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Legal Medicine
Is that branch of medicine that applies, medical and
surgical concepts, scientific knowledge and skills to medico legal
issues, in order to assist the trier of facts in the proper dispensation
of justice.
Medical Jurisprudence
is the study of the Medical Law and its applicable
Jurisprudence that governs, regulates and defines the practice of
medicine.
I. INTRODUCTION: THE FILIPINO PHYSICIAN
Medical education in the Philippines is principally offered and
developed by accredited and government recognized medical
schools in the country. The Philippine medical schools are graduate
schools offering the Doctor of Medicine (M.D.) degree. The M.D. is a
four-year professional degree program which qualifies the degree
holder to take the licensure exam for medical doctors in the
Philippines.
Professional medical degree
The Doctor of Medicine (M.D.) is a four-year professional
degree program dealing with medical theories, practices,
technologies, and problem solving.
The completion of the degree program with one-year postgraduate
internship qualifies a candidate to take the licensure exam for
medical doctors in the Philippines.
After becoming a licensed doctor, a Physician may choose to stop
there and start earning as a G.P. (general physician), or be a
residence doctor or take a speciality in a field he or she wants which
will take almost 4-5 years (for training.)
Admission to medical schools
Before applying to any medical school, a candidate must earn
a bachelor's degree with credits in certain required subjects. The
most common pre-medical degrees include
biology, pharmacy, medical technology, biochemistry, nursing,
and physical therapy.
In addition, a candidate must take the National Medical Admission
Test (NMAT), the national entrance exam for all medical schools in
the Philippines.
PRACTICE OF MEDICINE
1. PRC vs De Guzman (G.R. No. 144681, June 21, 2004)
DOCTRINE: Until the moral and mental fitness of the respondents
could be ascertained, according to petitioners, the Board has
discretion to hold in abeyance the administration of the Hippocratic
Oath and the issuance of the certificates to them. The writ of
mandamus does not lie to compel performance of an act which is not
duly authorized.
The respondents nevertheless argue that under Section 20, the Board
shall not issue a certificate of registration only in the following
instances: (1) to any candidate who has been convicted by a court of
competent jurisdiction of any criminal offense involving moral
turpitude; (2) or has been found guilty of immoral or dishonorable
conduct after the investigation by the Board; or (3) has been declared
to be of unsound mind. They aver that none of these circumstances
are present in their case.

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Petitioners reject respondents argument. Section 8 [30] of

Rep. Act No. 2382 prescribes, among others, that a person who
aspires to practice medicine in the Philippines, must have
satisfactorily passed the corresponding Board Examination. Section
22, in turn, provides that the oath may only be administered to
physicians who qualified in the examinations. The operative word
here is satisfactorily, defined as sufficient to meet a condition or
obligation or capable of dispelling doubt or ignorance. Gleaned from
Board Resolution No. 26, the licensing authority apparently did not
find that the respondents satisfactorily passed the licensure
examinations. The Board instead sought to nullify the examination
results obtained by the respondents.
2. DECS vs San Diego (GRN 89572, December 21, 1989)
FACTS: Roberto Rey San Diego, the private respondent is a graduate
of the University of the East with a degree of Bachelor of Science
in Zoology. The petitioner claims that he took the NMAT three times
and flunked it as many times.
ISSUE: Petition whether the private respondent who has thrice
failed the National Medical Admission Test(NMAT) is entitled to
take it again as it is a requirement for admission to any Medical
School in the Philippines. He invoked of his constitutional rights to
academic freedom and quality education, squarely challenging the
constitutionality of MECS Order No. 12, Series of 1972.
HELD: The private respondent cannot take the NMAT again and
pursue his medical profession because of the following grounds:
For the pur po se of g a ug in g at lea st i nit i a l ly b y t he
a dm i ssio n te st an d b y th e t hree -f l un k r ul e, a student shall
not be allowed to take the NMAT again after three successive
failures.
The State ensures that medical profession is not permeated by
incompetents to whom patients may unwarily hand over their lives
and health.
It is not enough to simply invoke the right to quality education as
a guarantee of the Constitution, while one has the right to aspire to
be a doctor, he does not have the constitutional right to be a doctor;
one must show that he is entitled to it because of his preparation and
promise.
T he con fl i ct th at t he ch al le n ge d r ule v i ol ate s t he e q ua l
pr ote ct ion cla use i s n ot we l l-t a ken . Conformable to Article
III, Section 1 of the Constitution, a law does not have to operate with
equal force on all person or things
II. MEDICAL ACT OF 1959, CODE OF ETHICS
Objectives. This Act provides for and shall govern
(a) the standardization and regulation of medical education;
(b) the examination for registration of physicians; and
(c) the supervision, control and regulation of the practice of medicine
in the Philippines.
For the purpose of implementing the provisions of this Act, there are
created the following agencies:
(1) the Board of Medical Education under the Department of
Education, and
(2) the Board of Medical Examiners (Board of Medicine) under the
Commissioner of Civil Service NOW Professional Regulation
Commission (PRC).

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The Board of Medical Education Its Functions

The Board of Medical Education shall be composed of the
1. Secretary of Education or his duly authorized representative, as
chairman;
2. the Secretary of Health or his duly authorized representative; 3.
the Director of the Bureau of Private Schools or his duly authorized
representative;
4. the chairman of the Board of Medical Examiners or his duly
authorized representatives;
5. a representative of the Philippine Medical Association;
6. the Dean of the College of Medicine, University of the Philippines;
7. a representative of the Council of Deans of Philippine Medical
Schools; and
8. a Representative of the Association of Philippine Medical Colleges,
as members.
The officials acting as chairman and members of the Board of
Medical Education shall hold office during their incumbency in their
respective positions.
Functions: (Section 5)
The functions of the Board of Medical Education shall be:
1. To determine and prescribe minimum requirements for admission
into a recognized college of medicine;
2. To determine and prescribe requirements for minimum physical
facilities of colleges of medicine, to wit: buildings, including
hospitals, equipment and supplies, apparatus, instruments,
appliances, laboratories, bed capacity for instruction purposes,
operating and delivery rooms, facilities for out-patient services, and
others, used for didactic and practical instructions in accordance
with modern trends;
3. To determine and prescribe the minimum number and the
minimum qualifications of teaching personnel, including studentteacher ratio and curriculum;
4. To determine and prescribe the number of students who should
be allowed to take up the preparatory course taking into account the
capacity of the different recognized colleges of medicine.
5. To select, determine and approve hospitals or some departments
of the hospitals for training which comply with the minimum
specific physical facilities as provided in subparagraph (b) hereof:
and
6. To promulgate and prescribe and enforce necessary rules and
regulations for the proper implementation of the foregoing
functions.

General practice of Medicine (Art 3 Section 8)

No person shall engage in the practice of medicine in the Philippines
unless:
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(1) he is at least twenty-one years of age,

(2) has satisfactorily passed the corresponding Board of
Examination and
(3) is a holder of a valid Certificate of Registration duly issued to him
by the Board of Medical Examiners.
Acts Constituting Practice of Medicine (Section 10)
A person shall be considered as engaged in the practice of medicine
(1) who shall, for compensation, fee, salary or reward in any form,
paid to him directly or through another, or even without the same,
physical 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
(2) who 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 physical
condition; or
(3) who shall use the title M.D. after his name.
Exemptions (Section 11):
The preceding section shall not be construed to affect
1.

2.
3.

4.

5.
Admission requirements (Section 7)
The medical college may admit any student who has not been
convicted by any court of competent jurisdiction of any offense
involving moral turpitude and who presents
1.
a record showing completion of a bachelor's degree in
science or arts;
2.
a certificate of eligibility for entrance to a medical school
from the Board of Medical Education;
3.
a certificate of good moral character issued by two former
professors in the college of liberal arts; and
4.
birth certificate. Nothing in this Act shall be construed to
inhibit any college of medicine from establishing, in
addition to the preceding, other entrance requirements
that may be deemed admissible.

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6.

7.

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;
any legally registered dentist engaged exclusively in the
practice of dentistry;
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;
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;
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;
any person who administers or recommends any
household remedy as per classification of existing
Pharmacy Laws; and
any psychologist or mental hygienist in the performance of
his duties, provided such performance is done in
conjunction with a duly registered physician.

Limited practice without any certificate of registration (Section 12)

1.

Physicians and surgeons from other countries called in

consultation only and exclusively in specific and definite
cases, or those attached to international bodies or
organization assigned to perform certain definite work in
the Philippines provided they shall limit their practice to
the specific work assigned to them and provided further

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they shall secure a previous authorization from the Board

of Medical Examiners.
2.

Commissioned medical officers of the United States armed

forces stationed in the Philippines while rendering service
as such only for the members of the said armed forces and
within the limit of their own respective territorial
jurisdiction.

3.

Foreign physicians employed as exchange professors in

special branches of medicine or surgery whose service
may in the discretion of the Board of Medical Education,
be necessary.

4.

Medical students who have completed the first four years

of medical course, graduates of medicine and registered
nurses who may be given limited and special
authorization by the Secretary of Health to render medical
services during epidemics or national emergencies
whenever the services of duly registered physicians are
not available. Such authorization shall automatically cease
when the epidemic or national emergency is declared
terminated by the Secretary of Health.

Functions of the Board of Medical Examiners (Board of Medicine)

The Board of Medical Examiners, with the approval of the
Professional Service Commission, shall promulgate such rules and
regulations as may be necessary for the proper conduct of the
examinations, correction of examination papers, and registration of
physicians
Section 22. Administrative investigations.
In addition to the functions provided for in the preceding sections,
the Board of Medical Examiners shall perform the following duties:
(1) to administer oath to physicians who qualified in the
examination;
(2) to study the conditions affecting the practice of medicine in all
parts of the Philippines;
(3) to exercise the powers conferred upon it by this article with the
view of maintaining the ethical and professional standards of the
medical profession;
(4) to subpoena or subpoena duces tecum witnesses for all purposes
required in the discharge of its duties; and
(5) to promulgate, with the approval of the Commissioner of Civil
Service, such rules and regulations as it may deem necessary for the
performance of its duties in harmony with the provisions of this Act
and necessary for the proper practice of medicine in the Philippines.

DUE PROCESS: Section 23. Procedure and rules. Within five days
after the filling of written charges under oath, the respondent
physician shall be furnished a copy thereof, without requiring him or
her to answer the same, and the Board shall conduct the
investigation within five days after the receipt of such copy by the
respondent. The investigation shall be completed as soon as
practicable.
SECTION 24. GROUNDS FOR REPRIMAND, SUSPENSION OR
REVOCATION OF REGISTRATION CERTIFICATE.
(1) Conviction by a court of competent jurisdiction of any criminal
offense involving moral turpitude;
(2) Immoral or dishonorable conduct;
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(3) Insanity;
(4) Fraud in the acquisition of the certificate of registration;
(5) Gross negligence, ignorance or incompetence in the practice of his
or her profession resulting in an injury to or death of the patient;
(6) Addiction to alcoholic beverages or to any habit forming drug
rendering him or her incompetent to practice his or her profession,
or to any form of gambling;
(7) False or extravagant or unethical advertisements wherein other
things than his name, profession, limitation of practice, clinic hours,
office and home address, are mentioned.
(8) Performance of or aiding in any criminal abortion;
(9) Knowingly issuing any false medical certificate;
(10) Issuing any statement or spreading any news or rumor which is
derogatory to the character and reputation of another physician
without justifiable motive;
(11) Aiding or acting as a dummy of an unqualified or unregistered
person to practice medicine;
(12) Violation of any provision of the Code of Ethics as approved by
the Philippine Medical Association.
Refusal of a physician to attend a patient in danger of death is not a
sufficient ground for revocation or suspension of his registration
certificate if there is a risk to the physician's life.
Section 26. Appeal from judgment. The decision of the Board of
Medical Examiners (Board of Medicine) shall automatically become
final thirty days after the date of its promulgation unless the
respondent, during the same period, has appealed to the
Professional Regulation Commission and later to the Court of
Appeals. If the final decision is not satisfactory, the respondent may
ask for a review of the case, or may file in court a petition for
certiorari.
Section 27. Reinstatement. After two years, the Board may order the
reinstatement of any physicians whose certificate of registration has
been revoked, if the respondent has acted in an exemplary manner in
the community wherein he resides and has not committed any
illegal, immoral or dishonorable act.
III. LIABILITIES OF PHYSICIANS
Kinds of Liabilities of Physicians:
1. Administrative liabilities
2. Civil liabilities
3. Criminal liabilities
i. Administrative Liability
A practice of medicine is a privilege and not a right; hence
it could be taken away from the physician.
In administrative liabilities, a physicians profession is
temporarily withdrawn from him to protect future patients.
Penalty: Reprimand, Suspension or revocation of license
Quantum of Evidence: Substantial Evidence
Jurisdiction: Board of Medicine, Professional Regulatory
Commission (Quasijudicial body); Philippine Medical Association
Example: Non-compliance of National and Local laws which include
Sanitary Code, Fire Code etc
ii. Criminal Liability

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-For Acts or Omissions constituting a crime. Acts or

omissions constituting a crime can be done with deceit (deliberate
intent) and fault (negligence, imprudence, lack of skill/foresight).

Jurisdiction: Regular Courts

iii. Civil Liability
Civil liabilities make a physician liable to compensate the
patient for the injury he suffered on account of his wrongful act or
breach of contract. It may include moral or punitive damages.
Penalty: Damages (NCC Arts 19-21 or Article 2176 Torts)
Quantum of Evidence: Preponderance of Evidence
Jurisdiction: Regular Courts
IV. HUMAN BODY
V. MEDICAL NEGLIGENCE CASES
LEGAL MEDICINE AND THE LEGAL SYSTEM
Courts routinely call upon physicians to give expert
testimony in a trial, especially concerning the findings of an autopsy
and the results of laboratory tests.
As an expert witness he is allowed to express an opinion
about the validity of the evidence in a case and may quote the
statements of other experts in support of an opinion.
Ordinary testimony is restricted to statements concerning
what the witness actually saw or heard.
The evidence to be presented by the legal medicine expert
must signify a relation between the facts called the Factum
Probandum or proposition to be established and the factum
Probans which is the material evidencing the proposition.
The Physician must present RELEVANT, MATERIAL
AND COMPETENT EVIDENCE.

If physician is an employee, the hospital may be held

liable.

Physicians are not employees but are considered as

individual contractors.

Key elements (Employer-employee

relationship):
1.
Hiring
2.
Firing
3.
Wages
4.
Control

How to make a hospital under the doctrine of apparent

authority liable
General Rule: A hospital is not liable for the
negligence of an independent contractor-physician.
XPT: When physician is the "ostensible" agent of the
hospital (doctrine of apparent authority)
Requisites for the doctrine to apply:
(1) the hospital, or its agent, acted in a manner that would
lead a reasonable person to conclude that the individual
who was alleged to be negligent was an employee or agent
of the hospital;

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(2) where the acts of the agent create the appearance of

authority, the plaintiff must also prove that the hospital
had knowledge of and acquiesced in them; and
(3) the plaintiff acted in reliance upon the conduct of the
hospital or its agent, consistent with ordinary care and
prudence.

Penalty: Imprisonment, fines (from Special Laws/ RPC)

Quantum of Evidence: Proof beyond reasonable doubt

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LEGAL BASIS:

Law on Agency

Negligent Act of an agent, principal may be held

liable.

Acting as an agent of the hospital

1.
Forms
2.
Waiver
3.
Prescription pad
4.
List of physicians
5.
Corporate Negligence: How to make physician liable
o
Captain of the Ship Doctrine
Still applicable in the Philippines though
western countries are not applying the same.
Mistakes not automatically negligence
Negligence is not sufficient; it must be gross
negligence.
Standard of care: failure to follow it must be
established

Pre-operative procedure
Expert witness: to establish failure to follow
standard of care
o
Same expertise as the accused
o
Preferably from the same locality

EXCEPTION: res ipsa loquitur

The injury of the patient is sufficient
Common sense will tell you that there was negligence

Four (4) elements:

(1) the accident was of a kind which does not ordinarily
occur unless someone is negligent;
(2) the instrumentality or agency which caused the injury
was under the exclusive control of the person in charge;
and
(3) the injury suffered must not have been due to any
voluntary action or contribution of the person injured.
(4) Matter of convenience on the part of the injured party

MEDICAL NEGLIGENCE CASES

3. Dr. Cantre vs. Go (G.R. No. 160889, April 27, 2007)
FACTS: Hours after giving birth to her fourth child. Nora
experienced hypoglemic shock. The attending physician and her
team performed the necessary steps to stop the bleeding. He used a
droplight to warm Nora and her baby. After the operation, Noras
husband noticed a gaping wound on Noras left arm, about four (4)
inches long. He asked the physician what caused the wound and he
replied that it was due to the blood pressure cuff.
The spouses went to the NBI for physical examination and
found out that it was a burn caused by the droplight. A droplight
can cause burn on the skin even just for ten (10) minutes. Thye filed a
complaint for damages against the doctor and the hospital.
The doctor said it was the nurses fault. The nurse forgot to remove
the droplight.
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ISSUE: Is the petitioner liable for the injury sustained by Nora Go?
HELD: YES.
Res ipsa loquitur x Medical negligence cases
In medical negligence cases, 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
The wound not an ordinary occurrence in the act of delivering a
baby; could not have happened unless negligence set in somewhere
caused by an instrumentality within defendant's exclusive control It
doesn't matter WON the injury was caused by the droplight or by
the blood pressure cuff, since both are within the exclusive control of
the physician in charge [Dr. Cantre] under the captain of the
ship doctrine [surgeon in charge of an operation is held liable for his
assistants' negligence during the time when they are under the
surgeon's control].
The doctrine of [r]es ipsa loquitur as a rule of evidence is peculiar to
the law of negligence which recognizes that prima facie negligence
may be established without direct proof and furnishes a substitute
for specific proof of negligence. In the instant case, all the requisites
for recourse to the doctrine are present. First, the entire proceedings
of the cesarean section were under the exclusive control of Dr.
Batiquin. In this light, the private respondents were bereft of direct
evidence as to the actual culprit or the exact cause of the foreign
object finding its way into private respondent Villegas' body, which,
needless to say, does not occur unless through the intervention of
negligence. Second, since aside from the cesarean section, private
respondent Villegas underwent no other operation which could have
caused the offending piece of rubber to appear in her uterus, it
stands to reason that such could only have been a by-product of the
cesarean section performed by Dr. Batiquin. The petitioners, in this
regard, failed to overcome the presumption of negligence arising
from resort to the doctrine ofres ipsa loquitur. Dr. Batiquin is
therefore liable for negligently leaving behind a piece of rubber in
private respondent Villegas' abdomen and for all the adverse effects
thereof.. Still, her good intentions characteristics do not justify
negligence.
4. Batiquin vs Court of Appeals (GRN 118231, July 5, 1996)
FACTS: On Sept 1988, Petitioner Dr. Batiquin performed a simple
caesarean section on Respondent Mrs. Villegas when the latter gave
birth. Soon after leaving the hospital, respondent began to suffer
abdominal pains and complained of being feverish. The abdominal
pains and fever kept on recurring and this prompted respondent to
consult with another doctor, Dr. Kho. When Dr. Kho opened the
abdomen of respondent to check her out respondents infection, she
discovered that a piece of rubber material, which looked like a piece
of rubber glove and was deemed a foreign body, was the cause of the
respondents infection. Respondent then sued petitioner for
damages. RTC held in favor of petitioner. CA reversed, ruling for the
respondent.
ISSUES: Whether petitioner is liable to respondent.
HELD: YES, UNDER THE RULE OF RES IPSA LOQUITUR, DR.
BATIQUIN IS LIABLE.
Res ipsa loquitur. The thing speaks for itself. Rebuttable
presumption or inference that defendant was negligent, which arises
upon proof that the instrumentality causing injury was in
defendant's exclusive control, and that the accident was one which
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ordinary does not happen in absence of negligence. Res ipsa loquitur

is a rule of evidence whereby negligence of the alleged wrongdoer
may be inferred from the mere fact that the accident happened
provided the character of the accident and circumstances attending it
lead reasonably to belief that in the absence of negligence it would
not have occurred and that thing which caused injury is shown to
have been under the management and control of the alleged
wrongdoer. Under this doctrine the happening of an injury permits
an inference of negligence where plaintiff produces substantial
evidence that the injury was caused by an agency or instrumentality
under the exclusive control and management of defendant, and that
the occurrence was such that in the ordinary course of things would
not happen if reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is peculiar to
the law of negligence which recognizes that prima facie negligence
may be established without direct proof and furnishes a substitute
for specific proof of negligence. The doctrine is not a rule of
substantive law, but merely a mode of proof or a mere procedural
convenience. The rule, when applicable to the facts and
circumstances of a particular case, is not intended to and does not
dispense with the requirement of proof of culpable negligence on
the party charged. It merely determines and regulates what shall be
prima facie evidence thereof and facilitates the burden of plaintiff of
proving a breach of the duty of due care. The doctrine can be
invoked when and only when, under the circumstances involved,
direct evidence is absent a n d n ot re a di l y a v a i la b le.
In the instant case, all the requisites for recourse to the doctrine are
present. First, the entire proceedings of the caesarean section were
under the exclusive control of Dr. Batiquin. In this light, the private
respondents were bereft of direct evidence as to the actual culprit or
the exact cause of the foreign object finding its way into private
respondent Villegas's body, which, needless to say, does not occur
unless through the intersection of negligence. Second, since aside
from the caesarean section, private respondent Villegas underwent
no other operation which could have caused the offending piece of
rubber to appear in her uterus, it stands to reason that such could
only have been a by-product of the caesarean section performed by
Dr. Batiquin. The petitioners, in this regard, failed to overcome the
presumption of negligence arising from resort to the doctrine of res
ipsa loquitur. Dr. Batiquin is therefore liable for negligently leaving
behind a piece of rubber in private respondent Villegas's abdomen
and for all the adverse effects thereof.
5. Fe Lasam vs. Ramolete (G.R. No. 159132, December 18, 2008)
FACTS: On July 28, 1994, respondent, three months pregnant Editha
Ramolete was brought to the Lorma Medical Center (LMC) in San
Fernando, La Union due to vaginal bleeding. Upon advice of
petitioner relayed
Via telephone, Editha was admitted to the LMC on the same day. A
pelvic sonogram was then conducted on Editha revealing the fetus
weak cardiac pulsation. The following day, Edithas repeat pelvic
sonogram showed that aside from the fetus weak cardiac pulsation,
no fetal movement was also appreciated. Due to persistent and
profuse vaginal bleeding, petitioner advised Editha to undergo a
Dilatation and Curettage Procedure (D&C) or "raspa." The procedure
was performed by the petitioner and Editha was discharged the next
day. On September 16, 1994, Editha was once again brought at the
LMC, as she was suffering from vomiting and severe abdominal
pains. She was found to have a massive intra-abdominal hemorrhage
and a ruptured uterus. Thus, Editha had to undergo a procedure for
hysterectomy and as a result, she has no more chance to bear a child.
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Respondents:
Petitioners failure to check up, visit or administer medication on
Editha during her first day of confinement at the LMC;
Petitioner recommended that a D&C procedure be performed on
Editha without conducting any internal examination prior to the
procedure;
Petitioner immediately suggested a D&C procedure instead of
closely monitoring the state of pregnancy of Editha.
Petitioner: it was Edithas gross negligence and/or omission in
insisting to be discharged against doctors advice and her unjustified
failure to return for check-up as directed by petitioner that
contributed to her life-threatening condition on; that Edithas
hysterectomy was brought about by her very abnormal pregnancy
known as placenta increta, which was an extremely rare and very
unusual case of abdominal placental implantation; that whether or
not a D&C procedure was done by her or any other doctor, there
would be no difference at all because at any stage of gestation before
term, the uterus would rupture just the same.
HELD: Medical malpractice is a particular form of negligence which
consists in the failure of a physician or surgeon to apply to his
practice of medicine that degree of care and skill which is ordinarily
employed by the profession generally, under similar conditions, and
in like surrounding circumstances. There are four elements involved
in medical negligence cases: duty, breach, injury and proximate
causation.
In the present case, respondents did not present any expert
testimony to support their claim that petitioner failed to do
something which a reasonably prudent physician or surgeon would
have done. Petitioner, on the other hand, presented the testimony of
Dr. Augusto M. Manalo, who was clearly an expert on the subject.
He testified that the rupture occurred minutes prior to the
hysterectomy or right upon admission on September 15, 1994 which
is about 1 months after the patient was discharged, after the D&C
was conducted. It is evident that the D&C procedure was not the
proximate cause of the rupture of Edithas uterus. The defenses in an
action for damages, provided for under Article 2179 of the Civil
Code are: When the plaintiffs own negligence was the immediate and
proximate cause of his injury he cannot recover damages.
But if his negligence was only contributory, the immediate and
proximate cause of the injury being the defendants lack of due care,
the plaintiff may recover damages, but the courts shall mitigate the
damages to be awarded. Proximate cause has been defined as that
which, in natural and continuous sequence, unbroken by any
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 a 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. The Court notes the findings of the Board of Medicine:
When complainant was discharged on July 31,1994, herein
respondent advised her to return on August 4, 1994 or four (4) days
after the D&C. This advice was clear in complainants Discharge
Sheet. However, Complainant failed to do so. This being the case, the
chain of continuity as required in order that the doctrine of
proximate cause can be validly invoked was interrupted. Had she
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returned, the respondent could have examined her thoroughly.

Contributory negligence is the act or omission amounting to want of
ordinary care on the part of the person injured, which, concurring
with the defendants negligence is the proximate cause of the injury.
Difficulty seems to be apprehended in deciding which acts of the
injured party shall be considered immediate causes of the accident.
Where the immediate cause of an accident resulting in an injury is
the plaintiffs own act, which contributed to the principal occurrence
as one of its determining factors, he cannot recover damages for the
injury.
6. Rogelio Nogales vs. Capitol Medical Center (G.R. No. 142625,
December 19, 2006)
FACTS: Dr. Estrada applied low forceps to extract Corazon's baby.
In the process, a cervical tissue was allegedly torn. The baby came
out in an apnic, cyanotic, weak and injured condition. The bab
survived, but the mother died of profuse vaginal bleeding. The
husband sued CMC and the doctors.
ISSUES:
1) Whether an employee-employer relationship existedbetween
CMC and Dr. Estrada
2) whether CMC is vicariously liable for the negligence of Dr.
Estrada
HELD:
In Ramos vs. CA, weheld:
In other words, private hospitals, hire, fire and exercise real control
over their attending and visiting "consultant" staff. While
"consultants" are not, technically employees, the control exercised,
the hiring, and the right to terminate consultants all fulfill the
important hallmarks of an employer-employee relationship, with the
exception of the payment of wages. In assessing whether such a
relationship in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule that for the
purpose of allocating responsibility in medical negligence cases, an
employer-employee relationship in effect exists between hospitals
and their attending and visiting physicians.
Dr. Estrada is an independent contractor. Applying the control test,
SC did not find evidence pointing to CMC's exercise of control over
Dr. Estrada's treatment and management of Corazon's condition.
The patient was under the exclusive prenatal care of Dr. Estrada.
CMC merely allowed Dr. Estrada to use its facilities when Corazon
was about to give birth, which CMC considered an emergency.
But while SC held that Dr. Estrada is not CMCs employee, CMC is
vicariously liable under the doctrine of apparent authority.
General Rule: A hospital is not liable for the negligence of an
independent contractor-physician.
XPT: When physician is the "ostensible" agent of the
hospital (doctrine of apparent authority)
Requisites for the doctrine to apply:
(1) the hospital, or its agent, acted in a manner that would lead a
reasonable person to conclude that the individual who was alleged
to be negligent was an employee or agent of the hospital;
(2) where the acts of the agent create the appearance of authority, the
plaintiff must also prove that the hospital had knowledge of and
acquiesced in them; and
(3) the plaintiff acted in reliance upon the conduct of the hospital or
its agent, consistent with ordinary care and prudence.
Two Factors to consider:
1) An inquiry on whether the hospital acted in a manner which
would lead a reasonable person to conclude that the individual who
was alleged to be negligent was an employee or agent of the
hospital. The hospital need not make express representations to the

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patient that the treating physician is an employee of the hospital;

rather a representation may be general and implied.
2) An inquiry on whether the plaintiff acted in reliance upon the
conduct of the hospital or its agent, consistent with ordinary care
and prudence.
Application of these factors to this case:
1) CMC impliedly held out Estrada as a member of its medical staff.
a) CMC granted staff privileges to Dr. Estrada. CMC extended its
medical staff and facilities to
Dr. Estrada.
b) CMC made Rogelio sign consent forms printed on CMC
letterhead. These forms did not indicate that he was an independent
contractor-physician. No one from CMC informed the
Spouses
c) Dr. Estrada's referral of Corazon's profuse vaginal bleeding to Dr.
Espinola, who was then the Head of the Obstetrics and Gynecology
Department of CMC, gave the impression that
Dr. Estrada as a member of CMC's medical staff was collaborating
with other CMCemployed specialists in treating Corazon.
2) Rogelio testified that he and his wife specifically chose Dr. Estrada
to handle Corazon's delivery not only because of their friend's
recommendation, but more importantly because of Dr. Estrada's
"connection with a reputable hospital, the CMC." In other words, Dr.
Estrada's relationship with CMC played a significant role in the
Spouses Nogales' decision in accepting Dr. Estrada's services
7. Professional Services vs. Agana (G.R. No. 126297, February 2,
2010)
In this case, the Court, while affirming the existing doctrine that
hospitals as a general rule are not civilly liable for the tortuous acts
of their medical consultants in view of the absence of an employeremployee relationship between, nonetheless made the following pro
hac vice doctrinal pronouncements on the liability of the respondent
hospital based on the doctrines of ostensible agency and
corporate negligence, thus:
FACTS: Professional Services, Inc. (PSI) filed a second motion for
reconsideration urging referral thereof to the Court en banc and
seeking modification of the decision dated January 31, 2007 and
resolution dated February 11, 2008 which affirmed its vicarious and
direct liability for damages to respondents Enrique Agana and the
heirs of Natividad Agana (Aganas). Manila Medical Services, Inc.
(MMSI), Asian Hospital, Inc. (AHI), and Private Hospital
Association of the Philippines (PHAP) all sought to intervene in
these cases invoking the common ground that, unless modified, the
assailed decision and resolution will jeopardize the financial viability
of private hospitals and jack up the cost of health care.
ISSUE: Whether or not Professional Services Inc. has been erred to
be held liable for the Negligence of Dr. Miguel Ampil.
HELD: YES, after gathering its thoughts on the issues, this Court
holds that PSI is liable to the Aganas, not under the principle of
respondeat superior for lack of evidence of an employment
relationship with Dr. Ampil but under the principle of ostensible
agency for the negligence of Dr. Ampil and, pro hac vice, under the
principle of corporate negligence for its failure to perform its duties
as a hospital.
While in theory a hospital as a juridical entity cannot
practice medicine, in reality it utilizes doctors, surgeons and medical
practitioners in the conduct of its business of facilitating medical and
surgical treatment.

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**Where an employment relationship exists, the hospital

may be held vicariously liable under Article 2176 in relation to
Article 2180 of the Civil Code or the principle of respondeat superior.
Even when no employment relationship exists but it is shown that
the hospital holds out to the patient that the doctor is its agent, the
hospital may still be vicariously liable under Article 2176 in relation
to Article 1431 and Article 1869 of the Civil Code or the principle of
apparent authority. Moreover, regardless of its relationship with the
doctor, the hospital may be held directly liable to the patient for its
own negligence or failure to follow established standard of conduct
to which it should conform as a corporation.
**Under the "control test", an employment relationship
exists between a physician and a hospital if the hospital controls
both the means and the details of the process by which the physician
is to accomplish his task.
As priorly stated, private respondents maintained specific
work-schedules, as determined by petitioner through its medical
director, which consisted of 24-hour shifts totaling forty-eight hours
each week and which were strictly to be observed under pain of
administrative sanctions.
**That petitioner exercised control over respondents gains light from
the undisputed fact that in the emergency room, the operating room,
or any department or ward for that matter, respondents' work is
monitored through its nursing supervisors, charge nurses and
orderlies. Without the approval or consent of petitioner or its
medical director, no operations can be undertaken in those areas. For
control test to apply, it is not essential for the employer to actually
supervise the performance of duties of the employee, it being
enough that it has the right to wield the power.
8. Ramos vs. Court of Appeals (G.R. No. 124354 , April 11, 2002)
FACTS: Erlinda Ramos, after seeking professional medical help,
was advised to undergo an operation for the removal of a stone in
her gall bladder (cholecystectomy). She was referred to Dr. Hosaka, a
surgeon, who agreed to perform the operation on her. The operation
was scheduled for June 17, 1985 at 9:00 in the morning at private
respondent De Los Santos Medical Center (DLSMC). Since neither
petitioner Erlinda nor her husband, petitioner Rogelio, knew of any
anesthesiologist, Dr. Hosaka recommended to them the services of
Dr. Gutierrez.
Petitioner Erlinda was admitted to the DLSMC the day
before the scheduled operation. By 7:30 in the morning of the
following day, petitioner Erlinda was already being prepared for
operation. Upon the request of petitioner Erlinda, her sister-in-law,
Herminda Cruz, who was then Dean of the College of Nursing at the
Capitol Medical Center, was allowed to accompany her inside the
operating room.
At around 9:30 in the morning, Dr. Hosaka had not yet
arrived so Dr. Gutierrez tried to get in touch with him by phone.
Thereafter, Dr. Gutierrez informed Cruz that the operation might be
delayed due to the late arrival of Dr. Hosaka. In the meantime, the
patient, petitioner Erlinda said to Cruz, "Mindy, inip na inip na ako,
ikuha mo ako ng ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still not
around, petitioner Rogelio already wanted to pull out his wife from
the operating room. He met Dr. Garcia, who remarked that he was
also tired of waiting for Dr. Hosaka. Dr. Hosaka finally arrived at the
hospital at around 12:10 in the afternoon, or more than three (3)
hours after the scheduled operation.
Cruz, who was then still inside the operating room, heard
about Dr. Hosakas arrival. While she held the hand of Erlinda, Cruz
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saw Dr. Gutierrez trying to intubate the patient. Cruz heard Dr.
Gutierrez utter: "ang hirap ma-intubate nito, mali yata ang pagkakapasok.
O lumalaki ang tiyan." Cruz noticed a bluish discoloration of Erlindas
nailbeds on her left hand. She (Cruz) then heard Dr. Hosaka instruct
someone to call Dr. Calderon, another anesthesiologist. When he
arrived, Dr. Calderon attempted to intubate the patient. The nailbeds
of the patient remained bluish, thus, she was placed in a
trendelenburg position a position where the head of the patient is
placed in a position lower than her feet. At this point, Cruz went out
of the operating room to express her concern to petitioner Rogelio
that Erlindas operation was not going well.

3) After a careful consideration of the arguments raised by DLSMC,

the Court finds that respondent hospitals position on this issue is
meritorious. There is no employer-employee relationship between
DLSMC and Drs. Gutierrez and Hosaka which would hold DLSMC
solidarily liable for the injury suffered by petitioner Erlinda under
Article 2180 of the Civil Code. urther, no evidence was adduced to
show that the injury suffered by petitioner Erlinda was due to a
failure on the part of respondent DLSMC to provide for hospital
facilities and staff necessary for her treatment. For these reasons, the
Supreme Cord reverse the finding of liability on the part of DLSMC
for the injury suffered by petitioner Erlinda.

Cruz quickly rushed back to the operating room and saw

that the patient was still in trendelenburg position. At almost 3:00 in
the afternoon, she saw Erlinda being wheeled to the Intensive Care
Unit (ICU). The doctors explained to petitioner Rogelio that his wife
had bronchospasm. Erlinda stayed in the ICU for a month. She was
released from the hospital only four months later or on November
15, 1985. Since the ill-fated operation, Erlinda remained in comatose
condition until she died on August 3, 1999.

9. Cereno vs. CA (G.R. No. 167366 September 26, 2012)

FACTS: At 10:30 P.M., Raymond was brought inside the operating
room. For During that time, the hospital surgeons, Drs. Zafe and
Cereno, were busy operating on gunshot victim. Meanwhile, another
emergency case, a woman who was giving birth to triplets and was
brought to the operating room with the only anaesthesiologist, Dr
Tatad.

Petitioners filed with the Regional Trial Court of Quezon

City a civil case for damages against private respondents. After due
trial, the court a quo rendered judgment in favor of petitioners.
Essentially, the trial court found that private respondents were
negligent in the performance of their duties to Erlinda. On appeal by
private respondents, the Court of Appeals reversed the trial courts
decision and directed petitioners to pay their "unpaid medical bills"
to private respondents.
Petitioners filed with this Court a petition for review on certiorari.
The private respondents were then required to submit their
respective comments thereon. On December 29, 1999, this Court
promulgated the decision which private respondents now seek to be
reconsidered.
ISSUES:
1. WHETHER OR NOT DR. ORLINO HOSAKA (SURGEON) IS
LIABLE FOR NEGLIGENCE;
2. WHETHER OR NOT DR. PERFECTA GUTIERREZ
(ANESTHESIOLOGIST) IS LIABLE FOR NEGLIGENCE; AND
3. WHETHER OR NOT THE HOSPITAL (DELOS SANTOS
MEDICAL CENTER) IS LIABLE FOR ANY ACT OF NEGLIGENCE
COMMITTED BY THEIR VISITING CONSULTANT SURGEON
AND ANESTHESIOLOGIST.
RULING: In the case at bar, the following issues were resolved as
follows:
1) Dr. Hosaka's irresponsible conduct of arriving very late for the
scheduled operation of petitioner Erlinda is violative, not only of his
duty as a physician "to serve the interest of his patients with the
greatest solicitude, giving them always his best talent and skill," 44
but also of Article 19 of the Civil Code which requires a person, in
the performance of his duties, to act with justice and give everyone
his due.
2) Dr. Gutierrez claim of lack of negligence on her part is belied by
the records of the case. It has been sufficiently established that she
failed to exercise the standards of care in the administration of
anesthesia on a patient. Dr. Gutierrez omitted to perform a thorough
preoperative evaluation on Erlinda. Further, there is no cogent
reason for the Court to reverse its finding that it was the faulty
intubation on Erlinda that caused her comatose condition. There is
no question that Erlinda became comatose after Dr. Gutierrez
performed a medical procedure on her.
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After some time, Drs. Zafe and Cereno, proceeded to examine

Raymond and they found that the latters blood pressure was normal
and "nothing in him was significant." There being no other available
anesthesiologist to assist them, Drs. Zafe and Cereno decided to
defer the operation on Raymond. At 11:15 P.M, Drs. Cereno and Zafe
started their operation on Raymond at around 12:15 A.M., upon
opening of Raymonds thoracic cavity, they found that 3,200 cc of
blood was stocked therein. Dr. Cereno did not immediately transfuse
the blood since the bleeders had to be controlled first. Blood was
finally transfused on Raymond at 1:40 A.M. However, during the
operation, Raymond died due to massive loss of blood.
Parents of Raymond filed a case against the doctors. The doctors
were found negligently liable. Hence this appeal.
ISSUE: Whether or not Drs. Zafe and Cereno are guilty of gross
negligence in the performance of their duties.
HELD: NO. The type of lawsuit which has been called medical
malpractice or, more appropriately, medical negligence, is that type
of claim which a victim has available to him or her to redress a
wrong committed by a medical professional which has caused
bodily harm. In order to successfully pursue such a claim, a patient
must prove that a health care provider, in most cases a physician,
either failed to do something which a reasonably prudent health care
provider would have done, or that he or she did something that a
reasonably prudent provider would not have done; and that the
failure or action caused injury to the patient.
Given that Dr. Tatad was already engaged in another urgent
operation and that Raymond was not showing any symptom of
suffering from major blood loss requiring an immediate operation,
We find it reasonable that petitioners decided to wait for Dr. Tatad
to finish her surgery and not to call the standby anesthesiologist
anymore. There is, after all, no evidence that shows that a prudent
surgeon faced with similar circumstances would decide otherwise.
In medical negligence cases, it is settled that the complainant has the
burden of establishing breach of duty on the part of the doctors or
surgeons. It must be proven that such breach of duty has a causal
connection to the resulting death of the patient.

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Upon opening of his thoracic cavity, it was discovered that there was
gross bleeding inside the body. Thus, the need for petitioners to
control first what was causing the bleeding.
10. Jarcia vs. People (G.R. No. 187926 February 15, 2012)
FACTS: Roy Alfonso Santiago Jr after being hit by a taxicab was
brought by her mother to the Manila Doctors Hospital for an
emergency treatment. Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr.
Marilou Bastan (Dr. Bastan) junior (general) residents of the said
hospital conducted an X-ray of the victims ankle and it was alleged
that the X-ray result showed no fracture (as read by Dr. Jarcia); that
Dr. Bastan entered the emergency room(ER) and, after conducting
her own examination of the victim, informed Mrs. Santiago that
since it was only the ankle that was hit, there was no need to
examine the upper leg; that eleven (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 Xray revealed a right mid-tibial fracture and a linear hairline fracture
in the shaft of the bone.
The NBI indorsed the matter to the Office of the City Prosecutor of
Manila for preliminary investigation. Probable cause was found and
a criminal case for reckless imprudence resulting to serious physical
injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr. Pamittan,
before the RTC. They were found guilty beyond reasonable doubt of
the crime of Simple Imprudence Resulting to Serious Physical
Injuries.
That the negligence exhibited by the two doctors does not
approximate negligence of a reckless nature but merely amounts to
simple imprudence. Simple imprudence consists in the lack of
precaution displayed in those cases in which the damage impending
to be caused is not the immediate nor the danger clearly manifest.
The elements of simple imprudence are as follows.
1. that there is lack of precaution on the part of the offender; and
2. that the damage impending to be caused is not immediate of
the danger is not clearly manifest.
Dissatisfied, the petitioners appealed to the CA.
After trial and applying the doctrine of res ipsa loquitor the RTC
found petitioners to be guilty of simple negligence. The decision was
affirmed in toto by the CA.
ISSUES: (1) Whether or not res ipsa loquitor is applicable in this
case.
(2) Whether or not the petitioner physicians are criminally negligent
RULING: As to the first issue: The doctrine of res ipsa loquitur does
not apply since the circumstances that caused patient Roy Jr.s injury
and the series of tests that were supposed to be undergone by him to
determine the extent of the injury suffered were not under the
exclusive control of Drs. Jarcia and Bastan. It was established that
they are mere residents of the Manila Doctors Hospital at that time
who attended to the victim at the emergency room. While it may be
true that the circumstances pointed out by the courts below seem
doubtless to constitute reckless imprudence on the part of the
petitioners, this conclusion is still best achieved, not through the
scholarly assumptions of a layman like the patients mother, but by
the unquestionable knowledge of expert witness/es. As to whether
the petitioners have exercised the requisite degree of skill and care in
treating patient Roy, Jr. is generally a matter of expert opinion.
As to the second issue: Petitioners were negligent in their
obligation. It was proven that a thorough examination was not
performed on Roy Jr since as residents on duty at the emergency
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room, Dr. Jarcia and Dr. Bastan were expected to know the medical
protocol in treating leg fractures and in attending to victims of car
accidents.
Thus, simple negligence is resent if: (1) that there is lack of
precaution on the part of the offender, and (2) that the damage
impending to be caused is not immediate or the danger is not clearly
manifest.
In failing to perform an extensive medical examination to
determine the extent of Roy Jr.s injuries, Dr. Jarcia and Dr. Bastan
were remiss of their duties as members of the medical profession.
Assuming for the sake of argument that they did not have the
capacity to make such thorough evaluation at that stage, they should
have referred the patient to another doctor with sufficient training
and experience instead of assuring him and his mother that
everything was all right.
Moreover, the contention of petitioners that they cannot be held
liable since Roy is not their patient, since they are not the attending
physicians but merely requested by the ER does not hold water.
Physician-patient relationship exists when a patient engages the
services of a physician, a physician-patient relationship is generated.
And 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.
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.
Petitioners were absolved in the criminal charge for the reason that a
reasonable doubt existed but the are liable for damages. There is no
direct evidence proving that it was their negligence that caused the
suffering of Roy.
11. Rubi Li vs. Soliman (G.R. No. 165279 June 7 2011)
An Application of the Common-Law Doctrine of Informed Consent in a
Medical Malpractice (Medical Negligence) Case under Article 2176 of the
Civil Code
The ponencia enumerated the four essential elements that a plaintiff
must prove in a medical malpractice action based on the doctrine of
informed consent, paraphrased as follows: (1) the physicians duty
to disclose material risks; (2) the physicians failure to disclose, or
inadequate disclosure, of those risks; (3) the patients consent to
the treatment she otherwise would not have consented to, which is
a direct and proximate result of the physicians failure to disclose;
and (4) plaintiffs injury as a consequence the proposed treatment.
The gravamen in an informed consent case requires the plaintiff to
point to significant undisclosed information relating to the
treatment which would have altered her decision to undergo it.

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Applying the foregoing to this case, it was held that petitioner Dr.
Rubi Li, an oncologist who performed chemotherapy on
respondents daughter, who was sick with malignant bone cancer,
adequately disclosed material risks inherent in the chemotherapy
procedure performed with respondents consent. When petitioner
informed the respondents beforehand of the side effects of
chemotherapy, which includes lowered counts of white and red
blood cells, decrease in blood platelets, possible kidney or heart
damage and skin darkening, there is reasonable expectation on the
part of the doctor that the parents of the child understood very well
that the severity of these side effects will not be the same for all
patients undergoing the procedure.
As a physician, Dr. Li can reasonably expect the childs parents to
have considered the variables in the recommended treatment for
their daughter afflicted with a life-threatening illness. On the other
hand, it is difficult to give credence to the parents claim that
petitioner Dr. Li told them of 95% chance of recovery for their
daughter, as it was unlikely for doctors like petitioner who were
dealing with grave conditions such as cancer to have falsely assured
patients of chemotherapys success rate. Besides, informed consent
laws in other countries generally require only a reasonable
explanation of potential harms, so specific disclosures such as
statistical data, may not be legally necessary.
Quite incongruously, however, the ponencia went on to declare that
in the absence of expert testimony on the standard of care in
obtaining consent in chemotherapy treatment [since the witness for
the respondents-parents was not an expert, not being an oncologist
but a mere Medical Specialist of the Department of Health charged
with receiving complaints against hospitals], the Court felt hesitant
in defining the scope of mandatory disclosure in cases of malpractice
based on lack of informed consent such as this case involving
chemotherapy treatment.
Petitioner Dr. Li was found NOT liable to pay damages to the suing
parents.
VI. MEDICO-LEGAL ASPECTS OF DEATH
o

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Clinically dead; no BP, no respiration, no heartbeat, no

heart rate
o
Temperature drop (3 hours) cooling
o
Changes of muscle (3 stages)

Primary flaccidity (lupaypay)

Immediately || mainit pa

Rigor Mortis rigidity

3-6 hours-12 hours

complete rigor mortis

Secondary Flaccidity (lupaypay ulit)

24-36 hours || malamig na

o
Putrefaction 24-36 hours
o
Post mortem lividity gravitating of the blood

(3 hours) while cooling || tells the

position of the dead
o
Cadaveric spasm local/certain

Portion of the muscle becomes rigid,

not the entire body

Does not happen to all

o
Cannot give time of death but give clue if suicide
o
Stomach contents (3-4 hours)
o
Presence of flies/maggots (24hours)

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VII. PHYSICAL INJURIES

Different kinds of injuries:

o
Contrusion discoloration
o
Humatona bukol (elevation)
Regions of the body:
Head
Hands
Ankle
Fingers
Toes
Thighs
Legs
Forearms
Face
o Frontal
o Zygomatic cheeks
o Mandible mouth/jaw
o Maxillam ilalim ng ilong
o Temporal side
o Parietal lalamunan
o Occipital batok
o Orbit eyes
Body
o Chest (L/R)
o Abdomen

Right upper quadrant

Right lower

Left upper

Left lower

Epigastrro gitna

Injuries
o
Laceration blunt
o
Incision sharp-edged instrument
o
Abrasion gasgas
o
Stab knife
o
Punctured ice pick, screw driver (pointed objects)
VIII. GUNSHOT WOUNDS
o
Gunshot

Bullet
Flame (Singeing)- 6
Smoke- (Smudging)-12
Unburned powder (asdfghjkl;)-24

IX. SEX CRIMES

o Sex crimes
Defense wounds
Document laceration
Position clock
Extent/degree
o Incomplete
o Complete
o compound
12. People vs. Alverio (G.R. No. 194259, March 16, 2011)
FACTS: Alverio was found guilty of the crime of rape. He appealed
and questioned the decision on the ground that his guilt was not
proved beyond reasonable doubt. Alverio raises three (3) grounds in
support of his argument. First, he assails the trial court for giving
credence to the sole testimony of the victim. He claims that the
prosecution should have presented other witnesses to corroborate
the testimony of the victim. Second, he contends that the medical
certificate presented as evidence was not testified to by the signatory
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himself and should therefore not be considered as corroborative

evidence. Lastly, he claims that the trial court gravely erred in
convicting him of the crime of rape for failure of the prosecution to
prove his guilt beyond reasonable doubt.
After a careful perusal of the records of this case, however,
the Court is satisfied that the prosecutions evidence sufficiently
established Alverios guilt with moral certainty.
In addition, Alverio submits that although the medical
certificate was presented as evidence, its contents were never
testified to by the signatory himself and, as such, cannot be
considered as corroborative of the claim of the victim that she was
raped.
Such argument, however, cannot prosper. Medical evidence is
dispensable and merely corroborative in proving the crime of rape.
Besides, a medical certificate is not even necessary to prove the crime
of rape. The gravamen of rape is carnal knowledge of a woman
through force and intimidation.
The elements needed to prove the crime of rape under paragraph
1(a) of Article 266-A of the Revised Penal Code are: (1) the offender
is a man; (2) the offender had carnal knowledge of a woman; and (3)
the act is accomplished by using force or intimidation. All these
elements were sufficiently proved by the prosecution. The testimony
of AAA overwhelmingly proves that Alverio raped her with the use
of force and intimidation.
Furthermore, Alverios defense of alibi cannot stand versus the
positive identification of AAA. Nothing is more settled in criminal
law jurisprudence than the rule that alibi and denial cannot prevail
over the positive and categorical testimony and identification of the
accused by the complainant.
Accordingly, We find that the prosecution has discharged its burden
of proving the guilt of Alverio beyond reasonable doubt.
WHEREFORE, the appeal is DENIED. The CA Decision in CA-G.R.
CR-H.C. No. 00020 finding accused-appellant Jimmy Alverio guilty
of the crime charged is AFFIRMED
13. People vs. Domantay (G.R. No. 130612 May 11, 1999)
FACTS: Domantay was found guilty with the crime of Rape with
Homicide. Domantay appealed. Among his arguments was the fact
thereis no sufficient evidence to hold him guilty of raping Jennifer
Domantay.
As the victim here was six years old, only carnal
knowledge had to be proved to establish rape. Carnal knowledge is
defined as the act of a man having sexual intercourse or sexual
bodily connections with a woman. 52 For this purpose, it is enough if
there was even the slightest contact of the male sex organ with the
labia of the victim's genitalia. 53 However, there must be proof, by
direct or indirect evidence, of such contact.
Dr. Ronald Bandonill's report on the genital examination he had
performed on the deceased reads:
GENITAL EXAMINATION; showed a complete laceration of the right side
of the hymen. The surrounding genital area shows signs of inflammation.
xxx xxx xxx
REMARKS: 1) Findings at the genital area indicate the probability of
penetration of that area by a hard, rigid instrument.
Hymenal laceration is not necessary to prove rape; neither does its
presence prove its commission. As held in People v. Ulili, a medical
certificate or the testimony of the physician is presented not to prove
that the victim was raped but to show that the latter had lost her
virginity. Consequently, standing alone, a physician's finding that
the hymen of the alleged victim was lacerated does not prove rape. It
is only when this is corroborated by other evidence proving carnal
knowledge that rape may be deemed to have been established.
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This conclusion is based on the medically accepted fact that a

hymenal tear may be caused by objects other than the male sex organ
or may arise from other causes. Dr. Bandonill himself admitted this.
He testified that the right side of the victim's hymen had been
completely lacerated while the surrounding genital area showed
signs of inflammation. He opined that the laceration had been
inflicted within 24 hours of the victim's death and that the
inflammation was due to a trauma in that area. When asked by the
private prosecutor whether the lacerations of the hymen could have
been caused by the insertion of a male organ he said this was
possible. But he also said when questioned by the defense that the
lacerations could have been caused by something blunt other than
the male organ.
In contrast, in the case at bar, there is no circumstantial
evidence from which to infer that accused-appellant sexually abused
the victim. The only circumstance from which such inference might
be made is that accused-appellant was seen with the victim walking
toward the place where the girl's body was found. Maybe he raped
the girl. Maybe he did not. Maybe he simply inserted a blunt object
into her organ, thus causing the lacerations in the hymen. Otherwise,
there is no circumstance from which it might reasonably be inferred
that he abused her, e.g., that he was zipping up his pants, that there
was spermatozoa in the girl's vaginal canal.
Indeed, the very autopsy report of Dr. Bandonill militates against the
finding of rape. In describing the stab wounds on the body of the
victim, he testified:
[A]fter examining the body I took note that were several
stab wounds . . . these were all found at the back area sir . .
. extending from the back shoulder down to the lower
back area from the left to the right.
Considering the relative physical positions of the accused and the
victim in crimes of rape, the usual location of the external bodily
injuries of the victim is on the face, neck, and anterior portion of her
body. Although it is not unnatural to find contusions on the
posterior side, these are usually caused by the downward pressure
on the victim's body during the sexual assault. It is unquestionably
different when, as in this case, all the stab wounds (except for a
minor cut in the lower left leg) had their entry points at the back
running from the upper left shoulder to the lower right buttocks.
It is noteworthy that the deceased was fully clothed in blue shorts
and white shirt when her body was immediately after it was found.
Furthermore, there is a huge bloodstain in the back portion of her
shorts. This must be because she wearing this piece of clothing when
the stab wounds were inflicated or immediately thereafter, thus
allowing the blood to seep into her shorts to such an extent.
Even assuming that Jennifer had been raped, there is no
sufficient proof that it was accused-appellant who had raped her. He
did not confess to having raped the victim.
From the foregoing, we cannot find that accused-appellant
also committed rape. In the special complex crime of rape with
homicide, both the rape and the homicide must be established
beyond reasonable doubt.
14. Union Motor vs. NLRC (G.R. No. 159738 December 9, 2004)
FACTS: Respondent Alejandro A. Etis was hired by petitioner as an
automotive mechanic. On 22 September 1997, the respondent made a
phone call to the company nurse and informed her that he had to
take a sick leave as he had painful and unbearable tootache. Etis then
consulted a dentist who scheduled him for a tooth extraction but the
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same was rescheduled for several times due to inflammation. As a

result, respondent was not able to report for work for 10 days.
The petitioner considered respondents consecutive absences as
abandonment of office under the Company Rules and terminated the
services of the respondent. The respondent then filed a complaint for
illegal dismissal before the arbitration branch of the NLRC against
the petitioner.
The Labor Arbiter rendered a Decision dismissing the complaint.
The Labor Arbiter ruled that the respondents failure to report for
work for ten (10) days without an approved leave of absence was
equivalent to gross neglect of duty, and that his claim that he had
been absent due to severe toothache leading to a tooth extraction was
unsubstantiated. The Labor Arbiter stressed that "unnotarized
medical certificates were self-serving and had no probative weight.
Respondent then appealed to the NLRC. NLRC reversed the Labor
Arbiters Decision. CA affirmed NLRCs Decision.
ISSUE: Do medical certificates need to be notarized in order to be
admissible as evidence?
RULING: NO. Nowhere in our jurisprudence requires that all
medical certificates be notarized to be accepted as a valid evidence.
Verification of documents is not necessary in order that the said
documents could be considered as substantial evidence. The medical
certificates were properly signed by the physicians; hence, they bear
all the earmarks of regularity in their issuance and are entitled to full
probative weight. Common sense dictates that an ordinary worker
does not need to have these medical certificates to be notarized for
proper presentation to his company to prove his ailment; hence, the
Labor Arbiter a quo, in cognizance with the liberality and the
appreciation on the rules on evidence, must not negate the
acceptance of these medical certificates as valid pieces of evidence.
15. People vs. Colorado (G.R. No. 200792 November 14, 2012)
FACTS: Neil Colorado was convicted by the RTC for raping his fullblood sister AAA who was then 12-year old when the crime was
committed. Colorado appealed from the RTCs decision to the CA,
reiterating in his appeal the defenses of denial and alibi. The CA
affirmed Colorados conviction.
Colorado also questions the weight of Dr. Sanchezs medico-legal
certificate, arguing that AAAs hymenal lacerations could have
resulted from the sexual aggressions allegedly committed against
her by DDD and their brother-in-law.
ISSUE: Is a medical certificate necessary to prove the commission of
rape?
RULING: NO. As explained by the Court in People v. Balonzo, a
medical certificate is not necessary to prove the commission of rape,
as even a medical examination of the victim is not indispensable in a
prosecution for rape. Expert testimony is merely corroborative in
character and not essential to conviction. An accused can still be
convicted of rape on the basis of the sole testimony of the private
complainant. Furthermore, laceration of the hymen, even if
considered the most telling and irrefutable physical evidence of
sexual assault, is not always essential to establish the consummation
of the crime of rape. In the context that is used in the RPC, "carnal
knowledge," unlike its ordinary connotation of sexual intercourse,
does not necessarily require that the vagina be penetrated or that the
hymen be ruptured. Thus, even granting that AAAs lacerations
were not caused by Colorado, the latter could still be declared guilty
of rape, after it was established that he succeeded in having carnal
knowledge of the victim.

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16. Atienza vs. Sioson (G.R. No. 177407 February 2011)

FACTS: Private respondent Editha Sioson wen to Rizal Medical
Center for check-up. The tests revealed that her left kidney is normal
but the left is non-functioning and non-visualizing. Thus she
underwent kidney operation. After the operation, Editha and her
husband filed a complaint for gross negligence and/or incompetence
committed by petitioner Atienza which consists of the removal of
Edithas fully functional right kidney, instead of the left nonfunctioning and non-visualizing kidney.
To prove that her kidneys were both in their proper anatomical
locations at the time she was operated, she offered as evidence
photocopied medical documents. Petitioner filed his
comments/objections to private respondents [Editha Siosons] formal
offer of exhibits. He alleged that said exhibits are inadmissible
because the same are mere photocopies, not properly identified and
authenticated, and intended to establish matters which are hearsay.
He added that the exhibits are incompetent to prove the purpose for
which they are offered. BOM, however, admitted the said documents
as evidence.
ISSUE: Should the introduction of photocopied documents as
evidence be allowed?
RULING: YES. The introduction of secondary evidence, such as
copies of the exhibits, is allowed. Witness Dr. Nancy Aquino testified
that the Records Office of RMC no longer had the originals of the
exhibits because [it] transferred from the previous building, x x x to
the new building . Ultimately, since the originals cannot be
produced, the BOM properly admitted Edithas formal offer of
evidence and, thereafter, the BOM shall determine the probative
value thereof when it decides the case.
Furthermore, the fact sought to be established by the admission of
Edithas exhibits, that her kidneys were both in their proper
anatomical locations at the time of her operation, need not be proved
as it is covered by mandatory judicial notice.
17. Custodio vs. Sandiganbayan (G.R. No. 96027-28, March 08,
2005)
The report of the forensic group may not be considered as newly
discovered evidence as petitioners failed to show that it was
impossible for them to secure an independent forensic study of the
physical evidence during the trial of the double murder case. It
appears from their report that the forensic group used the same
physical and testimonial evidence proferred during the trial, but
made their own analysis and interpretation of said evidence. They
cited the materials and methods that they used for their study, viz:
MATERIALS AND METHODS
MATERIALS:
a. Court records of the case, especially photographs of: a) the
stairway where the late Sen. Aquino and his escorts descended; b)
the part of the tarmac where the lifeless bodies of the late Sen.
Aquino and Galman fell; and c) the autopsy conducted by the NBI
Medico-legal team headed by Dr. Mu[]oz; and the autopsy report of
the late Sen. Benigno Aquino[,] Jr. signed by Dr. Mu[]oz and Dr.
Solis;
b. The gun and live ammunitions collected at the crime scene;
c. A reference human skull photos and X-rays of the same to
demonstrate wound location and bullet trajectory;

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d. The reports of interviews and statements by the convicted military

escorts, and other witnesses;
e. Re-enactment of the killing of Aquino based on the military
escorts[] version, by the military escorts themselves in the Bilibid
Prison and by volunteers at the NAIA Tarmac;
f. Various books and articles on forensic and the medico-legal field[;]
g. Results of Forensic experiments conducted in relation to the case.
METHODS:
a. Review of the forensic exhibits presented in the court;
b. Review of TSNs relevant to the forensic review;
c. Study of and research on the guns, slugs and ammunitions
allegedly involved in the crime;
d. Interviews/re-enactment of the crime based on the militarys
accounts, both in the Bilibid Prison where the convicts are confined
and the MIA (now NAIA) stairway and tarmac;
e. Conduct of ocular inspection and measurements on the actual
crime scene (stairway and tarmac) at the old Manila International
Airport (now NAIA);
f. Retracing the slugs trajectory based on the autopsy reports and
experts testimonies using an actual human skull;
g. X-rays of the skull with the retraced trajectory based on the
autopsy report and experts testimonies;
h. Evaluation of the presented facts and opinions of local experts in
relation to accepted forensic findings in international publications on
forensic science, particularly on guns and [gunshot] wound injuries;
i. Forensic experiments and simulations of events in relation to this
case.[18]

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