TABLE OF CONTENTS:

I.

CRASH INJURY, DECAPITATION, AND ELECTROCUTION

A.

ASPHYXIA
-

Impaired normal exchange of gases due to interference in the process of respiration

Reduction of oxygen in the blood and the elevation of CO 2.

1.

Main classes:
o Respiratory Obstruction
o Circulatory Arrest

2.

Sequence of events (p.37)

3.

Classification
a. Asphyxia by HANGING (p.38)

Hanging

Complete Hanging

Incomplete Hanging

- Ligature tightened - Feet do not touch - Sitting, kneeling, lying or

over the neck
floor
whole body does not cause
by suspension
complete compression of
of body
neck

Typical
Hanging

Aypical
Hanging
-

CAUSES OF DEATH IN HANGING:

o Injury to spinal cord and brain
o Constriction of the neck
o Cardiac Arrest

DETERMINATION WHETHER HANGING IS SUICIDAL, HOMICIDAL OR ACCIDENTAL

Usually SUICIDAL HANGING,
unless proven otherwise
1. Accessible
Materials
used: rope, beddings,
wire
2. Fibers from the ropes in
the hands of victim
3. Movement of rope on the
beam or anchorage from
upward or downward as
the body has been
suspended
b.

HOMICIDAL HANGING
1.
2.
3.
4.

is

Defense
wound
in
victims body
Blood stains & other
injuries
Signs of struggle in
clothing, furniture, etc.
Nature of windows,
curtains, doors

Strangulation by Ligature
Manual Strangulation use of one or both hands; pressure for 2 mins.;
Special forms (p. 42)

HANGING

HANGING

By strangulation homicidal (p. 41); death by obstruction of airway, reflex cardiac arrest; compression
of blood vessels in the neck

ACCIDENTAL
not common

Ligature mark is inverted V-shape;

above the thryroid
Vertebral injury is common

STRANGULATION BY LIGATURE
Ligature mark is horizontal; across or
below the thryroid\
No vertebral injury

c.

By suffocation

Smothering

Choking
-

d. By drowning
Submersion in water or other fluid; hindrance in free passage of air
PRIMARY DROWNING
Dies in a few minutes

e.
f.
B.

Closure of mouth or nose by solid

objects
Hands, pillows, cushions, etc.

Obstruction of respiratory track by

foreign bodies
Food, blood, etc. ; accidental

SECONDARY DROWNING
Initial recovery from drowning but eventually dies
hours/days after incident

By compression on the chest

By breathing irrespirable gases

DEATH

SOMATIC DEATH (Clinical Death)

Complete & persistent cessation of
respiration, circulation, & almost all
brain functions
1.

MOLECULAR
DEATH
(Cellular
Death)
Cessation of life of individual cells of
the body; occurs one at a time after
somatic death

APPARENT DEATH
(state
of
suspended animation)
State of temporary cessation of the
vital activities of the body

SIGNS OF DEATH

1.

2.

3.
4.

CESSATION OF RESPIRATION (detection: - Breathing is the upward & downward movement of

p. 45)
chest or abdomen; becomes irregular when dying
then, suddenly gasps separated by long period
intervals until last respiratory movement occurred.
CESSATION
OF
HEARBEAT
& Heart stops beating in a persistent & cont. man
CIRCULATION
cannot be revived by cardiac massage & o
(detection: p. 46)
resuscitative measures for 5 minutes
Pulse beat and blood circulation stops
COOLING OF THE BODY
- Gradual lowering of the body temperature until it assu
the temperature of the environment
INSENSIBILITY OF THE BODY & LOSS OF - SENSES:
a. Changes in the Eyes: stare in vacant expres
POWER TO MOVE (Central nervous system
without movement of the eyes in any direction
brain & spinal cord)
-

b.

5.

CHANGES IN THE BODY AFTER DEATH

loss of corneal and light refle

haziness of cornea, fixation of p
flaccidity of eyeball

Changes in the Skin

Change in color; loss of elasticity of s
opacity of skin; absence of reactio
injury
a.

b.

Changes in the Muscles

Stages:
Primary flaccidity,
Post-mortem rigidity or rigor mortis
Secondary flaccidity
Change of color in the Blood

2.

II.

IMPORTANCE OF POST-MORTEM LIVIDITY

i.
It is a sign of death
ii. It approximates the time of death in a person
iii. It determines the position of the body after death
iv. It may indicate the cause of manner of death

IDENTIFICATION OF PERSONS AND MATERIALS

Importance of Identifying a Person:
1. A person arrested to assume responsibility of the criminal act committed.
2. A wanted person/shoot-to-kill order should first be identified before arresting/killing.
3. A missing person was found later either living or dead.
a. Estate or wealth of dead persons; for legal heirs
b. The identity of remains to be exhumed must be established; determine if human origin, race, age, sex, time
and cause of death
THE LAW OF MULTIPLICITY OF EVIDENCE which is applicable to identification states that the greater the
similarities or dissimilarities, the greater is the probability for the conclusion to be correct.
Points to Consider in Identifying a Person
A.

FACE

B.
C.

EYES
NOSE

D.

HEAD

E.

EARS

F.
G.
H.
I.

MOUTH
BODY BUILT
HEIGHT
WEIGHT

J.
K.
L.

GAIT
COMPLEXION
MANNERISM

- configuration and shape; expression or forms; color

of face; marks on face
-

M. HANDS AND FEET

N.

III.

TEETH

Configuration, size, shape

Size, shape, condition of nares &
septum
Size, shape, condition of forehead &
hair
Config, size, shape, presence of holes,
tags, etc.
Size, lips
Shape
Size; measurements
Featherweight,
lightweight,
bantamweight, paperweight
Manner of walking
Color and presence of tattoo marks
Usual and peculiar movement of the
parts of body
Config, size, shape; number of fingers
and toes;
Natural or artificial, size, alignment,
loss of teeth

DETERMINATION OF AGE OF FETUS: RULES

For fetus less than < 25 cm long:

FIND THE SQUARE ROOT OF THE LENGTH IN

CENTIMATERS AND THE RESULT IS THE AGE OF
FETUS IN MONTHS:
AGE OF FETUS (month):

For fetus 25 cm long:

LENGTH ( cm)

DIVIDE THE LENGTH OF THE FETUS IN CM. BY 5

AGE OF FETUS:

LENGTH
5

IV.

EXTRINSIC FACTORS IN IDENTIFICATION:

1. Ring, bracelet, other ornamental wearing apparel
2. Personal belongings in possession and found in body wallet, letters, drivers license
3. Clothing
4. Dust in clothing
5. Identification made by close friends and relatives
6. Records in the criminal identification files: PNP, NBI, Immigration
7. Identification Photograph

V.

MEDIC0-LEGAL CASES subject to mandatory autopsy; no consent is required although the next-of-kin is informed of
the requirement and his signed consent is only courtesy
-

1.
2.

3.

VI.

Death certificate completed only with autopsy; if relatives refuse to cooperate, death certificates cause of death is:
undetermined = thus, as if no death certificate has been issued
If hospital has no authority to conduct such autopsy, it refers the case to PNP/NBI/MUNICIPAL/PROV. HEALTH
OFFICER
Injuries or deaths involving persons who have no means of being identified
Persons
pronounced
Dead
on
Arrival:
To be construed as being DOA at the emergency room of a hospital is liberally construed to mean also dying
within a short period of time from arrival which may be within 1-24 hours depending on the circumstances.
Deaths :
a. Occurring within 24 hours of admission, when the clinical course if death is unknown or undeterminable;
b. Unexpected sudden death especially when the deceased was in apparent good health;
c. Death due to natural disease but associated with physical evidence suspicious of foul play;
d. Death as a result of violence, accident, suicide, or poisoning;
e. Death due to improper or negligent act of another person

4.

Victims of Physical Injuries:

a. Physical violence, i.e. gunshot wound, stab wounds, mauling, etc
b. Vehicular accident
c. Asphyxia
d. Electrocution, chemical or thermal insult
e. Accident, attempted homicide or suicide
f. Poisoning

5.
6.
7.

Cases of Child Abuse, Domestic Violence, Sexual Abuse, Alcoholism, Drug Addiction
Mental incompetency
Iatrogenic cases brought about by negligent acts/omissions of hospital staff resulting to violation of rights of
patient or leading to his physical or mental incapacitation, physical injury or death.

LEGAL DOCTRINES APPLICABLE TO DETERMINE LIABLITY OF PHYSICIAN AND/OR HOSPITAL

1.

DOCTRINE OF VICARIOUS LIABILITY

(Doctrine of Imputed Negligence or Command Responsibilty)
a. Doctrine of Ostensible Agent

ostensible agent
n. a person who has been given the appearance of being an employee or acting (an agent) foranother (principal), which would make an
yone dealing with the ostensible agent reasonablybelieve he/she was an employee or agent. This could include giving the ostensible ag
entstationery or forms of the company, letting him/her use the company truck, telephone, or deskin the company office. Businesses sho

uld be careful not to allow such situations in which anostensible agent could bind the business on a contract or make the apparent empl
oyerresponsible for damages for an accident, libel or assault by the "agent."
b.
c.

Borrowed Servant Doctrine

Captain of the Ship Doctrine

Captain of the ship doctrine is the legal doctrine which holds that, during an operation in an operating room, a surgeon of
record is liable for all actions conducted in the course of the operation. The doctrine is a form of the "borrowed servant doctrine", in
which a party usually liable for his, her, its, or their actions is absolved of responsibility when that "borrowed servant" is asked to do
something that is outside of the bounds of policy.

G.R. No. 126297( Professional Services Inc. vs. Agana):

Many courts now allow claims for hospital vicarious liability under the theories of respondeat superior, apparent authority, ostensible
authority, or agency by estoppel. [20]

In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil Code, which reads:

Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged
to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the
parties, is called a quasi-delict and is governed by the provisions of this Chapter.

A derivative of this provision is Article 2180, the rule governing vicarious liability under the doctrine of respondeat
superior, thus:

ART. 2180. The obligation imposed by Article 2176 is demandable not only for ones own acts or omissions,
but also for those of persons for whom one is responsible.
x x x

x x x

The owners and managers of an establishment or enterprise are likewise responsible for damages caused
by their employees in the service of the branches in which the latter are employed or on the occasion of their
functions.

Employers shall be liable for the damages caused by their employees and household helpers acting within
the scope of their assigned tasks even though the former are not engaged in any business or industry.
x x x

The responsibility treated of in this article shall cease when the persons herein mentioned prove that they
observed all the diligence of a good father of a family to prevent damage.

A prominent civilist commented that professionals engaged by an employer, such as physicians, dentists, and pharmacists, are
not employees under this article because the manner in which they perform their work is not within the control of the latter

(employer). In other words, professionals are considered personally liable for the fault or negligence they commit in the
discharge of their duties, and their employer cannot be held liable for such fault or negligence. In the context of the present
case, a hospital cannot be held liable for the fault or negligence of a physician or surgeon in the treatment or operation of patients.

2.

RES IPSA LOQUITOR (Common Knowledge Doctrine)

DOCTRINE OF RES IPSA LOQUITOR

The thing speaks for itself.

E.g. objects left in a patients body, injury to a healthy part of the body, removal of the wrong part of the body, teeth dropped
down the windpipe, burns, disability resulting from injection of drugs to the body, infection resulting from unsterilized instruments,
fracture on a newly-delivered baby born by breech presentation, IM injections which resulted to leg paralysis.
A rebuttable presumption or inference that the defendantwas negligent, which arises upon proof that the instrumentali
ty or condition causing the injurywas in the defendant's exclusive control and that the accident was one that ordinarily
does notoccur in the absence of Negligence.
Res ipsa loquitur is one form of circumstantial evidence that permits a reasonable person tosurmise that the most Pro
bable Cause of an accident was the defendant's negligence.
3.

Doctrine of CONTRIBUTORY NEGLIGENCE

CONTRIBUTORY NEGLIGENCE
Careless act or omission on the part of the complaining party which, concerning with the defendants negligence, is the
proximate cause of injury.

Contributory negligence is conduct on the part of the injured party, contributing as a legal cause to the harm he has suffered,
which falls below the standard to which he is required to conform for his own protection. To hold a person as having contributed to his
injuries, it must be shown that he performed an act that brought about his injuries in disregard of warning or signs of an impending
danger to health and body. To prove contributory negligence, it is still necessary to establish a causal link, although not proximate,
between the negligence of the party and the succeeding injury. In a legal sense, negligence is contributory only when it contributes
proximately to the injury, and not simply a condition for its occurrence.
Pursuant to Article 217962 of the New Civil Code, the only effect such contributory negligence could have is to mitigate liability,
4.

Doctrine of CONTINUING NEGLIGENCE

DOCTRINE OF CONTINUING NEGLIGENCE

Contemplates of an unfailing duty of a defendant RN to appraise, make necessary investigation or examination of his
patients injury with reasonable care and skill, failure of whom constitutes a continuing act of negligence.

5.

Doctrine of ASSUMPTION OF RISK

ASSUMPTION OF RISK

When one assumes voluntary risk of injury from a known danger, then he is barred from recovery; that person who asserts and
was injured is not regarded injured.

6.

Doctrine of LAST CLEAR CHANCE

LAST CLEAR CHANCE

Implies thought, appreciation, mental direction and lapse of sufficient time to effectively act upon impulse to save the life or
prevent injury to another.
7.

Doctrine of FORSEEABILITY

DOCTRINE OF FORESEEABILITY

It contemplates of a condition of foreseeability wherein a duty of care, skill and training to all persons who are foreseeably
endangered by his conduct, with respect to the risks which make the conduct unreasonably dangerous.

8.

FELLOW SERVANT Doctrine

FELLOW SERVANT

If a servant is injured on account of the negligence of his servant, the master cannot be held liable.

9.

RESCUE Doctrine

RESCUE DOCTRINE

Provides that a person who goes to the rescue of a victim in an accident is injured, the original wrongdoer must be held liable
for such injury.

10. Doctrine of PROXIMATE CAUSE

An act from which an injury results as a natural, direct, uninterrupted consequence and withoutwhich the injury would not have
occurred.
Proximate cause is the primary cause of an injury. It is not necessarily the closest cause intime or space nor the first event that
sets in motion a sequence of events leading to an injury.Proximate cause produces particular, foreseeable consequences without the int
ervention of anyindependent or unforeseeable cause. It is also known as legal cause.

SOLE RESPONSIBILITY vs. SHARED RESPONSIBILITY

1. Partners
2. Agents
3. Employees
4. Other physicians who are neither partners not agents