuscitation or continued supportive maintenance would not be successful in resorting such
natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared. The
death of the person shall be determined in accordance with the acceptable standards of medical practice and shall be
diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately
qualified and suitably experienced in the care of such parties. The death shall be recorded in the patient's medical record.
Cardiac arrest
• the cessation of circulation of the blood due to failure of the heart to contract effectively (as evidenced by the
absence of a palpable pulse)
• a medical emergency that, in certain situations, is potentially reversible if treated early
• Cardiac causes ·
o 60-70% of sudden cardiac death ·
o coronary heart disease ·
o myocardial infarction (heart attack) ·
o congestive heart disease
• Non-Cardiac causes ·
o trauma ·
o internal hemorrhage
Respiratory arrest
• cessation of breathing due to the failure of the lungs to function effectively
• Causes
o · chemical (e.g., drug overdose) ·
o physical (e.g., head injury) · infection (e.g., tetanus) ·

o lack of oxygen (e.g., drowning, suffocation)
Brain death
Brain functions: · CerebralCortex

o Grey and white matter
o Directly or indirectly in charge of ALL neurological functions · ReticularActivatingSystem
o Arousal
o Sleep-wake cycle · (Injury to both will result in coma)
Legal definition (Brain death)-

· irreversible cessation of all functions of the entire brain, including the brain stem
· determination by the attending physician and consulting physician
· using acceptable standards of medical practice · opinion that further resuscitation attempt or continued
supportive maintenance would not be successful to restore natural functions
Causes
· traumatic head injury
· brain hemorrhage
· lack of oxygen
· cardio-respiratory arrest
2. States of consciousness
Fully conscious
Minimally conscious state

· Unable to communicate their thoughts and feelings
· Demonstrate inconsistent but reproducible behavioral evidence awareness of self or environment
· Like the vegetative state, the minimally conscious state may be chronic and sometimes permanent
· At present, no time intervals for “permanent minimally conscious state” have been agreed upon
Diagnostic Criteria
Purposeful behavior (including movements or affective behavior that occur in contingent relation to relevant
environmental stimuli and are not due to reflexive activity) such as:
· Pursuit eye movement or sustained fixation in direct response to stimuli
· Smiling or crying in response to verbal/visual stimuli · Reachingforobjects
· Touching objects in a matter that accommodates size/shape of object
· Vocalizations/gestures in response to questions
• Following command
• Gestural or verbal yes/no response (regardless of accuracy)
• Intelligible verbalization
• Emergence from MCS is signaled by the return of functional communication for object use
Vegetative state
· Patient awake but no sign of cognition/awareness
· Lasts longer than a few weeks
· Can open eyelids
· May have sleep-wake cycle
· No response from environmental stimuli
Diagnostic Criteria
• No evidence of awareness of self or environment and an inability to interact with others
• No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory,
tactile, or noxious stimuli
• Presence of sleep-wake cycles
• Sufficiently preserved hypothalamic and brainstem autonomic functions to permit survival with medical and
nursing care
• Bowel and bladder incontinence
• Variably preserved cranial-nerve and spinal reflexes
Persistent vegetative state

United States
· after 4 weeks under vegetative state
· may apply to court for discontinuance of artificial support · need to prove by medical opinion that the recovery is impossible
United Kingdom
· after the lapse of 1 year
· considered as “permanent” vegetative state (UK) · a presumption exists that recovery is impossible so no need to prove
impossibility of recovery · only the diagnosis of the attending physician that the condition persisted for at least or over a year
is necessary to discontinue further life support without legal liability
Locked-in syndrome
· awake &conscious
· no means of producing speech, limb or facial movements
· superficially resembling a vegetative state
· if stable & given proper medical care, life expectancy now is several decades
· preserved intellectual capacities
Categories:
· Classical- quadriplegia & anarthia w/ eye-coded communication
· Incomplete- remnants of voluntary responsiveness other than eye movement
· Total- complete immobility including all eye movements w/ preserved consciousness
• Etiology- damage to specific portions of the lower brain and brainstem, with no damage to the upper brain.
• Within 4 months, 90% die
Diagnostic criteria
• · Presence of sustained eye opening (bilateral ptosis should be ruled out as a complicating factor)
• · Aphonia or hypophonia
• · Quadriplegia or quadriparesis
• · Primary mode of communication that uses vertical or lateral eye movement or blinking of the upper eyelid to signal
yes/no responses · Preserved awareness of the environment
Causes
· stroke or brain hemorrhage usually of the basilar artery
· traumatic brain injury
· drug or medication overdose
· Amyotrophic lateral sclerosis aka Lou Gehrig's disease
· Multiple sclerosis
Coma
· Means “deep sleep”
· A state of unconsciousness; lacks awareness
· Person cannot be awakened; lacks wakefulness
· Lacks normal sleep-wake cycle
· Fails to respond normally to painful stimuli, light or sound
· Does not initiate voluntary actions 2.4.4.1. Diagnostic criteria
· absence of eye-opening on intense stimulation
· no evidence of awareness of self or environment
· at least (6) hours 2.4.4.1. Causes
· drug poisoning (40%)
· lack of oxygen due to cardiac arrest (25%)
· stroke (20%)
· trauma, excessive blood loss, malnutrition, hypothermia, hyperthermia, abnormal glucose levels, and many other
biological disorders (15%)
Comparison
Vegetative State Coma
· Somehow awake · Not awake
· With sleep-wake cycle · No sleep-wake cycle
· Can open eyelids · Cannot open eyelids
· May respond to loud sound · Do not respond to stimuli
3- the deepest levl of coma; total unresponsiveness 3 to 8- severe injury (Vegetative State) 9- not in a coma, but not full alert
(Minimally Conscious State) 9 to12- moderate injury 13 to 15- mild brain injury (or loss of consciousness for fewer than 20
mins.) 15- full consciousness
Death-related phenomena
Cadaveric spasm
· AKA postmortem spasm, instantaneous rigor, cataleptic rigidity, or instantaneous rigidity
· Rare form of muscular stiffening that occurs at the moment of death, persists into the period of rigor mortis
· Usually associated w/ violent deaths happening under extremely physical circumstances w/ intense emotion
· May affect all muscles in the body, but typically only groups, like forearms or hands
· Often crystallizes the last activity one did prior to death, like clutching grass of drowned victim, or holding knife
tightly
Comparison
Cadaveric Spasm Rigor Mortis
· Instantaneous · 2-3 hrs after death up to 12-24 hrs
· Strong intensity · Moderate intensity
· Predisposing factors: fear, fatigue, muscle contraction at time of death · Breakdown of ATP below critical levels
· Selected muscles · All muscles affected
Lazarus sign- a reflex movement in brain-dead or brainstem failure patients which causes them to briefly raise their arms and
drop them crossed on their chests (like Egyptian mummies)
Near-death experiences- refers to personal experiences associated with impending death, involving sensations including
detachment from the body, feelings of levitation, total serenity, security, warmth, the experience of absolute dissolution, and
the presence of a light. These have been hypothesized in medical journals as having the characteristics of hallucinations.
Time of death
Methods for estimating the time of death
· Body temperature
· Rigor mortis
· Physical changes in eyeballs
· Skin color
· Livor mortis
· Food digestion in digestive system
· Forensic entomology (based on which insects are present/their stage of development)
· Decay
Post-mortem changes and decomposition
Pallor mortis
· a post mortem paleness
· evident in those with light skin almost instantly
· occurs 15–20 minutes after the death
· due to lack of capillary circulation throughout the body
Algor mortis
· the most useful single indicator of the time of death during the first 24 hours post-mortem.
· the cooling of a human body is best represented by a sigmoid curve when temperature is plotted against time.
· there is an initial maintenance of body temperature which may last for some hours - the so-called "temperature plateau”
which may last from 1⁄ to 3-5 hours
· followed by a relatively linear rate of cooling which subsequently slows rapidly as the body approaches the environmental
temperature.
Affected by:
· size of the body – the bigger the body, the slower the cooling; the greater surface area relative to its mass, the faster the
cooling
· clothing & covering – slows cooling
· movement of air – more air movement, more rapid cooling
· humidity – more humid, more rapid cooling
· immersion in water – cooling is faster
Rigor mortis
· Caused by chemical changes in the muscles after death, causing limbs to stiffen
· All muscles in the body are affected.
· 2-6 hours - begins with the eyelids, neck, and jaw.
· 6-12 hours - spreads to the other muscles including the internal organs
· affected by the individual's age, sex, physical condition, and muscular build
· may not be perceivable in many infant and child corpses due to their smaller muscle mass
· may be used to estimate the time of death
· ambient temperature affects the length of time from onset
· position of corpse at time of death
Livor mortis
· settling of the blood in the lower (dependent) portion of the body
· causing a purplish red discoloration of the skin
· when the heart is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity.
· Intensity of color depends upon the amount of reduced hemoglobin in the blood.
· does not occur in the areas of the body that are in contact with the ground or another object, as the capillaries are
compressed
· As the vessel wall become permeable due to decomposition, blood leaks through them and stains the tissue. This is
the reason for fixation of hypostasis.
Putrefaction
· decomposition of proteins
· accelerated by anaerobic microorganisms found in the gastrointestinal tract
· broken down proteins excreted by the bacteria into gases and amines such as putrescine and cadaverine.
· gases leads to bloating
Skeletonization
· last stage of decomposition where last vestiges of soft tissues have decayed or dried exposing the skeleton
· by the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones
· acids in the soil destroys the bone
Case: RAMOS v. CA (1999)

Summary: (gall bladder stone case; botched intubation)
Doctrine: Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of cyanosis. As stated in the testimony
of Dr. Hosaka, the lack of oxygen became apparent only after he noticed that the nailbeds of Erlinda were already blue.[67]
However, private respondents contend that a second intubation was executed on Erlinda and this one was successfully done.
We do not think so. No evidence exists on record, beyond private respondents' bare claims, which supports the contention
that the second intubation was successful. Assuming that the endotracheal tube finally found its way into the proper orifice of
the trachea, the same gave no guarantee of oxygen delivery, the hallmark of a successful intubation. In fact, cyanosis was again
observed immediately after the second intubation. Proceeding from this event (cyanosis), it could not be claimed, as private
respondents insist, that the second intubation was accomplished. Even granting that the tube was successfully inserted during
the second attempt, it was obviously too late. As aptly explained by the trial court, Erlinda already suffered brain damage as a
result of the inadequate oxygenation of her brain for about four to five minutes.
Case: PEOPLE v. OLIVA (1999)
Summary: Avelino Manguba was sleeping with his family inside his house. When he went out to urinate, he saw the accused
Ferigel Oliva setting his house on fire. They called their neighbors to help while Ferigel was watching from a distance as the
fire razed Avelino’s house. When the neighbors including Benjamin Estrellon helped put out the fire, Ferigel shot Benjamin
which caused his death. There were several eyewitnesses to the crime so Ferigel and three others were charged with arson
and murder. While in custody of the police as a detention prisoner, Ferigel escaped and was apprehended only after 6 months.
The trial court convicted Ferigel but acquitted the three others. The SC affirmed this decision.
Doctrine/Medical Findings: Proof of corpus delicti is indispensable in prosecutions for felonies and offenses. Corpus delicti is
the body or substance of the crime. It refers to the fact that a crime has been actually committed. Corpus delicti is the fact of
the commission of the crime that may be proved by the testimonies of witnesses. In murder, the fact of death is the corpus
delicti. In arson, the corpus delicti rule is satisfied by proof of the bare occurrence of the fire and of its having been
intentionally caused. The uncorroborated testimony of a single eyewitness, if credible, may be enough to prove the corpus
delicti and to warrant conviction.Indemnity may be awarded without need of further proof other than the death of the victim.

C2017 Med Jur Finals Reviewer

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

C2017 Med Jur Finals Reviewer

Caricato da

Copyright:

Formati disponibili

MEDICAL

Module 8: Child Abuse p. 1

MODULE 8: CHILD ABUSE

Anatomy and physiology of the breast

Expanded Breastfeeding Promotion Act of 2009 (RA 10028)

WHO: 10 Facts on Breastfeeding

6. HIV and breastfeeding

7. Regulating breast-milk substitutes

4. no distribution of free or subsidized substitutes to health workers or facilities.

Men Can Lactate

2. Infant & childhood injuries and deaths

Note: Neonaticide is not a legal term; it is used for medical

Case: PEOPLE v. MORALES, G.R. No. L-44096 April 20, 1983.

RA 7610 Anti-Child Abuse Law

Case: SANCHEZ v. PEOPLE, G.R. No. 179090, June 5, 2009

Anti-Child Pornography Law & IRR

Anti-Bullying Law & IRR

Shaken Baby Syndrome

Effects of Child Abuse

MODULE 9: PHYSICAL INJURIES

Type of wounds based on skin integrity

WOUNDING AGENTS TYPE OF WOUNDS

i.e. Suicide Injuries

i.e. Back of hands

Palms and fingers

Outer part of thigh

• Caused by tearing of tissues (e.g., barb wires, saw)

i.e. Right Ocular Lacerations

i.e. leg lacerations

i.e. barb-wire lacerations

4. Stab wounds, puncture

• Length (depth) usually greater than width (diameter)

• Infection may go deeper

i.e. Single blade

Double edge knife

Back stab wound

5. Gunshot wounds (GSW)

assault and hunting rifles

• velocity > 1500 ft / s

• Hard Contact Gunshot Wound

• Near contact GSW

• Oblique GSW entrance

Distant GSW high velocity rifle

Intermediary target effect

• Bullets contain numerous pellets

Buckshot superficial perforating

• Usually more irregular in shape than entry wounds

Exit wound (High velocity rifle)

Lead snowstorm Pattern

Bullet wipe on clothing

Case: PEOPLE v. MAYINGQUE, G.R.No. 179709, July 6, 2010

Case: PEOPLE v. REFORMA, G.R. No. 133440, June 7, 2004

Major Arteries and Veins

MODULE 10: GENDER AND SEXUALITY

Legal implications of gender

Dictionary definition of “male”

Cryptochirdism – absence of one or both testes from the scrotum.

• parents' exposure to some pesticides

Case: PEOPLE v. CAGANDAHAN, G.R.No. 166676, September 12, 2008

MIXED GONADAL DYSGENESIS

MODULE 11: INSANITY AND PSYCHOLOGICAL INCAPACITY

1. Brain Anatomy and function

The brain is made up of many specialized areas that work together: