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LEGAL MEDICINE
1.1B AUTOPSY

AUTOPSY
Greek
Eye witness (auto - self; opsis - view)
Necropsy
Post-mortem
Postmortem examinations provide factual, objective information
to the decedents families that negate their suspicions and
obviate their desire to pursue a lawsuit.
(Bove 2002)
TYPES
Medico-legal or Forensic
Hospital

HOSPITAL AUTOPSY
- cause of death
- internal exam more impt
- consent from next-of-kin
- any pathologist
- clinical history

FORENSIC AUTOPSY
- manner of death
- external exam
- no consent from kin
- forensic pathologist
- crime scene

BENEFITS OF THE AUTOPSY TO THE PUBLIC

1. Provides reassurance to the family.
2. Identification of any contagious or familial disease.
3. Evaluation for insurance benefits and workmans compensation
benefits.
4. The autopsy as an educational tool.
5. Identification of new or previously unrecognized disease.
6. The autopsy as a quality control tool

AUTOPSY AS A QUALITY CONTROL TOOL

Keep track of competence
Develop clinical craftsmanship
Sharpen diagnostic skills
Increased diagnostic accuracy
Check appropriateness of intervention

IMPORTANCE OF DEATH CERTIFICATES

Information provides basis for state and national mortality statistics used
to:

Assess general health of population

Evaluate medical treatment success

Examine medical problems with higher prevalence in certain

demographies and to identify where medical research can have
the greatest effect

Identify public health problems and evaluate established

programs to help these problems

Allocate healthcare services and follow up studies of infant and

maternal deaths and infectious diseases

Identify disease cause

Evaluate diagnostic & therapeutic technique

Identify leading causes of death

Identify potential life - years lost to diseases or injury

Provide information for epidemiological studies

Identify geographical areas with increased death rates from

certain causes of death

Serve as the primary means for evaluating health at the local

level

Discrepancy between clinical diagnosis and autopsy diagnosis: 10-45%

EMOTIONAL DISCOMFORTS IN AUTHORIZATION OF AN AUTOPSY
BY FAMILY

Discomfort with cutting the dead body

Fear of being disrespectful to the dead

Anxiety about offending nature

Fear of objections from next of kin

Concern about biomedical development

Resistance to revealing one's diseases

Anxiety about offending God

Distrust of doctors and healthcare system

Apprehension about the funeral being influenced

Fear of not being dead

Other discomforts

4 TYPES OF EVISCERATION TECHNIQUES

En Masse - Organs are removed as a single bulky aggregate
En Bloc (Ghon) - thoracic pluck, coeliac pluck, intestines,
urogenital pluck
Virchow's - organs individually removed
Rokitansky (in situ) - dissection occurs in situ with little actual
evisceration

LOCAL REGULATIONS
Code on Sanitation of the Philippines (P.D. 856)
Implementing Rules and Regulations of Chapter XXI -->
Disposal of Dead Persons

DEATH CERTIFICATE REQUIREMENTS

No remains shall be buried or cremated without a death
certificate
The D.C. must be issued by the attending government or
private physician
When no physician is in attendance, it shall be issued by:

city/municipal health officer

mayor

secretary of the municipal board

councilor of the municipality where the death

occurred.
The basis of the Death Certificate shall be an affidavit duly
executed by a reliable informant stating the circumstances
regarding the Cause of Death.
The death shall be reported to the Local Health Officer within
48 hrs after death and the Death Certificate shall be forwarded
to the local civil registrar concerned within 30 days after death
for registration.
SHIPMENT OR TRANSFER OF CADAVER
Death certificate
Transfer permit from local health authority of point of origin
Properly embalmed remains
Transfer permit from places the remains will pass
Abroad: rules and regulations of the National Quarantine Office
MEDICOLEGAL CASES
If the LHO who issues a D.C. has reasons to believe or suspect
that the COD was due to violence or crime, he shall notify
immediately the authorities of the PNP or NBI concerned.

VIOLENCE OR CRIME PRESENT WHEN:

Stab wounds
Gunshot wounds
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1.1B AUTOPSY

Suicide
Strangulation
Accident resulting to death
Actual physical assault inflicting injuries upon a person
resulting in death
Sudden death of undetermined cause
In case the cause of death was due to violence or crime
mentioned in the preceding subsection, the deceased shall not
be buried until permission is obtained from the provincial or city
prosecutor where the death occurred.
In the absence of the city or provincial prosecutor, permission
shall be obtained from:

Municipal or city judge

Municipal or city mayor

Chief of police
DANGEROUS COMMUNICABLE DISEASES
AIDS
cholera
Ebola
Hepatitis
Plague
Yellow Fever
Meningococcemia
THE REMAINS (WITH COMMUNICABLE DISEASE):
Buried within 12 hrs after death
Not taken to any place of public assembly
Only adult members of the family permitted to attend the
funeral
Placed in a durable, air tight and sealed casket
Not granted permit for transfers.

AUTOPSY & DISSECTION OF REMAINS

Authorized to perform:

Health officers - provincial, municipal, city

Medical officers of law enforcement agencies such

as PNP, NBI

Members of the medical staff of accredited hospitals.

AUTOPSIES SHALL BE PERFORMED WHEN:
When required by special lawsare those enforced and
presently practiced by the authorities.
Upon orders of a competent court, a mayor and a provincial or
city prosecutor
Upon written request of police authorities
Whenever the solicitor general, provincial or city prosecutor as
authorized by existing laws, shall deem it necessary
Upon request of the next of kin

REQUIREMENTS FOR AUTOPSIES IN ACCREDITED HOSPITALS:

The director or chief of the hospital shall notify in writing the

next of kin of the death of the deceased and request
permission

When permission is granted or no objection is raisedwithin

48 hrs

If no next of kin, secure from local health authority

HOUSE BILL NO.1899

Proposed Mandatory Autopsy Bill
Death where the criminal violence appears to have taken
place;

Death by any accident or unintentional injury;

Suicide;
Death under suspicious, unusual, unnatural, or questionable
circumstances;
Death following an illegal abortion;
Death related to occupational illness or injury;
Death while in custody, in any jail or correctional facility or in
any mental health or social welfare facility;
Death where suspicion of abuse of a child, family or household
member, older or disabled person exists;
Death due to poison or acute or chronic use of drugs, alcohol
and other similar or related substances;
Death associated with diagnostic or therapeutic procedures;
Sudden death when the decedent was in apparent good health;
Death in any public or private conveyance;
Fetal and infant deaths;
Death in any emergency treatment facility, medical walk-in
center or clinic;
Deaths occurring under such other circumstances as the
government' pathologist or medico-legal officer may include in
the implementing rules and regulations.
SEC, 14. Unlawful Issuance of Death Certificate. -- It shall be
unlawful for any person to issue a death certificate of a person
who died in a violent, suspicious, questionable, unusual and/or
unnatural circumstances without complying with the required
autopsy.
EXTERNAL EXAMINATION
The first time an external examination is carried out is upon
discovery of a corpse. At this point the body should be checked
for visible signs of injury and those injuries that are most likely
to have caused subsequent death.
At this stage both the Pathologist and Scenes of Crime Officer
(SOCO) are present as well as authorized police personnel and
the body is checked over in what is known as a preliminary
examination.
Whilst the Scenes of Crime Officer (SOCO) is taking
photographs of the corpse and surrounding area - and in
particular photographing wounds and injuries pointed out to
him or her by the pathologist - the pathologist will examine
these wounds and measure them.
Clothing will also be examined for any signs of excreted bodily
fluids and/or fibres.
Once the body has been removed from the scene of crime and
taken for pathological examination there is another external
examination to be carried out before an autopsy can be
completed.
This examination is conducted to determine height and weight
and also to facilitate the photographing of the corpse in its post
mortem state. This is also done to ensure that no additional
post mortem injuries have been sustained.
The clothes of the deceased are thoroughly checked for fibres,
hairs, bodily fluids and blood stains; as well as for tears and
rips that might correspond to knife or gun attacks.
The body is then checked for signs of rigor mortis (stiffening of
the muscles post mortem) and lividity (settling of the blood post
mortem); both of these conditions can be measured and used
as a means of determining time of death. In addition to this
these conditions can also be used to help determine whether or
not a body has been moved post mortem prior to its discovery.
Sometimes x-rays are taken at the external examination stage
if there are visible head injuries.

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LEGAL MED

1.1B AUTOPSY

INTERNAL EXAMINATION
A large and deep Y-shaped incision can be made starting at
the top of each shoulder and running down the front of the
chest, meeting at the lower point of the breastbone. This is the
approach most often used in forensic autopsies so as to allow
maximum exposure of the neck structures for later detailed
examination. This could prove essential in cases of suspected
strangulation.
a T-shaped incision made from the tips of both shoulder, in a
horizontal line across the region of the collar bones to meet at
the sternum (breastbone) in the middle. This initial cut is used
more often to produce a more aesthetic finish to the body when
it is re-constituted as stitching marks will not be as apparent as
with a Y-shaped incision
a single vertical cut is made from the middle of the neck (in the
region of the 'adam's apple' on a male body)

USEFUL INFICATORS FOR AN AUTOPSY QUALITY ASSURANCE

PROGRAM

Discrepancies between pathologic & final diagnosis

Lack of documentation by x-ray, photography and other tests

Evidence of pathologic misdiagnosis in final autopsy reports

Specimens who no clinical information sent to Pathology

Number of:
- Autopsies
- Cases sent to reference autopsy, laboratory or registry
- Incident reports
- Patient complaints
- Physician complaints
- Staff complaints
- Outstanding survey deficiencies (JCAHO, CAP, AABB, state)
- Mislabeled specimens

Results of family satisfaction questionnaires

Infection rates

ETHICAL VALUE OF THE HUMAN CADAVER

The person is intimately identified with his/her body, to the
point that they are practically inseparable
The way we treat the human cadaver influences the way we
treat the person alive; to treat the dead body as a simple
carcass, as a waste product, would mean implicitly to lower the
evaluation standards applied to the person alive
Desire to respect the memory of the deceased.
The cadaver is the material carrier of an amount of events
regarding the deceased person that persist in our memory.
Disrespecting the cadaver would mean in a way to disregard
the deceased person him/herself
Moral-ethical imperative to respect the familys mourning
An improper attitude towards the cadaver would mean thus
disregarding those close to the deceased one
Moral-religious significance of the human body.
Christian religion
From a Christian point of view, the practice of allowing
autopsies and ones body for scientific research is acceptable
and even to be encouraged if a true need exists.
The teaching of Islam does not allow for voluntary autopsy
because it is considered a desecration of a human person who
was associated with the body. If the law requires it, however,
then the next of kin may acquiesce to it.

__________________________________________________________
END OF TRANX

Medical negligence is based on standard-of-care issues rather

than accuracy of clinical diagnosis.
Misdiagnosis indicates lack of advanced medical technology.
No significant relationship between accuracy of clinical
diagnosis and outcome of the suit.

LIABILITIES OF PHYSICIANS
Administrative
Criminal
Civil

1.
2.
3.
4.
5.

SOURCES OF LIABILITIES OF PHYSICIANS

Ethics of the Medical Profession in the Philippines
Medical Act of 1959 as amended
Civil Code
Revised Penal Code
Special laws

ADMINISTRATIVE LIABILITY
The practice of medicine is service to mankind irrespective of race,
creed or political affiliation. In its practice, reward or financial gain should
be a subordinate consideration.

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