Title: Dr. Rubi Li vs. Sps.

Soliman
GR 165279 June 7, 2011
Facts:
Respondents 11-year old daughter, Angelica Soliman, underwent a biopsy of the mass located in her lower
extremity at the St. Lukes Medical Center (SLMC) on July 7, 1993 and results showed that Angelica was suffering
from osteosarcoma, osteoblastic type, (highly malignant) cancer of the bone because of that a necessity of
amputation was conducted by Dr, Tamayo on Angelicas right leg in order to remove the tumor and to prevent
the metastasis that chemotherapy was suggested by Dr. Tamayo, which he referred to petitioner Dr. Rubi Li, a
medical oncologist.
The respondent was admitted to SLMC on August 18, 1993; however, she died eleven (11) days after the
(intravenous) administration of chemotherapy first cycle. Respondents brought their daughters body to the
Philippine National Police (PNP) Crime Laboratory at Camp Crame for post-mortem examination after the refusal
of the hospital to release the death certificate without full payment of bills. The Medico-Legal Report showed
that the cause of death as "Hypovolemic shock secondary to multiple organ hemorrhages and Disseminated
Intravascular Coagulation.
The respondents filed charges against the SLMC and physicians involve for negligence and failure to observe the
essential precautions in to prevent Angelicas untimely death. Petitioner denied the allegation for damages as
she observed best known procedures, highest skill and knowledge in the administration of chemotherapy drugs
despite all efforts the patient died. The trial court was in favor of the petitioner and ordered to pay their unpaid
hospital bill in the amount of P139, 064.43, but the Court of Appeals reversed the decision supporting the
respondents pray.
Issue:
WON Medical Malpractice is present in the case?
Held:
No, the case is dismissed.
Ratio:
Justice Villarama ruled that there are four essential elements a plaintiff must prove in a malpractice action based
upon the doctrine of informed consent: (1) the physician had a duty to disclose material risks; (2) he failed to disclose or
inadequately disclosed those risks; (3) as a direct and proximate result of the failure to disclose, the patient consented to
treatment she otherwise would not have consented to; and (4) plaintiff was injured by 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.
Examining the evidence on record, the ponencia held that there was adequate disclosure of material risks
inherent in the chemotherapy procedure performed with the consent of Angelicas parents. *The parents+ could not
have been unaware in the course of initial treatment and amputation of Angelicas lower extremity, that her immune
system was already weak on account of the malignant tumor in her knee. When [the doctor] informed the [parents]
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] understood very well that the severity of these side effects will not be the same for all
patients undergoing the procedure.
As a physician, petitioner can reasonably expect the 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 respondents claim that petitioner 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.
The element of ethical duty to disclose material risks in the proposed medical treatment cannot thus be reduced
to one simplistic formula applicable in all instances. Further, in a medical malpractice action based on lack of informed
consent, the plaintiff must prove both the duty and the breach of that duty through expert testimony. Such expert
testimony must show the customary standard of care of physicians in the same practice as that of the defendant doctor.

In this case, the testimony of Dr. Balmaceda *witness for the girls parents+ who is not an oncologist but a
Medical Specialist of the DOHs Operational and Management Services charged with receiving complaints against
hospitals, does not qualify as expert testimony to establish the standard of care in obtaining consent for chemotherapy
treatment. In the absence of expert testimony in this regard, the Court felt hesitant in defining the scope of mandatory
disclosure in cases of malpractice based on lack of informed consent, much less set a standard of disclosure that, even in
foreign jurisdictions, has been noted to be an evolving one.