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THE REVISED PENAL CODE AND OTHER SPECIAL LAWS
APPLICABLE TO PHYSICIANS
Revised Penal Code Provisions
False Medical Certificates
Article 174. False medical certificates, false certificates of
merits or service, etc. - The penalties of arresto mayor in its
maximum period to prision correccional in its minimum period
and a fine not to exceed P1,000 pesos shall be imposed upon:
1. Any physician or surgeon who, in connection, with the
practice of his profession, shall issue a false certificate;
and
2. Any public officer who shall issue a false certificate of
merit of service, good conduct or similar circumstances.
The penalty of arresto mayor shall be imposed upon any
private person who shall falsify a certificate falling within the
classes mentioned in the two preceding subdivisions.
“In connection”: The law does not require the existence of a patient-
doctor relationship
Note1: Private persons may commit the crime.
Note2: The law merely requires that the use of the false certificate is
“knowingly”
False Medical Certificate v. Incomplete Medical Certificate: In the
issuance of an incomplete medical certificate, there is no intent to falsify
such certificate.
Abortion Practiced by a Physician
Article 259. Abortion practiced by a physician or midwife and
dispensing of abortives. - The penalties provided in Article 256
shall be imposed in its maximum period, respectively, upon
any physician or midwife who, taking advantage of their
scientific knowledge or skill, shall cause an abortion or assist
in causing the same.
Any pharmacist who, without the proper prescription from a
physician, shall dispense any abortive shall suffer arresto
mayor and a fine not exceeding 1,000 pesos.
Note1: The physician is the best person to perform the abortion; as
such, he/she takes advantage of his/her knowledge or expertise.
Note2: The pharmacist issuing/selling abortifacients shall also be liable
under Art. 259 for “dispensing abortives.”
Simulation of Births
Article 347. Simulation of births, substitution of one child for
another and concealment or abandonment of a legitimate
child. - The simulation of births and the substitution of one
child for another shall be punished by prision mayor and a fine
of not exceeding 1,000 pesos.
The same penalties shall be imposed upon any person who
shall conceal or abandon any legitimate child with intent to
cause such child to lose its civil status.
Any physician or surgeon or public officer who, in violation of
the duties of his profession or office, shall cooperate in the
execution of any of the crimes mentioned in the two next
preceding paragraphs, shall suffer the penalties therein
prescribed and also the penalty of temporary special
disqualification.
Note1: Three offenses involved in Simulation of Births (Art. 347, RPC):
1. Simulation of birth and substitution of one child for another
2. Concealment or abandonment of legitimate child
 With intent to cause child to lose civil status
3. Cooperation in the execution of any of the two acts, in violation
of their duties, by:
 Physician
 Surgeon, or
 Public officer
Quasi-Delict
Article 365. 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.
Any person who, by simple imprudence or negligence, shall
commit an act which would otherwise constitute a grave
felony, shall suffer the penalty of arresto mayor in its medium
and maximum periods; if it would have constituted a less
serious felony, the penalty of arresto mayor in its minimum
period shall be imposed. x x x
Reckless imprudence consists in voluntary, but without
malice, doing or falling to do an act from which material
damage results by reason of inexcusable lack of precaution
on the part of the person performing of failing to perform such
act, taking into consideration his employment or occupation,
degree of intelligence, physical condition and other
circumstances regarding persons, time and place.
Simple imprudence consists in the lack of precaution
displayed in those cases in which the damage impending to
be caused is not immediate nor the danger clearly manifest.
Reckless Imprudence, elements:
1. Doing or failing to do an act (act or omission)
2. Voluntary but without malice
3. Material damage results thereto
4. Caused by inexcusable lack of precaution on the part of
the person committing the same
5. Taking into consideration:
 Employment or occupation
 Degree of intelligence
 Physical condition
 Other circumstances re: persons, time and place
Simple imprudence, elements:
1. Doing or failing to do an act (act or omission)
2. Voluntary but without malice
3. Lack of precaution
4. Damage impending to be caused is not immediate nor
danger clearly manifest

Case: Villareal v. People (G.R. No. 151258, December 1, 2014)
Question: Whether or not reckless imprudence can be committed with
malice or criminal design (criminal negligence) – No.
The presence of an initial malicious intent to commit
a felony is thus a vital ingredient in establishing the
commission of the intentional felony of homicide. Being mala
in se, the felony of homicide requires the existence of malice
or dolo immediately before or simultaneously with the infliction
of injuries. Intent to kill – or animus interficendi– cannot and
should not be inferred, unless there is proof beyond
reasonable doubt of such intent. Furthermore, the victim’s
death must not have been the product of accident, natural
cause, or suicide. If death resulted from an act executed
without malice or criminal intent – but with lack of
foresight, carelessness, or negligence – the act must be
qualified as reckless or simple negligence or imprudence
resulting in homicide.
Note1: Conspiracy cannot exist in reckless imprudence.
 Conspiracy, as a method of commission of a crime,
shows (criminal/malicious) intent.
 On the other hand, in quasi-crimes, intent to commit is
absent.
Note2: There is no such crime as “criminal negligence.”
Libel and Slander
Article 353. Definition of libel. - A libel is public and malicious
imputation of a crime, or of a vice or defect, real or imaginary,
or any act, omission, condition, status, or circumstance
tending to cause the dishonor, discredit, or contempt of a
natural or juridical person, or to blacken the memory of one
who is dead.
Article 358. Slander. - Oral defamation shall be punished
by arresto mayor in its maximum period to prision correccional
in its minimum period if it is of a serious and insulting nature;
otherwise the penalty shall be arresto menor or a fine not
exceeding 200 pesos.
Case: People v. Chavez (O.G. 8886, Vol. 53, No. 24)
Question: Whether or not the statement of the nurse is libelous – No.
Note1: There is no showing that there was malice (-ious intent) on the
part of the nurse when the statement was made.
Republic Act No. 9165
Comprehensive Dangerous Drugs Act
Section 18. Unnecessary Prescription of Dangerous Drugs. – The
penalty of imprisonment ranging from twelve (12) years and one (1) day
to twenty (20) years and a fine ranging from One hundred thousand
pesos (P100,000.00) to Five hundred thousand pesos (P500,000.00)
and the additional penalty of the revocation of his/her license to practice
shall be imposed upon the practitioner, who shall prescribe any
dangerous drug to any person whose physical or physiological condition
does not require the use or in the dosage prescribed therein, as
determined by the Board in consultation with recognized competent
experts who are authorized representatives of professional
organizations of practitioners, particularly those who are involved in the
care of persons with severe pain.
Person/s liable: Practitioner
Act/s punishable: Prescription of any dangerous drug to any person
whose physical or psychological condition does not require the use or in
the dosage prescribed therein
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 As determined by the Board in consultation with recognized
competent experts who are authorized representatives of
professional organizations of practitioners, particularly those
who are involved in the care of persons with severe pain.
Note1: As part of the penalty imposed (imprisonment and fine), judicial
revocation of license of the practitioner shall also be imposed.
Section 19. Unlawful Prescription of Dangerous Drugs. – The
penalty of life imprisonment to death and a fine ranging from
Five hundred thousand pesos (P500,000.00) to Ten million
pesos (P10,000,000.00) shall be imposed upon any person,
who, unless authorized by law, shall make or issue a
prescription or any other writing purporting to be a prescription
for any dangerous drug.
Person/s liable: Any person
Act/s punishable: Make or issue a prescription or any other writing
purporting to be a prescription for any dangerous drug, not authorized
by law
Note2: The person making or issuing the prescription should not be
authorized to issue/prescribe dangerous drugs to be covered by the
section.
Note3: The penalty imposed is reclusion perpetua to death.
Republic Act No. 10918
Philippine Pharmacy Act
Section 34. Physician’s Sample. – Pharmaceutical products
given or intended to be given to be given free to any health
professional by a manufacturer or distributor or its
professional service representative as part of its program or
promotion shall not be sold to any pharmaceutical outlet
or the consuming public.
The statement, “Sample, Not for Sale”, or its equivalent,
shall appear conspicuously on the primary and secondary
packaging of the drug or combination product (medical device
and drug) classified as drug according to the primary intended
mode of action to be given. It shall be unlawful to remove,
erase, or deface, or mark the original labels of the
samples.
Pharmaceutical products classified as antimicrobials,
including anti-TB medicines, and other classifications of
medicines, as may be prescribed by the FDA, shall not be
given or distributed as physician’s samples.
Note1: Samples should be given for free.
Note2: According to Atty. Capule, the problem with the law is that it is
easy to remove the sign “sample not for sale.”
Note3: If patients insist on buying outside the hospital pharmacy,
hospitals now require its patients to sign a waiver which provides for the
waiving of liability of the hospital in case of drug-related reactions when/if
the drug taken is purchased outside the hospital’s pharmacy.
Note4: When personnel who is not a pharmacist (employed in a
pharmaceutical establishment or outlet), thereby commits a violation of
the act, the owner of such establishment is jointly liable. (Sec. 46)
Note5: Not all drugstores are allowed to sell dangerous drugs. In re: RA
9165, the Philippine Drug Enforcement Agency (PDEA) may exercise
visitorial powers/rights on pharmacies (Sec. 40, RA 9165)

Presidential Decree No. 169
Requiring Doctors, Hospitals, Clinics, etc. to Report Treatment for
Physical Injuries
1. The attending physician of any hospital, medical clinic,
sanitarium or other medical establishments, or any medical
practitioner, who has treated any person for serious or less
serious physical injuries as those injuries are defined in
Articles 262, 263, 264 and 265 of the Revised Penal Code
shall report the fact of such treatment personally or by fastest
means of communication to the nearest Philippine
Constabulary unit without delay: Provided, That no fee shall
be charged for the transmission of such report through
government communication facilities;
Physical injuries are covered:
1. Serious Physical Injuries
2. Less Serious Physical Injuries
Note1: The intent of the law is to be able to report such injuries to the
nearest Philippine Constabulary
Note2: Under the RPC, cases of serious/less serious physical injuries
must be reported to the nearest government health authority (mayor,
under the IRR)
Note3: Under the Sanitation Code (P.D. 856, Sec. 91(f); IRR: Disposal
of Dead Persons, Ch. XXI), if it is suspected that a person is dead under
suspicious circumstances, the same must be reported to the police
authorities (PNP, NBI).
4.6. Medico-Legal Cases
4.6.1. If the local health officer who issues a death certificate
has reasons to believe that the cause of death was due to
violence or crime, he shall notify immediately the authorities
of the Philippine National Police or National Bureau of
Investigation concerned
Presidential Decree No. 603
Child and Youth Welfare Code
Article 166. Report of Maltreated or Abused Child. - All
hospitals, clinics and other institutions as well as private
physicians providing treatment shall, within forty-eight hours
from knowledge of the case, report in writing to the city or
provincial fiscal or to the Local Council for the Protection of
Children or to the nearest unit of the Department of Social
Welfare, any case of a maltreated or abused child, or
exploitation of an employed child contrary to the provisions of
labor laws. It shall be the duty of the Council for the Protection
of Children or the unit of the Department of Social Welfare to
whom such a report is made to forward the same to the
provincial or city fiscal.
What must be reported: Any case of maltreatment or abuse of a child,
or exploitation of an employed child
Period to report: Within 48 hours from knowledge of the case
Note1: Under the VAWC, it is not required for doctors and hospitals to
report to the police authorities.
Note2: In fact, medical records are made confidential under the law.
(Sec. 44, RA 9262)
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Republic Act No. 6675
Generics Act of 1988
B) Any juridical person who violates Section 6(c), 6(d), 7 or 8
shall suffer the penalty of a fine of not less than five thousand
pesos (P5,000.00) nor more than ten thousand pesos
(P10,000.00) and suspension or revocation of license to
operate such drug establishment or drug outlet at the
discretion of the Court: Provided, That its officers directly
responsible for the violation shall suffer the penalty of fine and
suspension or revocation of license to practice profession, if
applicable, and by imprisonment of not less than six (6)
months nor more than one (1) year or both fine and
imprisonment at the discretion of the Court
Note1: The law provides for judicial revocation of license as a doctor.
Note2: This is the second law that provides for a judicial revocation of
license, the first being RA 9165.
Note3: Revocation as part of the penalty is summary in nature.
Republic Act No. 8504
Philippine AIDS Prevention and Control Act of 1998
Compulsory HIV Testing – refers to HIV testing imposed upon
a person attended or characterized by the lack of or vitiated
consent, use of physical force, intimidation or any form of
compulsion.
Note1: Compulsory HIV testing is unlawful under RA 8504. (Sec.2(b)(1))
Note2: Written informed consent is required for voluntary HIV testing
(Sec. 15)
Note3: Lawful consent to HIV testing is deemed given as to donated
human body, organ, tissue, or blood when a person volunteers or freely
agrees to donate his/her blood, organ, or tissue for transfusion,
transplantation, or research. (Sec. 15(a))
Act No. 3753
Law on Registry of Civil Status (Issuance of Birth/Death Certificate)
Section 5. Registration and Certification of Birth. – The
declaration of the physician or midwife in attendance at the
birth or, in default thereof, the declaration of either parent of
the newborn child, shall be sufficient for the registration of a
birth in the civil register. Such declaration shall be exempt
from the documentary stamp tax and shall be sent to the local
civil registrar not later than thirty days after the birth, by the
physician, or midwife in attendance at the birth or by either
parent of the newly born child.
In such declaration, the persons above mentioned shall certify
to the following facts: (a) date and hour of birth; (b) sex and
nationality of infant; (c) names, citizenship, and religion of
parents or, in case the father is not known, of the mother
alone; (d) civil status of parents; (e) place where the infant was
born; (f) and such other data may be required in the regulation
to be issued.
In the case of an exposed child, the person who found the
same shall report to the local civil registrar the place, date and
hour of finding and other attendant circumstances.
In case of an illegitimate child, the birth certificate shall be
signed and sworn to jointly by the parents of the infant or only
the mother if the father refuses. In the latter case, it shall not
be permissible to state or reveal in the document the name of
the father who refuses to acknowledge the child, or to give
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therein any information by which such father could be
identified.
Any fetus having human features which dies after twenty four
hours of existence completely disengaged from the maternal
womb shall be entered in the proper registers as having been
born and having died.
Section 6. Death certificate and register. – No human body
shall be buried unless the proper death certificate has been
presented and recorded in the office of the local civil registrar.
The physician who attended the deceased or, in his default
the health officer concerned, or in default of the latter, any
member of the family of the deceased or any person having
knowledge of the death, shall report the same to the local
health authorities, who shall issue a death certificate and shall
order the same to be recorded in the office of the local civil
registrar. The death certificate, which shall be issued by the
attending physician of the deceased or, in his default, by the
proper health officer, shall contain the following data be
furnished by the person reporting the death; (a) date and
place of death; (b) full name, (c) age, (d) sex, (e) occupation
or profession, (f) residence; (g) status as regards marriage,
(h) nationality of the deceased, and (i) probable cause of
death.
During epidemics, bodies may be buried provided the proper
death certificates have been secured, which shall be
registered not later than five days after the burial of the body.
Act No. 3573
An Act Providing for the Prevention and Suppression of Dangerous
Communicable Diseases, and for Other Purposes
31. Variola or Smallpox
32. Varioloid
33. Varicella
34. Vincent's Angina
35. Whooping Cough
36. Yellow Fever
37. Any other disease publicly declared by the Director of Health to be
communicable and dangerous to the public health.
Republic Act No. 7170
Organ Donation Act of 1991
That the physician, head of hospital or officer designated by
the hospital for this purpose has exerted reasonable efforts,
within forty-eight (48) hours, to locate the nearest relative
listed in Section 4 hereof or guardian of the decedent at the
time of death. (Sec. 9)
Case: Alano v. Magud-Lugmao (G.R. No. 175540, April 7, 2014)
Question: Whether or not the “harvest” of the organ without the consent
of the family is valid. – Yes. The Court reasoned that the complainant
failed to adduce evidence to define reasonable time to constitute good
faith on the part of NKTI.
Furthermore, as found by the lower courts from the records of
the case, the doctors and personnel of NKI disseminated
notices of the death of respondent's son to the media and
sought the assistance of the appropriate police authorities as
early as March 2, 1988, even before petitioner issued the
Memorandum. Prior to performing the procedure for retrieval
of the deceased's internal organs, the doctors concerned also
the sought the opinion and approval of the Medico-Legal
Officer of the NBI.

Note1: The law is an exercise of police power; privacy and private Thus, there can be no cavil that petitioner employed
interests are set aside reasonable means to disseminate notifications intended
to reach the relatives of the deceased. The only question
Q: What is a “reportable disease”? a case of reportable or that remains pertains to the sufficiency of time allowed for
communicable disease," for the purpose of this Act, shall be held to notices to reach the relatives of the deceased. x x x
include any person sick of, or affected or attacked by, any of the
following diseases: Ultimately, it is respondent's failure to adduce adequate
evidence that doomed this case. x x x Here, there is no proof
1. Actinomycosis that, indeed, the period of around 24 hours from the time
2. Acute anterior poliomyelitis (infantile paralysis) notices were disseminated, cannot be considered as
3. Anthrax reasonable under the circumstances. They failed to
4. Asiatic cholera
present any expert witness to prove that given the medical
5. Beriberi (adults and infants)
technology and knowledge at that time in the 1980's, the
6. Cerebrospinal meningitis (epidemic),
7. Diphtheria doctors could or should have waited longer before harvesting
8. Dysentery (amoebic and bacillary) the internal organs for transplantation.
9. Encephalitis
10. Lethargica Note1: See: R.A. 349 in re: Double organ transplant
11. Filariasis Note2: Under the R.H. Law, consent of the other spouse is required in
12. Food poisoning
matters concerning the reproductive health (ligation, vasectomy, etc.).
13. Glanders
Under R.A. 349, consent of the other spouse is not required. Under R.H.
14. Influenza
15. Leprosy Law, in cases of disagreement, the courts will decide.
16. Malaria
17. Measles ”The issue of reproductive health is diluted by a third party – the courts.”
18. Mumps –Atty. Capule.
19. Ophthalmia Necrotorum
20. Plague
Baldos v. Court of Appeals (G.R. No. 170645, July 9, 2010)
21. Pneumonia (Lobar, Lobular, Or Bronchial)
Question: Whether or not late registration of birth is valid. – Yes. The
22. Rabies
23. Relapsing Fever applicable law in the case at bar is Act No. 3753, and not P.D. 651. Act
24. Scarlet Fever No. 3753 governs registration of births not covered by P.D. 651.
25. Septic Sore Throat (Epidemic)
26. Tetanus Under NCSO A.O. No. 1-83, the birth of a child shall be
27. Trachoma registered in the office of the local civil registrar within 30 days
28. Tuberculosis
from the time of birth.14 Any report of birth made beyond the
29. Typhoid And Paratyphoid Fever
reglementary period is considered delayed.15 The local civil
30. Typhus Fever
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registrar, upon receiving an application for delayed

registration of birth, is required to publicly post for at least ten
days a notice of the pending application for delayed
registration.16 If after ten days no one opposes the
registration and the local civil registrar is convinced beyond
doubt that the birth should be registered, he should register
the same.

Reynaldo’s certificate of live birth, as a duly registered public

document, is presumed to have gone through the process
prescribed by law for late registration of birth. It was only on 8
March 1995, after the lapse of ten long years from the
approval on 11 February 1985 of the application for delayed
registration of Reynaldo’s birth, that Nieves registered her
opposition. She should have done so within the ten-day period
prescribed by law. Records show that no less than Nieves
herself informed the local civil registrar of the birth of
Reynaldo. At the time of her application for delayed
registration of birth, Nieves claimed that Reynaldo was her
son. Between the facts stated in a duly registered public
document and the flip-flopping statements of Nieves, we are
more inclined to stand by the former.

Republic v. Cagandahan and Silverio v. Republic: DISTINGUISH


NATURE OF MEDICAL PRACTICE
Case: Harley v. Eddingfield, 156 Ind. 416 (Ind. 1901)
The alleged wrongful act was appellee's refusal to enter into
a contract of employment. Counsel do not contend that,
before the enactment of the law regulating the practice of
medicine, physicians were bound to render professional
service to everyone who applied. Whart. Neg. § 731. The act
regulating the practice of medicine provides for a board of
examiners, standards of qualification, examinations, licenses
to those found qualified, and penalties for practicing without
license. Acts 1897, p. 255; Acts 1899, p. 247. The act is a
preventive, not a compulsive, measure. In obtaining the
state's license (permission) to practice medicine, the state
does not require, and the licensee does not engage, that he
will practice at all or on other terms than he may choose to
accept.
Note1: Spells of Illness Doctrine – for every treatment, a new contract
is required; for every spell of illness, a doctor-patient relationship must
be established.
Three contracts when a patient enters the hospital:
1. Patient and Doctor
2. Patient and Hospital
3. Doctor and Hospital
Doctors as “independent contractors”
Note1: The liability of hospitals are vicarious and direct.
Case: Ramos v. Court of Appeals (G.R. No. 124354, 1999/2002)
Question: Whether or not an employer-employee relationship exists
between the hospital and a doctor who is an “independent contractor”. –
Yes (1999) No (2002).
1999 Decision (Control Test):
We now discuss the responsibility of the hospital in this
particular incident. The unique practice (among private
hospitals) of filling up specialist staff with attending and visiting
"consultants," who are allegedly not hospital employees,
presents problems in apportioning responsibility for
negligence in medical malpractice cases. However, the
difficulty is only more apparent than real.
In the first place, hospitals exercise significant control in the
hiring and firing of consultants and in the conduct of their work
within the hospital premises. Doctors who apply for
"consultant" slots, visiting or attending, are required to submit
proof of completion of residency, their educational
qualifications; generally, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in most
cases, and references. These requirements are carefully
scrutinized by members of the hospital administration or by a
review committee set up by the hospital who either accept or
reject the application. This is particularly true with respondent
hospital.
After a physician is accepted, either as a visiting or attending
consultant, he is normally required to attend clinico-
pathological conferences, conduct bedside rounds for clerks,
interns and residents, moderate grand rounds and patient
audits and perform other tasks and responsibilities, for the
privilege of being able to maintain a clinic in the hospital,
and/or for the privilege of admitting patients into the hospital.
In addition to these, the physician's performance as a
A D S A L V A D O R R e v i e w e r |6
specialist is generally evaluated by a peer review committee
on the basis of mortality and morbidity statistics, and feedback
from patients, nurses, interns and residents. A consultant
remiss in his duties, or a consultant who regularly falls short
of the minimum standards acceptable to the hospital or its
peer review committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real
control over their attending and visiting "consultant" staff.
While "consultants" are not, technically employees, a
point which respondent hospital asserts in denying all
responsibility for the patient's condition, the control
exercised, the hiring, and the right to terminate
consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the
payment of wages. In assessing whether such a relationship
in fact exists, the control test is determining. Accordingly, on
the basis of the foregoing, we rule that 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. This
being the case, the question now arises as to whether or not
respondent hospital is solidarily liable with respondent doctors
for petitioner's condition.
The basis for holding an employer solidarily responsible for
the negligence of its employee is found in Article 2180 of the
Civil Code which considers a person accountable not only for
his own acts but also for those of others based on the former's
responsibility under a relationship of patria potestas. Such
responsibility ceases when the persons or entity concerned
prove that they have observed the diligence of a good father
of the family to prevent damage. In other words, while the
burden of proving negligence rests on the plaintiffs, once
negligence is shown, the burden shifts to the respondents
(parent, guardian, teacher or employer) who should prove that
they observed the diligence of a good father of a family to
prevent damage.
In the instant case, respondent hospital, apart from a general
denial of its responsibility over respondent physicians, failed
to adduce evidence showing that it exercised the diligence of
a good father of a family in the hiring and supervision of the
latter. It failed to adduce evidence with regard to the degree
of supervision which it exercised over its physicians. In
neglecting to offer such proof, or proof of a similar nature,
respondent hospital thereby failed to discharge its burden
under the last paragraph of Article 2180. Having failed to do
this, respondent hospital is consequently solidarily
responsible with its physicians for Erlinda's condition.
2002 Decision:
It has been consistently held that in determining whether an
employer-employee relationship exists between the parties,
the following elements must be present: (1) selection and
engagement of services; (2) payment of wages; (3) the power
to hire and fire; and (4) the power to control not only the end
to be achieved, but the means to be used in reaching such an
end.
DLSMC maintains that first, a hospital does not hire or engage
the services of a consultant, but rather, accredits the latter and
grants him or her the privilege of maintaining a clinic and/or
admitting patients in the hospital upon a showing by the
consultant that he or she possesses the necessary
qualifications, such as accreditation by the appropriate board
(diplomate), evidence of fellowship and references. Second, it

is not the hospital but the patient who pays the consultants fee
for services rendered by the latter. Third, a hospital does not
dismiss a consultant; instead, the latter may lose his or her
accreditation or privileges granted by the hospital. Lastly,
DLSMC argues that when a doctor refers a patient for
admission in a hospital, it is the doctor who prescribes the
treatment to be given to said patient. The hospitals obligation
is limited to providing the patient with the preferred room
accommodation, the nutritional diet and medications
prescribed by the doctor, the equipment and facilities
necessary for the treatment of the patient, as well as the
services of the hospital staff who perform the ministerial tasks
of ensuring that the doctors orders are carried out strictly.
After a careful consideration of the arguments raised by
DLSMC, the Court finds that respondent hospitals position on
this issue is meritorious. There is no employer-employee
relationship between DLSMC and Drs. Gutierrez and Hosaka
which would hold DLSMC solidarily liable for the injury
suffered by petitioner Erlinda under Article 2180 of the Civil
Code. x x x
Moreover, the contract between the consultant in respondent
hospital and his patient is separate and distinct from the
contract between respondent hospital and said patient. The
first has for its object the rendition of medical services by the
consultant to the patient, while the second concerns the
provision by the hospital of facilities and services by its staff
such as nurses and laboratory personnel necessary for the
proper treatment of the patient.
Further, no evidence was adduced to show that the injury
suffered by petitioner Erlinda was due to a failure on the part
of respondent DLSMC to provide for hospital facilities and
staff necessary for her treatment.
Note2: Nowadays, the doctor as an employee or independent contractor
is immaterial.
Case: PSI v. Agana (G.R. No. 126297)
Question: Whether or not PSI is liable for the negligence of one of its
doctors. – Yes.
Note1: The case cited the doctrine provided by Ramos (1999).
2007 Decision (Apparent Authority/Ostensible Agency):
Apparent authority, or what is sometimes referred to as the
"holding out" theory, or doctrine of ostensible agency or
agency by estoppel, has its origin from the law of agency. It
imposes liability, not as the result of the reality of a contractual
relationship, but rather because of the actions of a principal or
an employer in somehow misleading the public into believing
that the relationship or the authority exists. The concept is
essentially one of estoppel and has been explained in this
manner:
"The principal is bound by the acts of his agent with
the apparent authority which he knowingly permits
the agent to assume, or which he holds the agent
out to the public as possessing. The question in
every case is whether the principal has by his
voluntary act placed the agent in such a situation
that a person of ordinary prudence, conversant with
business usages and the nature of the particular
business, is justified in presuming that such agent
A D S A L V A D O R R e v i e w e r |7
has authority to perform the particular act in
question.
The applicability of apparent authority in the field of hospital
liability was upheld long time ago in Irving v. Doctor Hospital
of Lake Worth, Inc. There, it was explicitly stated that "there
does not appear to be any rational basis for excluding the
concept of apparent authority from the field of hospital
liability." Thus, in cases where it can be shown that a hospital,
by its actions, has held out a particular physician as its agent
and/or employee and that a patient has accepted treatment
from that physician in the reasonable belief that it is being
rendered in behalf of the hospital, then the hospital will be
liable for the physician’s negligence.
Our jurisdiction recognizes the concept of an agency by
implication or estoppel. Article 1869 of the Civil Code reads:
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.
In this case, PSI publicly displays in the lobby of the Medical
City Hospital the names and specializations of the physicians
associated or accredited by it, including those of Dr. Ampil and
Dr. Fuentes. We concur with the Court of Appeals’ conclusion
that it "is now estopped from passing all the blame to the
physicians whose names it proudly paraded in the public
directory leading the public to believe that it vouched for their
skill and competence." Indeed, PSI’s act is tantamount to
holding out to the public that Medical City Hospital, through its
accredited physicians, offers quality health care services. 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.
2010 Decision (Ostensible Agency)
After gathering its thoughts on the issues, this Court holds that
PSI is liable to the Aganas, not under the principle of
respondeat superior for lack of evidence of an employment
relationship with Dr. Ampil but under the principle of ostensible
agency for the negligence of Dr. Ampil and, pro hac vice,
under the principle of corporate negligence for its failure to
perform its duties as a hospital.
While in theory a hospital as a juridical entity cannot practice
medicine, in reality it utilizes doctors, surgeons and medical
practitioners in the conduct of its business of facilitating
medical and surgical treatment. Within that reality, three legal
relationships crisscross: (1) between the hospital and the
doctor practicing within its premises; (2) between the hospital
and the patient being treated or examined within its premises
and (3) between the patient and the doctor. The exact nature
of each relationship determines the basis and extent of the
liability of the hospital for the negligence of the doctor.
Where an employment relationship exists, the hospital may be
held vicariously liable under Article 2176 in relation to Article
2180 of the Civil Code or the principle of respondeat superior.
Even when no employment relationship exists but it is shown
that the hospital holds out to the patient that the doctor is its
agent, the hospital may still be vicariously liable under Article
2176 in relation to Article 1431 and Article 1869 of the Civil
Code or the principle of apparent authority. Moreover,

regardless of its relationship with the doctor, the hospital may
be held directly liable to the patient for its own negligence or
failure to follow established standard of conduct to which it
should conform as a corporation. x x x
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 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.
There is, however, ample evidence that the hospital (PSI) held
out to the patient (Natividad) that the doctor (Dr. Ampil) 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 patients reliance upon the
conduct of the hospital and the doctor, consistent with
ordinary care and prudence.
Patient-Physician Confidentiality/ Privileged Communication
Case: Krohn v. Court of Appeals (G.R. 108854, June 14, 1994)
Question: Whether or not the presentation of the psychological
evaluation of the wife by the husband (for annulment purposes) is
admissible. – No. However, the court ruled that the same is not
privileged communication, but rather hearsay evidence.
Note1: Remedy of wife is to question the manner in which the husband
obtained the evaluation. (See: Data Privacy Act)
Case: Lim v. Court of Appeals (G.R. No. 91114, September 25, 1992)
Question: Whether or not the attending physician may be presented as
an expert witness. – Yes. The matters to which the physician will testify
is only about his knowledge and expertise on the field of medicine and
not on the consultation/confidences with his/her patient.
Note2: You cannot compel a doctor to give an opinion.
Case: Chan v. Chan (G.R. No. 179786, July 24, 2013)
The case is an annulment case. In his answer, the husband disclosed
that he was forced to be hospitalized. The wife then resorted to modes
of discovery (production of documents) under the Rules of Court for the
production of the records of the husband.
Question: Whether or not an answer to production of documents (modes
of discovery) amount to a waiver. – No. It is premature for the wife to
resort to such mode. The answer merely mentioned the information but
this does not mean that the same will be raised as an issue nor will it be
presented as evidence.
Patient-Litigant Waiver: Once a patient-litigant raised an issue
regarding his/her medical records, the same constitutes a waiver of the
confidentiality of such records.
Informed Consent v. Assumption of Risk
Case: Li v. Sps. Soliman (G.R. No. 165279, June 7, 2011)
Question: Whether or not there was informed consent on the part of the
parents of the patient. – Yes.
A D S A L V A D O R R e v i e w e r |8
There are four essential elements a plaintiff must prove in a
malpractice action based upon the doctrine of informed
consent: "(1) the physician had a duty to disclose material
risks; (2) he failed to disclose or inadequately disclosed those
risks; (3) as a direct and proximate result of the failure to
disclose, the patient consented to treatment she otherwise
would not have consented to; and (4) plaintiff was injured by
the proposed treatment." The gravamen in an informed
consent case requires the plaintiff to "point to significant
undisclosed information relating to the treatment which would
have altered her decision to undergo it.
Examining the evidence on record, we hold that there was
adequate disclosure of material risks inherent in the
chemotherapy procedure performed with the consent of
Angelica’s parents. Respondents could not have been
unaware in the course of initial treatment and amputation of
Angelica’s lower extremity, that her immune system was
already weak on account of the malignant tumor in her knee.
When petitioner informed the respondents beforehand of the
side effects of chemotherapy which includes lowered counts
of white and red blood cells, decrease in blood platelets,
possible kidney or heart damage and skin darkening, there is
reasonable expectation on the part of the doctor that the
respondents understood very well that the severity of these
side effects will not be the same for all patients undergoing the
procedure. In other words, by the nature of the disease itself,
each patient’s reaction to the chemical agents even with pre-
treatment laboratory tests cannot be precisely determined by
the physician. That death can possibly result from
complications of the treatment or the underlying cancer itself,
immediately or sometime after the administration of
chemotherapy drugs, is a risk that cannot be ruled out, as with
most other major medical procedures, but such conclusion
can be reasonably drawn from the general side effects of
chemotherapy already disclosed.
As a physician, petitioner can reasonably expect the
respondents to have considered the variables in the
recommended treatment for their daughter afflicted with a life-
threatening illness. x x x
Nevertheless, juries that ultimately determine whether a
physician properly informed a patient are inevitably guided by
what they perceive as the common expectation of the medical
consumer—"a reasonable person in the patient’s position
when deciding to accept or reject a recommended
medical procedure."
Question: Does informed consent amount to assumption of risk? No.
As to voluntariness
AR: There is total voluntariness on the part of the person/victim
IC: There is no voluntariness present. The decision was forced by the
circumstances
“All illnesses are not things that you volunteered to have.” –Atyy. Capule.
General Consent: upon admission in a hospital, you are deemed to
have consented to –
1.
Note1: Informed consent is required if an invasive procedure is involved.
Note2: In distinguishing lack of informed consent v. lack of consent, the
question to be asked is: “Had the risk been told to me, would I consent
to the same?”
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MEDICAL MALPRACTICE
 A D S A L V A D O R R e v i e w e r | 10

PHYSICAL INJURIES c. By means of inundation, fire, poison, explosion,

Revised Penal Code Provisions
Administering Injurious Substances
Article 264. Administering injurious substances or beverages.
- The penalties established by the next preceding article shall
be applicable in the respective case to any person who,
without intent to kill, shall inflict upon another any serious,
physical injury, by knowingly administering to him any
injurious substance or beverages or by taking advantage of
his weakness of mind or credulity.
Note1: There is no intent to kill.
Note2: If the person dies, the crime committed is reckless imprudence
resulting to homicide.
When/how committed: Inflict serious physical injuries by administering
any injurious substance or beverage:
a. Knowingly
b. Taking advantage of his weakness of mind or credulity
Mutilation
Article 262. Mutilation. - The penalty of reclusion temporal to
reclusion perpetua shall be imposed upon any person who
shall intentionally mutilate another by depriving him, either
totally or partially, or some essential organ of reproduction.
Any other intentional mutilation shall be punished by prision
mayor in its medium and maximum periods.
Note1: Mutilation v. Serious Physical – In mutilation, the intent is to
mutilate/ deprive him of some organ. On the other hand, the intent in
serious physical injuries is to inflict injury to another.
shipwreck, stranding of a vessel, derailment or assault
upon a street car or locomotive, fall of an airship, by
means of motor vehicles, or with the use of any other
means involving great waste and ruin.
d. On occasion of any of the calamities enumerated in the
preceding paragraph, or of an earthquake, eruption of a
volcano, destructive cyclone, epidemic or other public
calamity.
e. With evident premeditation.
f. With cruelty, by deliberately and inhumanly augmenting
the suffering of the victim, or outraging or scoffing at his
person or corpse.
“Qualified Less Serious Physical Injuries”
Any less serious physical injuries inflicted upon the offender's
parents, ascendants, guardians, curators, teachers, or
persons of rank, or persons in authority, shall be punished by
prision correccional in its minimum and medium periods,
provided that, in the case of persons in authority, the deed
does not constitute the crime of assault upon such person.
When committed: Serious less physical injuries inflicted upon:
1. Parents
2. Ascendants
3. Guardians
4. Curators
5. Teachers
6. Persons of rank
7. Persons in authority
Note1: If inflicted upon person in authority, the same does not
constitute assault upon the person.

“Qualified Serious Physical Injuries”

If the offense shall have been committed against any of the

persons enumerated in Article 246, or with attendance of any
of the circumstances mentioned in Article 248, the case
covered by subdivision number 1 of this Article shall be
punished by reclusion temporal in its medium and maximum
periods; the case covered by subdivision number 2 by prision
correccional in its maximum period to prision mayor in its
minimum period; the case covered by subdivision number 3
by prision correccional in its medium and maximum periods;
and the case covered by subdivision number 4 by prision
correccional in its minimum and medium periods.

The provisions of the preceding paragraph shall not be

applicable to a parent who shall inflict physical injuries upon
his child by excessive chastisement.

When committed: It is “qualified serious physical injuries” if inflicted

upon:
1. The following persons:
a. Father/Mother
b. Child
c. Spouse
d. Any ascendant/descendant
2. Under the circumstances
a. With treachery, taking advantage of superior strength,
with the aid of armed men, or employing means to
weaken the defense or of means or persons to insure or
afford impunity.
b. In consideration of a price, reward, or promise.