Legal Medicine Flashcards
Medical jurisprudence
Laws, rules and doctrines, legal opinions of the authority regarding the governance and regulation of the practice of medicine
The practice of medicine is a right or privilege?
Privilege
Law that governs the medical prac in the Philippines?
Medical act of 1959; as amended.
Natural law :
Divine law :
Moral law :
- Rational thinking
- 10 commandments
- Conscience
Substantive law:
Procedural law:
- Rights and obligations ofpeople in their daily lives between each other and society
- Substantive rights and duties are enforced: litigation criminal.
Public Law
Private Law
- Between state and subjecet; state’s political and sovereign capacity
- Relationship between 2 individuals.
Practice of medicine is based on the _________ power of the state
- Police
The govt should be able to protect the citizens from stupid doctors.
The nature of the contract between patient and physician consensual and fiduciary.
Meaning?
- Consensual: both consent to it
2. Fiduciary: based on trust and confidence.
Types of contractual relationships
- Expressed
- Implied contract
- Expressed: oral OR writing
2. Inferred (patient at doctors clinic, unconscious in ER)
The contract is “commenced” when?
- Invitation of physician
- Patient agrees
- Physician treats
Special NO RELATIONSHIP
- Pre employment PE
- Eligibility of insurance
- MD appointed by court to examine
- Surgeon performing autopsy
- Casual questions asked
Patterns of relationship
- Activity passivity
- Guided cooperation
- Mutual participation
- All doctor no input from patient
- Patient fully cooperates with doctor
- Equal, jammy/unsympathetic
Duties in the physician patient relationship
- Average MD knowledge
- Ordinary care and diligence
- Best judgment
- Utmost good faith
Duties of a patient
- Honest medical history
- Cooperate follow the instructions of the doctor
- Give feedback on the treatment
- State if he understands the treatemtn
- Exercise prudence of an ordinary patient
INHERENT Rights of a physician
- To choose patients WAIVED if in an emergency: loss to life and limb
- Limit the field of practice
- Determine appropriate management
- Avail of hospital services: clinic vs hospital; private vs public
INCIDENTAL rights
- Right of way
- Exemption from execution of instruments and library
- Hold public or private offices
- Right to compensation
- Right to membership in medical societies.
Unethical fees include
- Contingent fee
- Dichotomous fee/ splitting/ commission
- Pakyaw / straight fee
- Depends on success of treatment
- Self explanatory
- “Packages”: unethical bec if its not part of the package then you might not be able to give it
Legal age
Solis :
Family code of 1988:
- 16M 14F
2. 18
Criminal liability (revised penal code; article 365)
A crime is commited when?
- Deliberate harm
- Negligence
- Imprudence
- Lack of foresight
- Lack of skill
Burden of proof
- Criminal
- Civil
- Administrative
- Guilt beyond reasonable doubt
- Preponderance of evidence
- Substantial evidence / preponderance
Doctrine of vicarious liability
Employer-employee relationship: employer is liable also
Doctrine of ostensible agent
- Pathologist, radiologist and anes were chosen by the hospital; hospital still liable
- Doctor and hospital is liable
Borrowed servant doctrine
- MDs “borrow” the employees of the hospital;
- Resident does bubu; resident loses license; AP still pays.
- Happens
Captain of the ship doctrine
- Head surgeon is always liable: pay
1. Surgeon Chose his team.
Doctrine of Res Ipsa Loquitur
“Common knowledge”
Ex. Foreing bodies left inside after OR, cut off wrong leg
- Negligence occured
- Third party could not have caused the injury
- Duty to patient.
Doctrine of contributory negligence (doctrine of common fault)
- On the side of the patient; its his fault
2. Patient fails to fulfill his duties as a patient
Doctrine of continuing negligence
- Failes to do anything after even after seeing clear evidence something has to be done
- Ex.
Doctrine of last clear chance
Is criminally punishable
You fail to prevent the harm,
Doctrine of foreseeability
If patient is a known case of ______, doctor is held liable for not being able to safeguard him/her regarding the possible risks of that condition
Fellow servant doctrine
Hospital is not liable for damages towards an employee by another employee
Rescue doctrine
If a doctor is injured in helping a patient in an accident and is hit by another car; the doer of the initial accident is held liable.
Independent contract theory
If resident kills a patient: he loses license, gets jailed
AP still pays
Trust fund doctrine
All donations are earmarked for that certain charity ONLY
Implied waiver theory
Charity vs private cases are treated differently
Moral damages: are physical/psychological etc injuries caused by an ACT.
Award of damages are based on article _____ of the civil code
Article 2219 of the civil code
- Perdiem method: estimate the value
- Golden rule method: judge determines
Exemplary / corrective damages
Monetary compensation to add insult to the guilty so that others will not follow suit.
Patient rights
- Consent to treatment
- Right to religious beliefs
- Right of privacy
- Right to disclosure of information
- Confidential information
- Choose MD
- Right to treatment
- Refuse necessary treatment
Consent may not be necessary when it is implied / compulsory
(X2 examples)
- Emergency cases
2. Mandated by law
Full disclosure may not be necessary?
- Disclosure may cause upset to patient (child needs to be sutured)
- Medical procedure is publicly known to be safe.
Parts of written consent
- Name of MD
- Nature and extent of procedure
- Understandable language
- Allowed treatment
- Signature of patient and witness
Who can give consent?
- Patient > spouse > legal children > paternal parents
- Emancipated minor
A. Marriage, majority, concession of parents. - Minors under special circumstances if it will redound to life and death
Emancipation is revocable or irrevocable
Irrevocable
The right of consortium is the basis behind asking a spouse’s consent for procedures that will impair?
- Sexual function
2. Products of conception
Patient, doctors, students are what kind of persons in the hospital?
1.
Invitee or business visitors
For consent to be valid:
- Autonomous
- Legal
- Volunatary
- Informed
Justifiable grounds to refuse admission
- Full
- Chronically ill
- Only needs convalescent care
- Contagious
RA 4226
Hospital licensure act: hospital can be used by their MDs to treat to patients in danger of death or emergency
RA 6615
Licensed medical shiz should extend medical assistance in an emergency.
Medical records can be disclosed…
- Patient request
- Birth certificate, death certificate, immunization certificate, communicable disease
- Upon order of court.
Privileged communication
X5
- Husband and wife
- Lawyer/ staff of lawyer
- Person authorized to “practice” medicine
- Minister or priest
- Anything the. Govt official learns during time in office.
Who can become an ordinary witness?
- Must have the organ and power of perception
- Perception can be imparted to others
3.
Persons not disqualified from being witnesses
- Persons interested in the outcome of the case
- Criminals
- Religious views
Persons who cannot be a witness on acount of physical disqualifications
- Unsound of mind
2. Children of tender age and inferior capacity
Leading questions are allowed
- On cross examination
- Preliminary matters
- When its hard to get direct answers from witness
- Hostile witness
- Is speaking on behalf of a corporation
Misleading questions are not allowed becuase
- It assumes a fact which is not yet true.
Dying declaration vs hearsay
- Hearsay is not admisisble
2. Dying declaration can be admissible
Dying declaration is admissible if
- It concerns the cause and circumstances regarding why he is being put to death
- He knew he is being put to death
- Competent witness
- Criminal case: homicide, murder, paricide when the declarant is the victime
Subpoena ad testificandum
Subpoena duces tecum
- Testiomony
2. Documents
Qualifications board of medicine
- Natural born citizen
- Duly registered MD in the PHIL
- In practice for at least 10 years
- Good moral character
- Not a member of the faculty of any medical school and has no interest in any institution
Ignorantia legis nominem excusat
Ignorance of teh law excuses no one from compliance therewith
Conclusive test for teh presence of semen.
Acid phosphatase test
Test if the semen is human or not
Precipitin test.
Simple vs qualified seduction
Seduction
- Sexual intercourse via deceit
- > 12 <18
Simple: not a virgin
Qualified: virgin + perosn of “authority”
Forcible vs consented abduction
Abduction: carrying away of a women with lewd design
Forcible: against will
Consented >12 < 18 virgin with consent
Adultery vs concubinage
Adultery: married woman with not husband man who both know
Concubinage: husband with mistress underown house with sexual intercourse “scandalous circumstances” : so maid is concubinage.
Male vs female cranium
Male: larger mastoid shorter styloid
Female: smaller mastoid, longer styloid
Determination of sex
Presumptive vs highly probable vs conclusive
- Presumptive: features that make them socially male/femle
- Secondary sexual organs
- Conclusive: gonads
Dead body will climatize to the surrounding environment on average by ______ hours in tropical countries?
12-15
Algor mortis
Is cooling of the body.
Signs of death
- Cessation of heart and circulation
- Cessation of respiration
- Algor mortis
- Loss of power to move
- Changes in skin
- Changes in eyes.
Rigor mortis of the whole body occurs in ____ hours?
Rigor mortis starts ____ hours after death?
- 12
2. 3-6 hours
Primary flaccidity or period of muscular irritablity occurs
Immediately after death.
Flexed extremities, incontinence.
Conditions “simulating” rigor mortis
- Heat stiffening
- Cold stiffening
- Cadaveric spasm
- > 75 deg C; pugilistic attitude: lower and upper extremities are flexed, hands clenched
- Solidification of fat
- Instantaneous rigidity of muscles at the moment of death: ex at death its hard to take the weapon away from the body; secondary to neurlogic injury or chest injury causing death
Stage of secondary flaccidity after ____ _Hours
36 hours or the onset of decompensation.
Livor mortis
Blood accumulation in the dependent portions of the body.
Color of blood if death is caused by?
- Asphyxia
- Hemorrhage
- CO
- Hydrocyanic acid
- Phosphorus
- Postassium chlorate
- Snow or ice
- Asphyxia : dark
- hemorrhage : less dark
- CO : pink
- Hydrocyanic acid: bright red
- Phosphorus : dark brown
- Potassium chlorate : coffee brown
- Snow or ice : bright red
Putrefaction: protein breakdown leading to?
Evolution of foul smelling gases ad change in color of body.
Components of putrefaction
- Changes in tissue color:
- Evolution of gases in body
- Liquefaction
- Green is earliest change; marbolization: superficial veins are proiment
- Distension of abdomen and whole body
- Highly muscular organs liquefy late.
Duration of death
- Rigor mortis
- Post mortem lividity (livor mortis)
- Putrefaction
- 2-3 hours in philippines; full 12 hours.
- Libor mortis: 3-6 hours after death.
- Putrefaction 24-48 hours.
Entomology of the cadaver: if with maggots
- > 24 hours.
Skeleton with no tissue?
1-2 years.
Presumption of death
7 years
10 years if for succession
Autopsy vs post mortem examination
Internal examination is conducted autopsy
Non official vs official autopsy
- Non official: done by hospital cause of death
2. Official : determining time cause manner of death; recover evidence
Need for autopsy:
Death by violence Accidental death: drown burn bangungot Suicides Sudden death of persons with good health Death unattended by physician DOA Death occuring in unnatural manner
Deahty from asphyxia internal findings on autopsy in the lung pleura
Tardieu spots
External findings from deathy by asphyxia
Lividity : lips fingers toenails
Contusion ages
1 green
- Yellow
- Gone
- 4-5 days
- 7-10 days
- Gone by 14th to 15th
Post mortem findings of injury from cold
Blood is fluid in the heart bright red color.
Parenchyma of organs congested with petechial hemorrhage
Death from heat stroke post mortem findings
Rigor mortis quick
Quick putrefaction
Marked lividity
Postmortem findings burns and scalde
Boxers posture of body
Hemoconcentration
Boxer position in death by heat is secondary to?
Coagulation of protein in body.
Ante mortem vs post mortem burn
Ante mortem
- Inflammation
- Soot in trachea
- Carboxyhemoglobin
Main cause of death from lightning is?
Shock
Post mortem findings in death by lightning
Internal: fracture, hemorrhage, rupture of internal organs
Metallization is?
Embeded metal in the epidermis of teh person
