It goes without saying that every aspect of the It goes without saying that every aspect of the practice of a profession is interwoven directly or practice of a profession is interwoven directly or indirectly with legal rules and sanctions. The indirectly with legal rules and sanctions. The examination and registration of applicants for the examination and registration of applicants for the practice of a profession, the professional conduct practice of a profession, the professional conduct of registered practitioners, the maintenance of of registered practitioners, the maintenance of ethical and technical standards of the provision, ethical and technical standards of the provision, the illegal practice of unregistered persons and the illegal practice of unregistered persons and even the exercise of the powers and duties of the even the exercise of the powers and duties of the board created to examine applicants and administer board created to examine applicants and administer the law regulating such profession, are all the law regulating such profession, are all governed by specific provisions of law, for the governed by specific provisions of law, for the purpose of attaining a normal and orderly procedure purpose of attaining a normal and orderly procedure in the practice of the profession. Knowledge of law in the practice of the profession. Knowledge of law is essential not only in settling lawsuits but also is essential not only in settling lawsuits but also in preventing or minimizing them.in preventing or minimizing them.

Like any other citizen, a nurse may incur criminal Like any other citizen, a nurse may incur criminal liability or subject herself to criminal liability or subject herself to criminal prosecution either by committing a felony or by prosecution either by committing a felony or by performing an act which would be an offense against performing an act which would be an offense against persons or property. Ignorance of the law is not an persons or property. Ignorance of the law is not an excuse for failure to comply therewith. Violators excuse for failure to comply therewith. Violators of the criminal law cannot escape punishment on the of the criminal law cannot escape punishment on the ground of ignorance of the law; neither can ground of ignorance of the law; neither can violators of private right escape liability for violators of private right escape liability for actual loss thereby inflicted on the ground that actual loss thereby inflicted on the ground that they are ignorant of the law. they are ignorant of the law.

Like any other professions, a professional nurse Like any other professions, a professional nurse has many legal responsibilities to assume in the has many legal responsibilities to assume in the practice of her profession. These legal practice of her profession. These legal responsibilities are entwined in every service she responsibilities are entwined in every service she renders to a patient and they may be felt by her renders to a patient and they may be felt by her especially when questions arise involving especially when questions arise involving negligence in the performance of her duties, or in negligence in the performance of her duties, or in the care or supervision of patients, or in the the care or supervision of patients, or in the fulfillment of contractual obligations. It is of fulfillment of contractual obligations. It is of importance to a nurse that she knows the legal the importance to a nurse that she knows the legal the responsibilities attached to the various phases of responsibilities attached to the various phases of her professional practice so that she may be her professional practice so that she may be properly guided in the discharge of her functions. properly guided in the discharge of her functions.

It is one of the earliest and most famous cases of It is one of the earliest and most famous cases of negligence by a nurse, the Somera case, reported in negligence by a nurse, the Somera case, reported in the International Review, July 1, 1930, pp.325-334. the International Review, July 1, 1930, pp.325-334. A Case in point is that of one Lorenza Somera, a A Case in point is that of one Lorenza Somera, a Registered Nurse and as the head nurse, who was Registered Nurse and as the head nurse, who was found guilty of the crime of Homicide through found guilty of the crime of Homicide through reckless imprudence for the death of a young girl reckless imprudence for the death of a young girl in the operating room. The facts of this case are in the operating room. The facts of this case are narrated in the book, narrated in the book, Jurisprudence for nurses, by Jurisprudence for nurses, by Carl Scheffel and Eleanor MacGarvah. Lorenza Somera Carl Scheffel and Eleanor MacGarvah. Lorenza Somera was directed by the operating surgeon to prepare was directed by the operating surgeon to prepare 10% cocaine with adrenalin for administration to a 10% cocaine with adrenalin for administration to a patient for tonsillectomy. Below are the case facts patient for tonsillectomy. Below are the case facts in condensed from which was published in 1930 from in condensed from which was published in 1930 from the International Nursing Review and it is read as the International Nursing Review and it is read as follows:follows:

Sometime in May, 1928, one Pedro Clemente took his Sometime in May, 1928, one Pedro Clemente took his daughter, Anastacia Clemente, who was below fourteen daughter, Anastacia Clemente, who was below fourteen years of age, to one Dr. Gregorio Favis of Manila for years of age, to one Dr. Gregorio Favis of Manila for treatment. After examining her, the doctor decided that treatment. After examining her, the doctor decided that she should undergo a tonsillectomy, to which the father she should undergo a tonsillectomy, to which the father agreed. So she instructed the father and his daughter to agreed. So she instructed the father and his daughter to go to the St. Pauls Hsospital on May 26go to the St. Pauls Hsospital on May 26thth, where he would , where he would perform the operation at 7:00 O’Clock in the morning. Dr. perform the operation at 7:00 O’Clock in the morning. Dr. Favis then called up Sister Mercedes of the St. Paul’s Favis then called up Sister Mercedes of the St. Paul’s hospital and requested her to have intended operation hospital and requested her to have intended operation fixed on said date and hour. He also informed her that he fixed on said date and hour. He also informed her that he would follow the same orders given in previous cases of would follow the same orders given in previous cases of tonsillectomy performed in the hospital. The Head Nurse tonsillectomy performed in the hospital. The Head Nurse in the operating room in the morning of May 26in the operating room in the morning of May 26thth was one was one Lorenza Somera. Valentina Andaya and Consolacion Lorenza Somera. Valentina Andaya and Consolacion Montinola were student Nurses working in the operating Montinola were student Nurses working in the operating room under Somera. Montinola was the sterilizing nurse room under Somera. Montinola was the sterilizing nurse and Dr. Armando Bartolome was the assistant surgeon.and Dr. Armando Bartolome was the assistant surgeon.

A 2,000 year-old surgical procedure in which A 2,000 year-old surgical procedure in which the tonsils are removed from either side of the the tonsils are removed from either side of the throat. Is performed in response to cases of throat. Is performed in response to cases of repeated occurrence of acute tonsillitis or repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or peritonsillar abscess. obstruction, snoring, or peritonsillar abscess.

Sometimes the adenoids are removed at the Sometimes the adenoids are removed at the same time (adenoidectomy). Although performed less same time (adenoidectomy). Although performed less frequently than in the 1950s, it remains one of the frequently than in the 1950s, it remains one of the most common surgical procedures in children in the most common surgical procedures in children in the United States.United States.

Effectiveness of the tonsillectomyEffectiveness of the tonsillectomy

It has been questioned in a 2009 systematic It has been questioned in a 2009 systematic review of 7765 papers, published in the journal review of 7765 papers, published in the journal Otolaryngology—Head and Neck Surgery.Otolaryngology—Head and Neck Surgery.

The reviews found that The reviews found that

It was most likely not effective all the It was most likely not effective all the time, but rather was modestly effective, and that time, but rather was modestly effective, and that "not a single paper reported that tonsillectomy is "not a single paper reported that tonsillectomy is invariably effective in eliminating sore throats"invariably effective in eliminating sore throats"..

There was only a short-term benefit - "A There was only a short-term benefit - "A child who meets these strict criteria will probably child who meets these strict criteria will probably suffer from 6 throat infections in the next two suffer from 6 throat infections in the next two years. A child who has surgery now will probably years. A child who has surgery now will probably suffer from 3 throat infections. And in two years suffer from 3 throat infections. And in two years there will probably be no difference."there will probably be no difference."

The generally accepted procedure for The generally accepted procedure for tonsillectomy involves separating and removing the tonsillectomy involves separating and removing the tonsils from the tonsils from the subcapsular planesubcapsular plane – a – a fasciafascia of of tissue that surrounds the tonsils. Removal is tissue that surrounds the tonsils. Removal is typically achieved using a scalpel or with typically achieved using a scalpel or with electrocautery, although harmonic scalpels or electrocautery, although harmonic scalpels or lasers have also been used. Bleeding is stopped lasers have also been used. Bleeding is stopped with electrocautery, ligation of with electrocautery, ligation of suturessutures, and the , and the topical use of topical use of thrombinthrombin, a protein that induces , a protein that induces blood clotting.blood clotting.

The procedure is carried out with the patient The procedure is carried out with the patient lying flat on their backs, with the shoulders elevated lying flat on their backs, with the shoulders elevated on a small pillow so that the neck is hyperextended – on a small pillow so that the neck is hyperextended – the so-called 'Rose' position. A mouth gag is used to the so-called 'Rose' position. A mouth gag is used to prop the mouth open; if an prop the mouth open; if an adenoidectomyadenoidectomy is also being is also being performed, the adenoids are first removed with a performed, the adenoids are first removed with a curettecurette; the ; the nasopharynxnasopharynx is then packed with sterile is then packed with sterile gauzegauze. A tonsil is removed by holding it by the upper . A tonsil is removed by holding it by the upper part, pulling it slightly part, pulling it slightly mediallymedially, and making a cut , and making a cut over the anterior over the anterior faucial pillarfaucial pillar. After the tonsil is . After the tonsil is removed from its position, a snare can be used to make removed from its position, a snare can be used to make a small cut on the lower portion prior to removal of a small cut on the lower portion prior to removal of the tonsil. The use of the tonsil. The use of electrocauteryelectrocautery minimizes the minimizes the blood loss.blood loss.

On the Day set for the operation, Dr. Favis On the Day set for the operation, Dr. Favis arrived at the St. Paul’s Hospital a little before arrived at the St. Paul’s Hospital a little before 7:00 o’clock in the morning. After scrubbing his 7:00 o’clock in the morning. After scrubbing his hands and examining the patient, he asked for a ten hands and examining the patient, he asked for a ten percent Cocaine solution with Adrenaline and with percent Cocaine solution with Adrenaline and with it he swabbed the patient’s throat, and Miss Somera it he swabbed the patient’s throat, and Miss Somera repeated and verified the order. The sterilized repeated and verified the order. The sterilized table was prepared, with solutions and other needed table was prepared, with solutions and other needed articles. Dr. Favis asked his assistant, Dr. articles. Dr. Favis asked his assistant, Dr. Bartolome, for the Novocaine/Procaine solution. Bartolome, for the Novocaine/Procaine solution. Thereupon, Montinola handed to Dr. Bartolome a Thereupon, Montinola handed to Dr. Bartolome a syringe filled with solution and in turn, Dr. syringe filled with solution and in turn, Dr. Bartolome handed it to Dr. Favis, who then injected Bartolome handed it to Dr. Favis, who then injected it to the patient. A few minutes later, Dr. Favis it to the patient. A few minutes later, Dr. Favis asked for more solution, which he injected again to asked for more solution, which he injected again to the patient.the patient.

After the second injection, Dr. Bartolome After the second injection, Dr. Bartolome noticed that the patient became pale and acted as if noticed that the patient became pale and acted as if she was dizzy, to which condition he called Dr. she was dizzy, to which condition he called Dr. Favis’ attention. Dr. Favis said that the same was Favis’ attention. Dr. Favis said that the same was not unusual and he then asked for a third syringe of not unusual and he then asked for a third syringe of the solution, which he again injected to the patient. the solution, which he again injected to the patient. A few moments later, the patient showed symptoms of A few moments later, the patient showed symptoms of convulsion to which Dr. Bartolome again called Dr. convulsion to which Dr. Bartolome again called Dr. Favis’ attention. Thereupon, Dr. Favis ordered Favis’ attention. Thereupon, Dr. Favis ordered adrenalin and then injected it to the patient. A adrenalin and then injected it to the patient. A second injection was administered and the patient second injection was administered and the patient again showed signs of convulsions. After a few again showed signs of convulsions. After a few moments, the patient died. Dr. Favis then asked if moments, the patient died. Dr. Favis then asked if the Novocaine was fresh. Somera replied that it was the Novocaine was fresh. Somera replied that it was not Novocaine but a 10 percent solution of cocaine.not Novocaine but a 10 percent solution of cocaine.

• Is a crystalline tropane alkaloid that is obtained Is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant.from the leaves of the coca plant.

• The name comes from "coca" in addition to the alkaloid The name comes from "coca" in addition to the alkaloid suffix suffix -ine-ine, forming , forming cocainecocaine..

• It is a stimulant of the central nervous system and an It is a stimulant of the central nervous system and an appetite suppressant.appetite suppressant.

• Specifically, it is a serotonin-norepinephrine-Specifically, it is a serotonin-norepinephrine-dopamine reuptake inhibitor, which mediates dopamine reuptake inhibitor, which mediates functionality of such as an exogenous catecholamine functionality of such as an exogenous catecholamine transporter ligand.transporter ligand.

• Because of the way it affects the mesolimbic reward Because of the way it affects the mesolimbic reward pathway, cocaine is addictive.pathway, cocaine is addictive.

The pharmacodynamics of cocaine involve the The pharmacodynamics of cocaine involve the complex relationships of neurotransmitters complex relationships of neurotransmitters (inhibiting monoamine uptake in rats with ratios (inhibiting monoamine uptake in rats with ratios of about: serotonin:dopamine = 2:3, of about: serotonin:dopamine = 2:3, serotonin:norepinephrine = 2:5)serotonin:norepinephrine = 2:5)

The most extensively studied effect of The most extensively studied effect of cocaine on the central nervous system is the cocaine on the central nervous system is the blockade of the dopamine transporter protein. blockade of the dopamine transporter protein. Dopamine transmitter released during neural Dopamine transmitter released during neural signaling is normally recycled via the signaling is normally recycled via the transporter; i.e., the transporter binds the transporter; i.e., the transporter binds the transmitter and pumps it out of the synaptic cleft transmitter and pumps it out of the synaptic cleft back into the presynaptic neuron, where it is back into the presynaptic neuron, where it is taken up into storage vesicles.taken up into storage vesicles.

Cocaine binds tightly at the dopamine Cocaine binds tightly at the dopamine transporter forming a complex that blocks the transporter forming a complex that blocks the transporter's function. The dopamine transporter transporter's function. The dopamine transporter can no longer perform its reuptake function, and can no longer perform its reuptake function, and thus dopamine accumulates in the synaptic cleft. thus dopamine accumulates in the synaptic cleft. This results in an enhanced and prolonged This results in an enhanced and prolonged postsynaptic effect of dopaminergic signaling at postsynaptic effect of dopaminergic signaling at dopamine receptors on the receiving neuron.dopamine receptors on the receiving neuron.

Prolonged exposure to cocaine, as occurs Prolonged exposure to cocaine, as occurs with habitual use, leads to homeostatic with habitual use, leads to homeostatic dysregulation of normal (i.e. without cocaine) dysregulation of normal (i.e. without cocaine) dopaminergic signaling via down-regulation of dopaminergic signaling via down-regulation of dopamine receptors and enhanced signal dopamine receptors and enhanced signal transduction.transduction.

Cocaine is a potent central nervous system Cocaine is a potent central nervous system stimulant. Its effects can last from 20 minutes stimulant. Its effects can last from 20 minutes to several hours, depending upon the dosage of to several hours, depending upon the dosage of cocaine taken, purity, and method of cocaine taken, purity, and method of administration.administration.

The initial signs of stimulation areThe initial signs of stimulation are

• hyperactivityhyperactivity• restlessnessrestlessness• increased blood pressureincreased blood pressure• increased heart rateincreased heart rate• euphoriaeuphoria

Although cocaine overdose is not common, it Although cocaine overdose is not common, it can occur and can be fatal. Because cocaine can occur and can be fatal. Because cocaine affects the heart and respiratory system, an affects the heart and respiratory system, an overdose can cause death, especially when the drug overdose can cause death, especially when the drug is injected. is injected.

An overdose of cocaine can lead to:An overdose of cocaine can lead to:• Irregular heart beat or heart failureIrregular heart beat or heart failure• High blood pressure resulting in a brain High blood pressure resulting in a brain hemorrhagehemorrhage• Repeated convulsionsRepeated convulsions• Respiratory failureRespiratory failure

• It is a local anesthetic drug of the amino ester It is a local anesthetic drug of the amino ester groupgroup

• it is used primarily to reduce the pain of it is used primarily to reduce the pain of intramuscular injection of penicillin, and it is intramuscular injection of penicillin, and it is also used in dentistryalso used in dentistry

• owing to the ubiquity of the trade name owing to the ubiquity of the trade name Novocain, procaine is sometimes referred to Novocain, procaine is sometimes referred to generically as novocainegenerically as novocaine

Procaine is used less frequently today since more Procaine is used less frequently today since more effective (and hypoallergenic) alternatives such as effective (and hypoallergenic) alternatives such as lidocaine (Xylocaine) exist. Prior to the discovery of lidocaine (Xylocaine) exist. Prior to the discovery of procaine, cocaine was the most commonly used local procaine, cocaine was the most commonly used local anesthetic. Like other local anesthetics (with the anesthetic. Like other local anesthetics (with the exception of cocaine), procaine is a vasodilator, and is exception of cocaine), procaine is a vasodilator, and is often co-administered with epinephrine for the purpose often co-administered with epinephrine for the purpose of vasoconstriction. Vasoconstriction helps to reduce of vasoconstriction. Vasoconstriction helps to reduce bleeding and prevents the drug from reaching systemic bleeding and prevents the drug from reaching systemic circulation in large amounts. Also unlike cocaine, circulation in large amounts. Also unlike cocaine, procaine does not have the euphoric and addictive procaine does not have the euphoric and addictive qualities that put it at risk for abuse.qualities that put it at risk for abuse.

Allergic reactions to procaine are usually Allergic reactions to procaine are usually not in response to procaine itself, but to PABA. not in response to procaine itself, but to PABA. About 1 in 3000 people have an atypical form of About 1 in 3000 people have an atypical form of pseudocholinesterase, which does not hydrolyze pseudocholinesterase, which does not hydrolyze ester anesthetics such as procaine, resulting in a ester anesthetics such as procaine, resulting in a prolonged period of high levels of the anesthetic prolonged period of high levels of the anesthetic in the blood and increased toxicity.in the blood and increased toxicity.

At the trial before the court of first instance of At the trial before the court of first instance of manila, Consolacion Montinola, when questioned by the manila, Consolacion Montinola, when questioned by the prosecution on direct examination, affirmed that she did prosecution on direct examination, affirmed that she did not know who prepared the drug; that she heard Dr. Favis not know who prepared the drug; that she heard Dr. Favis ordered cocaine with adrenalin for injection; and that ordered cocaine with adrenalin for injection; and that likewise, she heard Somera verified the order. When likewise, she heard Somera verified the order. When questioned by the defense, Montinola Again testified that questioned by the defense, Montinola Again testified that she heard Somera verified the order was given and she heard Somera verified the order was given and verified. Even on the part of the prosecution, the verified. Even on the part of the prosecution, the evidence had brought out the fact that Dr. Favis ordered evidence had brought out the fact that Dr. Favis ordered 10 percent Cocaine Solution for injection and that Somera 10 percent Cocaine Solution for injection and that Somera verified said order. The autopsy report and testimony of verified said order. The autopsy report and testimony of the Medico-legal Officer showed that the patient was the Medico-legal Officer showed that the patient was suffering from status lymphaticus and that such patients suffering from status lymphaticus and that such patients were known to die even with so slight an injury as a were known to die even with so slight an injury as a needle-prick.needle-prick.

The decision on the case was rendered by the The decision on the case was rendered by the trial Court on May 7, 1929. in its decision, the trial Court on May 7, 1929. in its decision, the court absolved Dr. Favis and Dr. Bartolome of the court absolved Dr. Favis and Dr. Bartolome of the crime of which they were accused, but declared crime of which they were accused, but declared Somera guilty of the crime charged in the complaint Somera guilty of the crime charged in the complaint and condemned her {a} to suffer imprisonment for and condemned her {a} to suffer imprisonment for one year and one day, {b} to indemnify the heirs of one year and one day, {b} to indemnify the heirs of the deceased Anastacia Clemente in the sum of one the deceased Anastacia Clemente in the sum of one thousand {1000} pesos, with subsidiary imprisonment thousand {1000} pesos, with subsidiary imprisonment in case of insolvency, {c} to suffer further the in case of insolvency, {c} to suffer further the accessories provided in Article 61 of the Penal accessories provided in Article 61 of the Penal Code, and {d} top pay one-third of the costs, Code, and {d} top pay one-third of the costs, somera then appealed to the supreme court. She was somera then appealed to the supreme court. She was accused of homicide through reckless imprudence.accused of homicide through reckless imprudence.

•((LatinLatin homicidiumhomicidium, , homohomo human being + human being + caederecaedere to cut, to cut, kill)kill)

• Refers to the act of killing another Refers to the act of killing another humanhuman being.being.

• A common form would be murder(i.e. slaughter, A common form would be murder(i.e. slaughter, abortion, death penalty, etc.)abortion, death penalty, etc.)

•It can also describe a person who has It can also describe a person who has committed such committed such an act, though this use is an act, though this use is rare in modern rare in modern English.English.

•Homicide is not always an illegal act, so although Homicide is not always an illegal act, so although "homicide" is often used as a "homicide" is often used as a synonym for "synonym for "murdermurder," ," this is not formally this is not formally correct.correct.

Homicides do not always involve a crime. Homicides do not always involve a crime. Sometimes the law allows homicide by allowing Sometimes the law allows homicide by allowing certain defenses to criminal charges. One of the certain defenses to criminal charges. One of the most recognized is self defense, which provides most recognized is self defense, which provides that a person is entitled to commit homicide to that a person is entitled to commit homicide to protect his or her own life from a deadly attack.protect his or her own life from a deadly attack.

Some defenses include:

1.Right of self-defense and defence of others

2. Insanity defense—There are several tests to check insanity

o M'Naghten Ruleso Insane delusiono Irresistible impulse testo Substantial capacity testo Durham ruleo Diminished capacity test

3. Duress3. Duress

4. Defence of property4. Defence of property

5. Prevention of a crime5. Prevention of a crime

6. Privilege of public authority—A person who has 6. Privilege of public authority—A person who has public authority to commit an act is not criminally public authority to commit an act is not criminally liable.liable.

7. Entrapment—The defense of Entrapment exists when 7. Entrapment—The defense of Entrapment exists when a law enforcement officer (or an agent of an a law enforcement officer (or an agent of an officer) solicits, induces, or encourages another officer) solicits, induces, or encourages another to commit a crime which they otherwise would not to commit a crime which they otherwise would not have committed.have committed.

8. Mistake of fact—The defense of Mistake of Fact asserts 8. Mistake of fact—The defense of Mistake of Fact asserts that a mistake of fact will disprove a criminal charge if that a mistake of fact will disprove a criminal charge if it is honestly entertained, based upon reasonable grounds it is honestly entertained, based upon reasonable grounds and is of such a nature that the conduct would have been and is of such a nature that the conduct would have been lawful had the facts been as they were supposed to be.lawful had the facts been as they were supposed to be.

9. Mistake of law— Not a valid defense to crime except in 9. Mistake of law— Not a valid defense to crime except in rare instances where it negates an essential element of rare instances where it negates an essential element of the crime. Therefore the old saying "ignorance of law is the crime. Therefore the old saying "ignorance of law is no excuse" is appropriate as a general rule.no excuse" is appropriate as a general rule.

10.Unconsciousness— The defense of Unconsciousness holds 10.Unconsciousness— The defense of Unconsciousness holds that one who is unconscious, for instance, someone that one who is unconscious, for instance, someone walking in their sleep, does not have the capacity to walking in their sleep, does not have the capacity to commit a crime.commit a crime.

Criminal Negligence may be classified into Criminal Negligence may be classified into reckless imprudence or simple imprudence. It is reckless imprudence or simple imprudence. It is reckless imprudence when a person does an act or reckless imprudence when a person does an act or fails to do it voluntarily but without malice. From fails to do it voluntarily but without malice. From which a material damage results immediately. Simple which a material damage results immediately. Simple imprudence means that the person or nurse did not imprudence means that the person or nurse did not use precaution and the damage was not immediate or use precaution and the damage was not immediate or the impending danger was not evident or manifested.the impending danger was not evident or manifested.

Reckless Imprudence if he does an act or Reckless Imprudence if he does an act or fails to do an act, voluntarily but without fails to do an act, voluntarily but without malice, from which act or omission a material malice, from which act or omission a material damage result because of his inexcusable lack of damage result because of his inexcusable lack of precaution, taking into consideration his precaution, taking into consideration his employment or occupation, degree of intelligence, employment or occupation, degree of intelligence, physical condition, and other circumstances physical condition, and other circumstances regarding persons, time and place. regarding persons, time and place.

Any person who by reckless imprudence shall Any person who by reckless imprudence shall commit an act which had it been intentional, would commit an act which had it been intentional, would constitute a grave felony, can be liable to a constitute a grave felony, can be liable to a penalty of imprisonment ranging from 4 months and penalty of imprisonment ranging from 4 months and one day to 2 years and four months; if the one day to 2 years and four months; if the negligent act constitutes a less grave felony, the negligent act constitutes a less grave felony, the offender can be punished by imprisonment of one offender can be punished by imprisonment of one month to four months. month to four months.

Rules for Graduating penalties Rules for Graduating penalties

For the purpose of Graduating the penalties For the purpose of Graduating the penalties which, according to provisions of Article fifty to which, according to provisions of Article fifty to fifty seven, inclusive, of this code, are to be fifty seven, inclusive, of this code, are to be imposed upon persons guilty as principals of any imposed upon persons guilty as principals of any frustrated or attempted felony, or as accomplices frustrated or attempted felony, or as accomplices or accessories, the following rules shall be or accessories, the following rules shall be observed:observed:

1. When the penalty prescribed for the felony is 1. When the penalty prescribed for the felony is single and indivisible, the penalty next lower in single and indivisible, the penalty next lower in degree shall be that immediately following that degree shall be that immediately following that indivisible penalty in the respective graduated indivisible penalty in the respective graduated scale prescribed in the respective graduated scale.scale prescribed in the respective graduated scale.

2. When the penalty prescribed for the crime is 2. When the penalty prescribed for the crime is composed of two indivisible penalties or of one or composed of two indivisible penalties or of one or more divisible penalties to be imposed to their more divisible penalties to be imposed to their full extent, the next lower in degree shall be that full extent, the next lower in degree shall be that immediately following the lesser of the penalties immediately following the lesser of the penalties prescribed in the respective graduated scale. prescribed in the respective graduated scale.

3. When the penalty prescribed for the crime is 3. When the penalty prescribed for the crime is composed of one or two indivisible penalties and composed of one or two indivisible penalties and the maximum period of another divisible penalty, the maximum period of another divisible penalty, the penalty next lower in degree shall be composed the penalty next lower in degree shall be composed of the medium and minimum periods of the proper of the medium and minimum periods of the proper divisible penalty and the maximum period of that divisible penalty and the maximum period of that immediately following in the said respective immediately following in the said respective graduate scale. graduate scale.

4. When the penalty prescribed for the crime is 4. When the penalty prescribed for the crime is composed of several periods, corresponding to composed of several periods, corresponding to different divisible penalties, the penalty next different divisible penalties, the penalty next lower in degree shall be composed of the period lower in degree shall be composed of the period immediately following the minimum prescribed and of immediately following the minimum prescribed and of the two next following, which shall be taken from the two next following, which shall be taken from the penalty prescribed if possible; otherwise from the penalty prescribed if possible; otherwise from the penalty immediately following in the above the penalty immediately following in the above mentioned respective graduate scale. mentioned respective graduate scale.

5. When the law prescribes a penalty for a crime in 5. When the law prescribes a penalty for a crime in some manner not specially provided for in the four some manner not specially provided for in the four preceding rules, the courts, preceding by the preceding rules, the courts, preceding by the analogy, shall impose the corresponding penalties analogy, shall impose the corresponding penalties upon those guilty as principals of the frustrated upon those guilty as principals of the frustrated felony, or an attempt to commit the same , and upon felony, or an attempt to commit the same , and upon accomplices and accessories. accomplices and accessories.

In court, Ms. Montinola testified she heard In court, Ms. Montinola testified she heard Dr. Favis order cocaine with adrenalin for Dr. Favis order cocaine with adrenalin for injection and heard Ms. Somera to have verified injection and heard Ms. Somera to have verified the order. Facts not brought in the trial were 1) the order. Facts not brought in the trial were 1) that Ms. Somera. Had finished her training only on that Ms. Somera. Had finished her training only on May 20, 1929; 2) that she had not received her May 20, 1929; 2) that she had not received her registration certificate and was not an registration certificate and was not an experienced graduate as states in the prosecution; experienced graduate as states in the prosecution; 3) that Dr. Favis had performed tonsillectomy but 3) that Dr. Favis had performed tonsillectomy but once previously in St. Paul’s and that no order once previously in St. Paul’s and that no order from Dr. Favis was given before his arrival.from Dr. Favis was given before his arrival.

The two accused doctors were absolved of the The two accused doctors were absolved of the crime but Lorenza Somera was condemned to suffer one crime but Lorenza Somera was condemned to suffer one year and one day imprisonment and to indemnify the year and one day imprisonment and to indemnify the heirs of Anastacia Clemente the sum of P1, 000.00 heirs of Anastacia Clemente the sum of P1, 000.00 with subsidiary imprisonment in case of insolvency with subsidiary imprisonment in case of insolvency and to pay one-third of costs.and to pay one-third of costs.  

On December 20, 1929, the supreme court On December 20, 1929, the supreme court affirmed the aforesaid decision, stating as follows: affirmed the aforesaid decision, stating as follows: “Wherefore finding the decision of then lower court “Wherefore finding the decision of then lower court to be in accordance with the facts and the law, it to be in accordance with the facts and the law, it is confirmed in all respect, with costs against the is confirmed in all respect, with costs against the appealant.appealant.

In view of the recommendation of two of the In view of the recommendation of two of the justices of the supreme Court who reviewed the case justices of the supreme Court who reviewed the case uponupon the appeal of the counsel of the defense, the the appeal of the counsel of the defense, the unanimous recommendation of the Board of Pardons, unanimous recommendation of the Board of Pardons, and the petition of the Philippine Nurses and the petition of the Philippine Nurses Association for executive clemency, the Governor-Association for executive clemency, the Governor-General remitted the part of the sentence which General remitted the part of the sentence which called for prison confinement provided that called for prison confinement provided that Lolrenza Somera would not, in the future, Violate Lolrenza Somera would not, in the future, Violate any of the penal laws of the Philippines. any of the penal laws of the Philippines.

Executive Clemency is the power of a Executive Clemency is the power of a President in federal criminal cases, and the President in federal criminal cases, and the Governor in state convictions, to pardon a person Governor in state convictions, to pardon a person convicted of a crime, commute the sentence convicted of a crime, commute the sentence (shorten it, often to time already served), or (shorten it, often to time already served), or reduce it from death to another lesser sentence. reduce it from death to another lesser sentence. There are many reasons for exercising this power, There are many reasons for exercising this power, including real doubts about the guilt of the including real doubts about the guilt of the party, apparent excessive sentence, humanitarian party, apparent excessive sentence, humanitarian concerns such as illness of an aged inmate, to concerns such as illness of an aged inmate, to clear the record of someone who has demonstrated clear the record of someone who has demonstrated rehabilitation or public service, or because the rehabilitation or public service, or because the party is a political or personal friend of the party is a political or personal friend of the Governor.Governor.

Additional Info:Additional Info:

1. In 1929, in Manila, Lorenza Somera (a nurse), 1. In 1929, in Manila, Lorenza Somera (a nurse), was found guilty of manslaughter, sentenced to a was found guilty of manslaughter, sentenced to a year in prison, and fined one thousand pesos for year in prison, and fined one thousand pesos for following a physician's orders.. She was found following a physician's orders.. She was found guilty because when the doctor said cocaine guilty because when the doctor said cocaine instead of procaine, she did not question his instead of procaine, she did not question his orders.orders.

ManslaughterManslaughter is a legal term for the killing of is a legal term for the killing of a human being, in a manner ca human being, in a manner c onsidered by law as onsidered by law as less culpable than murder.less culpable than murder.

The law generally differentiates between levels The law generally differentiates between levels of criminal culpability based on the of criminal culpability based on the mens reamens rea, or state , or state of mind. This is particularly true within the law of of mind. This is particularly true within the law of homicide, where murder requires either the intent to homicide, where murder requires either the intent to kill, a state of mind called kill, a state of mind called malicemalice, or , or malice malice aforethoughtaforethought, which may involve an unintentional killing , which may involve an unintentional killing but with a but with a wilful disregardwilful disregard for life. for life.

Manslaughter is usually broken down into two Manslaughter is usually broken down into two distinct categories: distinct categories: voluntary manslaughtervoluntary manslaughter and and involuntary manslaughterinvoluntary manslaughter..

I. Voluntary manslaughterI. Voluntary manslaughter

Voluntary manslaughterVoluntary manslaughter occurs when the occurs when the defendant kills with malice aforethought defendant kills with malice aforethought (intention to kill or cause serious harm), but (intention to kill or cause serious harm), but there are mitigating circumstances which reduce there are mitigating circumstances which reduce culpability. Voluntary manslaughter is a lesser culpability. Voluntary manslaughter is a lesser included offence of murder. The traditional included offence of murder. The traditional mitigating factor was provocation, however others mitigating factor was provocation, however others have been added in various jurisdictions.have been added in various jurisdictions.

The following are some examples of defences which The following are some examples of defences which may be raised to mitigate murder to voluntary may be raised to mitigate murder to voluntary manslaughter:manslaughter:

1. 1. ProvocationProvocationA killing occurred after A killing occurred after provocationprovocation by an by an

event which would cause a reasonable person to lose event which would cause a reasonable person to lose control.control.

2. 2. Imperfect self-defenseImperfect self-defenseAllowed only in a limited number of Allowed only in a limited number of

jurisdictions in the United States. Self-defence jurisdictions in the United States. Self-defence is generally a complete defence to murder. is generally a complete defence to murder. However, a person who acted in an honest but However, a person who acted in an honest but unreasonableunreasonable belief that deadly force was belief that deadly force was necessary for self-defence could still be necessary for self-defence could still be convicted of voluntary manslaughter or deliberate convicted of voluntary manslaughter or deliberate homicide committed without criminal malice. homicide committed without criminal malice. MaliceMalice is found if a person killed intentionally and is found if a person killed intentionally and without legal excuse or mitigation.without legal excuse or mitigation.

3. Diminished capacity 3. Diminished capacity or a mental breakdown or a mental breakdown can be a defence to negate the mental state of can be a defence to negate the mental state of "malice". If a jurisdiction recognizes that a "malice". If a jurisdiction recognizes that a person can kill with justification, but also person can kill with justification, but also without any evil intent, that jurisdiction is free without any evil intent, that jurisdiction is free to define the crime as something less than murder. to define the crime as something less than murder. Not all US states do this; in many, a mental Not all US states do this; in many, a mental defect, or even mental illness, won't reduce the defect, or even mental illness, won't reduce the seriousness of the offence whatsoever. However, if seriousness of the offence whatsoever. However, if a US state legislature chooses, a diminished a US state legislature chooses, a diminished mental state may justify the finding of a lesser mental state may justify the finding of a lesser crime. This is distinguished from the complete crime. This is distinguished from the complete defence of Insanity.defence of Insanity.

II. Involuntary manslaughterII. Involuntary manslaughter

Involuntary manslaughterInvoluntary manslaughter is the unlawful is the unlawful killing of a human being without killing of a human being without malice malice aforethoughtaforethought. It is distinguished from voluntary . It is distinguished from voluntary manslaughter by the absence of intention. It is manslaughter by the absence of intention. It is normally divided into two categories; constructive normally divided into two categories; constructive manslaughter and criminally negligent manslaughter and criminally negligent manslaughter.manslaughter.

The Legal MetaphorThe Legal Metaphor

1.1.In 1929, in Manila, Lorenza Somera (a nurse), In 1929, in Manila, Lorenza Somera (a nurse), was found guilty of manslaughter, sentenced to a was found guilty of manslaughter, sentenced to a year in prison, and fined one thousand pesos for year in prison, and fined one thousand pesos for following a physician's orders.following a physician's orders.

a. She was found guilty because when a. She was found guilty because when the doctor said cocaine instead of the doctor said cocaine instead of procaine, she did not question his procaine, she did not question his orders.orders.

The Legal MetaphorThe Legal Metaphor

2. Nurses cannot just depend on what the doctors 2. Nurses cannot just depend on what the doctors say; they have to know if what the doctor orders say; they have to know if what the doctor orders is correct.is correct.

3. Nurses have adopted the ethic of advocacy for 3. Nurses have adopted the ethic of advocacy for patientspatients

a. Unfortunately hospitals don’t like having a. Unfortunately hospitals don’t like having problems called to the public's attention, problems called to the public's attention, and give the nurses a very bad time about and give the nurses a very bad time about

it.it.

Conclusion:Conclusion:

Discussion of this case among Nurses and nursing Discussion of this case among Nurses and nursing students led to remarks that the incident should not students led to remarks that the incident should not have happened had Miss Somera asked, “Doctor, did you ask have happened had Miss Somera asked, “Doctor, did you ask for Cociane or Novocaine?” and if the doctor insisted on for Cociane or Novocaine?” and if the doctor insisted on cocaine, she should have directed the nursing student tp cocaine, she should have directed the nursing student tp dip a cotton pledget in cocaine was administered dip a cotton pledget in cocaine was administered topically.topically.

A nurse must see to it that she understands the A nurse must see to it that she understands the action of a drug, its minimum and maximum dosages, route action of a drug, its minimum and maximum dosages, route of administration, the untoward effects so that she may of administration, the untoward effects so that she may skillfully, safely, and effectively carry them out. She skillfully, safely, and effectively carry them out. She should be able to report and record the effects on the should be able to report and record the effects on the patient so that the doctor can judge its therapeutic patient so that the doctor can judge its therapeutic value and know when to discontinue their use. value and know when to discontinue their use.

Tests and treatments should be explained to Tests and treatments should be explained to the patient in accordance with the general plan of the patient in accordance with the general plan of his care so that the patient casn give full his care so that the patient casn give full consent and cooperate in its implementation. Any consent and cooperate in its implementation. Any unfavorable psychologic or physical reaction unfavorable psychologic or physical reaction should be likewise reported so that the proper should be likewise reported so that the proper action may be taken. Sometimes, however, refusal action may be taken. Sometimes, however, refusal may be due to inaccurate presentation of facts. may be due to inaccurate presentation of facts. Patients must receive special sympathetic Patients must receive special sympathetic attention from the nurse. Every effort should be attention from the nurse. Every effort should be made to correct inaccurate views and modify made to correct inaccurate views and modify superficially-held beliefs. superficially-held beliefs.