Medneg Chapter 1

UNIVERSITY OF THE EAST 1
CHAPTER 1
THE RESEARCH PROBLEM
This chapter covers the historical and contextual background of

medical negligence in the Philippines the statements of problem ,its scope and
limitation as well as the significance of study ,conceptual and and theoretical
framework and definition of terms .
HISTORICAL BACKGROUND OF THE STUDY
In this part of the study the history of medical negligence and its
relation to the law is a lengthy one,spanning back thousands of years .Whereas the
Doctors and the medicine was written in the law code through the law books since
then During the 19th and 20th centuries .The famous Hammurabi’s Code known as
the one of the oldest lengthty writings known in the world. During the 1794 B.C
the Babylonian Codes existed it consists of the two hundred eighty two laws .That
can be traced back to the code of Hammurabi. The Babylonian codes one of the
sections mentions about the unintended consequenes for medical negligence states
a doctor must be inflict a retribution for an offense .The Hippocratic Oath is an oath
historically taken by the physicians.In these oath contents the medical ethics .In the
Western World it establishing several principles of medical ethics which remain
significance today. Hippocrates called the Father of medicine in Western Culture .
The Hippocrates who lived in ancient Greece is considered by many to be the Father
of Western Medicine .The oath had many versions over time but doctors still use it
nowdays . The Roman Law recognized medical malpractice as a legal wrong and
this concept was expanded and this was introduced around the 1200 C.E
According to the English common law ,United States the medical
negligence was the concept of a tort and damages law .Whereas it evolved through
decades of state and the federal court decisions and it modified legistative . As the
Black’s Law dictionary it states there that when it says a kind of tort is a legal wrong
committed upon the person or property in a independent contract it categories as
the negligence ,gross negligence.professional negligence,recklessness,and act of
intentional harm.
Sec 770, RA 1885 states Any person who shall practice medicine in the
Philippines without having previously obtained the proper certificate of registration
issued by the board of medical examiners as herein constituted or lawful board
which was its predecessor shall be considered as gulty of malpractice, In Medical
it is a professional negligence,since Doctors and part of medical sectors this is there
professional discharing their professional duties are expected to act with higher
standard of care of non professionals. This is a claim of patient or the family of
patient against a physician . A physician patient relationship in this is a forming a
services a of physician. It was also a duty of a part of physician that they must a
reasonably a competent doctor .,basically in medical literature may be used to
established the standard of the care.
There are three elements of medical negligence one is Duty it discussed
that it refers to the standard of behavior that imposes restrictions on ones conduct .
It must have a proof of a professional relationship between a physician and a
patient. Without of specific proof and evidence a physician that talking about has
no owes duty to the patient and the physician can incur any liability . Secondly the
Breach duty occurs when the doctor fails comply with or improperly performs his
duties it results injured in body or in health ,due to the actionable malpractice is
committed ,entitling the patient to damages. Lastly the proximate causation it states
it is proven by the patient the casual relation between the negligence must be the
proximate cause of the injury .
The standard of care required of doctors are characterised by these two the
factual and legal. To qualify a witness as a medical expert it must be shown to the
witness thst he has required professional knowledge ,learning and skill and familiar
with the standard required of a physician . In the 1960s and beyond, Anecdotal
medical malpractice evidence suggests that in the nineteenth and early twentieth
centuries, it became possible under American court standard to sue a medical
professional for negligence. The negligence described in the anecdotes generally
involves a disregard for the patients well being or an egregious error.
Medical professionals were expected to be held to a common sense
standard of ethics at the court's discretion, or be found guilty of negligence. Medical
lawsuits at this time were not regulated by the federal government whatsoever.
Since the 1960s, the growth of medical negligence lawsuits has risen substantially
and peaked in the mid 1990s as further medical negligence legislation became
available and data was collected.
Amounts began to grow fastest in the 1970s when courts began publishing
standards of medical malpractice awards for claimants who felt they were subject
to mistreatment or negligence by their treating physician .Data for medical
malpractice is also collected from the decisions rendered in appellate court. For
example, a court award for medical malpractice is not valid as discernible data for
damage awards if the award is reviewed, altered overturned by an appellate court.

In Philippines a medical neglience case against a doctor is a generic term
for what may technically be an administrative complaint, a civil suit for damages
under Article 2176 of the Civil Code, a criminal case under Article 365 of the
Revised Penal Code), or all three. The rulings of the Supreme Court on the liabilities
of doctors outline how to prove medical neglience. They lay down the standards of
evidence for proving whether a complaint for medical neglience should be upheld
or dismissed.
There is, however, a strain of Supreme Court rulings which have held a doctor
liable for negligence even without medical experts or evidence presented against a
defendant doctor.
CONTEXTUAL BACKGROUND
Medical Neglience in the Philippines is one of the most difficult civil cases
in the Philippines . The Medical procedures involving medical degree and they
knew medical matters whereas they must understood first ,prior in pursuing claim
that a treatment was attended with medical negligence . Furthermore , in order to
prove the existence of medical negligence in any case, the legal requirements of
the law must be completely satisfied.
The case of medical neglience falls into tort that we called the Quasi Delicts.
The mere fact of an unfortunate or even tragic outcome is often insufficient proof
of a doctor’s negligence.
Stated in 1997 Supreme Court the doctors are protected by a special rule of
law. They are not guarantors of care. They do not even warrant a good result. They
are not insurers against mishaps or unusual consequences. Furthermore they are not
liable for honest mistakes of judgment . In another hand the Supreme Court applied
the ruling of “Res Ipsa Loquitor” means that the thing speaks itself . In this cases
that there must be a medical testimony that provides the proof of negligence . Hence
the application of Res Ipsa Loquitor is ordinarily required to show not only what
occurred but how and why it occurred. The Supreme Court ruled that in order for
res ipsa loquitur to apply, three essential requisites must be present:
In order to allow resort to the doctrine, therefore, the following essential

requisites must first be satisfied, to wit: (1) the accident was of a kind that does not
ordinarily occur unless someone is negligent; (2) the instrumentality or agency that
caused the injury was under the exclusive control of the person charged; and (3) the
injury suffered must not have been due to any voluntary action or contribution of
the person injured.
Like the case on late November 2017 the Philippine Department of

Health (DOH) there was a school based dengue vaccination also known also known
as "Dengvaxia", Tagalog pronunciation: [dɛŋˈvakʃa]) program after French drug
based vaccine maker Sanofi Pasteur made a statement that its product poses higher
risks to people without prior dengue infection.
The growing population of death incurred in life taking medical malpractices

in Philippines . Despite of numerous life saving procedures that are experimental
but sadly it fraught with consequences such that even the best doctors cannot predict
the outcome of there outcome of the treatment whereas it is on other hand effectives
of treatment .
Being a researchers and a Legal Management students we all want that any
medical professional or hospital has to do to avoid the medical negligence in the
Philippines. All the patients keep well informed of the procedure which the doctors
or hospital intends to perform and conduct the right treatment to the patients in a
good faith and with the required degree that is legitimate .
The researchers are currently taking up degree of Bachelor or Art’s Major

in Legal Management and in their Senior Year. The cases of medical neglience in
the Philippines and the cases of scenarios happened to the victims of negligence of
medical praticioners are factors account for the choice of dissertation topic. This
dissertation topic the medical negligence may elighten the mind of the
researchers,proffesionals ,and students to study the medical negligence this kind
of incidents and circumstances happened in the Philippines. This research contains
information research identifys the different criticism concerning the different cases
of medical neglience on Supreme Court .
Statement of the Problem
1. How any cases of the selected Supreme Court cases be content analyzed in
terms of:
a. Facts,
b. Issues,
c. Decisions and the reasons behind them
d. Lessons
2. What are the strengths and weaknesses of the decisions of the Supreme Court
in each of these cases?
3. What are the reform measures that the Government may adopt to address the
weaknesses?
Significance of the Study
This study is significant to the following stakeholders.
Medical Practitioners
Our dissertation focuses about the role of medical practitioners in the world of
medicine . Our study aims to state the responsibilities and role of medical
practioners medical practitioners are responsible for manages types of illness that
present in an undifferentiated way at an early stage of development, which may
require urgent intervention provides preventive care and health education to
patients to approach of general practice aims to take into consideration the
biological, psychological, and social factors relevant to the care of each patient's
illness. Well trained enough in different particular skills in treating people with
multiple health issues. This study will help raise awareness among medical
practitioners on how they can be held liable of medical negligence. To established
to tell to our research about required to complete four years of vocational training
after medical school, including three years and two months in a hospital setting
.These designed to train the physicians working in medical institutions . Our

research stands and believed that this would help them to be more diligent in
performing their duties with the standard of care they must provide to their patients.
Medical Institutions
Our research speaks about the Medical Institutions are required to provide
truly scientific and appropriate treatment to injured or sick people and are expected
to have substantial facilities. To give our point of view to the Medical
Institutionsthe Philippines As part of efforts to systematize medical facility
functions the Minister of Health the Labour and Welfare approves individual
hospitals having capabilities of providing advanced medical care development of
advanced medical technologies and conducting advanced medical care training.
To state our research the roles of Medical Institutions the specific role of Medical
Institution one to provide advanced medical care ,to develop and evaluate advanced
technologies to the patients to lessen errors manually ,to conduct more advanced
training to the future medical practioners in the future to implement an intensive
care throughout the surgeries and presecribing through the patients. The service of
the Medical institution must be concentrarte of providing the institutions to conduct
more seminars and more intensive training through the practioners . To give
attention to the centers of medical education, centers of medical research, and
incubators for medical innovation and technology in the Philippines.To eliminare
the errors ,damages of the medical procedure through the hospitals.This study will
help medical institutions to provide outmost care in undertaking the practice of
medicine.
Victims of Medical Negligence
This research wants to tell that the victims of medical negligence must have
legal assistance in the case of medical negligence. We stand and claims would limit
access to justice for injured victims and increase the chances that victims do not
receive the level of damages they deserve. The government must give an action to
help those victims who experienced the damage of the negligence of medical
malpractice ,because injured people seeking damages justice.study will help the
victims by giving them the knowledge needed in proving that they are victims of
medical negligence, a notoriously complex field where insurers representing
defendants often complicate proceedings and delay accepting liability, only
demonstrates the government’s ignorance of the reality of these kinds of cases and
what victims have to go through. This research is a voice for the victims and the
improvement of the medical practioners and medical institutions in the Philippines
.This would also aid in raising awareness among other patients about their
experiences.
The Legal Researchers
This research may contribute to the legal researchers to study hazing incidents
and circumstances happened in the Philippines. This research contains information
that might help the work of a legal researcher. The analysis of this research would
help the legal researchers to identify the different criticism concerning to hazing
incidents decided by the Supreme Court.

Students
This study will give insights to the students about medical negligence in the
Philippines. This study will give them deeper understanding on how the law decides
for cases of medical negligence.
Legal Practitioners
This study will guide legal practitioners in deciding cases of medical
negligence, which includes legal claims that they must provide in order to prove if
a medical practitioner is liable of negligence. This research may guide the legal
practitioner especially those who has the power to decide on the courts of the
Philippines so that they can perform their legal functions effectively by enforcing
the rule of law and gives justice that they deserve. And also, to those pursuing to
uphold the rule of law such as lawyers. This study would help them to apply, justify
and protect the law commendably.
Scope and Delimination of the Study
This study focused on selected cases of medical negligence decided by
the Supreme Court in Philippines (1) Art. 2176. Whoever by act or omission causes
damage to another, there being fault or negligence, is obliged to pay for the damage
done. Such fault or negligence, if there is no pre-existing contractual relation
between the parties, is called a quasi-delict and is governed by the provisions of
this Chapter (2) Article 365 Revised Penal Code ( Criminal Neglience )
Imprudence and negligence. — Any person who, by reckless imprudence, shall

commit any act which, had it been intentional, would constitute a grave felony,
shall suffer the penalty of arresto mayor in its maximum period to prision
correccional in its medium period; if it would have constituted a less grave felony,
the penalty of arresto mayor in its minimum and medium periods shall be imposed;
if it would have constituted a light felony, the penalty of arresto menor in its
maximum period shall be imposed.(3) Art. 2180. The obligation imposed by Art.
2176 is demandable not only for one’s own acts or omissions but also for those of
persons for whom one is responsible. (4) Art. 1173. The fault or negligence of the
obligor consists in the omission of that diligence which is required by the nature of
the obligation and corresponds with the circumstances of the persons, of the time
and of the place. When negligence shows bad faith, the provisions of Articles 1171
and 2201, paragraph 2, shall apply.If the law or contract does not state the diligence
which is to be observed in the performance, that which is expected of a good father
of a family shall be required.
The researcher‘s research study is focused on selected cases of Medical
Negligence decided by the Supreme Court only. The cases filed and decided in the
Regional Trial Court and Municipal trial court and other cases that was not
extended and decided by the Supreme Court are beyond the scope of this study.
The research method used in in this study is documentary analysis. The research
techniques employed in this study are content analysis and critiquing. The
instrument used for gathering data is likewise a documentary. The documents used
in this study are the photocopies of the seven (7) selected Supreme Court decided
cases on Medical Neglience . The procedure for gathering data in this study is
likewise a documentary. The seven (7) Supreme Court decided cases on hazing are
in the Supreme Court Report Annotated (SCRA) found and updated in the library
of each law school ncluding the University of the East.
No statistics for analyzing the data is required in this study because the
analyses and interpretations made are basically qualitative in nature, which is, based
on the depth and quality of insights of the researchers.
Theoretical Framework
The Input – Process – Output (IPO) Scheme of the Systems Theory (Kelly,
1974) was used in thesis study. The inputs are from the seven selected cases on
Medical Malpractice . The process is the content analysis of each of the ten cases
in terms of facts, issues, decisions and its bases, and reasons. The outputs are the
critiques of each the ten decisions identifying the deficiencies and offering of
remedies to address the deficiencies.
Content analysis consists of four separate but interrelated parts.
The respective distinct functions of each of the parts are as follows:
1. Facts of the case - refer to the objective information of each side of the
controversy: Facts are the bases of analysis of the problem.
2. Issues – refers to the focus or center of the controversy which is elevated to the
courts for decisions.

3. Decisions – refers to (a) the conclusion of the judge or the tribunal on the issue
and (b) the bases of the decision in order the public to check or validate the
decision.
4. Lessons – refers to the basic principles which are the bases of the decisions
Conceptual Framework
The Theory that guides this study is the Input, Process and Output of the
Systems Theory which is diametrically depicted below in Figure 1.
Input Process Output
MEJHEHTTT Content Critique
Analysis of each of the Strengths
The Seven Selected Ten cases Weaknesses

I Court Cases on
Supreme In ter ms of: Remedies
Medical Neglience
1. Facts
2. Issues
3. Descision and its
Bases
4. Lessons
FEEDBACK LOOP
Figure 1. The Research Paradigm Guiding the Study The inputs of the study
are the seven selected Supreme Court Cases on Medical Neglience
.
The process involved in this study consists of the content analysis of each of the
seven cases in terms of facts, issues, decisions and its bases and lessons. The outputs
of this study are the identification of: (a) the strengths of the decision on each of
the seven cases; (b) the weaknesses of each of the decisions and (c) the legislative
reform measures to address the weaknesses. There are no independent and
dependent variables.
Definitions of terms
1. Content Analysis – means the decomposition or breaking of each case into
facts, issues, decision and lesson for the purpose of showing the function of each
part in relation to the case or the whole.
2. Critique – refer to the identification of the strengths and weaknesses or both
and remedies offered to address each of the weaknesses.
3. Decisions – refer to the judgment of the Court on the issues and the reason(s)
behind the decision to enable the public to validate the decision.
4. Facts – refer to the objective information or data from either sides or parties in
the case which are necessary to determine the issue(s) and the decision on the
issue.
5 . Neglience - Negligence is a term that includes carelessness, conduct lacking in
due care, or a deviation from normal standards of care that any reasonable person
would use in the same set of circumstances.
6 . Malpractice- is the failure of a professional to act within their profession's
standards or a failure to foresee consequences that another professional of the same
kind is expected to foresee.
7.. Issues – refer to the focus or center of controversy in the case which must be
decided by the Supreme Court in order to put an end to the controversy.
8. Lessons – refer to the basic principles that can be derived from the case.
9. The seven selected cases on hazing by the Supreme Court – refer to the cases
chosen by this research for content analysis in this study because each of these
cases meets two of the five criteria for selecting cases.(See Method of Sampling
Used in Chapter III)
10. Strength – the application of the principles of law and other legislative
principles in the ruling of the cases decided by the Supreme Court.
11. Weakness – the failure to apply principles of law in the rulings of the cases
decided by the Supreme Court to propose measures to solve the issue of the case
as well as the failure of the Supreme Court to analyze all the facts by overlooking
pertinent information in the case.
12. Medical Neglience -Any negligence by an act or omission of a medical
practitioner in performing his/her duty is known as medical negligence. Medical
negligence happens when the medical practitioner fails to provide the care which is
expected in each case thus resulting in injury or death of the patient. It can be any
tort or breach of contract of health care or professional services rendered by a health
care provider to a patient. The standard of skill and care required of every health
care provider in rendering professional services or health care to a patient shall be
that degree of skill and care ordinarily employed in the same or similar field of
medicine as defendant, and the use of reasonable care and diligence.

CHAPTER II
REVIEW OF RELATED LITERATURE AND RELATED STUDIES
This chapter covers the related literature amd studies local,foreign,about the
variables of the study .
Related Literature and Related Studies on the Variables of the Study
Related Literature
a) Foreign
Related Foreign Literature
According to the article "Clinical Errors and Medical Negligence" by
Femi Oyebode, Among hospitalized patients worldwide, 3–16s% suffer
injury as a result of medical intervention, the most common being the
negative effects of drugs. The frequency of negative drug effects appears
superficially to be higher in intensive care units and emergency departments
but once rates have been corrected for volume of patients, comorbidity of
conditions and number of drugs prescribed, the difference is not significant.
It is concluded that probably no more than 1 in 7 negative events in
medicine result in a malpractice claim and the factors that predict that a
patient will resort to litigation include a prior poor relationship with the
clinician and the feeling that the patient is not being kept informed. Methods
for preventing clinical errors are still in their infancy. The most promising
include new technologies such as electronic prescribing systems, diagnostic
and clinical decision-making aids and error-resistant systems. Clinical
errors and malpractice claims are increasingly important aspects of medical
practice. There is concern that the risk of acquiring disabling illness due to
medical of intervention during hospitalization is contributing to the cost of
care, adding to the burden of the patient and as a result of malpractice
claims, causing mounting and spiralling costs to the health-care system and
for society at large. The Institute of Medicine (IOM) report estimated the
total cost of medical error as USD 17–29 billion per annum. The report also
estimated that there were 7,000 additional deaths per annum due to medical
errors. The similarity of their report and our is that the aims of this are both
to produce a narrative review of the literature on clinical errors and
malpractice claims, respectively, with a view to describing the patterns,
costs, consequences and prevention of clinical errors and malpractice claims
as well as describing the complex relationship between the two. The
difference is that their literature is almost entirely from the USA ours is
more extensive and include other countries.
In the same article it is stated that much of the work on clinical and
medication errors is from the USA. However, in a recently reported study
from a typical British teaching hospital over a 4-week study period, 1.5s%
prescribing errors were identified and potentially serious errors occurred in
0.4s% of cases. The majority of errors originated from prescribing

decisions. In general practice, Rubin et al..developed a classification system
for errors and reported an overall error rate of 75.6/1,000 appointments. The
majority of errors were prescription errors (42s%) followed by
communication errors (30s%). The similarity is that their report and our
both agree that there are errors which resulted to the malpractice but our
difference is that the majority reason is from dosage errors. The relative
scarcity of data on patient safety in countries other than the USA and in
particular in developing and emerging economies has been commented
upon. There have been calls for knowledge sharing, arguing for the
development of an international knowledge database. There are increasing
numbers of reports on clinical errors from other countries. The evidence
suggests that 3–16s% of hospitalized patients suffer harm as a result of
medical care, which indicates the considerable burden of harm to patients.
Medical negligence claims are not coextensive with cases that are the
subject of a clinical error. The Harvard Medical Practice study reported that
the overall rate of negligence claims per discharge was 0.13s%. Of the 280
patients in the study who had experienced adverse events caused by clinical
error, only 8 filed a medical malpractice claim. This gave an estimate of
the4ratio of adverse event to malpractice claim of 7.6:1. The authors
concluded that this was a clear overestimation, as most of the events for
which malpractice claims were made did not meet the research criteria of
adverse events due to clinical error. In the UK, it was estimated that there
were 90,000 adverse events per annum, of which 13,500 involved the death
of patients, but only resulted in around 7,000 claims and 2,000 payments.
The similarity between their and our reports is that we agree that almost
majority of malpractice aren't reported due to not meeting the research
criteria. We can't find a difference since we agreed to what they reported.
It's hard to claim that they're wrong because we can't find valid enough to
counterpart their report.
In 1996/1997, medical negligence was estimated to cost the National
Health Service (NHS) in England GBP 235 million, and in 2010/2011 this
figure had risen to GBP 863 million. Negligence claims against GPs went
up 13-fold between 1989 and 1998. For example, it was reported that in
1989 there were 38 claims against GP members of the Medical Protection
Society, and by 1998 these claims had risen to 500. The similarity of their
and our repirts is that we both concluded that the greatest rise was in the
number of actions that ultimately failed or were abandoned. The difference
however, it must be noted that unlike data from medical protection
organizations, estimates of negligence claims in the NHS are subject to
revision. Some even argue that such estimates are exaggerated and that
although the rate of growth has increased, this does not amount to an
uncontrollable explosion as is sometimes inferred. The rising number of
malpractice claims reported in the UK is mirrored in other jurisdictions. In
the period 1999–2008, in Saudi Arabia, claims rose from 440 to 1,356. Most
claims were in obstetrics followed by general surgery.

According to the article entitled, "ni, The concept of medical tourism
might have been in practice for centuries, but due to the recent widespread
globalization, the medical tourism industry has been burgeoning and is set
to continue growing well into the future. But there are several struggles that
we still have to face in order to keep the reputation of medical tourism
strong. One of the greatest issues is the lack of legal regulation for cases of
medical malpractice. The fact that no standards are in place or no regulation
body has been created in order to address the very relevant issue of medical
malpractice is weakening the industry and all it has to offer. The similarity
between theirs and our report is that we agree that patients should have a
right to penalty if negligence has been done upon them and doctors need to
take responsibility for their actions. Additionally, as individuals invest in
the medical tourism industry, they need to work together to ensure that
patients have the safest medical journey possible and that they have an
outlet to voice their cases when medical negligence occurs. Finally, we need
to create a sound support system for practitioners to protect themselves in
the case of unfortunate results or complications that have occurred because
of unintentional practice. We can't find adeaquate reason to differentiate his
report from ours because we fully agree that this is right.
According to the article entitled, "Records of medical malpractice
litigation: a potential indicator of health-care quality in China" by World
Health Organization they stated that: "Our study indicates that, in China,
medical malpractice litigation has become much more common than

previously reported.5,25 However, we cannot determine if the increasing
frequency of such litigation reflects a decrease in the general quality of
health care. Between 2010 and 2015, similar increases in the annual
numbers of cases of medical malpractice litigation have been observed in
Japan,32 Mexico33 and the USA.6 The geographical differences that we
observed – in the total number of medical malpractice cases, the number of
cases per million population and the number of cases per 1000 physicians,
can probably be partially explained in terms of the uneven distribution of
health-care resources across China. The more developed eastern China
tends to have more medical resources than central or western China.34
Eastern China also appears to have relatively high incidences of medical
malpractice litigation per million population and per 1000 physicians –
although we were unable to determine what proportions of the incidence
recorded for a study area were represented by the residents of the study area
and by people from other areas who had travelled for treatment. One aim of
the health system reforms in China is to reinvigorate health-care services in
the country’s less developed areas. Our study results may re-emphasize the
importance of a more equal allocation of health-care resources across
China." The similarity of their with report is that we agree that uneven
distribution regardless of wherever country can be one of the variables
which can result to medical negligence. Afterall it isn't easy to be good in
your profession when you lack access and resources. They also stated that:
"Another possible factor in the uneven geographical distribution of medical

malpractice litigation across China is geographical variation in access to –
and/or attitudes towards – justice. In some areas of Central and Latin
America, nongovernmental organizations have assisted plaintiffs in
litigation for access to essential medicines. It seems possible that, in the
more developed areas of China, patients or patients’ families may be more
likely to be encouraged to file lawsuits by nongovernmental organizations
or other forms of social assistance." The similarity to our resesrch to their
is that we strongly agrre that geograohical variation and attitudes towards
justice can contribute to medical negligence however we don't believe that
families of patients are influenced by nongovermenfal organixations to file
lawsuit. They filed because they themselves must've felt the injustice when
their loved ones suffred the consequence of Medical Malpractice
.Additionally, they said: "Internal medicine, general surgery, orthopaedics
and obstetrics and gynaecology were found to be the leading specializations
of malpractice litigations, which is consistent with the previous literature.
The three most common allegations – misdiagnosis, delay in treatment and
lack of consent or notifications – were all aspects of process quality." We
strongly agree to the highlighted variables based akso to what we've been
researching.Furthermore they stated: "Most of the litigation cases we
investigated were associated with either the most severe or minor adverse
outcomes. Severe adverse outcomes are probably those most likely to result
in litigation while malpractice with minor adverse outcomes may be
relatively common simply because most adverse outcomes are of minor

severity. It has been suggested that medical error may be the third leading
cause of death in the USA. In China, fatal medical errors require much more
attention."They stated: "Of the cases we investigated, 68% ended with
monetary compensation. This percentage is close to the corresponding
values previously reported in China (67%), Japan (60%) and the USA
(56%) but substantially higher than the value reported for Canada
(33%).5,6,32,38 The between-country differences in this proportion
probably reflect between-country differences in legal and medical systems
and socioeconomic backgrounds."They also stated: "Our study had several
limitations. First, medical malpractice cases presumably represent only a
small proportion of the patients who receive health care of poor quality.
Second, we only analysed data from a single online database and it seems
unlikely that this database held records for all of the cases of medical
malpractice litigation that occurred in China over our study period. The
proportion of such cases that were included in the database may also have
changed during our study period. Third, in our analysis we ignored some
variables that were recorded in the database, e.g. the amount of
compensation awarded and the relative contributions made, to each lawsuit,
by lawyers and insurers. Finally, if we are to use litigation records as an
indicator of health-care quality, we probably have to assume that the
judiciary system involved is fair, independent and strong and that the
collection of data on medical malpractice litigation is reasonably
comprehensive or, at least, nationally representative." They have lots of

similarities with our research particularly the limited basis of database
online a we don't fully believe that the judiciary's role was fairly executed
hence we will to try our outmost skills to research about that. Lastly they
stated: "In conclusion, in the absence of more robust and traditional
indicators, analysis of medical litigation records may give useful
information on health-care quality. Medical malpractice is both a legal issue
and a health system issue, since it involves governments, health providers,
insurance companies, legal systems and patients. More studies are
necessary on this topic, not only for studying health-care quality but also,
ultimately, for strengthening health systems." We strongly agree that it is
an enormous and extensive problem all countries all over the world needs
to overcome whether lawfully or medically.
According to the article entitled "How Denmark Dumped Medical
Malpractice and Improved Patient Safety" by ProPublica they stated that:
"The Danish system offers lessons for policymakers in the United States,
where medical harm remains widespread and the mechanisms for
addressing it are often cumbersome and adversarial. The Danes’ primary
focus is on helping patients who have been hurt by the health care system.
While the reams of data gathered from claims aren’t used to publicly rate
doctors and hospitals, or to systematically search for bad actors, they can
help flag providers who have repeat errors and may pose a risk. For the past
three years, ProPublica has asked patients who’ve been harmed and their
family members for their stories. We’ve heard the same things time and
time again: After a medical error comes a struggle to get straight answers
and accountability. Financial compensation for additional care, pain,
disability or lost work is reserved only for a relative few.
The U.S. system for compensating injured patients — medical malpractice
lawsuits — effectively shuts out patients when the potential damages are
small. Proving negligence, the usual standard for winning compensation, is
difficult. There are scant incentives for doctors and hospitals to apologize,
reveal details about what happened, or report errors that might unveil a
pattern.
Denmark offers a radically different alternative, as do similar programs in
other Scandinavian countries and New Zealand. To be sure, these countries
have nationalized health care systems, unlike the public-private model in
the U.S. But alternative responses to patient harm have been tried on a
smaller scale. Virginia, for example, has a program designed to compensate
for severe neurological childbirth injuries that is similar in some ways to the
Danish system. Common to all these programs is a commitment to provide
information and compensation to patients regardless of whether negligence
is involved. That lowers the bar of entry for patients and doesn’t pit doctors
against them, enabling providers to be open about what happened. He said,
“It’s not easy to discuss a mistake, but there has to be a very safe relationship
between doctor and patient,” Hamberg said. “The most important thing in
patient safety is to talk about it.” Furthemore, "Denmark’s compensation
program has been in place since 1992, replacing a lawsuit-based approach
much like that in the U.S. The change followed a series of high-profile cases
in which patients weren’t able to get compensation through the courts
because it was too difficult to prove their doctor did something wrong. The
Danish parliament adopted a system similar to those used in Norway and
Sweden."
"Today, medical injury claims aren’t handled by the Danish court system
but by medical and legal experts who review cases at no charge to patients.
Patients get answers and can participate in the process whether or not they
ultimately receive a monetary award. Filing a claim is free. Patients are
assigned a caseworker to shepherd them through the process. The hospital
or doctor is required to file a detailed response, which patients may rebut.
Patients have access to their complete medical record and a detailed
explanation of the medical reviewers’ decisions. All of this is available for
patients and their families through an online portal, which alerts them when
there are developments in their claims process. Compensation is awarded if
reviewers determine the care could have been better, or if the patient
experienced a rare and severe complication that was “more extensive than
the patient should reasonably have to endure.”

They said: "Reviewers most often apply one of two criteria, said Peter
Jakobsen, chief consultant for legal affairs at the Patient Compensation
Association, the body that adjudicates claims. The first is the “specialist
rule:” How did the treatment compare to care an experienced specialist
would provide? The patient is entitled to compensation if not treated at this
level,” Jakobsen said. “You can have a situation with compensation where
the doctor did a normal, good job, but not at the specialist level.”
They stated that " A second common criterion is the “fairness rule.” If the
patient experienced a severe medical event that occurs less than 2 percent
of the time, he or she is eligible for an award. An unusual drug reaction or
an infection after a knee replacement are examples. Patients may file an
appeal at no cost if their claim is rejected. Appeals are reviewed by a seven-
member board of doctors, patient representatives, an attorney and two
representatives of the Danish health care system. Patients may request
district court review after an unsuccessful appeal, although that happens in
only about 2 percent of claims. If a patient believes negligence was
involved, it can be reported to a parallel system for professional
discipline."Overall they stated that "About one in three patients who file a
claim is compensated. The minimum eligible claim is under $2,000, and the
average paid out is $30,000, or about 15 percent of the typical amount
awarded in lawsuits against U.S. doctors." In the research, "Medical
malpractice, defensive medicine and role of the “media” in Italy", Research

was conducted into the most frequent causes of “malasanità” (medical
malpractice) and/or “malpractice” in Italy, seeking to understand the
reasons for this complex phenomenon and to provide a response to the many
open questions affecting the Italian health service. Their research is based
on the consultation of specialised journals and scientific periodicals,
institutional, medical and scientific websites, websites of patients and
citizens associations and documents published by Italian Medical
Associations and insurance companies. The aim of this research is to weigh
in the problem and propose a series of evaluations and recommendations
designed to promote the improvement of health care in Italy. Studying the
phenomenon, means understanding the causes and the social and economic
imbalances that characterize the provision of health care in Italy.
In Italy healthcare is one of the main sectors in which the national
government and regional administrations have been applying spending
reviews in order to improve public finances. The big financial deficits that
have been accumulated over time and the absence of good governance in
this sector, due to political and administrative incapablility, have brought
about a fall in the quality of the provided health services and an unequality
of them from one region to another. Because of the unending financial
problems, many citizens, especially in the South of Italy, do not have access
to many types of diagnostic and therapeutic procedures that are now
considered not qualified for the treatment of many diseases. Thus, the less
well-to-do run the risk of being deprived of their fundamental right to health
as enshrined in article 32 of the Italian Constitution. The similarity of their
research and ours is that we both agree that the lack of access to diagnostic
and therapeutic and also unending problem to poverty can be the prime
factor for medical negligence, the difference however, is that thankfully not
all countries is experiencing this inadequacy.
According to the research study about "Patient Safety in American
Hospitals Study", from 2004 to 2006 healthcare mistakes caused 238,337
avoidable deaths and generated costs of 8.8 billion dollars. The study, which
looked at 41 million patients in the Medicare public health system, was
published by Health Grades, guiding Americans to their best health, a health
rating agency. It found that patients treated in hospitals rated as high quality
are 43% less likely to be affected by medical errors than patients admitted
to structures considered to be of lower quality. The similarity between their
report and ours is that overall, medical errors affected almost 3% of all
Medicare patients, accounting for about 1.1 million incidents due to errors
occurring during the three years considered.
The diffrence is that unlike the United States of America, in Italy no
quantitative studies of medical errors have been conducted by independent
scientific research bodies. Cases have been reported by patients’ rights
groups such as TDM (Tribunale dei diritti del malato-Cittadinanza Attiva)
and private research bodies, which show the patients’ point of view and
describe their complaints and accusations, but none of them is objective nor
independent.
According to the research study entitled "A Landmark Turn in India’s
Medical Negligence Law" by New York Times/ by Gayathri
VaidyanathanAnuradha, Saha died painfully in May 1998 at the age of 36,
her skin sloughed off all over her body, except for her skull. She was
wrapped in bandages meant to prevent infections that had already spread in
her system. Her immunity had been affected after receiving a high dosage
of steroids from some of the top doctors in Kolkata.
For the past 15 years, her husband, Dr. Kunal Saha, has fought Indian courts
to hold at least five doctors and the hospital responsible. Though the lower
courts rejected his cases, Dr. Saha persisted, appealing all the way to the
Supreme Court, which found the doctors and AMRI Hospital (Advanced
Medicare & Research Institute Ltd.) in Kolkata guilty of negligence in 2009.
It took another four years for the Supreme Court to award Dr. Saha an
unprecedented amount in a medical negligence case in India — 60.8 million
rupees ($1 million), plus 6 percent annual interest for each of the 15 years
that Dr. Saha has been fighting his legal battle.The landmark ruling is
supposed to remind doctors, hospitals, and nursing homes that they will be
dealt with strictly if they do not maintain their standard of care, the Supreme
Court said in its judgment on Oct. 24.

"The patients, irrespective of their social, cultural and economic
background, are entitled to be treated with dignity, which not only forms
their fundamental right but also their human right,” wrote Justices
Chandramauli K.R. Prasad and V. Gopala Gowda. (Section 304A of the
Indian Penal Code of 1860). The similarity of our research to theirs is that
we agree that everyone deserves to be justly treated despite of their any
status in society and that all the doctors who have engaged into medical
malpractice should be held accountable for their inhumane ways but the
only difference is that we disagree that its fully the fault of the doctors who
are assigned to treat Dr. Kunal's wife. He has also at fault in this although
not legally. He is a doctor himself so instead of fully trusting other doctors,
he should've immediately withdrawed his wife the very moment he felt that
the other doctors were doing they're job wrong. He should've moved his
wife to US hospitals (their residence) when his intuition was telling him that
the Indian doctors were intentionally or untentionally killing his wife by
prescribing the wrong dosage of medicine.
In the research study entitled, "Medical Malpractice Reform:
Historical Approaches, Alternative Models, and Communication and
Resolution Program", society as a whole has an interest in cultivating a
medical system in which medical practitioners do not practice defensive
medicine but rather engage in process improvement at both the individual
level and the system level. Therefore, to be effective, medical malpractice

reform must balance the needs of all parties. The health care system must
promote a culture of open communication between clinicians and patients
that persists even after a patient has experienced a negative outcome
(regardless of who or what is to blame), allows for robust process
improvement, and offers compensation to injured parties. A possible
beneficial effect of such a culture may be that patients trust their physicians
when physicians truthfully explain that a poor outcome was due to the
natural history of disease rather than the negligent practice of medicine.
Such a system would be adversarial only as a last resort, and even under
those circumstances it should build on mediation-based models such as
communication and resolution programs, discussed in more detail below.
A 2013 study estimated that between 210,000 to 400,000 people die
annually in the US due to medical error. Ethically, a reformed medical
malpractice system must address the fact that medical errors do injure
patients and are at play in a significant number of malpractice cases. For
example, Studdert and colleagues analyzed 1,452 closed malpractice claims
from five liability insurers and concluded that 63 percent of the claims did,
in fact, involve injuries due to medical error.
Alternative dispute resolution (ADR) models, which allow physicians and
the health systems in which they operate to acknowledge openly when
errors have occurred and offer reasonable compensation to the injured
parties, balance the needs of clinicians—to act ethically by being truthful

and engaging in vigorous quality improvement—and of patients—to
receive compensation for negligence-induced iatrogenic harm. Alternative
dispute resolution allows litigants to move out of a “battle” mentality and
into a facilitated conversation to achieve resolution of the conflict.
Alternative dispute resolution typically includes either mediation or
arbitration. These two approaches are quite different, but both can be quite
effective in resolving disputes in a less adversarial and less costly manner
than traditional litigation. A number of health care institutions have
experimented with a unique twist on ADR by developing communication
and resolution programs (CRPs), novel approaches to addressing medical
error that have paid off in terms of the costs associated with malpractice
litigation. These programs encourage open communication and
transparency with patients and their families and facilitate restitution for
injured parties when appropriate. They also support physicians in disclosure
conversations with patients.
The Lexington, Kentucky, Veterans Affairs (VA) Medical Center was a
pioneer in this area. In 1987, the Lexington VA implemented its CRP, which
provided a full disclosure of the occurrence that led to harm as well as an
expression of regret on behalf of the institution and its personnel. Under this
system, patients and their families are invited to bring attorneys to discuss
offers of compensation early in the process. Although ADR in a health care
situation likely provides a number of benefits to both the health care

provider (by promoting honesty and ethical behavior) and to the patient and
patient’s family (by providing an honest accounting of what happened,
including a statement of regret and possibly an offer of compensation), the
empirical literature discussing ADR typically emphasizes quantitative,
economic measures in the form of payouts as a measure of success. With
the implementation of this program, the Lexington VA became the VA
hospital with the lowest payouts. Between 1990 and 1996, the average
settlement per claim in Lexington was approximately $15,622, whereas in
other VA institutions it was $98,000. Additionally, the average duration of
cases decreased from 2-4 years to 2-4 months.
CRPs also exist outside the VA system and come in two varieties: early
settlement and limited reimbursement. The University of Michigan Health
System (UMHS) was the first non-VA health system to adopt a CRP,
implementing an early settlement model in 2001. The similarity to our
research to theirs is that we agree that their should be transparency, open
communication, and compensation between the physicians and the patient
with his family in advance to avoid further misunderstandings and
complications however the only difference is that we believe that aside from
the early notice and compensation, the physicians should be still held liable
for criminal and civil charge if proved that they have further neglected their
patient or that he intellionally led his patient to death. An early notice or
warning isn't enough, they should do their best to ensure the betterment of
their patient's health and should be honest in the earlier stage if he isn't
capable enough to save so that the patient can move to another physician
who can truly cure and end his suffering. (Consumer Protection Act, 1986).
B) LOCAL STUDIES
b.) Local Literature
According to the article entitled “The Captain-of-the-Ship”, one of the
many cases of medical practice was the 14-year-old, Anastacia Clemente.
The victim was scheduled for a tonsillectomy or removal of the tonsils at
St. Paul’s Hospital on May 26, 1929 at 7:00am by Dr. Gregorio Favis
together with assisting surgeon Dr. Bartholome, assisting Nurse Lorenza
Somera and two student nurses Valentina Andaya and Consolacion
Montinola. During the operation, one of the doctors asked for a certain
medication in a syringe prepared by Somera and injected it to the patient
and later asked for more. However, a few minutes later the second doctor
start noticing paleness from the patient. But was told that it is not unusual
reaction and proceed adding the third dose. The victim started suffering and
succumbed to convulsions while both doctors tried managing it by injecting
adrenalin, a medication used for emergencies like this, twice yet she
eventually died after receiving the second shot. There are similarities shown
in the article to our study, *similarities*. The difference found in the article
to our study is that *differences*.

According to the article entitled “Hospitals are liable for doctors'
negligence”, in one case, (Ramos vs CA, GR 124354, 29 Dec 1999, 321
SCRA 584), a lady who went to hospital walking ended up being comatose
with serious brain injury secondary to some palpable mistakes in the
administration of anesthesia. Another case is, (PSI vs CA, GR 126297, GR
121467, GR 127590, 02 Feb 2010), some surgeons left two pieces of gauzes
inside the body of a patient and closed the incision in a surgical operation.
The patient had to go to the US to undergo a corrective medical procedure.
In the Ramos case, the doctors and the hospital were held solidarity liable
for actual damages of 1.352 million plus 8 thousand pesos every month for
the entire lifetime of the comatose victim, moral damages of 2 million,
temperate damages of 1.5 million, exemplary damages of 100 thousand, and
attorneys’ fees and cost of litigation. In the PSI case, a huge amount was
also awarded as damages. There are similarities shown in the article to our
study, *similarities*. The difference found in the article to our study is that
*differences*.
According to the article entitled “Woman trader sues hospital, doctor for
malpractice”, Jose Rody, husband of businesswoman Charimae Imperial
took him to Our Lady of Lourdes Hospital in Sta. Mesa, Manila after
complaining severe chest pains hoping that he will feel better. Fule, the
attending doctor, allegedly administered several tests including the ECG
test, and allowed him to go home. However Dr. Fule prescribed medicines
for his abdominal pains but not for his heart ailment and a day after the
diagnosis Jose had a heart attack and was dead on arrival at the
Mandaluyong Medical Center. The hospital claimed Dr. Fule was not an
employee but “a resident physician under training,” and had no control over
him but he denied this and said that he had "exercised his duty and sound
medical judgement and extended the best professional care” to the patient.
There are similarities shown in the article to our study, *similarities*. The
difference found in the article to our study is that *differences*.
According to the article entitled “Filipino nurse convicted for killing
patient through faulty blood transfusion”, Ali Huseyin, 76, had been
transferred to the intensive care unit following a heart bypass operation in
May 2014. It had been a straightforward procedure, and he had been taken
there to recover. But the next evening, he died of a fatal heart attack after
his attending nurse, Lea Ledesma, 49, accidentally gave him AB-type blood
when he had O-type blood. Based on her statement, she noticed that the
name of the blood bag did not match the patient’s details but since Mr.
Huseyin was conscious that time, she went ahead and asked him to confirm
his date of birth, which again should have been a red flag. However, at that
point in time, Ledesma was checking it against the wristband on his arm
instead of the blood. She then noted that the patients’ numbers did not
match, so she consulted a senior colleague who advised that she check to
ensure her patient’s details had been recorded correctly, which she did but
against the wrong computer records. Convinced that the blood was the right
one, she went on to perform the blood transfusion. Unfortunately, after his
death she had initially tried to pass off the medical blunder as being a
colleague’s error, but later admitted to being distracted and flustered when
checking the patient details. There are similarities shown in the article to
our study, *similarities*. The difference found in the article to our study is
that *differences*.
According to the article entitled “Parents of 2-year-old patient at Heart
Center cry malpractice”, a two-year-old boy is in a critical condition after
an alleged case of malpractice at the Philippine Heart Center. Stephen
Gabriel Valencia, the patient has a Down Syndrome and Tetralogy of Fallot,
a congenital heart defect that causes low oxygen levels in the blood and blue
color to the skin. Thus, the term "blue baby", due to this, Valencia
experiences irregular heart rhythms that prompted his parents, Tyrone and
Sarah, to have him confined at the hospital on December 10. They said he
was getting better until a nurse allegedly did something wrong during his
treatment. His parents said they saw the nurse hastily putting a cannula or
tube into the child's humidifier and oxygen tank without checking the
pressure. The doctor only instructed for the two-year-old for an X-ray. After
the incident, the baby suddenly had a hard time breathing and water went
out of his nose and mouth. Yet, the nurse kept on pushing in the cannula.
It was only 15 minutes after that the baby was revived and now they are
worried that his brain has been affected. There are similarities shown in the
article to our study , *similarities*. The difference found in the article to our
study is that *differences.
According to the article entitled “Mother gives birth unassisted by
nurses, newborn falls on the floor and dies”, the 27-year-old mother
Marnilyn Galapin and her family were all in grief after their newly-born
member fell on the floor and eventually died; allegedly due to nurses’
negligence. According to Galapin, she was left unassisted by the nurses at
the Cotabato Regional and Medical Center during her labor. She apparently
called the attention of nurses repeatedly and told them that she’s ready to
deliver the baby, but they ignored her. “I called the nurse to let them know
that I was about to give birth and the nurse answered, ‘We are not in the wet
market,’ it’s very rude. I wasn’t able to control myself and the baby already
went out”. It was only when the baby has fallen to the floor that they
approached and lifted the baby. Sadly, the infant had a bruise on his chest
and several hours died. There are similarities shown in the article to our
study, *similarities*. The difference found in the article to our study is that
*differences*.
According to the article entitled "Patient sues doc, nurses, hospital exec", a
medical doctor, four nurses and the administrator in a private-run hospital
in Davao City have been charged before the City Prosecution Office for
alleged medical negligence and malpractices. Facing charges for criminal

negligence, which is punishable under Article 365 of the Revised Penal
Code in relation to medical negligence or malpractice, are nurses Krist Ann
Camoro Longhay, Byron Miranda Laurente and Lolita Mante. Also named
in the charge sheet are Delma Gentapan, the hospital administrator, and Dr.
Marcos Chan Siyong. Jean Jabagat, who was previously confined at the
hospital after undergoing a surgical procedure called thyroidectomy on
April 21 last year, she claimed that after her surgery, she was informed by
her surgeon Dr. Henry Derla that she will be discharged by April 23. But
before that, accused Longhay allegedly injected a wrong medicine to the
complainant. As a result, Jabagat reportedly started to experience rapid
heart palpitation, difficulty in breathing, chilling, nervousness, and skin
rashes started appearing but was not attended to by the nurse who had
allegedly left the patient to check her medical records. Another doctor from
the hospital arrived at the room and administered an anti-allergy drug and
saved the complainant from the situation. The said doctor reportedly told
the complainant that Longhay allegedly "admitted to her obeing negligent
in injecting the wrong drugs out of haste because of the lack of nursing staff
at the surgery department that time.” There are similarities shown in the
article to our study, *similarities*. The difference found in the article to our
study is that *differences*.
According to the article entitled "8 doctors face negligence rap over death
of 6-yr-old girl”, the executive director of the Philippine Children’s Medical

Center (PCMC) and seven other doctors were accused of negligence in
connection with the death of a six-year-old girl who died after undergoing
appendectomy last year. Maricris Vegilla, who claimed that her daughter,
Ma. Cristina died on Sept. 27, 2005 after the respondents allegedly failed to
immediately conduct an appendectomy on her despite the urgency of her
case.
. In her complaint, Vegilla said that on Sept. 26, 2005, her relatives
rushed her daughter to the San Bernardino Hospital in Novaliches, Quezon
City due to severe stomach pain and fever. After being initially diagnosed
with appendicitis, the hospital staff informed them to transfer Cristina to
another hospital for further evaluation and management. The family decided
to bring the girl to the PCMC in Quezon City and was admitted immediately
at the emergency room. Attending doctor diagnosed the patient as suffering
from acute appendicitis and promptly recommended an emergency
operation. About 5:00 p.m. of the same day, they were told that the
operation could not start without the anesthesiologist around. Hence, the
patient was finally transferred to the operating room around 10:30 p.m. but
the operation started only after 30 minutes. After twohours of operation, her
mother was informed regarding her daughter’s condition as well as the
procedure done. But after an hour, the patient had seizure and was no longer
breathing. The doctors tried to revive the patient but expired shortly after.
Based on the findings on the autopsy conducted, the patient died of severe
pneumonia. There are similarities shown in the article to our study,

*similarities*. The difference found in the article to our study is that
*differences*.
In an article entitled, “Medical negligence suit vs Cebu hospital filed
before DOH”, Haryl and Marife Visaya lodged a medical negligence
complaint against four doctors in St. Anthony Mother and Child Hospital
after the death of their eight month-old son, Harry Morgan Visaya. The
respondents of the said complaint are Chief Doctor Robert Denopol, Rhea
Pacana, Roselle Lampayan and Venus Barte. Their son was first brought to
the hospital on June 3, 2015, because of diarrhea. However, his condition
took a turn for the worse. His parents alleged that the hospital staff failed to
reattach the IV fluid after it dislodged a couple of times. They were then
referred to Vicente Sotto Memorial Medical Center, a tertiary hospital. The
child died soon after because of “acute gastroenteritis with severe
dehydration in hypotensive shock”. The family blames SAMCH for the
death of their child citing that the hospital had been negligent with their
duties that resulted to the death of their child. The Visayas took the
complaint to DOH, however, they were asked to leave their complaint with
the security guard. They then took the matter to social media where it
garnered a lot of attention. The similarities of the article to our study is that
it talks about the presence of medical negligence complaints in the
Philippines. It also talks about the different agencies that are expected to
receive such complaints and how they handled the cases. The difference,
however, is that it has not yet been proven whether or not there really is
medical negligence. Moreover, the article did not cite how the complaint is
expected to progress with it landing just in the hand of a security guard. A
question then rises, if the agencies in the Philippines are prepared to take in
cases as such as that of the Visayas’.
In another article, “Res Ipsa Loquitur; Medical Negligence Cases”,
there are requisites to consider when deciding that negligence has actually
taken place through the Res Ipsa Loquitur doctrine. First, is that the
occurrence or accident is such that would have not taken place if not for
one’s negligence. Second, the accident is caused by “an instrumentality”
outside the control of the defendant/s. And third, “the possibility of
contributing conduct that will ultimately eliminate the factor of holding the
plaintiff responsible for the accident.
Such is the case that may be found in the article, “Speaking for itself”. The
article tells about the story of Marta, 47, who underwent a surgery to have
a stone in her gallbladder removed. Marta was described to be “robust” and
aside from a few discomforts, was considered healthy. After undergoing
tests including blood and urine tests, she was given clearance to undergo the
surgery. She was also found to be of sound mind, giving credence to her
status prior to her operation. The surgeon assigned to perform the operation
was Dr. Losada, and Dr. Cruz, who will administer the anesthesia. Dr.
Losada wa three hour late for the operation. During the administration of of
the anesthesia, Marta suffered an irreparable damage to her brain which
caused her to be taken to the Intensive Care Unit. She was then confined for
four months in the hospital. Even after being discharged from the hospital,
Marta needed medical attention as she was found to have suffered from
brain damage. It was for that reason that Ramon, Marta’s husband, together
with their children, decided to file a complaint for damages before the
Regional Trial Court against Dr. Losada, Dr. Cruz, and the hospital for their
alleged negligence on their treatment of Marta’s ailment. Ramon’s sister,
Caridad, a dean of the college of nursing in another hospital was present
during the surgery and had testified in favor of the ccomplainants. The
defendants, however refuted the complaint saying that Marta suffered brain
damage because of an allergic reaction to the anesthetic agent.
RTC ruled in favor of Ramon and Marta, citing that the hospital and
mentioned doctors were indeed negligent in the performance of their duty.
The hospital and the doctors were ordered to pay damages. However, the
defendants appealed their case before the Court of Appeals and reversed the
decision of RTC. The case was then taken to the Supreme Court, which with
finality, ruled in favor of the complainants, applying the doctrine of Res
Ipsa Loquitur. According to the SC, the defendants were not able to
“`disprove the presumption of negligence”. SC then ordered the defendants
to pay the complainant more than five million pesos in damages and
attorney’s fees.
The similarities of the article to the study is that it tackles medical
negligence and the many deciding factors that surround it. Medical
negligence was also proven in the case mentioned. There are no differences
to be cited with the article and the study.
According to the article, “Woman trader sues hospital, doctor for
malpractice”, a businesswoman, Charimae Imperial, sued Our Lady of
Lourdes Hospital and its doctor, Doctor Joven Fule Jr., after an apparent
negligence on the part of the doctor who examined her husband. Her
husband, Jose Rody, has been complaining of severe chest pains. Fule
allegedly administered several tests on Jose which includes an ECG test,
and allowed him to go home thereafter with Imperial adding that the
mentioned doctor prescribed Jose medicines for his abdominal pains and
not for is heart ailment. Jose Rody was then taken to Mandaluyong Medical
Center where he was declared dead on arrival, a mere day after the
diagnosis. After which, the plaintiff took the ECG strips to five doctors who
later confirmed that based on the strips, her husband was in fact suffering
from a heart attack. Doctor Fule vehemently denied the accusations against
him. The article is similar to the researchers’ study as it does focus on
medical malpractice or negligence. An element of medical malpractice is
that there should be physician-patient relationship which is formed when
the patient availed the services of the physician. The foregoing article
provides an example of physician-patient relationship where the patient was
taken in by his wife because of chest pains. The difference of the article to
the researchers’ study is that the case has not yet been resolved. Whether or
not medical malpractice took place, has yet to be proven in court. Also,
malpractice is much more broad than negligence.
In another article entitled, “The Bitter Pill of Medical Malpractice”, there
are about 600 doctors who are involved in medical negligence or
malpractice. However, only a few filed complaints are known. Proving
medical malpractice has been difficult in the country with doctors being
partly hesitant to testify against their colleagues.
To give more needed attention to cases of medical malpractice,
Congressman Oscar S. Rodriguez filed Medical Malpractice Act of 2002,
which seeks to penalize medical professionals who are found to have been
grossly negligent of their duties in curing patients. Today, the Medical
Malpractice Act sits at the Senate after it was filed by Senator Sergio
Osmeña III as Anti-Medical Malpractice Act of 2004, in gest, “An act to
protect patients against medical malpractice, punishing the malpractice of
any medical practitioner and requiring them to secure malpractice insurance
and for other purposes.”
The bill has met with a lot of disagreements. The strong lobby against the
bill has advertently caused the co-author of Medical Malpractice Act,
Congressman Constantino Jaraula, to withdraw his support.
Moreover, the Philippine College of Physicians opposed the bill citing that
it will cause medical costs to increase and that quality medical care is not
guaranteed even after the bill has been passed. Medical professionals will
be forced to conduct more diagnostic tests before they write down a

prescription as a precautionary measure. Doctors will also avail added
insurance to protect themselves. Rather than similarities, this article further
supports the study, elaborating the current atmosphere of the medical field
regarding sanctioning erring medical professionals. The only difference, in
one perspective, is that up until today, the Medical Malpractice Act and the
Anti-medical Malpractice have not come to fruition with more and more
cases being recorded each year. Technically, should a complaint be filed
before the court, it may be considered administrative in nature, a civil suit
for damages which constitutes a part of the Civil Code under Article 2176,
a criminal case under the Revised Penal Code Article 365, or all of the three
mentioned.
An article entitled, “Another Misdiagnosis which Led to Death?”
tells of a story about a grieving daughter who claims that her mother died
because of the doctor’s geligence in diagnosing the patient correctly. Joyce
Marie Alvarez brought her mother in Capitol Medical Center on April 27,
2005 after the latter complained of feeling ill and nausea. The doctors only
gave her medicines for dizziness. The mother then asked her daughter if
they could go home since they already have the prescription. Joyce asked
the doctor and permitted them to go home citing vertigo as the ailment of
her mother. A few days later, Joyce’s mother passed away. The medical
certificate states that the cause of her death was myocardial infraction or
most commonly known as heart attack. The symptoms for heart attack in
women is different from men’s. Men would usually feel an abrupt build up
of pressure in their chest similar to contractions. Women, on the other hand,
would only feel the pressure subtly and they would sometimes go unnoticed.
It is for this reason that Joyce argued that the doctors did not even try to
look for signs of heart attack nowing that those symptoms are sometimes
not noticeable. She also claims that the doctors did not even take her mothr’s
blood pressure insisting that, it could have helped with the proper diagnosis.
The similarity of the article to our study is the claim that medical negligence
has indeed been committed by the doctor leading to the death of the patient.
Had the doctor spent more time in assessing the symptoms of the patient,
she would have come up with a proper diagnosis. This may also be seen as
the failure of the doctor to adhere to “medical standard of care” which could
have guided her to arrive at a more reasonable conclusion in diagnosing her
patient The difference of the mentioned article is that it doesn’t mention
whether or not the victims have sued the doctor or the hospital regarding
the alleged medical negligence. Medical negligence consists of different
factors for it to be considered as such. Filing a complaint and litigation
would best prove if medical negligence had indeed taken place.
Another article, “The Story of Jessie Bass”, outlines the possible
medical negligence committed by an underexperienced staff of a world-
acclaimed medical center in the Philippines. Jessie Bass, a businessman,
went to St. Luke’s Medical Center on November 16, 2007 complaining of
stomache pains. His entire immediate family was in the United States during
that time. Dr. Edgardo Bondoc examined him and later diagnosed him for
acute appendicitis. However, instead of ordering the patient to take further
tests to confirm if he needed surgery, the doctor advised him to go home.
Jessie was worried about his condition and without a family to assist him,
he asked the doctor if he could be admitted to the hospital. The doctor later
agreed even quoted to have sai that he’ll take care of him. When he was
finally confined in the Hopital, Doctor Bondoc ordered a CT Scan to “rule
out possible gastro intestinal infectious diseases”. This happened in the
morning but Jessie waited until 7 pm to be taken in for scanning. The
hospital cited that the postponement was due to the patient’s alleged fever
and elevated blood pressure. It was not until 11:55 pm that Jessie’s scan was
carried out. Jessie was injected contrast dye as a test dose. 10 minutes after
administering the full dosage of the test dose, the CT Scan was done by a
team composed of a radiology technician and 1st year radiology resident,
Dr. Gilbert N. Sy. The patient however was pronounced dead at 1:20 am.
It was said that the staff did not observe proper protocol and caution
when following the procedure of the the CT Scan on the 64-slice CT Scan
Table. The National Bureau of Investigation confirmed through Jessie’s
autposy that he succumb to an inflamed appendicitis. Jessie’s family was
devastated after hearing the news of their loved one’s death especially in a
world renowned hospital. Jessie is said to have also suffered an allergic
reaction to the test dose. The team incharge of his scan failed to recognize
adverse allergic reactions. They were said to be incompetent to be carrying
out the procedure and there was also the absence of an experienced resident
to assist them. St. Luke’s denied the allegations and maintained that their
staff followed the protocol. However, experts have expressed disagreement
saying that the CT Scan was not necessary and if it were to be carried out,
at the very least, CT Scan protocol “should have been tighter under the
direct supervision of experienced medical personnel.” The similarity of the
article to the study is that it talks about the negligence of the doctor and his
lapse of judgement. Medical professionals have a duty to their patients to
provide medical standard of care. In this case, the doctor and the team who
performed the CT Scan, had been negligent in observing proper protocol
which could have avoided the death of the patient. The difference is that,
after experts expressed that the hospital and the doctors were negligent, the
case then becomes a medical malpractice with the negligence causing undue
injury to patient. It is important to note that medical negligence becomes
medical malpractice when the doctor’s negligence “makes the patient’s
condition worse, causes unreasonable and unexpected complications, or
necessitates additional medical treatment, to name just a few examples of
what’s considered “injury” in a malpractice case.”
In relation to the article above, another article entitled, “My Son's
Experience During a Routine CT Scan in St. Luke's”, explains the
harrowing experience of wo parents seeing their child suffer an allergic
reaction to the contrast dye on the CT Scan Table of St. Lukes Medical
Center. Renato’s son was almost 2 months when they took him to SLMC
for a CT Scan to find out the cause or confirm that their son has cerebral
palsy. However, the parents explained that the staff did not follow the
protocol in conducting the allergy test. They said that the skin test was only
done in 11 minutes instead of the standard 15 minutes. Moreover, Renato
heard the anesthesiologist complained about his time being wasted because
his patient was a child who moved around a lot. After the CT Scan, the
parents were informed that the anesthesiologist will be on stand-by until the
patient is fully awake. The anesthesiologist, however, was nowhere to be
found. Their son soon showed signs of allergic reaction after recovery from
anesthesia approximately 2 and a half hours after the CT Scan. The staff
waited for the anesthesiologist who was said to have never replied nor
checked the child. Eventually, they (staff) referred the worried parents to
the hospitals pediatric ER. At the said ER, the child was given
ipenhydramine (Benadryl) and EP (Ephenephrine) to control the symptoms
of the reaction. However, the child’s allergic reaction worsened. They were
advised to go home and wait of the allergy to subside after 3 days. It was
because of this, that his parents opted to transfer their child to Capitol
Medical Center where he was eventually admitted and treated.
The similarity of this article to the study is that it also explains the
negligence of the staff in following the proper protocol in administering the
test dose. The anesthesiologist was also negligent as he was nowehere to be
found when the child was alsready having adverse allergic reaction. The
notable difference, like the previous article, is that the case now becomes a
medical malpractice with the child suffering more injury. It must be noted
that the anesthesiologist did not check on the child especially when he was
already sufferring an allergic reaction. The case has not been solved as the
parents had only written a complaint letter to St. Luke’s. No charges have
been formally filed against the hospital and the doctor.
According to the study, “Medical Malpractice: An Overview Introduction”,
conducted by Jane Lao et al, currently the Philippines do not have a law that
serves as a guideline and also monitor the acts of medical practitioners.
Unlike the Integrated Bar of the Philippines, what the country has are
specialized divisions such as ` Philippine Heart Association, Philippine
Dermatological Society, and Philippine Neurological Association. Because
of this, there are no identifying grounds that medical practitioners can easily
refer to in relation to medical negligence and malpractice. This, in turn,
makes medical malpractice much more arduous to prove. The study also
outlines the factors of medical malpractice. They are, (a) Physician-Patient
Relationship, (b) Duty of a Physician, and, (c) Diligence Required.
Physician-patient relationship is said to be formed when a patient “engages
the services of a physician”. The professional services of the doctor was
accepted by the patient with the latter having full confidence that services
will help with his or her medical or surgical treatment. However, this
relationship has not yet been clarified by the Philippine Law. Medical
practitioners are thus, expected to perform their duties with die diligence
because there is public interest at stake (Reyes v. Sisters of Mercy G.R. No.
130547. October 3, 2000).

They duty of the physician refers to the duty expected from that of
a medical practitioner to perform according to accepted standards in treating
a patient.
The study also marks a difference between Negligence and
Malpractice.
Nicolas and De Vega Law Offices have oulined a concrete
explanation on how medical malpractice or medical negligence is treated in
the Philippines in “The Treatment of Medical Malpractice in the
Philippines”. According to them, proving medical malpractice in the
Philippines is one of the most difficult civil cases to take on. This is because
medical procedures consist of technical matters which must be cleared at
first before claiming that a malpractice or negligence has taken place. Legal
requisites must also be satisfied to prove the negligence. Negligence suits,
as per the law firm, require evidence that a medical practitioner “failed to
observe the degree of care precaution, and vigilance which the
circumstances justly demand”, which then causes injury to the other party.
In a case, the Supreme Court explained that the doctors are required
to exercise due diligence in performng their duty, to wit:
Throughout history, patients have consigned their fates and lives to
the skill of their doctors. For a breach of this trust, men have been quick to
demand retribution. Some 4,000 years ago, the Code of Hammurabi then
already provided: “If a physician make a deep incision upon a man with his
bronze lancet and cause the man’s death, or operate on the eye socket of a
man with his bronze lancet and destroy the man’s eyes, they shall cut off
his hand.” Subsequently, Hippocrates wrote what was to become part of the
healer’s oath: “I will follow that method of treatment which according to
my ability and judgment, I consider for the benefit of my patients, and
abstain from whatever is deleterious and mischievous. . . . While I continue
to keep this oath unviolated may it be granted me to enjoy life and practice
the art, respected by all men at all times but should I trespass and violate
this oath, may the reverse be my lot.” At present, the primary objective of
the medical profession is the preservation of life and maintenance of the
health of the people.
Needless to say then, when a physician strays from his sacred duty and
endangers instead the life of his patient, he must be made to answer therefor.
Although society today cannot and will not tolerate the punishment meted
out by the ancients, neither will it and this Court, as this case would show,
let the act go uncondemned.
xxx xxx
As a final word, this Court reiterates its recognition of the vital role the
medical profession plays in the lives of the people, and the State’s
compelling interest to enact measures to protect the public from “the
potentially deadly effects of incompetence and ignorance in those who
would undertake to treat our bodies and minds for disease or trauma.”
Indeed, a physician is bound to serve the interest of his patients “with the
greatest of solicitude, giving them always his best talent and skill.” Through
her tortious conduct, the petitioner endangered the life of Flotilde Villegas,
in violation of her profession’s rigid ethical code and in contravention of
the legal standards set forth for professionals, in general, and members of
the medical profession, in particular.” (Dr. Victoria L. Batiquin and Allan
Batiquin vs. Court of Appeals, G.R. No. 118231, 05 July 1996.)
In order to prove medical malpractice or medical negligence, 4
elements must be established according to the Supreme Court:
A word on medical malpractice or negligence cases. In its simplest
terms, 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 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 that failure or
action caused injury to the patient. Hence, there are four elements involved
in medical negligence cases: duty, breach, injury and proximate causation.
Senator Sergio Osmeña also filed a billed seeking to penalize
medical practitioners who have been found to have committed gross
negligence in the performance of their duties. The bill is called Senate Bill
No. 1720 or the ANTI-MEDICAL MALPRACTICE ACT OF 2004. The
Anti-medical malpractice act of 2004 is an act that aims to, “protect the
patients against medical malpractice, punishing the malpractice of any
medical praactitioner and requiring them to secure malpractice insurance
for other purposes.” Although this act is solely for medical malpractice, it
must be noted that negligence and malpractice go hand in hand. Until a
malpractice has been proven, most common than not, the erring party is
deemed to have also been negligent of his official duty as a medical
practioner
CHAPTER III
RESEARCH METHODOLOGY
This chapter covers the research locale of the study, the methods of
sampling used in the study, sources of data, the research method used, the
procedure for gathering data and the method for analyzing the cases. No
statistics was used because the study is basically qualitative or interpretative
in their nature.
Research Locale
The research locale or the venue of this study gathered from
different cases decided by the Supreme Court of the Philippines. The cases
are within the jurisdiction of the Supreme Court of the Philippines. The
cases on Medical negligence filed in the Supreme Court are only limited
where each of the cases selected originated.
The Method of Sampling Used in the Study
The researcher personally scanned and browsed Fifty (50)
Medical negligence cases decided by the Supreme Court starting with the
last decision. The Fifty (50) cases were selected on the basis of their meeting
at least four of the five criteria. The five criteria are: (1) the case must
involve Medical negligence, that an individual violates the laws and / or

rules and regulation (eg. Rights of due process, The element of “duty” as
and element of obligation, The element of tort liability for negligence, and
the perseverance of Res Ipsa Loquitor, etc.); (2) Controversial cases which
have relevance in this period of time; (3) the case must involve issues of
national significance; (4) the decision of the case must be precedent setting,
that is, it sets precedents to be followed in the future for cases of similar
nature; and (5) the case enables the researcher to identify the strengths,
weaknesses of each of the decisions and offer remedies to address the
weakness. Therefore, the method of sampling, that meets four (4) of the (5)
criteria.
The criteria enumerated above are chosen because of the
following: (a) the case must involve Medical negligence, that an individual
violates the laws and / or rules and regulation - the researcher study is a
critique on cases of Medical negligence therefore the materials should be
used must be contained of violations upon Medical negligence; (b)
Controversial cases which have relevance in this period of time - the cases
should be, must be the cases that the majority are interested in and does
affects them. (c) The case must involve issues of national significance - the
case or the material of the study must have an effect to the national
significance - the case or the material of the study must have an effect to the
nation and its citizen. (d) the decision of the case must be precedent setting,
that is, it sets precedents to be used, mused be a case that can be used as a
basis for future purposes so that the law and the legal practitioners could
improve the application of such law or decision; (e) the case enables the
researcher to identify the strengths, weaknesses of each of the decisions and
offer remedies to address the weaknesses - the case or material should be
used, must be able to identify the strength and weaknesses and remedies of
the case, for the researchers to critique and analyze the cases decided by the
Supreme Court and court contribute to help to improve the system of laws
in the Philippines.
In the light of at least four of the foregoing five criteria, the following
ten cases were selected. They are enumerated below:
CASE NO. 1
Noel Casumpang, Ruby Sanga-Miranda and San Juan
Dedios Hospital
VS
Nelson Cortejo
G.R. NO. 171127
March 11, 2015
(Death of Edmer Cortejo due to the inexcusable
lack of precaution of the doctors and the violation of Article
2176 of the Civil Code.)

CASE NO. 2 Orlando D. Garcia , Jr., doing business under the name and
style Community Diagnostic Center and Bu Castro
VS
Ranida D. Salvador and Ramon Salvador
G.R. NO. 168512
March 20, 2007
(Violation of Section 2 of R.A No. 4688, otherwise known as
Clinical Laboratory Law.)
CASE NO. 3 Rogelio P. Nogales for himself and on behalf of the minors,
Roger. Anthony Angelica Nancy and Michael Christopher, all surnamed
Nogales
VS
Capitol Medical Center
G.R NO. 142625
December 19, 2006
(Violation of Article 2180 in relation to Article 2176 of the
Civil Code and the doctrine of Apparent Authority find application in this
case)
CASE NO. 4 Rogelio E. Ramos and Erlinda Ramos, in their own behalf as
natural guardians of the minors, Rommel Ramos, Roy Roderick Ramos and
Ron Raymond Ramos.
VS
Court of Appeals De Los Santos Medical Center, Dr. Orlino Hosaka and
Dra.
Perfecta Gutierrez
G.R. NO. 124354
December 29,1999
(The Doctrine Res Ipsa Loquitor finds application in this case.)
CASE NO. 5 Dr. Idol L. Bondoc
VS.
Marilou R. Mantala
G.R. NO. 203080
November 12, 2014
(Guilty of Grave Misconduct and violation of Article 2
Section 1 Of The Code OF Medical Ethics of the Medical Profession in
the Philippines.)
CASE NO. 6 Dr. Milagros L. Cantre
vs
SPS. John David Z. Go and Nora S. Go
G.R. NO. 160889
April 27. 2007
(The Captain of the Ship doctrine finds application in this case.)
CASE NO. 7 Dr. Emmanuel Jarcia, Jr. and Dr. Marilou Bastan
vs.
People of the Philippines
G.R. NO. 187926
February 15, 2012
(Guilty of Reckless Imprudence resulting to serious physical injuries.)
CASE NO. 8 Professional Services, Inc.,
vs.
The Court of Appeals and Natividad and Enrique Agana
G.R. NO. 126467
February 11, 2008
(Violation of Article 2180 of the Civil Code and for its own
negligence under Article 2176)

CASE NO. 9 Nilo B. Rosit
vs.
Davao Doctors Hospital and Dr. Rolando G. Gestuvo
G.R. NO. 210445
December 7, 2015
(Guilty of Medical negligence and the doctrine Res Ipsa Loquitor
Finds application in this case.)
CASE NO. 10 Spouses Fredelicto (deceased) and Felicisma Flores
vs.
Spouses Dominador Pineda and Virginia Saclolo and
Florencio, Cndida, Marta, Godofredo, Baltazar and Lucena, all surnamed
Pineda, as heirs of the deceased Teresita S. Pineda, and United Doctors
Medical Center.,
G.R. NO. 15899
November 14, 2008
(Death of Teresita S. Pineda due to the Doctor’s breach of duty and
negligent conduct)
The Sources of Data
The Supreme Court Reports Annotated (SCRA) found in some law
school and Also in the Supreme Court’s electronic library contain the ten
selected cases on Medical negligence each of which is content analyzed.
The Research Methods Used
Content analysis and critiquing if the decision of each the ten
cases on Medical negligence decided by the Philippine Supreme Court
contained in the Supreme Court Annotated (SCRA) are the research
techniques sued in this study.
Procedure for Gathering Data
Since the researches are the students of the University of the
East, they browsed the cases from the Supreme Court Reports Annotated
(SCRA) from the Supreme Court of the Philippines. They made a copy of
the selected cases from the SCRA.
The Method for Analyzing the Cases
The two methods of analyzing the case in this study are: (a)
content analysis and (b) critiquing.

Each of the ten (10) cases was content analyzed in terms of:
1. Facts
2. Issue(s)
3. Decision(s) and bases, and
4. Lesson(s)
Critiquing was done by (1) one identifying the strengths and weaknesses
of each of the ten (10) decisions and (2) offering legislative reform measures to
address the weaknesses.
Statistics was not used in this study because it is purely qualitative or
interpretative in nature.
CHAPTER IV’
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
Chapter IV answers each of the three problems raised in Chapter 1, namely:
(a) How are each of the selected Supreme Court Cases on Medical negligence be
content analyzed in terms of facts, issue(s), decision(s) and the reason therefor and
lesson(s); (b) what are the strength and weaknesses of the decisions of the Supreme
Court in each of these cases; and (c) what are the legislative reform measures that
medical institutions will implement to address the weaknesses.
Problem No. 1
How many each of the selected Supreme Court Cases on Medical Negligence
be content analyzed in terms of facts, issues, decision(s) and the reason therefor,
and lesson(s)
CASE NO.1 Noel Casumpang, Ruby Sanga - Miranda and San Juan Dedios
Hospital
vs.
Nelson Cortejo
G.R. NO. 17112
March 11, 2015
(Death of Edmer Cortejo due to inexcusable lack of precaution of
the doctors and the violation of Article 2176 of the Civil Code)
FACTS
Edmer Cortejo (Edmer) was brought to the emergency room of San Juan de
Dio Hospital (SJDH) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty
in breathing, chest pains, stomach pain, and fever. Dr. Ramoncito Livelo (Livelo),
a family doctor, initially attended to Edmer and after a few tests had the initial
impression of Bronchopneumonia Dr. Livelo then gave Edmer some antibiotics to
lessen his fever and loosen his phlegm. Jesus did not know anyone from SJDH.
Jesusa used her fortune card and was referred to a Fortune Care Coordinator, who
was then absent. She got assigned to Dr. Noel Casumpang (Casumpang) who
appeared to be an employee of the hospital. Dr. Casumpang examined Edmer for
the first time and merely used a stethoscope and determined that it was
Bronchopneumonia. Not Satisfied, she stated that Edmer had high fever, no cold or
cough; Dr. Casumpang that it was normal for Bronchopneumonia. The following
day, Edmer vomited phlegm with blood streak, and upon examination ordered by
Dr. Casumpang, due to the advice of Dr. Sanga, Edmer blood test showed the he is
suffering from Dengue Hemorrhagic Fever, which prompted his parents to transfer
him to the Makati Medical Center, instead of transferring him to the ICU which Dr.
Casumpang suggested. Upon examination in the Makati Medical Center, the
attending physician diagnosed Edmer with Dengue Fever stage IV that was already
in its irreversible stage. Soon after Edmer died. Believing that Edmer’s death was
caused by negligent and erroneous diagnosis of his doctors, the respondent
instituted an action for damages against SJDH and its physicians: Dr. Casumpang
and Dr. Sanga before the RTC of Makati.

Issue(s)\
I. Whether or not Casumpang had committed inexcusable lack of precaution in
diagnosing and in treating the patient.
II. Whether or not Sanga had committed in excusable lack of precaution in

diagnosing and treating the patient.
III. Whether or not the SJDH is solidary liable with the physicians.
Decision:
Yes. The Court ruled in favor of the respondent and held that the physicians
were negligent. They also held that the SJDH was solidarily liable for the damages.
We affirm the hospital’s liability not on the basis of Article 2180 of the Civil Code,
but on the basis of the Doctrine of Apparent Authority or The Principle of Agency.
Despite the absence of employer - employee relationship between SJDH and the
petitioning doctors, SJDH is not free from liability. Therefor, we hold that, under
the Doctrine of Apparent Authority, a hospital can be held vicariously liable for the
negligent acts of a physician providing care at the hospital, regardless of whether
the physician is an independent contractor, unless the patient knows, or should have
known, that the physician is an independent contractor. SJDH impliedly held out
and clothed Dr. Casumpang with apparent authority leading the respondent to
believe that he is an employee or agent of the hospital. SJDH also impliedly held
out Dr. Casumpang, not only as an accredited member of Fortune Care, but also as
a member of its medical staff. Lastly SJDH cannot disclaim liability since there is
no showing that the respondents knew, or should have known, that Dr. Casumpang
is only an independent contractor of the hospital. In this case, estoppel has already
set in.
Lesson:
The following are the principles which can be learned from the decision of
the Supreme Court in this case. These are: (1) The Court’s goal will always uphold
the rule of law to defend what is right and just. And give the justice that the victims
deserves to have. The law should always be fair and that even when the law is harsh
we must still follow it. A life was lost and the family was seeking for justice they
deserve and it is the duty of the court of justice to uphold the law and punish the
accused for committing such unlawful act; (2) Every Medical Institution should
inform their clients or patients on things they should know and should give the best
of care that they needed, once stepping into inside the Institution; (3) Even though
there is no connection between the Medical Institutions and the physicians, still the
Hospital is held liable to any injury or damage caused by the physicians under the
Doctrine of Apparent Authority regardless of whether the physician is an
independent contractor; (4) The court’s will always follow the elements of tort
liability mostly when it comes to Medical Malpractice these are; duty, breach,
injury and proximate cause that are present in this case where the physicians forget
to do their duty of care and their lack of precaution in diagnosing the patient will
fall on the breach or in this case negligence. The negligent actions of the physicians
which is the proximate cause that lead the victim into his death is what we call the
injury; (5) the court has a strong law that will protect the people in this kind of
situation. Under the R.A 2382 or The Medical Act of 1959 article III section 24.
Known as the Grounds for reprimand, suspension or revocation of registration
certificate where any physicians who violates these rule must meet it consequence.
CASE NO. 2 Orlando D. Garcia Jr. doing business under the name and style
community
Diagnostic Center and Bu Castro
vs.
Ranida D. Salvador and Ramon Salvador
G.R. NO 168512
March 20, 2007
(Violation of Section 2 of R.A 4688 otherwise known as the Clinical
Laboratory Law)
Facts:
Ranida D. Salvador started working as a trainee in the Accounting
Department of Limay Bulk Handling Terminal, Inc. As a prerequisite for regular
employment, she underwent a medical examination at the Community Diagnostic
Center (CDC). Garcia who is a medical technologist, conducted the HBs Ag
(Hepatitis B Surface Antigen) test and on October 22, 1993, CDC issued the test
result indicating that Ranida was “HBs Ag: Reactive.” The result bore the name
and signature of Garcia as examiner and the rubber stamp signature of Castro as
pathologist. When Ranida submitted the test result to Dr. Sto. Domingo, the
Company physician, the latter appraised her that the findings indicated that she is
suffering from Hepatitis B, a liver disease. Thus, based on the medical report
submitted by Sto. Domingo, the Company terminated Ranidas employment for
failing the physical examination. When Ranida informed her father, Ramon, about
her ailment, the latter suffered a heart attack and was confined at the Bataan Doctors
Hospital. During Ramons confinement, Ranida underwent another Hbs Ag test at
the said hospital and the result indicated that she is non - reactive. She informed
Sto. Domingo of this development but was told that the test conducted by CDC for
confirmatory testing was more reliable because it used the Micro-Elisa Method.
Ranida went back to CDC for confirmatory testing, and this time, the Anti-HBs
conducted on her indicated a “Negative” result. Ranida also underwent another HBs
Ag test at the Bataan Doctors Hospital using the Micro-Elisa Method. Result: non-
reactive Ranida submitted the test results from Bataan Doctors Hospital and CDC
to the Executive Officer of the Company who requested her to go another undergo
another similar test before her re-employment would be considered. Thus, CDC
conducted another HBs Ag test on Ranida which indicated a "Negative" result. Ma.
Ruby G. Calderon, Med-Tech Officer-in-Charge of CDC, issued a Certification
correcting the initial result and explaining that the examining medical technologist
(Garcia) interpreted the delayed reaction as positive or reactive. Company rehired
Ranida July 25, 1994 - Ranida and Ramon filed a complaint for damages against
petitioner Garcia and a purportedly unknown pathologist of CDC, claiming that, by
reason of the erroneous interpretation of the results of Ranidas examination, she
lost her job and suffered serious mental anxiety, trauma and sleepless nights, while
Ramon was hospitalized and lost business opportunities. Castro was named as the
pathologist Garcia denied the allegations of gross negligence and incompetence and
reiterated the scientific explanation for the "false positive" result of the first HBs
Ag test in his December 7, 1993 letter to the respondents Castro claimed that as
pathologist, he rarely went to CDC and only when a case was referred to him; that
he did not examine Ranida; and that the test results bore only his rubber-stamp
signature. TC dismissed complaint – respondents should have presented Sto.
Domingo and medical expert to testify on the explanation given by Garcia CA
reversed TC decision Garcia maintains he is not negligent, thus not liable for
damages, because he followed the appropriate laboratory measures and procedures
as dictated by his training and experience; and that he did everything within his
professional competence to arrive at an objective, impartial and impersonal result.

Issue:
I. Whether or not Garcia is held liable for negligence
II. Whether or not CDC is liable for damages.
Decision:
Yes, the Court finds that Garcia was negligent. They also find CDC is held
liable for the damages. Negligence is the failure to observe for the protection of the
interest of another person that degree of care, precaution and vigilance which the
circumstances justly demand, whereby such other person suffers injury. For health
care providers, the test of the existence of negligence is: did the health care provider
either fail to do something which a reasonably prudent health care provider would
have done, or that he or she did something that a reasonably prudent health care
provider would not have done; and that failure or action caused injury to the patient;
if yes, then he is guilty of negligence. The elements of an actionable conduct: 1)
Duty 2) Breach 3) Injury 4) Proximate Causation. The Violation of a statutory duty
is negligence. Where the law imposes upon a person the duty to do something, his
omission or non performance will render him liable to whoever may be injured
thereby. Violations of RA 4688 or otherwise known is The Clinical Laboratory Law
committed by CDC. Firstly because CDC is not administered, directed and
supervised by a licensed physician as required by law, but by Ma. Ruby C.
Calderon, a licensed Medical Technologist - Castro was named as head of CDC,
but his infrequent visits to the clinical laboratory barely qualifies as an effective
administrative supervision and control over the activities in the laboratory.

Secondly Garcia conducted the HBsAG test of respondent Ranida without the
supervision of Castro, who admitted that he does not know and has never met her.
Last but not the least the disputed HBsAG test result released to Ranida without the
authorization of Castro. Garcia may not have intended to cause the consequences
which followed after the release of the HBsAG test result. However, his failure to
comply with the laws and rules promulgated and issued for the protection of public
safety and interest is failure to observe that care which a reasonably prudent health
care provider would observe. Thus his act or omission constitutes a breach of duty.
Indubitably, Ranida suffered injury, as a direct consequence of Garcias failure to
comply with the mandate of the laws and rules afore quoted. She was terminated
from the service for failing the physical examination; suffered anxiety because of
diagnosis; and was compelled to undergo several more tests. All these could have
been avoided had the proper safeguard been scrupulously followed in conducting
the clinical examination and releasing the clinical reports. Article 20 of the Civi
Code of the Philippines provides legal basis for the award of damages to a party
who suffers damage whenever one commits an act in violation of some legal
provision that finds Orlando Garcia guilty of gross negligence.
Lesson
The following are the principles which can learned from the decision of the
Supreme Court in this case. These are: (1) In doing such a negligent act would cause
you into a consequence that could affect your life but most importantly the life of
the innocent even if you don’t mean any harm it will surely make you liable and
responsible; (2) Every rules and regulations imposed by any Institutions must be
established certainty and specifically because this would lead to possible confusion
among the individuals and might mis interpret the essence and purpose of such rules
and use it for their personal advantage; (3) The Ignorance of law excuses no one so
there is no excuse when a person violates a rule in doing such a negligent act,
furthermore the legal maxim: The law is harsh but it is the also proves that every
action has its consequence that we need to face; (4) The violation of RA 4688
otherwise known as The Clinical Laboratory Law is a firm law that would protect
the right of every individual and punish who violated such laws; (5) Article 20 of
the Civil Code of the Philippines is a strong legal basis for such cases like this when
it comes to committing an act towards violation; (6) Negligence is an act where the
persons fails to observe the protection of the interest of another person.
CASE NO. 3 Rogelio P. Nogales for himself and on behalf of the minors, Roger,
Anthony,
Angelica Nancy and Michael Christopher, all surnamed Nogales
vs.
Capitol Medical Center
G.R. NO 142625
December 19, 2006

(Violation of Article 2180 in relation to Article 2176 of the Civil Code and the
doctrine of Apparent Authority find application in this case)
Facts
Pregnant with her fourth child, Corazon Nogales, who was then 37 years old
was under the exclusive prenatal care of Dr. Oscar Estrada beginning on her fourth
month of pregnancy or as early as December 1975. While Corazon was on her last
trimester of pregnancy, Dr. Estrada noted an increase in her blood pressure and
development of leg edemas indicating preeclampsia which is a dangerous
complication of pregnancy. Around midnight of May 26,1976, Corazon started to
experience mild labor pains prompting Corazon and Rogelio Nogales to see Dr.
Estrada at his home. After examining Corazon, Dr. Estrada advised her immediate
admission to Capitol Medical Center (CMC). Upon her admission, an internal
examination was conducted upon her by a resident-physician. Based on the doctor’s
sheet, around 3am, Dr. Estrada advised for 10mg valium to be administered
immediately by intramuscular injection, he later ordered the start of intravenous
administration of syntociron admixed with dextrose, 5% in lactated ringer’s
solution, at the rate of 8-10 micro-drops per minute. When asked if he needed the
services of anesthesiologist, he refused. Corazon’s bag of water ruptured
spontaneously and her cervix was fully dilated and she experienced convulsions.
Dr. Estrada ordered the injection of 10g of magnesium sulfate but his assisting
Doctor, Dr. Villaflor, only administered 2.5g. She also applied low forceps to
extract Corazon’s baby. In the process, a 10 x 2.5cm piece of cervical tissue was
allegedly torn. The baby came out in an apric, cyanatic weak and injured condition.
Consequently the baby had to be intubated and resuscitated. Corazon had professed
vaginal bleeding where a blood typing was ordered and she was supposed to
undergo hysterectomy, however, upon the arrival of the doctor, she was already
pronounced dead due to hemorrhage.
Issue
Whether or not in the conduct of child delivery, the doctors and the respondent
hospital is liable for negligence.
Decision
Yes. In general, a hospital is not liable for the negligence of an independent
contractor-physician. There is, however an exception to this principle. The hospital
may be liable if the physician is the ostensible agent of the hospital. This exception
is also known as the doctrine of apparent authority. Under the doctrine of apparent
authority a hospital can be held vicariously liable for the negligent acts of a
physician providing care at the hospital, regardless of whether the physician is an
independent contractor, unless the patient knows, or should have known, that the
physician is an independent contractor. Along with Borrowed servant doctrine
provides that once a surgeon enters the operating room and takes charge of the acts
or omissions of operating room personnel and any negligence associated with each
acts or omissions are imputable to the surgeon, while the assisting physicians and
nurses may be employed by the hospital, or engaged by the patient, they normally
become the temporary servants or agents of the surgeon in charge while the
operation is in progress, and liability may be imposed upon the surgeon for their
negligent acts under the doctrine of Respondeat superior. Furthermore this violates
the Article 2180 in relation of Article 2176 in the civil code that says; The
obligation imposed by Article 2176 is demandable not only for one's own acts or
omissions, but also for those of persons for whom one is responsible
Lesson:
the Supreme Court in this case. These are: (1) That the Hospitals can be held liable
for the consequences even if the physician is an independent contractor this is what
we called the doctrine of Apparent Authority; (2) and also this case shows that once
the surgeon enters the operating room and takes charge with the help of the any
assisting physicians inside, whatever the acts or omissions committed by the
surgeon will only fall on him exempting the assisting physicians because they
simply become a temporary servants of the surgeon who is in charged this is
commonly known as the doctrine of Borrowed servant and Respodeat superior; (3)
The court firmly believes that the death of Corazon Nogales is an act of a negligence
by her doctor and should have the justice that she and her family deserves. (4) We
should be more careful in our actions especially if we know that this can majorly
affect the person and her family. (5) In doing such a negligent act has its
consequences that we need to face in order to for us to pay the damages that we
made towards the victim.

CASE NO. 4 Rogelio E. Ramos and Erlinda Ramos, in their own behalf as a natural
guardians of the minors, Rommel Ramos, Roy Roderick Ramos and
Ron Raymond Ramos
vs.
Court of Appeals, De Los Santos Medical Center, Dr. Orlino Hosaka
and Dra. Perfecta Gutierrez
G.R. NO. 124354
December 29, 1999
(The doctrine of Res Ipsa Loquitur finds application in this case)
Facts:
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985 a 47-year
old robust woman. Except for occasional complaints of discomfort due to pains
allegedly caused by presence of a stone in her gall bladder, she was as normal as
any other woman. Married to Rogelio Ramos, an executive of Philippine Long
Distance Telephone Company (PLDT), she has three children whose names are
Rommel, Roy Roderick, and Ron Raymond. Because of the discomforts somehow
interfered with her normal ways, she sough professional advice. She was told to
undergo an operation for the removal of a stone in her gall bladder. She underwent
series of examination which revealed that she was fit for the said surgery. Through
the intercession of a mutual friend, she and her husband met Dr. Osaka for the first
time and she was advised by Dr. Osaka to go under the operation called
cholecystectomy and the same was agreed to be scheduled on June 17,1985 at
9:00am at the Delos Santos Medical Center. Rogelio asked Dr. Osaka to look for a
good anesthesiologist to which the latter agreed to. A day before the scheduled
operation, she was admitted at the hospital and on the day of the operation,
Erlinda’s sister was with her insider the operating room. Dr. Osaka arrived at the
hospital late, Dr. Guttierez, the anesthesiologist, started to intubate Erlina when
Herminda heard her say “and hirap ma-intubate nito, mali yata ang pagkakapasok”.
This prompt Dr. Osaka to order a call to another anesthesiologist, Dr. Caldron who
successfully intubated Erlina. The patient’s nails became bluish and the patient was
placed in a trendelenburg position. After the operation, Erlina was diagnosed to be
suffering from diffuse cerebral parenchymal damage and that the petitioner alleged
that this was due to lack of oxygen supply to Erlinda’s brain which resulted from
the intubation.
Issue(s):
I. Whether or not the doctrine of Res ipsa loquitur apply in this case.
II. Whether or not the the negligence of the respondents cause the
unfortunate comatose condition of petitioner Erlinda Ramos.

Decision:
Yes. The Court finds the doctrine of Res ipsa loquitur appropriate in the
case at bar. The doctrine of Res ipsa loquitur is where the thing which caused
the injury complained of is shown to be under the management of the
defendant or his servants and the accident is such as in ordinary course of
things does not happen if those who have its management or control use
proper care, it affords reasonable evidence, in the absence of explanation by
the defendant, that the accident arose from or was caused by the defendant's
want of care. Erlinda submitted herself soundly and fit for surgery. However,
during the administration of anesthesia and prior to the performance of
cholecystectomy she suffered irreparable damage to her brain. Thus, without
undergoing surgery, she went out of the operating room already decerebrate
and totally incapacitated. Obviously, brain damage, which Erlinda sustained,
is an injury which does not normally occur in the process of a gall bladder
operation. Considering that a sound and unaffected member of the body (the
brain) is injured or destroyed while the patient is unconscious and under the
immediate and exclusive control of the physicians, we hold that a practical
administration of justice dictates the application of res ipsa loquitur. With
regard to Dra. Gutierrez, the court find her negligent during the anesthesia
phase. As borne by the records, respondent Dra. Gutierrez failed to properly
intubate the patient which she admitted. During intubation, such distention
indicates that air has entered the gastrointestinal tract through the esophagus
instead of the lungs through the trachea. Entry into the esophagus would
certainly cause some delay in oxygen delivery into the lungs as the tube which
carries oxygen is in the wrong place. Even granting that the tube was
successfully inserted during the second attempt, it was obviously too late. An
experienced anesthesiologist, adequately alerted by a thorough pre-operative
evaluation, would have had little difficulty going around the short neck and
protruding teeth. Hence, she was negligent. As for Dr. Orlino Hosaka, as the
head of the surgical team and as the so-called captain of the ship, it is the
surgeons responsibility to see to it that those under him perform their task in
the proper manner Respondent Dr. Hosakas negligence can be found in his
failure to exercise the proper authority (as the captain of the operative team)
in not determining if his anesthesiologist observed proper anesthesia
protocols. In fact, no evidence on record exists to show that respondent Dr.
Hosaka verified if respondent Dra. Gutierrez properly intubated the patient.
Furthermore, it does not escape the court that respondent Dr. Hosaka had
scheduled another procedure in a different hospital at the same time as
Erlinda's operation, and was in fact over three hours late for the latter's
operation. Because of this, he had little or no time to confer with his
anesthesiologist regarding the anesthesia delivery. This indicates that he was
remiss in his professional duties towards his patient.Thus, he shares equal
responsibility for the events which resulted in Erlindas condition.

Lesson:
The following are the principles which can be learned from the
decision of the Supreme Court in this case. These are: (1) Physicians should
take good care of their patients and give them the best that they can do; (2)
In order for us to be called professionals then we should act professionally,
and one mistake that we do is not knowing how to manage our time
properly, “Time is gold.” is what we people say but we should remember
that it is gold because it is valuable, rare and indispensable and once we let
it go, they are a lot of things that could happen and be missed; (3) Every
Doctors should be more vigilant in assisting their patients since we gave
them our 100% trust, and trust should be valued and be respected by the
every doctors; (4) The court finds the doctrine of Res Ipsa Loquitur or
known as “The thing speaks for itself" is present in this case since the
operation of Erlinda should have not put her into coma, then it is clearly
shown that if only just the physicians had been more careful and attentive
then the operation would be successful.

vs.
Marilou R. Mantala
G.R. NO. 203080
November 12, 2014
(Guilty of Grave Misconduct and violation of Article 2 Section 1 Of The Code Of
Medical Ethics of the Medical Profession in the Philippines.)
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(s):
I. Whether or not petitioner’s conduct during the delivery of
respondent’s baby constitute grave misconduct
II. Whether or not the petitioner violated the Code of Medical Ethics.
Decision:
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. 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. Furthermore Article II
section 1 of the code of medical ethics of the medical profession in the Philippines
states: that: 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. Hence 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.
Lessons
the Supreme Court in this case. These are: (1) Doctors should give the best care and
full attention when it comes to their patients especially when they are in a critical
condition like giving birth; (2) A professional doctor should know not let his
assistants or any other physicians to handle serious cases when he can do it by
himself to prevent any injuries towards the patient; (3) and that doctors should not
decide on his own but to inform the patient or the patients family about the up
coming operation to get their approval and consent; (4) Any physicians should
know that there will always be a life on line when it comes to doing their job, so
they should be more careful in doing such actions; (5) There are consequences that
we must face in everything that we do whether we did it on purpose or not that can
affect our whole lives; (6) Every Medical physicians should not speak badly about
their patients situation but help and encourage them to be strong in every step to
their recovery.
Vs.
Marilou R. Mantala
G.R NO. 203080
November 12,2014
(Guilty of Grave Misconduct and and Violation of Article 2 Section
1of the Code Of Medical Ethics of Medical Profession in the Philippines )
Facts:
The Respondent was conceded at the Oriental Mindoro Provincial Hospital
(OMPH) on the date 3th of April year , 2009, at the time around 11:00am, with the
guide from the Bansud Municipal Health Office. The respondent due to deliver of
her 5th child and was well considered for a caesarian section because her baby was
big and her womb and they find out there was excessive amniotic fluid in her
womb. Around 7:00am she was started having her labor she was initially brought
to the Bongabon Health Center after that incident . Notwithstanding , the health
center stated to her that they must to proceed directly to the hospital. Acoording
In her complaint-affidavit, the 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. The
petitioner was heard modulating words that is so unseemly of the physician
profession referring to the respondent’s states while she in her labor with the
respondent child. Thenceforth the respondent filed a complaint for the 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.
Decision :
The Petitioner Dr. Idol L. Bondoc is now before this Court arguing that the CA
erred in affirming the Ombudsman’s ruling that he is guilty of grave misconduct
and imposing on him the penalty of dismissal from the service .Through his
Government service according to Section 10, Rule III, Administrative Order No.
07, as amended by Administrative Order No. 17, in relation to Section 25 of
Republic Act No. 6770 stated that penalty of dismissal shall carry with it that of
cancellation of eligibility, forfeiture of the retirement benefits, and the perpetual the
disqualification for reemployment in the government service pursuant to Section
58, Rule IV of the Uniform Rules on Administrative Cases in the Civil Service. SO
DECIDED.12
The foregoing ruling was affirmedby the Court of Appeals and the petitioner’s
motion for reconsideration the result was denied. On the other hand the Court of
Appeals concurred that petitioner should have chosen to stay in the delivery room
and personally attend to the patient as he is the most competent person to render
medical service in view of respondent’s critical condition. It likewise faulted the
petitioner for deliberately leaving the laboring and unstable respondent tothe care
of his inexperienced subordinates at the time she was about to give birth. As to
petitioner’s excuse that he had to attend to an equally important cesarean operation,
the CA said there was no sufficient showing of the latter’s urgency and assuming it
to be true, still, petitioner should have exerted efforts to refer respondent’s case to
another competent doctor or one of his consultants.
Lessons:
There are lessons that can be found in the decisions made by the court to this case.
(1)the duty of the doctor must required to be reasonable and competence toward to
physicans patient according to Article II, Section 1 of the Code of Medical Ethics
of the Medical Profession in the Philippines states:A physician must attended to
his patients faithfully and conscientiously. He should secure for 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 patients 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 issimply the reasonable average merit among
ordinarily good physicians, i.e.reasonable skill and competence. In the case of the
petitioner fell 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 childbirths like this.
There is no such excuse for a phsycians that they have no experienced in pertating
to operating like this .The Hospital administarators must not hired this such kind
of physicians that inexperienced staff, by themselves, to handle laboring patients
with high-risk pregnancies and maternal/fetal complications because it was so
unfair for the patients who will paid for the hospitalization and aftermath this would
be happening . (2) The petitioner Dr. Idol Bondoc he must not only comiited but
also it his duty as a physician showing ethical norms of his profession. He showed
misconduct which is wrong that he treated his patient like that . In other hand
misconduct means that transgression of some established and definite rule of action,
more particularly, unlawful behavior or gross negligence by a public officer,or its
a forbidden act, a dereliction of duty, willful in character, and implies wrongful
intent and not mere error in judgment. They violated the law and that’s the reason
that Dr. Idol Bondoc liable for grave misconduct. The Court is more inclined to
believe respondent’s version which was duly corroborated by Dr. Fabon who heard
petitioner saying that: "Meron pa nga kami sa DR macrosomnia, polyhydramnios
pa, pero paanakin na lang ‘yon. Abnormal din namanang bata kahit mabuhay and
as you can see the petitioner was clearly committed being desolation of duty and a
breach of his professional obligations resulting of the his patient suffered a lot and
severe complications
CASE NO.7 Dr. Milagros L. Cantre
Vs.
SPS John David Z. Go and Nora S, Go
G.R NO 160889
(The Captain Of the Ship doctrine finds application on this case)
FACTS
Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr. Jesus
Delgado Memorial Hospital. She was the attending physician of respondent Nora
S. Go, who was admitted at the said hospital. After Nora gave birth to her fourth
child, she suffered profuse bleeding inside her womb due to some parts of the
placenta which were not completely expelled after delivery. Consequently, Nora
suffered hypovolemic shock, resulting in a drop in her blood pressure. Petitioner
and the assisting resident physician performed various medical procedures to stop
the bleeding and to restore Noras blood pressure. While petitioner was massaging
Noras uterus for it to contract and stop bleeding, she ordered a droplight to warm
Nora and her baby. Nora remained unconscious until she recovered.While in the
recovery room, her husband noticed a fresh gaping wound inches in the inner
portion of her left arm, close to the armpit. He asked the nurses what caused the
injury. He was informed it was a burn. Forthwith, he filed a request for
investigation. In response, the medical director of the hospital, called petitioner and
the assisting resident physician to explain what happened. Petitioner said the blood
pressure cuff caused the injury.The husband of Nora brought her to NBI wherein
the medico-legal officer testified that the wound was caused by the droplight
resulting to burn. It was later treated through skin grafting, a kind of plastic surgery.
However, Nora’s movements were restricted and pain is constantly felt due to her
injury. Hence, prompting the spouses to file a complaint for damages against the
petitioner and the hospital. The trial court ruled in favor of the respondent spouses
which was affirmed with modifications by the CA.
ISSUE
Whether the petitioner is liable for the injury suffered by respondent Nora Go
Ruling :
Petitioner’s motion for reconsideration was DENIED by the Court of Appeals .
Petitioner insists the droplight could not have touched Nora’s body. She maintains
the injury was due to the constant taking of Nora’s blood pressure. Petitioner also
insinuates the Court of Appeals was misled by the testimony of the medico-legal
officer who never saw the original injury before plastic surgery was performed.
Finally, petitioner stresses that plastic surgery was not intended to restore
respondent’s injury to its original state but rather to prevent further complication.
In this petitioner was GUILTY of negligent in her duties as Nora’s attending
physician. In the ruling on the negligence of petitioner may be made based on the
res ipsa loquitur doctrine even in the absence of such additional exhibits. According
to the The Hippocratic Oath it mandates physicians to give primordial consideration
to the well-being of their patients. If a doctor fails to live up to this precept, he is
accountable for his acts. This notwithstanding, courts face a unique restraint in
adjudicating medical negligence cases because physicians are not guarantors of
care and, they never set out to intentionally cause injury to their patients. However,
intent is immaterial in negligence cases because where negligence exists and is
proven, it automatically gives the injured a right to reparation for the damage
caused. Hence, considering the specific circumstances in the instant case, we find
no grave abuse of discretion in the assailed decision and resolution of the Court of
Appeals. Further, we rule that the Court of Appeals’ award of Two Hundred
Thousand Pesos (₱200,000) as moral damages in favor of respondents and against
petitioner is just and equitable.
LESSONS:
In the case of Dr. Cantre vs Go there case is all about the involving medical
negligence,.,because there was negligence exist proven and automatically gives the
injured reparation caused damage by the petitioner .

According the doctrine of res ipsa loquitur it 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:
( 1.)The accident is of a kind which ordinarily does not occur in the absence of
someones negligence;(2.)It is caused by an instrumentality within the exclusive
control of the defendant or defendants; and (3.)The possibility of contributing
conduct which would make the plaintiff responsible is eliminated.
Basically to the first requirement, the gaping wound on Noras arm is certainly not
an ordinary occurrence in the act of delivering a baby, far removed as the arm is
from the organs involved in the process of giving birth. Such injury could not have
happened unless negligence had set in somewhere.
Second thing I see in this case that whether the injury was caused by the
droplight or by the blood pressure cuff is of no moment. Both instruments are
deemed within the exclusive control of the physician in charge under the captain of
the ship doctrine. This doctrine holds the surgeon in charge of an operation liable
for the negligence of his assistants during the time when those assistants are under
the surgeons control. In this particular case, it can be logically inferred that
petitioner, the senior consultant in charge during the delivery of Noras baby,
exercised control over the assistants assigned to both the use of the droplight and
the taking of Noras blood pressure. Hence, the use of the droplight and the blood
pressure cuff is also within petitioners exclusive control. Third, when the time that
there was the gaping wound on Noras left arm, by its very nature and considering
her condition, could only be caused by something external to her and outside her
control as she was unconscious while in hypovolemic shock. Hence, Nora could
not, by any stretch of the imagination, have contributed to her own injury.
Petitioners defense that Noras wound was caused not by the droplight but by the
constant taking of her blood pressure, even if the latter was necessary given her
condition, does not absolve her from liability. As testified to by the medico-legal
officer, Dr. Arizala, Jr., the medical practice is to deflate the blood pressure cuff
immediately after each use. Otherwise, the inflated band can cause injury to the
patient similar to what could have happened in this case. Thus, if Noras wound was
caused by the blood pressure cuff, then the taking of Noras blood pressure must
have been done so negligently as to have inflicted a gaping wound on her arm, for
which petitioner cannot escape liability under the captain of the ship doctrine. (1)
Captain-of-the-Ship Doctrine is a principle of medical law, holding a surgeon liable
for the actions of assistants who are under the surgeon's control but who are
employees of the hospital, not the surgeon. The surgeon as "the captain of the ship,"
is directly responsible for an alleged error or act of alleged negligence because he
or she controls and directs the actions of those in assistance. This common law
doctrine is often used in operating room situations.
On the other hand the petitioners argument that the failed plastic surgery was not
intended as a cosmetic procedure, but rather as a measure to prevent complication
does not help her case. It does not negate negligence on her part.
That petitioner was negligent in the exercise of her profession stands unrebutted. In
this connection, the Decision of the Supreme court according to Civil Code
provides:
ART. 2176. Whoever by act or omission causes damage to another, there being
fault or negligence, is obliged to pay for the damage done.
ART. 2217. Moral damages include physical suffering, mental anguish, fright,
serious anxiety, besmirched reputation, wounded feelings, moral shock, social
humiliation, and similar injury. Though incapable of pecuniary computation, moral
damages may be recovered if they are the proximate result of the defendants
wrongful act or omission.
Therefore under the law the Petitioner Dr. Milagros L. Cantre obliged to pay for
SPS John David Z. Go and Nora S, Go for the moral damages that the complaint
suffered due to the proximate result of petitioner’s negligence.
CASE NO. 8 Dr.Emmanuel Jarcia Jr.and Dr. Marilou Bastan
Vs.
People of the Philippines
G.R NO. 187926
Febuary 15,2012
(Guilty of Reckless Imprudence resulting to serious physical injuries)

UNIVERSITY OF THE EAST
100
FACTS:
Mrs. Santiago lodged a complaint with the National Bureau of Investigation
(NBI ) against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr. Marilou
Bastan (Dr. Bastan), for their alleged neglect of professional duty which caused her
son, Roy Alfonso Santiago (Roy Jr.), to suffer serious physical injuries. Upon
investigation, the NBI found that Roy Jr. was hit by a taxicab; that he was rushed
to the Manila Doctors Hospital for an emergency medical treatment; that an X-ray
of the victim’s ankle was ordered; 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 X-ray revealed a right mid-tibial fracture and a linear hairline fracture
in the shaft of the bone.
ISSUE :
WHEREFORE, premises considered, the Court finds accused beyond reasonable
doubt of the crime.
DECISION:
The Court believes that accused are negligent when both failed to exercise the
necessary and reasonable prudence in ascertaining the extent of injury of Alfonso

101
Santiago, Jr. it holds concurrently and finds the foregoing circumstances sufficient
to sustain a judgment of conviction against the accused-appellants for the crime of
simple imprudence resulting in serious physical injuries. 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 imprudence are:
(1)that the offender does or fails to do an act; (2) that the doing or the failure to do
that act is voluntary; (3) that it be without malice; (4) that material damage results
from the imprudence; and (5) that there is inexcusable lack of precaution on the
part of the offender, taking into consideration his employment or occupation,
degree of intelligence, physical condition, and other circumstances regarding
persons, time and place. Considering all the evidence on record, The Court finds
the accused GUILTY for simple imprudence resulting to physical injuries. The CA
is correct in finding that there was negligence on the part of the petitioners. After a
perusal of the records, however, the Court is not convinced that the petitioners are
guilty of criminal negligence complained of. The Court is also of the view that the
CA erred in applying the doctrine of res ipsa loquitur in this particular case.
LESSONS :
102
The case of Dr.Emmanuel Jarcia Jr.and Dr. Marilou Bastan Vs. People of
the Philippines teaches us First all about The Doctrine of Res Ipsa Loquitor means
Where the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not
happen if those who have the management use proper care, it affords reasonable
evidence, in the absence of an explanation by the defendant, that the accident arose
from want of care. The doctrine of res ipsa loquitur as a rule of evidence is unusual
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, however, 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 given case, is not meant 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 helps the
plaintiff in proving a breach of the duty. The doctrine can be invoked when and
only when, under the circumstances involved, direct evidence is absent and not
readily available. application of the doctrine of res ipsa loquitur are: (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. In this case, the
circumstances that caused patient Roy Jr.’s injury and the series of tests that were
103
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 patient’s 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.
Second , As to Dr. Jarcia and Dr. Bastan’s negligence I see that the
totality of the evidence on record clearly points to the negligence of the petitioners
resulting to reckless imprudence consists of voluntarily doing or failing to do,
without malice, an act from which material damage results by reason of an
inexcusable lack of precaution on the part of the person performing or failing to
perform such act.
All told, the petitioners were, indeed, negligent but only civilly, and not criminally,
liable as the facts show.
Based on 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 for them all possible benefits that
104
may depend upon his professional skill and care. As the sole tribunal to adjudge the
physician’s failure to fulfill his obligation to his patients is, in most cases, his own
conscience, violation of this rule on his part is discreditable and inexcusable. In this
case, unfortunately the petitioners failed to observe the most prudent medical
procedure under the circumstances to prevent the complications suffered by a child
of tender age.
Lastly As to the Award of Damages the Court is aware that no amount of
compassion can suffice to ease the sorrow felt by the family of the child at that
time. Certainly, the award of moral and exemplary damages in favor of Roy Jr. The
Court, likewise, finds the petitioners also liable for exemplary damages in the said
amount. Article 2229 of the Civil Code provides that exemplary damages may be
imposed by way of example or correction for the public good.
SECTION 5. – Exemplary or Corrective Damages
Art. 2229. Exemplary or corrective damages are imposed, by way of example or
correction for the public good, in addition to the moral, temperate, liquidated or
compensatory damages.
CASE NO.9
Professional Services Inc.
Vs.
The Court of Appeals and Natividad and Enrique Agana

105
G.R NO 126467
Febuary 11,2008
(Violation of Article 2180 of the Civil Code and for its own
negligence)
FACTS :
Natividad Agana was rushed to the Medical City General Hospital because of
difficulty of bowel movement and bloody anal discharge. Dr. Miguel Ampil
diagnosed her to be suffering from cancer of the sigmoid. 11th of April 1984 Dr.
Ampil performed an anterior resection surgery on Natividad and found that the
malignancy in her sigmoid area had spread on her left ovary, necessitating the
removal of certain portions of it. Dr. Ampil obtained the consent of Natividad’s
husband, Enrique Agana to perform hysterectomy. After a couple of days,
Natividad consulted both Dr. Ampil and Dr. Fuentes about the excruciating pain in
her anal region. Dr. Ampil recommended that she consult an oncologist. The
Aganas went to the United States to seek further treatment and was told she was
FREE from cancer. After that Natividad's daughter found a piece of gauze
protruding from her vagina. Dr. Ampil proceeded to her house and extracted by
hand a piece of gauze measuring 1.5 inches in width and assuring that the pain will
vanish. When the pain intensified, Nativided went to Polymedic General Hospital
where Dr. Ramon Gutierrez found a foul-smelling gauze measuring 1.5 inches in
width which badly infected her vaginal vault which formed a recto-vaginal fistula
106
forcign her stool to excrete through the vagina. 0ctober of 1984 Natividad
underwent another surgery to remedy the damage and because of the operation
Natividad died so she was substituted by her children .
ISSUE:
W/N Dr. Fuentes may be held liable under the principle of res ipso loquitor
DECISION:
The Court decision telling that Dr. Ampil was GUILTY in the negligent party
surgeons used gauzes as sponges to control the bleeding of the patient during the
surgical operation immediately after the operation, the nurses who assisted in the
surgery noted in their report 2 sponges lacking 2 gauzes were extracted from the
same spot of the body of Mrs. Agana element 3 "control and management of the
thing which caused the injury" to be wanting .Dr. Fuentes performed the surgery
and thereafter reported and showed his work to Dr. Ampil who allowed Dr. Fuentes
to leave the operating room .Under the "Captain of the Ship" rule, the operating
surgeon is the person in complete charge of the surgery room and all personnel
connected with the operation res ipsa loquitur not a rule of substantive law, hence,
does not per se create or constitute an independent or separate ground of liability,
being a mere evidentiary rule mere invocation and application of the doctrine does
not dispense with the requirement of proof of negligence:

107
Art. 2176. Whoever by act or omission causes damage to another, there being fault
or negligence, is obliged to pay for the damage done. Such fault or negligence, if
there is no pre-existing contractual relation between the parties, is called a quasi-
delict and is governed by the provisions of this Chapter.
ART. 2180. The obligation imposed by Article 2176 is demandable not only for
one’s own acts or omissions, but also for those of persons for whom one is
responsible.
The owners and managers of an establishment or enterprise are likewise responsible
for damages caused by their employees in the service of the branches in which the
latter are employed or on the occasion of their functions.Employers shall be liable
for the damages caused by their employees and household helpers acting within the
scope of their assigned tasks even though the former are not engaged in any
business or industry The responsibility treated of in this article shall cease when
the persons herein mentioned prove that they observed all the diligence of a good
father of a family to prevent damage.failed to adduce evidence showing that it
exercised the diligence of a good father of a family in the accreditation and
supervision.private hospitals, hire, fire and exercise real control over their attending
and visiting ‘consultant’ staff control test is determining 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
108
ART. 1869. Agency may be express, or implied from the acts of the principal, from
his silence or lack of action, or his failure to repudiate the agency, knowing that
another person is acting on his behalf without authority. By accrediting Dr. Ampil
and Dr. Fuentes and publicly advertising their qualifications, the hospital created
the impression that they were its agents, authorized to perform medical or surgical
services for its patients doctrine of corporate negligence or corporate responsibility
knowledge of any of the staff of Medical City Hospital constitutes knowledge of
PSI
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the
assistance of the Medical City Hospital . Professional Services, Inc. is ORDERED
pro hac vice to pay Natividad substituted by her children Marcelino Agana III,
Enrique Agana, Jr., Emma Agana-Andaya, Jesus Agana and Raymund Agana) and
Enrique Agana the total amount of P15 million, subject to 12% p.a. interest from
the finality of this resolution to full satisfaction.ital’s staff, composed of resident
doctors, nurses, and interns.
LESSONS:
The Court holds that, in this particular instance, the concurrent finding of the
RTC and the CA that PSI was not the employer of Dr. Ampil is correct. Control as
a determinative factor in testing the employer-employee relationship between
doctor and hospital under which the hospital could be held vicariously liable to a
109
patient in medical negligence cases is a requisite fact to be established by
preponderance of evidence. Here, there was insufficient evidence that PSI exercised
the power of control or wielded such power over the means and the details of the
specific process by which Dr. Ampil applied his skills in the treatment of Natividad.
Consequently, PSI cannot be held vicariously liable for the negligence of Dr. Ampil
under the principle of Respondeat superior. [Latin.] A common-law doctrine that
makes an employer liable for the actions of an employee when the actions take
place within the scope of employment. There is, however, ample evidence that the
hospital (PSI) held out to the patient that the doctor was its agent. Present are the
two factors that determine apparent authority: first, the hospital's implied
manifestation to the patient which led the latter to conclude that the doctor was the
hospital's agent; and second, the patient's reliance upon the conduct of the hospital
and the doctor, consistent with ordinary care and prudence . In this jurisdiction,
case of Professional Services Inc Vs. The Court of Appeals and Natividad and
Enrique Aganathe statute governing liability for negligent acts is Article 2176 of
the Civil Code, which reads: Art. 2176. Whoever by act or omission causes damage
to another, there being fault or negligence, is obliged to pay for the damage done.
Such fault or negligence, if there is no pre-existing contractual relation between the
parties, is called a quasi-delict and is governed by the provisions of this Chapter.
A derivative of this provision is Article 2180, the rule governing vicarious liability
under the doctrine of respondeat superior, thus: ART. 2180. The obligation
110
imposed by Article 2176 is demandable not only for one’s own acts or omissions,
but also for those of persons for whom one is responsible.
The owners and managers of an establishment or enterprise are likewise responsible
for damages caused by their employees in the service of the branches in which the
latter are employed or on the occasion of their functions. The Employers shall be
liable for the damages caused by their employees and household helpers acting
within the scope of their assigned tasks even though the former are not engaged in
any business or industry. The responsibility treated of in this article shall cease
when the persons herein mentioned prove that they observed all the diligence of a
good father of a family to prevent damage.
The professionals must be engaged by an employer, such as physicians, dentists,
and pharmacists, are not “employees” under this article because the manner in
which they perform their work is not within the control of the latter.In other words,
professionals are considered personally liable for the fault or negligence they
commit in the discharge of their duties, and their employer cannot be held liable for
such fault or negligence.In the context of the present case, “a hospital cannot be
held liable for the fault or negligence of a physician or surgeon in the treatment or
operation of patients.The foregoing view is grounded on the traditional notion that
the professional status and the very nature of the physician’s calling preclude him
from being classed as an agent or employee of a hospital, whenever he acts in a
professional capacity. It has been said that medical practice strictly involves highly
developed and specialized knowledge, such that physicians are generally free to
111
exercise their own skill and judgment in rendering medical services and
interference and the important thing A doctor practices medicine in a hospital
setting.
CASE NO. 10 Nilo B. Rosit
Vs.
Davao Doctors Hospital and Dr. Rolando G. Gestuvo
G. R NO 210445
December 07,2015
(Guilty of Medical Neglience and Doctrine Res Ipsa Loquitor finds application in
This case
Facts:
On January 15, 1999, Rosit figured in a motorcycle accident. The X-ray soon
taken the next day at the Davao Doctors Hospital showed that he fractured his jaw.
Rosit was then referred to Dr. Gestuvo, a specialist in mandibular whooperated on
Rosit. During the operation, Dr. Gestuvo used a metal plate fastened to the jaw with
metal screws to immobilize the mandible. As the operation required the smallest
screws available, Dr. Gestuvo cut the screws on hand to make them smaller. Dr.
Gestuvo knew that there were smaller titanium screws available in Manila, but did
not so inform Rosit supposing that the latter would not be able to afford the same.
112
Following the procedure, Rosit could not properly open and close his mouth and
was in pain. X-rays done on Rosit two (2) days after the operation showed that the
fracture in his jaw was aligned but the screws used on him touched his molar. Given
the X-ray results, Dr. Gestuvo referred Rosit to a dentist. The dentist who checked
Rosit, Dr. Pangan, opined that another operation is necessary and that it is to be
performed in Cebu. In Cebu, Dr. Pangan removed the plate and screws thus
installed by Dr. Gestuvo and replaced them with smaller titanium plate and screws.
Dr. Pangan also extracted Rosit's molar that was hit with a screw and some bone
fragments. Three days after the operation, Rosit was able to eat and speak well and
could open and close his mouth normally. On his return to Davao, Rosit demanded
that Dr. Gestuvo reimburse him for the cost of the operation and the expenses he
incurred in Cebu but Dr. Gestuvo refused. Thus, Rosit filed a civil case for damages
and attorney's fees with the RTC against Dr. Gestuvo and DDH, the suit docketed
as Civil Case No.
Issue:
Whether or not Dr. Gestuvo is guilty of medical malpractice?
RULING :
For this Court has held that Dr. Gestuvo was GUILTY of Medical Neglience to
Mr. Nilo B. Rosit . That the reason that this physician caused a patient body into
harm. To establish medical negligence, this Court his an expert testimony is
generally required to define the standard of behavior by which the court may
113
determine whether the physician has properly performed the requisite duty toward
the patient. This is so considering that the requisite degree of skill and care in the
treatment of a patient is usually a matter of expert opinion. However, when the
doctrine of res ipsa loquitur applies, the need for expert medical testimony is
dispensed with because the injury itself provides the proof of negligence. And the
doctrine of res ipsa loquitur may be availed of if the following essential requisites
are satisfied:
(1) the accident was of a kind that does not ordinarily occur unless someone is
negligent;
(2) the instrumentality or agency that caused the injury was under the exclusive
control of the person charged;
(3) the injury suffered must not have been due to any voluntary action or
contribution of the person injured.12 Here, the essential requisites for the
application of the doctrine of res ipsa loquitur are present. The first element was
sufficiently established when Rosit proved that one of the screws installed by Dr.
Gestuvo struck his molar because the size and length was too long or improperly
placed, both facts are the product of Dr. Gestuvo's negligence. Anent the second
element, it is sufficient that the operation which resulted in the screwhitting Rosit's
molar was, indeed, performed by Dr. Gestuvo. No other doctor caused such fact.
Lastly, the third element was satisfied in this case because it was not shown that
Rosit's lung disease could have contributed to the pain. What is clear is that he
114
suffered because one of the screws that Dr. Gestuvo installed hit Rosit's molar.
Clearly then, the res ipsa loquitur doctrine finds application in the instant case and
no expert testimony is required to establish the negligence of defendant Dr. Gestuvo
The court also found that Dr. Gestuvo is guilty of negligence on the ground that he
deprived Rosit of the opportunity to make an informed consent. There are four
essential elements a plaintiff must prove in a negligence 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. The four adverted essential elements above are
present here. First, Dr. Gestuvo clearly had the duty of disclosing to Rosit the risks
of using the larger screws for the operation. Second, Dr. Gestuvo failed to disclose
these risks to Rosit. Third, had Rosit been informed that there was a risk that the
larger screws are not appropriate for the operation and that an additional operation
replacing the screws might be required to replace the same. Fourth, as a result of
using the larger screws, Rosit experienced pain and could not heal properly because
one of the screws hit his molar. This was evident from the fact that just three (3)
days after Dr. Pangan repeated the operation conducted by Dr. Gestuvo, Rosit was
115
pain-free and could already speak. Without a doubt, Dr. Gestuvo is guilty of
withholding material information which would have been vital in the decision of
Rosit in going through with the operation with the materials at hand. Thus, Dr.
Gestuvo is also guilty of negligence .
LESSSON:
This is a petition filed under Rule 45 of the Rules of Court SEC. 2. Time for
filing; extension. – The petition shall be filed within fifteen (15) days from notice
of the judgment or final order or resolution appealed from, or of the denial of the
petitioner’s motion for new trial or reconsideration filed in due time after notice of
the judgment. A suit for damages thereat which Nilo B. Rosit Rosit commenced
against Dr. Rolando Gestuvo Dr. Gestuvo . And this case the Court explained the
concept of a medical negligence case and the elements required for its prosecution.
The Doctrine of Res ipsa loquitur is availed by the plaintiff, the need for expert
medical testimony is dispensed with because the injury itself provides the proof of
negligence. The reason is that the general rule on the necessity of expert testimony
applies only to such matters clearly within the domain of medical science, and not
to matters that are within the common knowledge of mankind which may be
testified to by anyone familiar with the facts. The Court shows us the jurisdiction
applied on The Doctrine of Res Ipsa Loquitor. , Latin for “the thing speaks for
itself,” is a legal theory wherein the facts and circumstances surrounding an injury
allow the court to presume that negligence has occurred. In an ordinary negligence
case, the plaintiff must prove that the defendant owed the plaintiff a duty and that
116
his conduct failed to measure up to that duty.However, under res ipsa loquitur, the
defendant’s negligence may be presumed and thus does need not be proven.
The elements of res ipsa loquitur are:
1) the defendant was in exclusive control of the situation or instrument that caused
the injury;
2) the injury would not have ordinarily occurred but for the defendant’s negligence;
and
3) the plaintiff’s injury was not due to his own action or contribution.[5]
If these elements are met, the burden shifts to the defendant to show that he was not
negligent
Res ipsa loquitur typically arises in cases where the negligent act is so obvious that
there is no need for evidence of what happened.What must have happened is
apparent from the surrounding circumstances. The finder of fact must be able to
infer, through common knowledge and experience, that negligence occurred. In this
case Dr. Gestuvo negligence in the operation the plaintiff's injury must is a medical
malpractice negligence where obviously went wrong in surgery of Dr. Gestuv to
his patient Rosit . A negligence in the surgery of Rosit from motorcycle accident
have ended up in him suffering or suturing may have been proven to be ineffective..
This is sufficient to swing the burden of proof of evidence that Dr. Gestuvo guilty
of medical negligence.
117
PROBLEM NO. 2
What are the strengths and the weaknesses of the decisions of the Supreme
Court in each of these cases?
The strengths of the decisions are the basic principles which are the bases
of the ruling. Principles are the relationship of two or more variables that have been
consistently shown to be true and valid. Principles are strengths because facts come
and go but principles remain the same until they are modified for very strong
reasons.
The strengths and weaknesses of the decisions in each case are identified
below:
118
Vs.
Marilou R. Mantala
G.R NO. 203080
November 12,2014
(Guilty of Grave Misconduct and and Violation of Article 2 Section
1of the Code Of Medical Ethics of Medical Profession in the Philippines )
The strenghts of this case are: 1.)

119
120

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UNIVERSITY OF THE EAST 1

THE RESEARCH PROBLEM

This chapter covers the historical and contextual background of

HISTORICAL BACKGROUND OF THE STUDY

According to the English common law ,United States the medical

committed upon the person or property in a independent contract it categories as

the negligence ,gross negligence.professional negligence,recklessness,and act of

Philippines without having previously obtained the proper certificate of registration

issued by the board of medical examiners as herein constituted or lawful board

which was its predecessor shall be considered as gulty of malpractice, In Medical

it is a professional negligence,since Doctors and part of medical sectors this is there

standard of care of non professionals. This is a claim of patient or the family of

patient against a physician . A physician patient relationship in this is a forming a

reasonably a competent doctor .,basically in medical literature may be used to

established the standard of the care.

There are three elements of medical negligence one is Duty it discussed

It must have a proof of a professional relationship between a physician and a

duties it results injured in body or in health ,due to the actionable malpractice is

proximate cause of the injury .

centuries, it became possible under American court standard to sue a medical

professional for negligence. The negligence described in the anecdotes generally

involves a disregard for the patients well being or an egregious error.

Medical professionals were expected to be held to a common sense

standard of ethics at the court's discretion, or be found guilty of negligence. Medical

available and data was collected.

to mistreatment or negligence by their treating physician .Data for medical

damage awards if the award is reviewed, altered overturned by an appellate court.

In Philippines a medical neglience case against a doctor is a generic term

that a treatment was attended with medical negligence . Furthermore , in order to

the law must be completely satisfied.

res ipsa loquitur to apply, three essential requisites must be present:

In order to allow resort to the doctrine, therefore, the following essential

Like the case on late November 2017 the Philippine Department of

The growing population of death incurred in life taking medical malpractices

The researchers are currently taking up degree of Bachelor or Art’s Major

Statement of the Problem

c. Decisions and the reasons behind them

in each of these cases?

Significance of the Study

This study is significant to the following stakeholders.

present in an undifferentiated way at an early stage of development, which may

require urgent intervention provides preventive care and health education to

patients to approach of general practice aims to take into consideration the

practitioners on how they can be held liable of medical negligence. To established

.These designed to train the physicians working in medical institutions . Our

to have substantial facilities. To give our point of view to the Medical

Institutionsthe Philippines As part of efforts to systematize medical facility

hospitals having capabilities of providing advanced medical care development of

advanced medical technologies and conducting advanced medical care training.

training to the future medical practioners in the future to implement an intensive

the Medical institution must be concentrarte of providing the institutions to conduct

attention to the centers of medical education, centers of medical research, and

incubators for medical innovation and technology in the Philippines.To eliminare

help medical institutions to provide outmost care in undertaking the practice of

Victims of Medical Negligence

medical negligence, a notoriously complex field where insurers representing

defendants often complicate proceedings and delay accepting liability, only

improvement of the medical practioners and medical institutions in the Philippines

The Legal Researchers

and circumstances happened in the Philippines. This research contains information

incidents decided by the Supreme Court.

for cases of medical negligence.

This study will guide legal practitioners in deciding cases of medical