Atienza vs Board of Medicine (GR No.

177407 February 9, 2011)

Atienza vs Board of Medicine

GR No. 177407 February 9, 2011

Facts: Due to her Lumbar parts, private respondent Editha Sioson went to Rizal Medical Center (RMC) for check-up on February
4, 1995. Sometime in 1999, due to the same problem, she was referred to Dr. Pedro Lantin III of RMC who, accordingly, ordered
several diagnostic laboratory tests. The tests revealed that her right kidney is normal. It was ascertained, however, that her left
kidney is non-functioning and non-visualizing. This, she underwent kidney operation in 1999, September. On February 18, 2000,
private respondents husband Romeo Sioson, filed a complaint for gross negligence and/or incompetence before the board of
medicine against the doctors who allegedly participated in the fateful kidney operation. It was alleged in the complaint that the
gross negligence and/or incompetence committed by the said doctors, including petitioner, consists of the removal of private
respondents fully functional right kidney, instead of the left non-functioning and non-visualizing kidney. Among the evidence
presented are certified photocopy of the results of the ultrasound and X-ray conducted to Editha with the interpretation that both
of her kidneys are in their proper anatomical location.

Issue: Whether or not the doctors who conducted the kidney operation are liable for gross negligence despite the evidence
presented were mere photocopies.

Held: Yes. To begin with, it is a well settled rule that the rules of evidence are not strictly applied in proceedings before
administrative bodies such as the Board of Medicine. It is the safest policy to be liberal, not rejecting them on doubtful or
technical grounds, but admitting them unless plainly irrelevant, immaterial or incompetent, for the reason that their rejection
places them beyond the consideration of the court, if they are thereafter found relevant or competent; on the other hand, their
admission, if they turn out later to be irrelevant or incompetent, can easily be remedied by completely discarding them or ignoring
them.

Unquestionably, the rules of evidence are merely the means for ascertaining the truth respecting a matter of fact. This, they
likewise provide for some facts which are established and need not be proved, such as those covered by judicial notice, both
mandatory and discretionary. Laws of nature involving the physical sciences, specifically biology include the structural make-up
and composition of living things such as human beings. In this case, we may take judicial notice that Editha’s kidneys before, and
after the time of her operation, as with most human beings, were in their proper anatomical locations.

Dela Torre vs Imbuido (GR No. 192973 September 29, 2014)

Dela Torre vs Imbuido

GR No. 192973 September 29, 2014

Facts: At around 3:00pm of February 3, 1992, Carmen was brought to Divine Spirit General Hospital’s operating room for her
caesarian section operation, which was to be performed by Dr. Nestor. By 5:30pm, of the same day, Pedrito was informed by his
wife’s delivery of a baby boy. In the early morning of February 4, 1992, Carmen experienced abdominal pains and difficulty in
urinating. She was diagnosed to be suffering from urinary tract infection (UTI), and was prescribed medication by Dr. Norma. On
February 10, 1992, Pedrito noticed that Carmen’s stomach was getting bigger, but Dr. Norma dismissed the patient’s condition
as mere fratulence. When Carmen’s stomach still grow bigger despite medications, Dr. Norma advised Pedrito of the possibility
of a second operation on Carmen. Dr. Norma, however, provided no details on its purpose and the doctor who would perform it.
At around 3:00pm on February 12, 1992 Carmen had her second operation. Later in the evening, Dr. Norma informed Pedrito
that “everything was going on fine with his wife.” The condition of Carmen, however, did not improve. It instead worsened that on
February 13, 1992, she vomited dark red blood. At 9:30pm of the same day, Carmen died. Per her death certificate upon
information provided by the hospital, the immediate cause of Carmen’s death was cardio-respiratory arrest secondary to cerebro
vascular accident, hypertension and chronic nephritis induced by pregnancy. An autopsy report prepared by Dr. Partilano,
medico-legal officer designate of Olongapo City, however, provided that the cause of Carmen’s death was shock due to
peritonitis severe with multiple intestinal adhesions; status post caesarian section and exploratory laparotomy. Pedrito claimed in
his complaint that the respondents failed to exercise the degree of diligence required of them as members of the medical
profession, and were negligent for practicing surgery on Carmen in the most unskilled, ignorant, and cruel manner.
Issue: Whether or not respondents were liable for medical malpractice that resulted to Carmen’s death.

Held: No. 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, or his or her family as in this case, must prove that healthcare 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 failure or action caused injury to the patient.

Four essential elements must be established namely: 1.) duty; 2.) breach; 3.) injury and 4.) proximate causation. All four
elements must be present in order to find the physician negligent and thus, liable for damages.

For the trial court to give weight to Dr. Partilano’s report, it was necessary to show first Dr. Partilano’s specialization and
competence to testify on the degree of care, skill and diligence needed for the treatment of Carmen’s case. Considering that it
was not duly established that Dr. Partilano practiced and was an expert on the fields that involved Carmen’s condition, he could
not have accurately identified the said degree of care, skill and diligence and the medical procedure, that should have been
applied.

Alano vs Logmao (GR No. 175540 April 7, 2014)

Alano vs Magud-Logmao
GR No. 1755540 April 7, 2014

Facts: At around 9:50pm of March 1, 1988, Arnelito Logmao then 18 y/o, was brought to the East Avenue Medical Center
(EAMC) in Quezon City by two sidewalk vendors, who allegedly saw the former fall from the overpass near the Farmer’s Market
in Cubao, Quezon City. The patient’s data sheet identified the patient as Angelito Lugmoso of Boni Ave., Mandaluyong.
However, the clinical abstract prepared by Dr. Paterno F. Cabrera, the surgical resident on-duty at the emergency room of
EAMC, stated the patient is Angelito Logmao. Dr. Cabrera reported that Logmao was drowsy with alcoholic breath, was
conscious and coherent; that the skull x-ray showed no fracture; that at around 4:30am of March 2, 1988, Logmao developed
generalized seizures and was managed by the neuro-surgeon resident on-duty; that the condition of Logmao progressively
deteriorated and he was intubated and ambu-bagging support was provided; that admission to the ICU and mechanical
ventilation support became necessary, but there was no vacancy at the ICU and all the ventilation units were being used by other
patients; that a resident physician of NKTI, who was rotating at EAMC, suggested that Logmao be transferred to NKTI; and that
after arrangements were made, Logamo was transferred to NKTI at 10:10am. At the NKTI, the name Angelito Logmao was
recorded as Angelito Lugmoso. Lugmoso was immediately attended to and given the necessary medical treatment. As Lugmoso
had no relatives around, Jennifer Misa, transplant coordinator was asked to locate his family by enlisting police and media
assistance. Dr. Enrique Ona, chairman of the Department of Surgery, observed that severity of the brain injury of Lugmoso
manifested symptoms of brain death. He requested the laboratory section to conduct tissue typing and tissue cross-matching
examination, so that should Lugmoso expire despite the necessary care and medical management and he would be found to be
a suitable organ donor and his family would consent to organ donation, the organs thus donated could be detached and
transplanted promptly to any compatible beneficiary. The identity of Lugmoso was verified by Misa from EAMC and she was
furnished the patient’s data sheet. She then contacted several radio and television stations to request for air time for the purpose
of locating the family of Angelito Lugmoso of Boni Ave., Mandaluyong who was confined at NKTI with severe head injury after
allegedly falling from the Cubao overpass, as well as police station no. 5 Eastern Police District. Lugmoso was pronounced brain
dead on March 3, 1988 7:00am. Two hours later, Dr. Ona was informed that EEG recording exhibited a flat tracing thereby
confirming his brain death. He was found to be a suitable donor of the heart, kidneys, pancreas, and liver, and after the extensive
search, no relatives were found. Dr. Ona then requested the removal of the specific organs of Lugmoso from the herein
petitioners, Dr. Alano, the director of NKTI who thereafter issued a memorandum stating that only after the requirements of RA
349 as amended by PD 856 was complied, they can remove the specified organs of Lugmoso. Lugmoso’s remains was brought
at La Funeraria Oro. A press release made by NKTI announcing a double organ transplant led to the findings of the relatives of
Lugmoso.

Issue: Whether or not the removal of Lugmoso’s organs were valid.

Held: Yes. The internal organs of the deceased were removed only after he had been declared brain dead; thus the emotional
pain suffered by respondent due to the death of her son cannot be in any way be attributed to petitioner. Neither can the court
find evidence or second to show that respondent’s emotional suffering at the sight of the pitful state in which she found her son’s
lifeless body be categorically attributed to petitioner’s conduct.

Thus, there can be no cavil that petitioners employed reasonable means to disseminate notifications intended to reach the
relatives of the deceased. The only question that remains pertains to the sufficiency of time allotted for notices to reach the
relatives of the deceased.

If respondent failed to immediately receive notice of her son’s death because the notices did not properly state the name or
identity of the deceased, fault cannot be laid at petitioner’s door. The trial and appellate courts found that it was the EAMC, who
recorded the wrong information regarding the deceased’s identity to NKTI. The NKTI could not have obtained the information
about his name from the patient, because as found by the lower courts, the deceased was already unconscious by the time he
was brought to NKTI.

Bondoc vs Mantala (GR No. 203080 November 12, 2014)

Bondoc vs Mantala
GR No. 203080 November 12, 2014

Facts: Respondent was admitted at the Oriental Mindoro Provincial Hospital (OMPH) on April 3, 2009, at around 11:00am, with
referral from the Bansud Municipal Health Office. She was due to deliver her 5th child and was advised for a caesarian section
because her baby was big and there was excessive amniotic fluid in her womb. She started to labor at 7:00am and was initially
brought to the Bongabon Health Center. However, said health center also told her to proceed directly to the hospital. In her
complaint-affidavit, respondent alleged that inside the delivery room of OMPH, she was attended to by petitioner who instructed
the midwife and two younger assistants to press down on respondent’s abdomen and even demonstrated to them how to insert
their fingers into her vagina. Thereafter, petitioner went out of the delivery room and later, his assistants also left. After hours of
being in labor, respondent pleaded for a caesarian section. The midwife and the younger assistants pressed down on her
abdomen causing excruciating pains on her ribs and made her very weak. They repeatedly did this pressing until the bay and
placenta came out. When she regained consciousness, she was already at the recovery room, she learned that an operation
was performed on her by petitioner to removed her ruptured uterus but what depressed her most was her stillborn baby and the
loss of her reproductive capacity. The respondent noticed that her vulva swollen and there is an open wound which widened later
on and was re-stitched by petitioner. Petitioner was heard uttering words unbecoming of his profession pertaining to the
respondent’s states while in labor. Respondent filed then a complaint for grave misconduct against the petitioner before the
ombudsman. The petitioner resigned as medical officer of OMPH, alleging that the complaint against him is now moot and
academic.

Issue: Whether or not petitioner’s conduct during the delivery of respondent’s baby constitute grave misconduct.

Held: Yes. Misconduct is defined as a transgression of some established and definite rule of action, more particularly unlawful
behavior or gross negligence by a public officer, a forbidden act, a dereliction of duty, willful in character, and implies wrongful
intent and not mere error in judgement. It generally means wrongful, improper or unlawful conduct motivated by a premeditated,
obstinate or intentional purpose. The term, however does not necessarily imply corruption or criminal intent. To constitute an
administrative offense, misconduct should relate to or be connected with the performance of the official functions and duties of a
public officer. On the other hand, when the elements of corruption, clear intent to violate the law or flagrant disregard of
established rule are manifest, the public officer shall be liable for grave misconduct.

In deliberately leaving the respondent to a midwife and two inexperienced assistants despite knowing that she was under
prolonged painful labor and about to give birth to a macrosomic baby by vaginal delivery, petitioner clearly committed a
dereliction of duty and a breach of his professional obligations. The gravity of respondent’s conditions is highlighted by the
expected complications she suffered – her stillborn baby, a ruptured uterus that necessitated the immediate surgery and blood
transfusion and vulvar hematomas.
Article II section 1 of the code of medical ethics of the medical profession in the Philippines states: A physician, should attend to
his patients faithfully and conscientiously. He should secure fore them all possible benefits that may depend upon his
professional skill and care. As the sole tribunal to adjudge the physician’s failure to fulfill his obligation to his patient is, in most
cases, his own conscience, violation of this rule on his part is discreditable and inexcusable.

A doctor’s duty to his patient is not required to be extraordinary. The standard contemplated for doctors is simply the reasonable
coverage merit among ordinarily good physicians i.e. reasonable skill and competence. Even by this standard, petitioner fill short
when he routinely delegated an important task that requires his professional skill and competence to his subordinates who have
no requisite training and capability to make crucial decisions in difficult child births.

A physician should be dedicated to provide competent medical care with full professional skill and accordance with the current
standards of care, compassion, independence, and respect for human dignity.

Bontilao vs Gerona (GR No. 176675 September 15, 2010)

Bontilao vs Gerona
GR No. 176675 September 15, 2010

Facts: On December 28, 1991, respondent Dr. Carlos Gerona, an orthopedic surgeon at the Vicente Gullas Memorial Hospital,
treated petitioner’s son, 8 y/o Allen Roy Bontilao, for a fractured right wrist. Respondent administered a “U-spint” and immobilized
Allen’s wrist with a cast, then sent Allen home. On June 4, 1992, Alen re-fractured the same wrist and was brought back to the
hospital. The x-ray examination showed a complete fractured and displacement bone, with the fragments overlapping each
other. Respondent performed a closed reduction procedure, with Dr. Vicente Jabagat as the anesthesiologist. Then he placed
Allen’s arm in a plaster cast to immobilize it. He allowed Allen to go home after the post reduction x-ray showed that the bones
were properly aligned, but advised Allen’s mother, petitioner Sherlina Bontilao, to bring Allen back for re-tightening of the cast not
later than June 15, 1992. Allen was however, only brought back after the said date. By then, because the cast had not be re-
tightened, a rotational deformity had developed in Allen’s arm. The x-ray examination showed that the deformity was caused by a
re-displacement of the bone fragments, so it was agreed that an open reduction surgery will be conducted on June 24, 1992 by
the respondent, again with Dr. Jabagat as the anesthesiologist. On the said date, Sherlina was allowed to observe the operation
behind a glass panel. Dr. Jabagat failed to intubate the patient after 5 attempts so anesthesia was administered through a gas
mask. Respondent asked Dr. Jabagat if the operation should be postponed given the failure to intubate, but Dr. Jabagat said that
it was alright to proceed. Respondent verified that Allen was breathing properly before proceeding with the surgery. As
respondent was about to finish the suturing, Sherlina decided to go out of the operating room to make a telephone call and wait
for her son. Later, she was informed that her son died on the operating table. The cause of death was asphyxia due to the
congestion and edema of the epiglottis. Hence, a criminal, administrative and civil case was filed by the parents of Allen against
the doctors for the negligence that caused Allen’s death.

Issue: Whether or not respondent is liable for medical negligence due to the death of Allen.

Held: No. The trial court erred in applying the doctrine of res ipsa liquitor to pin liability on respondent for Allen’s death. Res ipsa
liquitor is a rebuttable presumption or influence that the defendant was negligent. The presumption only arises upon proof that
the instrumentality causing injury was in the defendant’s exclusive control, and that the accident was one which ordinarily does
not happen in the absence of negligence. It is a rule of evidence whereby negligence of the alleged wrong does may be inferred
from the mere fact that the accident happened, provided that the character of the accident and circumstances attending it lead
reasonably to the belief that in the absence of negligence it would not have occurred and that the thing which caused injury is
shown to have been under the management and control of the alleged wrong doer.

Res ipsa liquitor is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied defending upon the
circumstances of each case. In malpractice case, the doctrine is generally restricted to situations where a layman is able to say,
as a matter of common knowledge and observation, that the consequence of professional care were not as such as would
ordinarily have followed if due care had been exercised.

Moreover, we note that in the instant case, the instrument which caused the injury or damage was not even within respondent’s
exclusive control and management as Dr. Jabagat was exclusively in control and management of the anesthesia and
endotracheal tube. The doctrine of res ipsa liquitor allows the mere existence of an injury to justify a presumption of negligence
or the part of the person who controls the instrument causing the injury, provided that the following requisites concur:

1. The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or co-defendants;
3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.