DISSECTING PHILIPPINE LAW AND JURISPRUDENCE ON MEDICAL MALPRACTICR Drowew P, Angabi* 1 will follow thet seueow of tgleven which, shecoreing fo ey oebihty ean Jurgerbent, I consider for the Lemp of wey patients, arud abstein from tnbeaterer is deleterrans dun weiscietans. = Hippocratic Oath 1 INTRODUCTION ‘Throughout history, people have consigned their fates and lives to the shall of their doctors, Te the medical prptession, society entrusts the sucted duty fof preserving the virtues of life and good health. Hence, only the nivst qualified individuals should engage in this pawteesion, Imbued with compelling stute interest, the license te practice medicine - oD uy, at any time and fi After all, the PPE 7 fachice oF Medicine is nat only « nght,* hut also a privilege? earned through years oT education and tomnings In dditen te state fation, the conduct of doctors is ikewise otuelly govemed by the Yipee Oath, a code of discipline and ethical tules which dectors have imposed tipon themselves in recognition antl tance a pone sueiety. Ifa doctor taile to give due vegard to the health an ef Tis patiens, ‘se mandated by his oath, the law makes him S77 Ce ¢ for such act or omii < accountable fur act Gf onsissicas, rcepm Sik Ate _ownes® Angeles «4 Fraiveome gf Phiten Mrdunl Maier Lav, $8 PHIL Ly. 895, (page sated) (UE Tuchauel Gude Bet, ice ofthe Underetecstry Sex Lage Aft, Depatiant of Agana Raat 2 gone. Uiraty of it Uipines Cogs cf Lae C13 perth B.S. Chemo, ‘Aton ; 2 datignat ©. Gout of Apptale, W.R Mo, (182M shersinater “Boniguin'), S27 Phi 96S, 68H, ful 5, 2996. Soy ot Avia. 24 $189 at 251 amg Merenton y Yates, 183 Ky. 196, 268 9) BO. Hilpeh Brasatuaaet OR No, 130547 (havcinaber "Repae%, 308 Phul. €7, 107, Oct 3, “% * Se Boaril of Medicine ¥, Ots, GR He. [SGD 388 SCRA 234 In £4, 2008, ttey Frotiesiondl Regulation Comm,» De Gueman, OR No, 144683, 432 SCRA $05, hn. 21, 2H04, i 806wit) DISSECTING PHOLIPPINE LAW AND JURBPRUDENCE «497 ‘This paper secks to thissact Philitpine law and fimupewlence in the matter af medical malpractice mosey ty anive at a definitive iindetetandling of this eoierging branch of tort liv. Tr is concetled that, to dhie day, there it no law that sheitly governs ox specifically penalizes, by way of civil Gr eaniinal ability, ‘jnediaal Malpractice. Since the Conelusots of a similar study mote thas six (6) years sat ihe eyetian ered the sane, Ciinently, there are these (3) pending bills betuce the 15% Congress, ninwely Howse Bill Nos. 1008 and 1616* and Senate Bill Ne, 2669! which all remain silent sith respect te the matter of medical malpractice, However, with the vecent dew of jurisprudence from the Supreme Court on the subject matter, this paper will show that thee i¢ tutrently an emerging and promising framework toe sitedical malpmeties in the Philippines. It @ the hope of the author that the strengthening and the eventual entienchmerit of medical malprence law within the Phihpping jurisdiction will not only develop our civd law on texts and damages, but, moze impertantly, strengthen SUE exieting medical institutions by testing the practice of medicine through the nitvrgreing ptandard of accountability under the tule of law. n. WHAT CONSTITUTES THE PRACTICE GF MEDICINE: ‘The practice of medicine in the Philippines ig governed by the Medi Act of 19891" which repei he Medical Law.” While if provides ne clear-cut defininan ef the practice of medicine, Sestich 16 thereat previeles: Bwotlon 10, sr: comsetenting praticr of ibvtitee A person shal) be consiclerte #3 engaged in the practice Gf tiedichie if he shall (a) for compensation, tee, Yh. Kl SP 52) Paws nah MeLic (4 wolity of reward in any Rurm, poid fo hia directly uF thiotigh Anothet, ot Mate d évet without the same, physically examine any person, and ditgiiure, treat, operate or prescribe any remedy for any human divease, ge pe defutmity, physical, menttl of physical condition oF any ailment, seal or imaginary, regardless of the nature of the temedy of meatnenst wdminittivedd, prercibed or reeommentecl, ct (6) by meane ef signs, cards, advertisements, wetten oF privted matter, or through the radio, 1 ee Joseph Joeener ©. Paves ot al Mein’ Mnpontie Law on eh Baines Seater Jae ad Powe Desatons * PHI LJ. 849 (2004, * iataauctd Wy Hin mets L avis LD, ‘Rep, fox the ** Dish olf hubs aud Hany, WEsidan P. Belle (Rep. cae Alibamion Bazty Let), spielen af hulp? /werercohpreas gov phy duwnicad/ atic 15 /HBOOL0G pat * Snneductd by Hen. Marlen Abigal & Biv Bie. fet the 20 Yow. of Mihea! Wing, evailoble tata former corgicat acu. phy dewnlvad hans, 1S) HBCDG G pdf (last sccesend Apr 12.2043, % Inteduced = by «= Mott, «=m, Peanikin §= koto, «= aay wt itp/ Jara. orctane. ger phy liselama/ LOGUE 4A pel (lave accemesed Apr. 12, 2011}. ‘Rep. Act No, 2382. Thisie the Medical Act of 4999. “Old Adnunietranive Code, as amended by Act Mo. 3111, ch. 31. Fz @& te HeyBO8 PHILIPPINE LAW JOURNAL {VOL. 85 teletision or any otter mente oF communication, wither wifes or undertake by Key tamune GY meted to Se or gf ¢ prescribe any semedy tar ary tminan cliveare, snyuny, defrmnity, phywe: mental of phyneal coudivion, os '¢) vee the tithe MLD, after has tiime tat, ‘Roophanis supplied ‘Thuis, gection 11 of the Medical Act of 1999 explicit! therefrom ve includ DevOUTE (samy miedical sudent ely encoled in an approved weeded! college ot Kea#e tehaol ¥ training, eeving without any professional fee an any goverment of pavate heepital, provided that he rendere such sernce 27 Under the threct nuprrnon and canteol of a repsteted physician, f iby any | Aleph a £ deniisny; ged t ich egrtered swasweus ot motherapis}, provided thet he applicy minseage a oI pl means upon written ordet or Prescription of 4 dhl sepistered physician, or provided that tuck : — Du cke spplicution of massage or physical meas shall be limited to pliysical or < muscular development; ich wu chily repintered net whi mechanically file or sells letses, Ute, ye, we 4 Htullat apphances or whe is engages in a the mechanical examination of ees tot the PUEpore OF eonetnictinly of adjusting ee. spectacles and lenses, 161i Sho tenders any service gratuitous! ur ih places where Tw services of & registered physician, ourte or mitelaes S16 available, ib aay payel 1 of tential hygienist formance of bes, Petlormance i done in comma a wagittered physician. befMiki) SPOS ELTNE PERE AT ERT LAW ADP TUR “9 prsetiee medicine undet the same cules and regulathorss govectnng cihzens (er Pausse Muteuver, it is w be Suted that Section 1146) uf the Medieat Act is the daseat Philippine equivalent ef a Samaritaw stature that ane from lability a pevion (such ax an off-du TH, MEDICAL MALPACTICE AND IT# FARMENTS Whenever a medical practitioner fails to meet the standards demanded of hin by his profession, he mag be held li reach 6f duty. Such action i¢ migse cotnmonly known a a medial malpractice iE ty ed ts ty at the | deliets.!* fae Tas CO rip aeiaaic yap Dahle naa aoe erage rules and with injunous results to the panent; the bad profesmonal treatment of disease, of bodily injury, from reprehensible ignorance or carelessness, or with etisranal intent! In the Amenican juntdicnon where cur law on medical malpractice was derived, it has been reasoned that while malpractice generilly anses from ee ee es eee ene £ through lack of skill or neglect te apply it, if possessed, and it aay be salut, neghgent or ignorant? Thus, actice const of aeconduct, Bit As ‘Se Leck's Law Dicticnaky fi Bd 2006. ve 1% 52 omg ROLL Pearce Ae ROWALE BOVCE, CRMANAL LAW GS! (ed ad FED. Cee Coie ae eT PUGS 6d a 455. 1 i, aim 7, Elba, 1 NW 123, 40 Mab. 456; Granger + Sail, #5 SWF 1106 287 bie 197 4970 C58 $02 at 455. DEP90 PHILIPPINE Law JOURNAL {VOL. 85 professional wt _fidhicia evil Borrowing these prieiples, Plilippute law hay defined af action for medical malpractice te be 4 type of eldim to redress « wrong comimitted b mecheal puafessional thut hae Caused bodily hann toa jt A Siciined ly, the Tijopis view inatag accra alpractse te cave of nngigence sweinw to prevad iv the Philippine junisthotion, 7 4 “medical negligence” was Gave Rue & Paseasie® desi Cort oh September” 3 199 fis was tollewed by Gave a Ci i 8 y Yevenher 8 1087, Thue notwithstanding, ea atop aie actionable medical malpmetice to acty of negligence. In fact, out laws on the Fe a* the Code of Ethies of mihee Firyt case to equate wedlionl mal th Jeane the Medical Pratession provide for nlimerous acts and grounds coneituting CHEB) / achonable mualpietice, Tit kestuctive interpretation of medical malpbietice must be elismituated, A. Physician - Patient Relationship A pbyvician-patient telatianship ia formed when a patient engages the services of d physician” The teltionslip of physcas-aud patent See ie Toleasional seevicer of 9 phrncan cepted has net been ont m he Pluhppiie jitisdiction and even undér Ametican jurigpradence from which ew lw co medical malpractice puiginates, Thete is suthonty w the effeet that the e lal pot A conteactu gelationship. Ina ine of cases from American junsprudence, thas been hel ts The duty of & physician or muneors to being ¢kill andl ware fo the amuellondlion of the condition of hie patient does nut atiae from contiact, bout hor tts foutsdation in philic considemtions which ace ineeparable from the fanue ind exercive of lis callings it ie predicated by the law oth the relation which existe bewentn phiyrician anet patient > PG. netiy Af plgetard Huty i cep Waite Cumberland Stauny Heay, tyatem, Ine, Sy AI2d BM NC 2 review seed 85 $242, 519M. SL treed pty chm rma HS Had BK Seo ae SSha Gout uf Appa, Gk Mo, 122445 thrreiuader "Cnt, 346 Phill. 87, EM, Mise, £8, 1997, OR No. 7814, Qheceiefter “Corea Rateedy"), 344 Phil 323, Sep § 1057, % Crus, $43 Ph. $72,976, Now 1, 125. 2 Lean 2. Tuatio, GR, Ne. 176763 hessinatter “Lucae”), 586 SCRA 17 306, Api. 22, 200%; Garcia Rueds, 344 Phil 323, 332, dep. 5, 1957, 64 Are fe 34 190.9247 op tae ¥, Cometock, ZAG Pind By, Ab ALR 34 3:0 (Sth Ci. 2950); Clean v, Hensbewia, 1:9 Comm. 398, 177 A 202 (1935); N ae ‘ton y. Hanaltcn, 92 Ga app. 727, 89 SEB 8S, $3 AL R2d 436 (1955).211) DIssRCTING PHILIPPINE Law AND JURISPRUDENCE 901 ‘Thie obrervation tinds rune sippurt in Philaypine law as act, 2176 of the Civil Corte provides that a qussrdelict cequites that there he no pie-existing contractual felations between the parties! This finding. however, ilat be taken with a grain of salt as it is wall settled in our jucisdietion that the lact that the parties are bound by contractual relations does not prevent the action based on tert from prbspesing. The existence of a contract does net bag the commision of a fort by one party against another ani the consequent recovery of damages therpione, expecially if it @ the vexy coromistion of the tort that enuses the breach of center? However, the notion ef a phystcian-patient relationship a¢ a form of contgaet is consistent with the eucrent stedical malpsactien deeteine whereby the duty of « physician ts said to aniae when the services af a physician ane engaged by the patient? Numerous authGiater fro Amencan junsprudence™ espouse the view that the relationship of phyacisn of sutgeon and patient is one dosing out of a contract, through express of imphed consent. Such a view 1# likewite consistent with eur law on contracts’ The xeldtionship is created when a physician's professional services are rendered to and accepted by mother person lor purposes of medical care of treatment.S Whenever a person consults a deetar in relation with a medical condition, ailment, ef disease, or his suspicion there, 4 contract is thewby created between them by iniphed consent. Thus, the veluntary aeceptance of the physician-patient celatonship by the affected pncties creates w rion Jfeacie presumption of « contractual relationship between them? ‘The existines of such eantsact may be estublished depending on the questions ef whether the patient knosingly entcurted himself ty the care of the physician or whether the physician fook affimative action in accepting or fteating the patient for his ailinettS The » SHVEL Cope, wet, 2176. Seas to iteeat af Appeal, G.R No. 110298, 257 BORA 26%, Cet 18, 1993, oes oe eS EG f. Ne, pera SCRA 1117, Jun 28 188. Se ate ‘is France » Caunorcene, 16 SORA 155; Vasqura ve. Buje, 4 Phd) $60: Cangec ve. Manda Rasrsad, 98 Pl. 76%; Yarmace vvé, Manta Raikoad, 33 Phil. 8 me ze 2 ayac-pean ¥. Rarnolets, C.K. No. 130122 theveinattet “Cayas Lagan’, 574 SORA 439, 454, Dec. im sco RSS Soe 13, ‘Ape 21, 202%; Cruz, 340 Phi. 672, #83, Hire 19, 1997; Gareia Rueda ‘Mal Ptul $28, 992, Sep. 5, 1997. s i - Semunta, 276 Ya B29, 66H 8.E.Bd 127 (2008); Kelley v, Mila Teansbvars Bmengeney Pagneine a ak sara 87 Ti obi Lyi, Btn, 31 Tae 301}; Walker e. jes. Niza Sef find 10925 Teacy » Mikieell Boer Phauacenticals, Inc., 8 D, 3d 147, BO NI Henly Spencet €. Wen, 125 So. 24-429, 97 A.LB-dd 1224 (La, Ct App 28Ot 1960, ai ely fee pian GTM CODE, wre 1303, 19:5, 1348, and 2319. Sr oy Manns Tokaprraes, Oe (ope ce time Prmtirrins 447 {1942}, Claie,# Rulens 127 SCRA SIX Leung Basse. O'Bien, 38 atte Maaes. ers isd ; 9d A153 176, 463 MVS. 24 ADT (2d Trap’ 1 Se ea ee ot ona oea tr Bhancs, 58 Tene App. 19, 426 S24 168, 35 ALR (yo). . =902 PHILIPPINE Law JOURNAL [VoL. 85 relubon of medical pitetitivner and patient continues nti the physician's setvices ace no longer needed ux tint tenranated by the partes * Arcatdingly, a physician ot surgeon who operded ott 4 patretit without the latter's ohsent may be held answerable for damages. It shay be usferted thom the judicial pronouneemerts of dur Supreme Court that a phyvician-pauent partakes of the character of a euntenct ae it ix by far move consistent with ordinary experionce than the former view, ‘The consideration, as an element of the contract, insofar as the doctor ie concemed usually consists ef ample compensation for hig professional setvices by the pabent, Howyver, even if the physician’s services weve rendered giatuitously or at the cequést of « third pasty, the pliysician may snl} be held lable for an actionable malpractice.” On the other hand, the consideration on the part of the patent is the exercise, by the ductor, of a reasonable degree uf care which may range trom d diagnose of his ailment, # eure to his sicknesé, ot therapy to address a condition, consistent with the shingent standards of the medical profession, that will eventually lead to the patient’s recovery and a cestosation te his former or optimal state of health. ‘This interpretation of @ physician-patient relatienship taken in relation ‘with relevant ease law, leads to @ conclusion that a physician-patent relationship is at clement of medical malpractice cases, It can be reasonably atid that it is through this relation that the duty of a physician of naungeon towaitls a patient atizes, Thus, in accepting a vase, the Physictan, for all intents and purposes, reprerents that he hav the needed training and skill possessed by physicians and murgeons practicing ny the same field; avd that he wi employ mich thining, care, and skill in the teeatment of the patient” It is the y breach of that duty imposed by the physician-pationt relationship that the law deems av actionable for SM CIR gt 31 Aaw feu 2A B14 oy 205, see 3) a 288. 346 SORA 173, a1, Cayac-Lasarn, CRA Gon, and 13 Nor tiv Coca tae sa a ee Sanne Pm prerdl Lem, S05 SCBA 173, 200, Aor. 24,2009, Gaca Bet Phil. 332, Sep. 5, 1997. DILU211) DISSECTING PH®LIPPINE LAW AND JURISPRUDENCE 903 B. Dowty of « Physician Duty tetets to the etaralard of behavior which unposer restriction: on wane’ cundilet By the phynsian-pationt relationship, a duty is imposed cn the phyaean to use the same level of cate that any teasmnably compttent doctor worded use 19 treat a condition wider the same circumstances.” Stated otherwise, in Weeating his patient, @ physician is under a duty to the pationt te exercive that degree of cart, skill anc diligence which physicians in the game genezal neghborhoud and in the same general line of practice emlinasily potvess and ewereise in like cases. For the lay Fikpitto, it is the very expertise of a physician, surgeon or, the reputation of # aka institution, coupled with the proven competence and reputation of ite medical staff, which convinces hin or her to entaist hiy or her very lite or good health to treatment in exchange for hetty medical feet and therefore, the physiciari, stugeon, ot medical institution has the seeiprocal obhgation to make oud on its duty. Ax to what partiedarly constitutes this standard, there hay been no hard and fat mile delineating the duty demanded of a physician: Instead, what we have i at approximation of the standard dethanced which we infer feen the vanous proncuncements of the Supreme Court, 1s Get Baar the duty of a duty te “serve the interest of his patient #1 ways Tue Te giving thes etrine however war Tesnipered in ays down the current standard, all known practiti gatdatick to determine whether of mor a physicay it guilty of actionable malpractice is enunciated in Cie 8 Cont of Appeals in this wie: “fw]hether of not a phytician hat committed nh ‘inexcusable: lack of precaution’ in the treatment of his Patient is to be determmed according to the standard of vise ubserted by other membert of the ptofession in good swing under similat cixcunstthoes beating in mand the advanced stale Of the profession at the tims of trestinent or the ee * Phot ¥. Pineda GR Ne. $8608 thateinalter “Plarer), S71 SCRA ¥3, $1, Mob 14, 2 GRA Mabry Law ReLArnis to Mabical MALPRACTICN 361 (2d) pone © Cayo Lara, S74 SCRA 432, #34, De. 38, 2908, arog Reyes, 395 ML 87, 96, Oct 3, 2060. Sue ee at Foe, 286 Mia Ap STK, 77? MW.3a 511 Chey, co, 173, 20%, aw. 24, 2000, sty Sayyder * Parwalec, 143 (Sonn 260, 122 A2d 2 (tis, in Kags, EPH E88 et OE gi a 7 an SA iJ 21908 Cops CF BTHICE CF THE MEDICAL PROFESSION, art 1, ( Reyse, 386 Phil 87, 104, Oct. 5, 2066, a ee904 PHILIPPINE LAW JOURNAL [VOL. 85 present state of tiedical ectertoe."* Thus, the Supreme Coit went on t nde that: at pohysiviettr ts wat crm iecatven of thet goed vomit of trratmend” axel that the “mee tact that a pabent does not get ell of that « bad ceault occurs Hyough the coutse ot treatment dots hot in reelf ivdieate tailuse ta exercise due cane which giver tise to an actionable malpeetice.”®! The reeuft is oot determinative of the pettormance of the physicians and he is sot required to be indallible.”5* However, the pliases “degree of skill and diligence ordinarily exercised by the average members uf the iecieal pivtession in the sate Ux similax localities” and “due conademtion to the state of the profession at the tine” necessanly unplies that the standard of care jx not a fixed or nigid one ax gan be said of other profersions cr mcusties imbued with public interest. In fact, in Repos o Sisters of Mery Hopital, the Supreme Court distinghithed the standard uf care dnd diligence demanded from medical practitioners fiom common eattiers a& the practice of medheine is alveady condihoned tipen the highest degree uf diligence arid that there is no ned to tequire extraordinary diligence trom it, Netwithetinding such pronouncement, the standard must wary from case to case with due emphasis on the qualification and reputation sf the physician or surgeen, the level of equipment and technology at his dirposal, the lovality where he serves, and other material and relevant cisciumataness which have a bearing on his sbility to dischntge the obligations demanded by his patient and the profession, With this jn mind, we Must, in proper cases, distinguish betwees a physician preticing merhtine in a far~ flung bare of sur archipelago az against a phprician working for the premiere hoxpitals in dur county whereby a stueter atundard is demanded Era the latter as agtinst the former, This does ot in an? way mean that the atandaid of care is lower for medical prcntioners situated int retnote or cural areas witholt access to advanced medical equipment and facilities o¢ who do not enjpy the Support of a full complerient of medica) staff, Rather, it merely cases the bar fur tore medical phictitioners who have access to aufficient resources which cannot justify any form of noghgertce or vimaiun m die diligetice which cenulte in injny to a patient. Common tise dictates that a physician or suigeon employed with ole county's prendere hospitals should be held to a higher standard uf care and diligetsce thats other physictins whose capabilities ate hriited by the lack of foanpowes, facilities, and other medical reeeurees, Frvin the Yovegoing, it can be conchided the statdagd ov duty incanbent wpon a medical practivoner' is relative avd ie dependent on the hisan competency of good doctors it the particwlat lavality ox field of practice. As the etme faduse of a course Uf treatment to produce the desired effect dey qot of itself give nite to 0 a eae 3 Sr, $46 Phe. 802, B83, Row. b4, 3097. Lucas, 385 SCRA 193, WA, Ape 24, 200. %'16. oto Conrana ¥. Peat, 15.424 to8 (19a),wi) Disshe TING PHILIPPINE LAW AND JURISPRUDENCE 905 drawing of Hegligenen or the prourt af the inedical practitioner, wii Lie anid that ae Jorg ae the medical pimetiioniog exemiver that degree of cute, will and diligerion thal ordnanly characteris the inpeondble average mbent arnvonig Hie areinarily geod phyncians in the sanye general neighborhood andl in the sone gervecal line of practice with rhie considenition it the advanced state ot the parlassion at the tine of (yeatment of the present etate of medical science, the medical practitioner oa be snd to hive fulfilled the dity of care and dikgence dequined by ww There 1» howewen, @ vignilicant kek in adopting evel « etandacd of cave whieh was borrowed from Anierican law?? It is apparent that the afolementioned standard hai been developed by the long history and experience Of Amencan society in inplementing ite medical nymlpenctice lawa as well as ensuting that the option) quality of care seeved by thet medical institution Conndeting that the reahites of the Philippine modieg! and healthcare systems cannot be in any way wnilaly mtuated with the ktate of Amorican medical and healtheare syetems, the application of the American éhinlard at cate in our junseliction i# sisceptible of vanchoning iniquitous or even abseil interpretanony, One of the logeal consequences of having a flexible standatcl of care pegged at the “ of skill and diligence oxcdinanly exervised by the avemge members of the medical profession th the same or dinsilar lovdlitiee” would be lo justify 4 judgment exonerating « physician just becouse of the relative incumpetenon of all other ivedieal practitionsre in that partioular lovalily and field of practice, ‘The tendency to hold medical potetitionsr te a lower shindard of care in certain wrens would promote the dechne in the quality of medical care which i¢ the very el sought to be prevented! by a medical penctce statute, ‘Thus, the need of ont leyitlatune to fintoe w spetific vtandard of care tor sibdital practinonery that eunlosins to the Philippine reality pervading the practice of medicine becomes teadily apparent, CG, Breach of Duty and Injury Genenilly, the injury contemplated by the law is bodily injury to oy deathy of the patieltt®* Such injury iy Gocanuittd by reason of an act comnitted either throtigh fault or negligence amounting to a breach of duty on the part of the medical peattitioner, As pointed out eather, breach of chity a9 the finbure of the phydeian te rome that degere of cate, skill and dhhyence tt ovdinasily chaimetennset setaenabla eres ae acing he eater gait became aris ine the sate geteeal neyhbothoull ated in the same getreral hive ot peactice. The law dyes not merely penalize svegligence, but the failure 10 exepeiae the epquisite care, shall and diligence which # mut limited only to negligent acts. It covert acteO06 PHILIPPINE LAW JOURNAL [VOL 85 committed by Gult through tack of foresght or lack of +kill gesulting to injury suffered by a patient. Tr aleu wrehater the Bulure to take the feversary precatitions w prevent tureseeable hatm caused by a disability of the patient, knot of should have been known by the phyncian, that ieveases the mageitiide of nisk to bins Hence, the Supreme Court has culed that the fellowing acts constitute breaches of duty ef a physiein: inadequacy of facilities, lack of provisions, untidiness of the clinie and fhiluye ta conduct pre-operation twats on the patient; the act of seeing the patient fue the first time only aa hour befure the scheduled operative procedure’; scheduling another procedure in a ciffecent hospital thirty nuputes apatt trom the patient’a achecuiled operation causing the surgeon to be over thie houre late for the proceduce’’; leaving of sponges ox ether foreign objects in the wound after the inesion has been closed®; and failuré to consider the patient's high blood dugar and subjecting the patient to an evaluative procedure which caused the patient's death due to cumplications trem diabetex®?, It has been proposed that the law also contemplate of other injury auffeved by the patient and be not lintited to bodily injury in gehetal.! This Preposition would be a welcome development to the law on medical malpractice andl would be mone consistent with the dofinition of injury Under the law on quast- Selicts which deve not distinguish between bodily and Hen-bodily injury, This snterpretatioh Hinds imped apptoval wy MseOrvte x Roapeide? where the Supreme Court beld an chstetician-gynecologistechaultant ar fiable for actual s sullored by the plaintit following her taihire fo arrive in tiie for the plaintiffs scheduled operation, 1, Levdspeasitiy of Bogpert Testiovory Cleady, such standard oe duty is not definite or specific by which one can conveniently determine and delineate fr the benefit of medical ractinoners, Genonilly, a physician is premined te have conformed te the stundactd of cate and fequived of the citcwnstances.? He is alse Prtmumed to have the SORA BS 94.0% Now ja. 2008, hil #73, 816, Novy, 3, 190%, ferme eetiee, Ihe. Aqmin Oh No, 126927 (hetsinatten "Pro DOR 476, fam: 9, 3007; Bowlin, 329 Phd. ss, ferticinal Zervivet, Ine.”, 513 Pcie O71 SoRh gn Su New ta aa’ RE Paseo: hits 7, « TOR Mo. - Takes, S84 SCRA 632, Oot. © Se Lateay, $86 SCRA13, GaN ae hoe Am. he gx. d Ape. 3: BO Cruz, 346 Fil, 872. 1 AG, UIT, Sev ala 6 $57 Pa 8 dag)” MEAN. Pay, 1s Ril tl GAG Wel} Rome en ele2011) DISSECTING PHULIPPINE LAW AND JURISPRUDENCE 907 necremiy knowledge to pracice Wit proterian. Thus, it w a gehesal cule in tevedical malpractice cases that the plaintiff bears the ome of proving the eandard ol diligence and care imposed on the physician was Neale consoftance with the baric duetane of “he whe alleges proves”. This standard level of care, skill aod dihgeriee i¢ a matter best acklteesed by expert medical teattmony, becauise the standard pf ware in a meclival nvalpractice case is a nmter peculiady within the knowledge of experts in the field.” In Laveas r. Trai, 0 war held that in the absence ef # provert standard of level of cave, skill and diligence for a particular course of cate or treatment, there ean be no fibding of neglgence agunst the medical practitioner, The Court went on further to say that witheut « standard of care, the Couvt will have no yardstick upon which to evaluate or weigh the attendant facts of this eave to be able to state with confidence that the acts complained of, indeed, constituted negligence and, thus, should be the subject of pecuniary reparation’? It i# tot enough that the standard or duty of the physicith be merely defined. It is also essential that expert testimony establizh the fact that the physician's conduct in the treatment and care falls below such standart. Thus, the production of expert testimony as evidence in medical malpractice suits has been repeatedly held as indispensable, Médical negligence cases are beat proved by opinions of expert wimesses belonging th the came general neyhboshood and in the same general line of practice.’ Courts give deference te expert opinion of qualitied physitans and sumgeans az the litter possess teelitieal shila by which laymen in moet instances are incapable of intelligently evaluating: fience the indizpeneability of expert testimonies.” To further stress the indispensability of ‘expert medital testimony, the Supreme Court held in Paver « Promdv’”? that the ctitical and clinching factor in » medical negligence case i» proof of the catisal connection between the negligence which the evidence established and the plaintif’s injuries? Such connection ean only be proverr by expert medical testimony. et $0 6) Ass, Siw. 2d $309 ot 417, Ricklsbetyy ¥. avers Fourgiation Nusthem Hovwpuale, 226 Or, 01%, 269 2d 1990, b4 ALR24 1927 Hoots, © See Gracie Rutda, 344 Phd, SAS Mi, 5, 1997; Cine, 346 Phil. $72, $85, Now, 18 1997. See aw Nite Hote! biatila Garden v. Rapes, OR. 134239, 482 SCRA 532, Fe. 2, 2005. © Lica, S86 SCRA 173, 206, Ape 26, 2009. ata Ichnton +. Superior Cotwt, 49 Cd. Rpt, 34 S52 (Cal App. Ad Diee 206, Ont kW © Cette, 346 Phil $72, 884, Now. 18, 1987. Uscas, 966 SCRA 173, 201-20 Age. 21, 2008, Wik ak % Bletes, $71 SCRA 63, 91, Nov. 14, 2008. id at 99.O08 PHILIPPINE LAW JOURNAL [VoL. 85 ‘The reaeon for thia ve olraets. A verdict in a atalpmotice actian cannot be based om speculation er curderhiné" Mere innuy suffered hy the plaintity desing: the course of uvatnent does wot ietity an award of damages in hie thivatic.”4 The causes of the iojunes ayvolved th malpractice achons aye detetminable coly in the light of sciehttis: knowledge and as eth, it has been teceynsimed that expert featinvany is tteually neeeseary ts support the conclusion ag to causation.) Generally, to qualify #8 an expert witness, one must have acqhired special knowledge of the eubjeet matter about which he or she is teenty, either by the study of recognised authenties en the subject or by practical experienct.”® Thus, in Roe the Supreme Court upheld the norereliance by the lower courte on the so- called expert witness presented hy the plainnff. In the eaid egse, the patient died from typhord fewer and hit heire eued the doctor and the hespitsl fox medical malpractice, Ts aysport their contention they presented the testimony of a doctor whe lates appeared tu have Au extensive experience in typhoid fever cases. Said the Court: First, While petitioners prevented Dr. Apolinar Vaealares ab an it witiess, we do not Find higs fo be so as he is not a specialist on inbetious dvensee like typheid fever, Puetbermore, slthough he may fiave hud extemive experience in performidy dutopsies, he adiutted that he had Jet do ote ofr ts body ele fpphaid lets at he Mase be oonocid toe postineetent on Jante Reyes. Tt is alee pliin from his testimony that he har treated only sbint there eases of typhoid fever... a ‘He is thus not quulified w prove that Dx. Martyn Riew erred in het diagnosis. Both lower eaurts wete therefore cofrect ith dhecarding his testihorty, which i+ really inadunissible. 2, Dactvine of Res kpna Languitie at Eoorrption Although geiseally, expert meclical testimony is relied upon its eee wuits to prove that « phystcion hae done a negligent act ot that he hat deviated from the standard ouedicd piovedure, the Supreme Court in Rawr & Cow? of ah Titese 869 BORA 973, 301, 204, Aye 21, 2009. “ie SFA Scan ek ee V8, 3008; Cau, 346 Ph. $72, 864, Nov. 1, 1997, ame 61 id pay, Reyes, 396 Phil. 87, 100-101, Oct. 4 20602011) Dd TING PHILIPPINE LAW AND JURISPRUDENCE 9 Appeals bela that the docttune ef 1 saa nquitir may be avetled by the plantitf to anpore 4 finding of print fig? negligence aganet a physeian, Kes spur Aguiter in a» maasain foe the rule that the laet of the occurrence ef on injury, taken with the surrounding cuccumstances, poay pettt an inference or (aie & pretumption of negligence, dr make out 2 plaintift’s prin farie case, and prnennt a question of fact for defendant to meet with att explandtiba.”? Where the thing which caused the uijory complained of is shown tw be under the management of the defendant or his eereants and the accident is such af in ordinary couse of thisige does not happen if those who have ite management or control wae proper cate, it affords reasonable evidence, in the absence of explanation by the defendant, that the accident aroge from or wae caused by the defendant's want et care, This shifts the burden of proof is shifted to the defendant to establish that he hae indeed observed diie care and diligenes* Wher the doctnne of res (par laguitur is availed by the plantiff, the need tor expert medical testimony is dispensed ith because the injury itvelf prowides the proof of negligence! The xationsle of the application ot the doctrine 1s explained as follows: ‘The doctrine of res duit dngintier is sinaply a recognition af the postulate Psat, as a inatter of common kwowledge andl experience, the very nanure uf csc Srp 6 cesaiican i) a OS Reece ae part of the person whe evntrols the instrimentality caulsuig the injury in thie shsehce of rome explanation by the defendanc who ® charged with However, it must be pointed out that res iu doguitir ia bt a cule of substantive law but a mere procecwal rule, and as such, does not credte of constitute at independent or separate groiind of hability,? Fucther, it mist be atteesed that the applicability of the ducttine of res jw Aplin does wot dispense with the requireinent that proof of negligence needs to be arduced, It does not automatically shift the oars from the plaitif to the defendant. To invoke the rule cof res pat fagaitier, the plaintitl tnust first prove its essential elements) * Ramst eee A854, 378 Phil. 0, Devetebay 29, 199% Arexsinaltes “Rane ¥ Cavkt of Appeals (Cecistan;’ affinied m Raawe 7. Gent of appeals, GR Se TIS tee 44, 2062, 7. Coutt sf Appady (Reestusing). mizie, Bataquir,, 327 Phil. 965, 978-079. Tal. 4, 1996, Ramee» Go of ppete Decor at 1231, ng SOKm, MeDtGas, RETR ANH 239 (1988) ft at 1.9, © Id at 1220, Baquin, 327 Phil. 998, 979-980, [id 5, 1990,O10 PHILIPPING Law JOURNAL VOL. 85 1 The acetdlent & of « few which ordinarily doce net qvetie in the absorice itl tomecue’s peglygence, 2 fr caved by am metnnenlity withen the exchinive cunt olde | Laas defervhnt ov detenutunts; wd 3. The poewibility of contwbuting céricct which weal pak the plulhtitt nu" roxpomnitle is elianyttedd OF the foregoing elements, Ae ee ameaecae © “The appheatliteret rneypieedeguinres Thus, the doctrine ot ree doe doywiter has found appheation in situations where sugeons leave a foreign chject intide the patient's body", whbre the brain damage is sullered by « patient fellowiig a standard gallbladder opération®® and where the patient suffer an injury caused by instraments within the exclusive centrel of the sungon’®, Tt dees net apply to cases imvolving the metit of the physician's treatment as it is & matter that is placed beyond the realm of common wunderstanding.” Thus, the dactane of iby (ue lequitar found no appheation in a cave whore 0 patient died barely two (2) days fiom admittance allegedly due to the faulty choice and admineyteation of an antibiotic when it appeased that the patient was alceady grively ill from wphoid fever even before ha was adttiitted to the hospital foe treatment,% "Gass ¥ Ge, Ge. 1608¥8 Dibvemafter Canute’, $22 SCRA, FEM ie ‘ 30°, S88, Ais. 37. S207, Ramoe v. aime mat nee Yate ow 354 Pad 958, $1159) and outer came Be Boy) u tr pri 227 Ph 898, 6. hatet » Contof Appede pe Mec, SLSSRA 478, tan. 31, 2007, nr HeGante, $2 SRA a, 886 ge, 2, 2, Ruree ¥, Senn of. Wearon), 4 ™ Siegen oe Pl Se ia ee yeaa2011) Di TING: PHILIPPINE LAW AND JURISPRUDENCE O11 BD, Carmation held bable that iy proven by # peepondenines ot evidence that the weroromresion eee tart cncrerviecrte chemerenicad-avetneee : ; withour-which-the-tesultwould-nethave-oceurred.’* Thue, it can be vaid that an injagy ox dainage is prosamately eauaed by an act or 4 failuve to act, whenever it appears frusti the evidence in the caxe that the act or crnexun played 4 substantial yraet in beinging about or actually cmising the injury or damage; and tint the injury o¥ damage Way either a direct meult or a cedsonably probable consequence of the act et onuséion,’> . t A ieee maieta ae Ciao Latins v, Ruiteoleir is particularly instenctive tn illusteating lement Gf proxamat cause as applied to of medical malpractice. bikewnae guilty of negligence hineelf TV. PARTIES LIABLE A. Physicians and Surgeons As the author of the at cavisiy the injury, it is the ering physician or auigeon who genetally bears hability for damages suffered by vittue of art. 2176 of the Civil Code. ty clenventé ot an actionable maiprachee: duty, breach, iniity, andeproxemate a eaneianneand ” Meise, $1 SORA 83, 99, Now 14, 3008, Wa de Datacla v. Medina, 193 Phil. 181, 18 (1957), Capre-Latanty S72 SCRA 48, 458, Dac. 8, L008, atmy Ramos 7. Colat cf Appeste (Decision), af ™ Fears, 971 SORA 83, ¥9, Nev, 14, 2008. 1236,912 PHILIPPINE LAW JOURNAL [VOL 85 causation.” Upon the establtrent of these clemettts, lability attaches to the pliyncian atid fie is Hell hable for damages suffeted by the phaiottl Hewever, the-fosegomp descidder-the-conventional-phencin-patien s ; epmetitionerstoralb-at-hie healtteeoncenss. The practice of mediene however has grnenilly veered wway trom general practice and is currently « highly specialized profession. A doctor has even called it “superspecalization” wherein there are different types ot epecialist [ur ene diseased organ. Te illusteate, he describes the situation as thus: If ore hit « heart problem, he,rhe may need to sec a general heart epecialist called 2 yyteral cardiologist, then snother heart specialist called on ectophynolopitt for one's abnownal heart beat oy atthythmia, and another heart specialist called an invasive carchologist fur opening the clogs in one’s heast arteries, Problems in ohe's bowels or liver will likewise ¢encl ene to different ype: of liver specialists. "Thuis, it hae become the numn that 4 patient engages the servicer of more than one deetor in attending te his needé a demanded by his condition, which at tines afe ata Hitinber suflicient ts conditute a personal seine of servants. In fact, some Filipinos have regacded the qimber of specialists and consultants one ponaults tegulasly sas status eyinbrol ‘This neo reahty of the practice 6f medicine poses a aignificant challenge to medical rhalprctice law as to whom liability must attach when there ix injury eullered by the patient in the cousse of tieatment due te negligence, ‘This is moat relevant in the field of surgery where a patient is hot only treated by a stngecn, butis, in addition, dtrended to by at least an ivlogist to facilitate the administration of annembesia, and if applicable, anvther doctor whose specialty involves the pact to be subjected to stgery, Genesally, a member of « surgical team is fiable only to the extent of his/her role in the surgery!" Thus, an anesthesiologist war held lishle dus to negligence it the admihistiation of Laka 56 BORA (78, 200, Ape 2, 200%, sep Oarria Rueda, S48 * Rated Caatu, KD. Te De ents Pps ene Pal Dey opus Be aes mate w Jagd ah blasmderyls uae Ade Rteyl /ew/ 00002 13-1 aaa! The PCE atyd-the-Riipitio- % Rafael Cantilo, bo, The Pes? aed oft Fipine Trevreun, Phil. Daly Reb 12, 2609, anautetle aa case! 2 be = net ination eu S13 WES PoP de Rips eee Ramor ¥, Gout of Appeale (Decision): Ramor ©. Sorat of Appeal (hereinaftes ° Ns detlical Cente - (Rerohibonk Pee Se “Negaler'), SIL SCRA 204, 230,wit) DISSECTING PHILIPPINE LAW AND JURI@PRUDENCE 913 mnarsthesta at in other peocedties Necestaty or incidental to such procedure. A verident phyncian was absolved fiom hability, noteathstanding the neghgence of the OB-GYN when it wes chown that her only cole i) @ Buled delivery that vesulted in the death of the patient waz te take a routine inteasal exaMhisiation and that che wae tot ptesent at the dehvery seam when dhe negligent act occurred.1"> In the anne cave, an anasathasiologat was absolved from hability hen it was found that ie war not negligent in the administration ef anaesthesia and that no hiability cass attach to him as his field of specialization did nat cover obstetrics and gynecology. . A question howevet, atisay ax to the liability ef a surgeon who heads the muggeal tea in a botched procedure or pechaps a physician whb is assisted theeugh the course of treatment by numerous specialists whe may, by their own cateless acts, cause injury te # patent. This question linds primerdial importance conadering wn situations auch as there where it is almost anpotable to smpute or prove a finding of negligence with absdlute precision, Te anewes, again in the absence of poritive law ta provide tov thé remedies in meh situations, the Supreme Court has adopted appropriate doctrines from American jiniprudence te address this vacuum in our law. Thus, the doctrines of negligence pera “ , tehave found appleation in Philippine medical foalpractioe suite, The doctene of negligence prr s* was enunciated in Thagar « Permcndegt® and affirmed in Afomers 1; Cont of Appeile’® where the Supreme Cunt laid down the rule az folluws: cae Ee a eam, “will be deemed to be prunumaie cause of the tnmry. Srorinscesaras eoarpaieaicmaanenrine tee Sp Ramee y, Ocint cf Appeal (Cedacnh Rahses ¥ curt ef Appeala (Reschutich). W Nogales, S11 SCRA 204, 235, fanceanbbes {8 2006, g Wid e0-N, SR No. LLMs, 51 SCRA WL, Jun. 4 LICR MGR No. 1M00%, 441 SCRA 34, Get. 26, dot914 PHILIPPINE LAW JOURNAL (VOL. 85 What prevents this doetsine ftv applying full force in the sealm of medical malpractice is the fact that the #atutory duty of a medical ptactitioner is ‘faut dehneated in clear and absolute tense, Despite the celatwnty of the statutory duty of a medical practitioner, our Supceme Court has applied this doctrine in the cases of Gareia, fi, 8 Sndeader'*? anid Proftasteual Services, Ime Aga’, In Garcha, Jr, the Supreme Govt upheld the liability uf a clinical Jabcxatory For releasing a fale positive result for hepatitie after it committed a iolation of bee. 2 of R.A. No. 4688"! aiid DOH Administrative Order No. 49-B Series of 19885 which requited clinical lsboratonies to be placel under the technical and athninsteahve supervision of licensed physiaan duly qualitied nm labasatory medicine, lus Profession? Setrties Lm, the Supteme Court niled in this wie: {phe act of “leaving of oy offer fortign substances in the wound after the incision fas been at least aria fore negligence by the operabitig stitgeon... “Toe piut it simply, sich act wt comidend so tnconattent WE Bd ge 5 TBB (cltahttise ctnittedd, Sens. ees 168512 349 BORA $68, 575, Mach 22, 2007. Ut Gata, fr. ¥. Salvadis, S16 SCRA at 875. 3 Prateoorenl Serves Inc, AFECRA ATA Jat, 31,2007. Se Se ae crt noe een a and Si the and Mluntenance of Ghinical Labotatcnes in the Philppinee”.211) DIsSKCTING PHILIPPINE LAW AND JURISPRUDENCE 915 witli dhe care as to tates aty inference OF eglipence. ‘These an even leona ob aitthoritior to the efieet that much 4¢tw negligence pray we‘ ‘The significance all sich pedmouncements oo the eftitacy of the negligence pre se doctrine in the tealrtt of nredical melpnietice eit cannot be ovevensphasized. It in effect qualitind a particular act a¥ a violation of a statutory duty ef a mincical peactinoner tantimoutt to negligence Ae, Howbvet, stlbeaies “nubstitute fot specitie proot ab neghyence.!"” 4 Gaaphain.of the Ship Woctriwe ‘The “Captain-of-the:Ship" ducttine is defined a> “Neeoettnermpesine , O18 This doctane was introduted in Philippine junspruderice in ‘RUM ynyepnme!? where a surgeon wat held lable after a wemiin who was scheduled for a standard chokezstectony'® wuifered isvepatable brain damage due to the negligence of the anaesthestologiet. The Court, epesking though Justice Kapunan defined the dowsing of “Cap tain-of-the-Ship” ax follows: Atemunciates the linbality of the augeun not only for the wronpfl acto itooa ‘Menphasis supplied ‘This, the Supine Court declared that assinyeon Agethesse-callecd Se 0 Pyofesti z = Fa 9538) aad eas ee Imes S18 HGRA 478, 48, Jam. 31, 200%, eng Seth, esos, 157 So. 3am 1 BPinguth, 327 Phil. 965, 977-054, tu, ate Liv pacrionany Ba ed eg reece ne! SUSGRA 7 Jon 31 ineymectany is the ewacal euetnen Bladder ‘x ances Gout of apps (Beemenh iS916 PHILIPPINE LAW JOURNAL [VOL 85 (RRR. Th fet, the smigeon in that cree, was precisely miulged av negligent for being more than thee hours late fur the scheduled pivcedure, ‘The doerine was aibsequently upheld by the Supreme Cantt in its Regohatan'?? dated Aptil 11, 2002 which denied the Moturi fue Revonsidetation by the meepantlente which taised the argument that the tree in LIS junsprudence i te peject the apphication of the “Captiitafthe-Shis” dectine, The Suprenie Court trjected this cuntention mth this wise: OE Siar dase bs waitin Assen jurisprudence Wo che away with men the Captaaiof-the-Ship doctrine dees not mean thas thie Geupt will v4 foato 4 follow vsid trend. Bue regurd fot the peculiar taetidl cireunatahces Mou; cobtwining in thie ense justit the application of the Captin-ofthe Ship ue doctrine Ftom the few on record it can be logically infested that Dr. Horaka exereined « certain deyuee of, tthe very least, eupesvinion ovet the “GDF procecute then being periouned on Feinda ee ows Be pal the ate services of Dr. Hosaka and Dr. Gutiberez seere secured po tha performance of acts withiti their reepective fields uf expertiae for the treatment of petitioner Exlinds, and thet oe Hoes hig not exerche control ever the other, they were certainly pet completely independent of each other to ably eplipet the other plysicinn 4H 82 ty abaolve one from the 1 ot ach of x «Tie quite apparent that they have a comment 4 ee teat the patient, which: ere ‘ecbesttates that they ci i each ciate petforming the neceneury snedica profedincs eee on series of Appeal (Reschiion), Secviers Ine, S43 9R 476, 1 Sar, 53a ee ee AS, Jan. 34, 2007.wii} DISSECTING PHILIPPINE LAW AND JURISPRUDENCE. 217 Andther doctrine that ean find appheation iy the “Borcwed Servant” duoteine whith war cited in the Court of Appeals decision Mivleotetionin?’, Tt isa . " reget mincencnaten Mevmear ir oe . It has been defined az follows: Sec canvaapromnmnevtmeeterenany SES ” spmtind SuRea However, this dortine hae Rot been tullp-adeptsd it Philippine oMespatdeost se-the rssus of sis -apphenticn by-the Court of Appeale-was-not elevated tothe Supreme Courmise-resohition, B. Hospitals Gerietally speaking, a hospital ix a place appropnated te the keception of persone ack be intitm in bedy or mind, te which people nuiy tesort tet medical or surgical tedtment."?> Hospitals may be either public, stich ag thove hospitals govemed ditectly by the state, tv ctficers, of those owned and operuted by public cetpomtions of government agencies!®", or private which are those hospitals founded and maintained by pnvate pettone or a corpotation.* Hospitals are getierally incoeponated bodies created by special law of charter or by ittcorpoimtion uneler a general law.!>! It is not neceesaty, however, that hospitals be iheorporated a they may be created by will or convesance of chatitably dieposed petvons, in whith event, their power snd purporey are declared! Wy way wf teaste in the ingtnument of thear creation.t% READE CY Ne. dat 6, fo, tog aria. lane, 182 Ga App. 1b, 334 0.624 BAS, 549 (1987, , c meee App 8 3346.8, {1987}; Yoana ¥. Spatemd, 25 Cal2a 46 Aor, Iie. 2492 a8 654 6 Bees Joe. 24 G20 0 863-864 41 C18 G1 esse 1 46 age, ee. 2d G4 at 850.553. oid 88).ois PHILAPPING Law JOURNAL (VoL. 85 Af @ general nile mad in the Absence of 2 stamitory provirion to the contrary, a hogpital created and exrung for purely governmental purposes and under the ve cwnerdip and control of the stele oY a gaveenetiental subdivision is not liable for the Heglgener or misconduct wf itv employees.‘ This is because mich hospitals are held to be govemmental agencies brought into being te aid in the preformance of the public duty of protecting society from the individual unfortunate or incompetent in mind, body, ov murals.) On the other hand, it has been opined by an eminent civiliat that a private hospital capnot be held liable te the fault or negligence of a phyvician of surgeon in the treatment or operation of patients. The foregoing view it grotinded on the traditional notion that the professional stitus and the very nature of the physician’s calling preclude hun fiom being classed as an agent or employee of « hospital, whenever he acts in a puofersional expaeity.°* Physicians are said to be generally tree to exercise their cum skill and judgment in tendering medical services sans interference’ owing to the highly developed and specialized natute of the practice of mediving.!** Hence, when @ doctor prictices medicine in a hespitdl setting, the hespitad and its employees ae deemed to subserve him in his minietrttions to the patient and his achons are of hug own seeponsibility.' Hewever, the teditional ee has baal war due to the medémization of the prtctice uf medicine. Hospitals become incteasingly achve in the supplying of anid cegulating mechcal care to patients and their cole was no longer limited to furnishing room, tood, facilines fet treatment and epetation, and attendants for its patients? and inttead have become centers for healing and treatment due to the facilities avulable that would enable competent medical practitioners w for the needs of their patients, E Ar a foe tr CLE $9 0 882 cmmy Order 7. tetewon, 254 Ml App. 89 manele ‘4 $20 Wt WSS cteg Cinieresty of Louk © Motealfe, 2:0 Ip 32, 287 Sw 943, ap See 2 ett ral a, Wit B13 3GRA 478, 49%, Ja. 31, 2007, Askanene Pevesen, ae Sa ae be hy Qoedeien, 147 Ack x ae ae aie (1924). Lome sages 9 Ta had 8 272 Seapinteded br statue om whey Meo ¥, Meacy Ihe Ce. . Beaches, 83 F ad aoe eden jeeiae Aone AS22198, Wet ng MPa Bn, 2 Aa SS8 ES as gomy OM or vig MER +. Cilot 38 Cole App 374, S20 p 24544 977)214] DISSECTING PHILIPPINE LAW AND JURBPRUDENCR 919 At piesent, hospitsle of a atictly pavate chanacter adap be held ov found lishle te patients ae well as te strangers the the negligence wf titi sereante!* The mete fact that the compentation eeceived is inadequate, or that ao cothpensiton is weecved, does not affect the application of the rule of libility.! Amenean law wecognier that even hospitals have a duty to exercise that eegree of cake, skill, and diligence abd by hospitals in the community, and vequired by the express or imphed contract of undertaking.“ In the Philippine junisdietion, the fullowing are the emerging: trends which jnatily the imputation of ability wn private hospitals, 1, Vieurions Liability of un Eamphayet ander art, 2180 of the Cell Cook ‘The landmark case af Rewos % Ceant of Appeut ersed all doubts as to whether thete can be an employer-employee relationship between hospitals and dovtare, The very words of the Supceme Court were of the following tenor: Tn ather words, private hospitals, hilt, fite and exetelse tal control bver theit attending and wait “consttnt” staff While “consultants are not, technically, oe the control exercised, the hiring, and the fight to terminate consultants wll fulfill the important hallmatries of ‘an employer-employee relationship, with the exception of the payment of wages. In aeeeseing whither such a relafianghip in fact exists, the control test is detemsining. Accordingly, on the basis of the foregoing, we nile that for the emo of allacuting responsibility in merical negligelice cases, an efployer-emphoyee relationship in effet emete ‘betweett hospitals and dheit attending and vinting physicians. Aw wueh, a hospital can be held lisble for the negligence of i@ doctos- employee Wased on art, 2180 of the Civil Code whieh conaders a person accountable not only for his own acts but also for there ef others based on the fonnier’s tespoisibility undey a velationship of patria pa/esnai!® Astele 2180 of the Civil Code which provider, fo wit: ‘The obligation imposed ty article 2176 is demanclble net only for une's ow! nett of omissions, bit alo fot thore of persons for whom oe is Emplogers shall be hable for the damages caused by their sn ih A Ht 28 $8 8 $0 ag cae» Newman Hespail, Sk Ge App 104, 198 SE 122 met wether cates, 46 Deni Community He spinal sry, $88 Va 746, 49 SERA WH 173 ALIS Set Gand Tiamorad Hetenal > Mlanbsht ¢2 App Do 234 Soa Pad 72h, 3) ALIA 1276, tevmyhan Hospeea v. Byatnon, 2:8 Ala Ada 118 Se 741; Thompacn #. Methadirt Hoxphtal, 211 63, X67 14 ™* Protietional Sermices Ino, S93 SQRA 4M Jan 91, 2007; Ramee ¥. Gout of Appts (Rewohitiont, Mi Ramee ©. Cour of Appeals (Dean, at (241-41 (cmaphane applied, craton canited). MOTd st 1241 ahng Jose ViTuG, COMPENDIUM Ce CIVIL LAW AND JURISPRUDENCE 822 (1993)920 PHILIPPINE LAW JOURNAL [VOL. BS sinployect.. acting Withie the tcope of their atsipned tarke, even thatuph the fomnes ate not eogagedt int atty Ninbee or industty.. The sepensitibry weattd of at this atiiele shell erase when the pemons iain mentitered Prove that they wtiterved all dhe diligenwe of a good Haber of « Kune to prevent damage: ‘The is a codification of the Ametican doettine of arpearhat superiars? whieh holds an employer et principal liable for the employee's or agerit' wrongfid acts committed within the sespe of the employment or ageney.!® The vicanous habulity of an employer is well-entrenched in ouc junsdieton as it is founded on public policy that 18) a deliberate allocation of risk of losses enused by torts of employees and that in holding an emplofer strictly liable, he is givers the greatest incentive te be careful in the selection, sistruction and mupervision of bis servants, and to take every precaution tu see that the enterprite is eunducted safely.” As auch, the fate mandates chat liability for damages attach te emplatert for the npgligent acts of their employees who ave acting within the eeope of their assigned tasks, 2. Vietrions Liability awiler the Decisive of Apparent Authority ‘The doctune of apparent autheirty, also known as “holding out theory” oe dectring of catensible ageney oe agesicy by estoppel, is a means of imposing hability not based oh contract but based an principle of estoppel, ‘The deetine of apparent authority was introduced to medical malpractice actions in the care of Nogaits & Capite/ Merial Center, In that case the Supreme Court speaking through Juries Antomo T. Carpio, adopted the sitionale of the Tihinois Supreme Gourt in the case of Gilbert & Syatmort Municipal Mospital’? as follows: [Linder the doettine of it authority « hospital can be held sicatioutly Hable for the egligent acts of a physiczan providing eate at the seb arm? ter bce ear ag taal n it ae vt ik ah * ‘The elements of the actin have been vet ett as Litevally eneane “ler thie eupesjor take aceon” 3 BLACK Lew DICTIONARY fieh a. 206%). or FetAY Lane. Ine.» Heice oF Milecdan, OR No. 154278, Geceruber 22, 2002 cng Weta L Poe, ant Roiaet K JME Lax OP ToRTs SCO-SC1 (1989). Sw aise Metts ‘Transit Conramicn 2 Saed hoped, $80 92RA, 1 (1998). $8150 Ml bd S11 ce ee oe Desembes 19, 2006,2011) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 921 For + hovpital to be lable under the docmine of apparent withianity, » plainticf mist sew thas (2) the Noepital, ur ie agent, weted in a voatther that would lead! 4 tegannable person to conchute Hat the individ! Who war alleged to be peghgent was an employee of gent Ui the Avdsepsital, 2) where the acts od die agent crewte the appeanywe of mithority, whe plait must also prove ftiat fe horpatal had knowlege of nid acyaercot tm them; and (3) tw pldinuiff weted hs reliance upen thé conduct of the hoepital or ity agens censietent with ardinary care andl prvdlenen The clement ef “holding out" on the part af the hospital doo dot tequire an expatay repregentation by the hospital that the peiwon alleged to be negligent is an emplopee. Rather, the element a vatelivel if the horpetal haleh itself out as « provider of emuergtncy room care wilhwit jforming the patient thar the cane is provided by independent contacter. The clement of justifiable reliance on the part ef the plainwff ie tatished if the phuntft yeliey upon the hospital 16 pouvide comet emetgeticy room cate, mather than upon a specific phyviciait,” ‘To apply the doctrine of appatent authority, the Court in Nageles laid down & two-tactor test to deteamine the liability of a husptal through the acts of an independent contracwr-physician, Those two factors are the representation factor'S and the patient rehanee!™ taetor. This test is sy made because the doctrine of apparent authority is @ spevien of the doctrine of 1 The doctrine of extoppel is embodied by me iat of the Givil Code! Heoppel rests on this cule: “[Ww]henever a patty has, hy hie own declanition, at, or omission, iitentonally and deliberately led anuther to beheve a particular thing true, and to set upon such belief, he cannot, in any htigation arising ont ef such devlatation, act wk onusien, be permitted to falsity at"! The Court it app estoppel in medica) malpractice cases was guided by the culing of the New ‘atk Supreme Couet in Ria MitabelA5? where it said: Asa genendl proporition, ‘(3] hoxpitel may hot be Hitdd for the acts of da acest vo oe ploy of Sheep ee proup of independent vontnctors’ — Vitatious Wabiliiy for gretion! tualfiretice may be imporeel, howevw, imnder an apparent, or atteswible, Pera, eC "Om eA ie reer called, ageney by erupyel ur by haley 1 wo Se BREST! SCRA 204.223, Dente 18, 2005, wnt tae nd mate enh aon isyendmed comclitive Upon the petscr SUL SCRA 204 223, Deemer 45 ‘Comex ©. Ginete, : amsiee 3pm Biel ofthe Reece 9, 2, ating De ¥ » 337 Phil 453 (196) MN AD.M 984, Bio NY-S.Ad 16> i00)PHBLUPPING Law JOURNAL [VOL. 85 Easontal to the eseation of aj parent anthwaty are Words wr candle of die pttncipal, esanrweinicated tore thud patty, dha give rise te the Sbpesaanite snidibelied that the agent possesses authority W act on hebalf of tte pritcipal, Alun, the dul party must reasonably ely upore the Rbpanenice of authcaity evented by the principal Finally, the third piety must accept the services of the agent in reliance upon the perceived teletionship between the sent and the psincipal The dectine of estoppel ia extentially grounded GA equity intended to avoid « cleat cate of injuatice,”" Ite application to medical malpmetice cases may be oasentially vid to grant tehel to parties who have sutfered mjury but find no femedy in positive law, Thus, piwauant to the dictates of equity and justice, courts are allowed to grant relief tu the pastios a clearly justified by the circumstances. Fron case law, the eatendial elements of estoppel are: (1) lack of knowledge and of the neane of knowledge of the teuth ax the facts in question; (2; relianee, in good faith, upon the conduct and statements of the party to be tstopped; {3} action ot maction bared thereon of such character as to change the position Gr ttatus of the party clining the estuppel, to his injury, detriment or prejudies,'6 With respect to the foregoing, it has been said that the most important clement of ‘equitable estoppel tt the party invoking the doctrine must have been misled to one’s prsiudicn) 8 Akin w the eluents of estoppel, the first element of the tert for the applicability bE the doctrine of apparent suthorsty is the representation factor, The representation focuses on the manifestations and acts of the hospital which would lead a reasonable person to believe that the individual allegedly negligeht was an emplogee of the hewpitul’®, Such represehtation may be either expiee? of implied. Itas important to note that the essence of this factor iv not the manser by which the hospital acted but whether such act ob acts if taken singly or collectively by the hospital ov its agents can perrunde a reasonable perwn ti believe that that the individual allegedly negligent was an employee of the hospital, In dppleing the wid test, the Supreme Court cobcluded in Noguits that there war aifticent representation, albeit implied, on the part of the part of the teypondents that the negligent physician, although an independent eoHtmctor, was eects 4 Id teemphanes andhcitstioty onutted) + Wranula Kentents) Paik Cetmtet, fre, ¥. Oe f Appeals, 3 0 Mes 13, 2000, La Naa Drug my», Ceuwt, od pede GR fer tenn ae eae Phd Savings Bark +. Chewhing Feed Ge 77826, $89 RA Tat LG Ne siN MSCRA IN Se aL ie EE SE ite as * an Gan hag Lk SK Ne x ‘* Noples S11 SORA 204,223, Becynber 1 atu,” POS 17282611) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 923 om employee of the hospital ax far ax the patent wae coneered. ‘The Court first peated ont the rtaff privilege! gyanted by the hospital w favour uf the doctors ta the foc of extending the use of ite medical facshties and the servicer of its oedscal statl an the botched operation, The Court thes exantined the Consent to Atlmrsion and Agtcement and Consett to Operation which were required signed by a representative of the patient by the hospital as a preesndlition fer admission wod treatment thereat. The sat documents taken collectively fave a clear impression that the hospital exercised slipervision and eunteel ever its staff and phyncine aiid thus placing the achons af the former under its seepotysibility. The Supreme Court concretwed itt conclusion of representation by the hospital by losking at the referral of the patient's condition te the heepital’s Head of Obstettive thd Gynecology Departinent, thereby giving an impression that the finghgent phivsician was a member of thé hospital's medieal staff in Collaboration with ite othet employed specialists.4®* 9 fd wie Mt"This Consent ro Adminaun and Ameement plositedk MINOW ALi, MEN BY THESH PRED 1, Regelic Nogales, of legal age. a romdent cf 174 fd. lalate fla, being tht fether/meether /Wathat:feuter/ spore: petten ws custody cf Ma Scraper, and repyerenting lus har ‘lin and free will, dy ectiaest id avtihit aid Ma. Corser sages tos ts it perseaty ac by ne coop an og ineaguces, that d ns ‘of by and at Center and/or its wtaff, may une, adapt, or Employ stich mens, futme or methods of cure, treatment, retremtinent, oF emer, Menkes ae he tray tee and most expedieii that Ma Cotazon and I will any aiid aff rules, regulations, Wirectione, nd instructions of the Cogito! Medical Center and/or ite vai anc, that {wail pet helt et responable ahd heteby waits atid Eotawet dhacharge and held @ae ths Phyaiclats the Gapibel Medical Conmt and/'at ste stati Born aby and all dare af whatewar kid of nate, mining from dicey i wntlisectly, ox by teascn 2 émd ete, teeanmenl, vr seWektinent, or emergency MaMHle of iMrervention cf phen, the Capitol Medical Center and/ex tte staff jenoptsseix seceded) e = “hab the Consent to Operation presto: 1 ROGELIO NOGALBS, % % of my own volinen spd thee will de cubgtot and gubmit ohid GORAZON NCNALBS te Hyotsiectasyy ty he Ht "nt robo agit Madea Cer ne meet operahors, treamnant, wi efitgency meaturee ae be ineceneay Party wine patty dirariese. i a booty onthe ovens Sutgeon, his absistants, snesthreclogiets, the Suns itaaeal ro: talked psec tes oy ect e aacar eee paras, ging fice dives ot indivsctly, cr by reach af dai operation ef epeciticns, tristment, ct amatgency mews, ot mitsyentioh of the smrintantey, ancstheaoibets, the Capite] Medical Genter and/ct ite rtaif, retained, Id at 205205) at 236. & Md924 PHILIPPINE LAW JOURNAL (VoL. 85 ‘The wecand frctor ix the patent's reliance ort the inaoifestation and acte uf the hospitel.'® th ts cherctonmed aars soquity on whether the plaintd? acted in teliance upaty the conditet of the haspital or its agent, constetent with fotcinaty cate and prudence.) This is akin to Wve secerid element of wxuppel, which is: rehance, tn goed faith, tipo the conduck and statements of the purty to be extopped.io ‘Ths thetor hav been emphatixed av the most importnt element bf equitable estoppel iv thar the pasty invoking the decttine must have been itutled to one’s prejudice." Thus, itis essential that thor mtist be a showing that the party injured has vehed on the employment relationship between the hospital and the negligent pbyrician in keeking treatment from the Hegligent physician, It must be pointed out that the application of the doctsine must he predicated on a positive act and not on 2 Hexative ohe, Thus, mere lack nf knowledge ae to the abaenco of an employer. emnployee selationyhip will nut sullice. The reputation of the hovpital has been “unitormly recognized’ by conta wt an important factor in eletennuriing: whether or not the fretor of selionce is present!’ However, if the Pationt spproached a hospital intending to meaive care trom a *pocitic physician while in the hospital the factor of reliance bat been held to be abstnt..7) Another way w show that a patient relied on a hospital can often be extablithed by an infevetioe from evidence that “ppart perronnel were supplied by the hospital to avsist the pationt's personal phyticion, ana the pationt had 0 twason to believe they were onythitly ether than hospital employees”? In the case of Nogales, the Supreme Cow held that the planiffe vehed upon a pereived employinent relationship between the ering doctor and the huspital, which was of colsiclenable reputation, when they accepted the doctor's services.) Jat the eave ct! Pryfisiewel Sernied, dnc, i: Agama, the Supreme Coust a had the opportunity t apply the doctine of apparent a this oie inoipiite ty Ori Medheal City fow the nbghigent acts of one its Nugeons following botched surgical opevation, Ths, whére the hospital publicly displayed in its laby the names and speciahsations of the physicians associated ox actiedited by it “it now estopped fiom pasting: all the blarie to the physicians whose fames it proudly parncded eh fe. cae iitwctoly leading the public to believe that it vouched for theie #ill a Compatence.”\"4 The Supreme Court further veiterated wie ta fd gt Di. Nowe Haden. 62 $a wt (2008) oe, Sree Bak Cheeky cd Gin, IR, No 77506 SST AGRA M94, 925, Jul 4, 200%, 10 Am fu Precefof Past Mf fete Pte Re bay hg yy ent eg 14 Wie 2a 188, 425 UR fa NESE Pa SA ny on 8 Cae Nel Ca 45 ea 5, se & Negdes, $11 SCRA 204, 220.225, tecemioar DY, 20K ‘" Profeesical Serwces ine, $13 SCRA aa, S0D508, Jan, 32, 2607.2011) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 925 feat the dloctnine of apparent suthouty Ands appropaate application ity adjudging hovpitals as vicancusly Rable tos the toftious acts of ite phyriomy ar corporate ovtiies that own and operate such hospitals can only act en wothbe individuals agents oe in this case, physicians!” The nanae of the lishibity puiwuant tu the doctnine of apparent authonty ys aolsdaty in conformity with art, 2194 of the Civil Code 4, The Doctrine of espera Negligeme The doctsine of corporate neghigtnce was introduced in the landmark case of Professinnal Seravces, Im, &, Agnan'', Tt involved no lee than the triedical giant, Medical City General Hospital, ene of the country’s bigyest and moat tuccessful hoxpitals!™. The case was a complaint for damages filed by the Sinrique Agana and Navidad Agana (ater substituted by het heits) against Dr, Miguel Ainpil and Dr. ivan Fuenter for the injusies uttered by Natividad when Ds. Anipd and Dx, Fuentes neglected to remove trom her body, two gauxes which wete used in a hysterectomy performed on April 11, 1984 at the Medical Gy General Hospital. When the case way elevated Supreme Court, the Supreme Court in its Decision dated January 31, 2007 adjudged PST as prinwaily and golielacly able with Be. Armpill® pursuant tu the ruling i Ramos a Cut af. wherein hespitale and its doctors were declared to be bound by emploperemployee relations, under the doctaine of apparent authority!# and the doctrine of corporate negligence. The doctrine of corporate nehgence is a doetine taoted in American jusapaudence which finds its engin in the case of Darlington & Cheuieiton Coovninnity Mewariel Heipital’®. whece the Supreme Quit of Ilinvie saeerd the hospital as negligent “in Fuing to have a sufficient number of trained nurses attending the anent; failiig to cequise + consultation with or examtunation by methbers of the F338 a HS #% Brofeaaesial Sectices Ine, SLA SCRA AT%, Ja 21, 2007, cS fe The Mekal wtht Capit ci’ Heath ata Nesge/ Jere dhommadicacity. ity Hise. aapac'SS=816 {lsat iaited on Mach. DI, = fa Pend Ses ns, ZORA ARS Tan 3, Se me piatestenal Services, In, 13 SORA ATE, 6, Jan, 41, 2007. ae %. Chatlesten. ‘Hismnctaal Howpital 34 MIL 24 326, 2) NER. Za 2k3, & Gaiste ¥. Homitd, 18 NI 2, 0 A dd 534 5 L Gupsr, Se Caw Div i973); Pubcell x co Vs Asis. App. 75,500 P. ad (AST: Movpiied Auahesty oc losexs Mie oeree he an oa926 PHILIPPINE LAW JOURNAL (VOL. 85 The doctuine of ceaporste neghgence developed as meeponie to the pwwhlen of allocatng hospital's linbihty for the reglgent arte of health prietitionest, absent tacte ws anppoct the application at reyseaihit oxperier of appatent authonty.' [typ an otfshoot ftom the development of mudéen hospitals ur eecagnition ot the fact thar the chity af providing quality medical service ts no longer the sole prerogative and sesponsibility of the physician, Hoypitily now tend te orgamae a highly professional snedical staff where competence and performance need to he monitord by the hospitals commensurate with their inhexent responsibility te provide quality medical care.’ Under the docttine ot xerporate negligence, the hoxpital over a ditect duty te itt patente to ite patients te ensube their safety and well-being while at the hespital** In Philippine jusisdietion, this has been trandated ax the “duty to exercise reavnable core to protert fram hatm all patients admitted insto its facility for medical treatment." Iy has been also defined as « divect theoty of ability againat a hospital, which contemplatee some form of aystermic Apgligence by hospital, net sunply @ vicancus theury of liability based on the negligence of its employees.!* The doctrine of coupentte eghgence has been deactibed as “broader than the corteept of negligent eredentialing in that corporate negligence includes acte of direct Peicial gions atich as negligence in diet aaa cate or iw failing te enforce hospital guidelines regarding patient care.” ‘This dootring las led 16 the recognition of additional duties on hospitals. Asnong these duties include: the \ise of reasonable care in the mainteriance of sate and adequate fseilities and equipment”; the selection and tetention of competent phyncians; the averseeing er supervision of all persons who practice medicine within its walls’; the formulation, adoption and enforcement of adequate rules and policies that enmue quality enze for ite patients!%; to make a ceavinable effort ink monitor and oversee the ¢reatmest prescribed and administéced by the phyncians piacheing in its prenises”? Breach of any of the foreguitiy duties wi justify « finding of direct liability againat the haat bared Baste dpeatade! 3 Profesional Bervioes, Inc, S13 BORA 474, 80%, Jan. 31, 2007. wets eghaed © Gacribelnan, 18 duis, App, 75, 20 P2d 335 (973, sing,” ME Io 30 FAD cy Serve. btn: Nencosil Hogpil, $85 F, Rupp. de 23% (HD. Pm Mt Prodeefonal Rervicws, fxs, $13 BGRA 478, SOB, Jan. 31, 2007, WGA Ast be Stn ¥. Abitgtom Mintworial Hospital : nang oen Re rn a Sy tate ZAYAS oxieg Lanes v. Wateenfle, 135 NUW.24 300 chan, Pioleedctal «8 . aed sa ncaa pti S23 BORA 478, Bo4.505, Jan. 31,3007 nary ath Bulg, 543 Pa a wie ‘Rung A S05 caning Boat. Rie? 252 8B 2d 30, cee denied 300 NC.194, 209 8.8 24 62 (L960)2011) DISsBCTING PHILIPPINE LAW AND JURISPRUDENCE 927 coxpomte neghgence, The defitree of lack of knowledge ok nonce of cortan facts te the hewpital « not « delense. An upetstor of the huspital har actial or constitutive knowledge of the precechuces catned out seythws if premites.!” Lastly, the nate oF liability under the doctant of corporate nee i# direct!" as Sexponate Heghgence is m ttvell an actcinable act for the hespital can be ued under our law on quari-dehets, However, in a Revulution'** dated February 2, 2010, the Supreme Court verelved » second Motion for Reconsideration filed by PSI which rustained the Linbihty is not under the panewple of reondear operior fox lack of evidence of an anployment relatonship with Dr, Ampil but under the panciple of ostensible agency for the negligence of Dr. Ampil and, pre hav vir, under the principle of corporate neghgence for atv falune to pectoan ite duties as # hospital. The ramiticanons of the deviation in legal hesmeneuher by the Supreme Gourt cannot be overemphaayed. By conveniently inserting the phtase “pro ar wef’ the entite nuing of the Cevmt in the tase of Professonal Seoviens, Ime, & Agana is breathed a new life of its own. The gerwamen of the ruling by the Supreme Court \s Aavumanzed by Justice Renate Corona bwn words, 4 at All tine notwithstanding. we make it vleat that PST's huspital inability Based Seca eee only te this case, gow waige eur coms ees Maloy of Pat ce tam oe ‘apd ie — ‘wilh Dt. Aopa snd on edited cotgbsum dy to Newt (nghass Citing “citcumstmnces peculiar t this case,” the Supreme Court in effect atte ee for te oom of Pl and Pet » Pre hae oe is a Latin term meaning “for this one particular cetasion.”™ Thus, wiing expressly qualified bar vite cannot tolled pes: bs &pesciclent to gevoen Saar cooceo™e Henge be 16 0 "58 caling Prades». Bwana, 921 Aste. 346, 422 P- {a 102 09 he a fe tas 34 8, © Prcfemmenal Sermces, Sores I apna Raton a 756 Mrphans eapphech. See ermine whe cat. z eoumanoni = ‘Seed Famers Farry ¥. Commun on Hlectone, GR Ne. 164702,928 PHILIPPINE Law JOURNAL [VOL 85 Notwithstanding the ruling by the Supreme Court 47 tie ihaputing be Habehty of PSI on dhe basis of the duetunte of corporate rogligence pre Ane id ie revervation by the Court's euling a» pee Bar sv must nat ansl cannot be ae mean that the doctane of evipotate Hegligence is No longer weed bend The doctrine of torporate neghgente ia baseil of the ciety impused on hospitals oe exmvige reasnable cate to protect from harrn all patients admitted! litte its facslity for medical treatment. The deetine tt corposate negligence deer not impose any additional duty on hospitals, It merely recognizes the wherent responsibility of hospitals ty provide quality inedical care*"! Such mherent responsibility partakes of a positive duty imposed on # hospital, albeit a junidical entity, te exercise such tequisite level of diligence and cate in the conduct of ste buaners in providing quality medical cate, Ae wae explained at length earlier, it is He very bteach of that duty that the law comziders we an actionable malpractice tue which liability may be impased on the hospital consiztent with auc law quasi-deliets, In fact it is the very Supreme Court en daae that recogni¥ed the selt- imposed corporate duty of hospitals te it patents: Mortovtr, regordless of its relationship with the doctor, the hospital nudy be Told dincode lite tw the patient for its own neghgerwe er failure to fallow estatiizher! standard of wentaet fo which it should conform ay a eaparatians Such selfinpesed standatde by hospitals are in fact commen knowledge aineng the people for being halliwrk ef peernier hospitals that serve aé its badge of honoe te astute prospective pahents of the quahty of services they aller and the excellence of its specialiste. Take for example the following Mission Statement of oe of the country’s top hospitals: ‘To deliver excellent hewlihcare thiayh cating and competent profssicauls, utilising world-class ee and reroute! i¢ we shall do i the moat finariciatly viable way without losing sight of otit pritiacy. purpore - ta be cf service to Gad atid maitkind 222 ee gat) se 59), Jan. 34, 2007. et ell, Zomba, Ue ANS. Ap. 75, 800 Pad 395 {:€73 a Vrodatcna. Sevag, I. ana (BM Sete Reeuty nay Pate You, iaprean [eemuDeNe 21 (hoi and US. dis aod ippelats court came, $e ate Daitip v. Chacetom ‘SSermaanity Mervcwal Micapubah 1451.8. 352 860 (I Bape. 29, 1965) we Liha adhe it Mision = Stument = atilahe at Irish eematagvaenly Nelddepericaet tral last visited March 19, 2010), es also the Capital Medical Senter, a ee Mea feta the Supreme Court recognized the criminal liability of a person whe attempts to treat a person of all despite lacking the requisite medieal training: to practice medicine undee the law. In that case, the Court convioted the accused of unpradence as detined under the Ole Petal Code tor wrapping a piect of dothing which had been sonked in petroleum around the victim's fret and then lighted the clothing for an hour and a halt, thereby tausing severe injunes to the latter in an Attempt to cre ulcers in her feet. The Court recognized however, aa a mitigating factor, that the aceused had ne intention to cause an evil but eather te semedy the victim's ailment, Prue : Buewsige,* invalved a woman chiropiaetar who roaintained an alice iy Manila und sepuetented hersell as a doctor by treating the head and boy of hee aasietint for the purpose of cunng hin of the mlosenta, diseares, pains and physical defeets from which he pretended te suffer. She offered and advertised her seunices as a physicun by means of earls, Intterheads, and signs which whe exposed en the door of het office ax well at in newepapers whieh were published and sioulated throtyhout the City of Mafila, ttt her advertisements atid related publication she prefixed to her name the letters ‘Dea’ for the Purpose of causing the public ti believe that che war a doctor. She demutted te the Information cling that it charges her sith move than one (1) offense and fhit to tequive chivopractor® to take the medical exasiinations for the pkichce bf medicine aricants to # probibition of their prnctict which is wxeonstitutional, The Supreme Gourt brurhed avide much arguments ane! found her of vialatiig the Medieal Law an penalized hy section 2678 of the Old Adininisteative Code, as fillows; ‘The offerme fete petuiiaed i “violation of the btbdicd Low The atwntte maker nie distinction: Uetwerry ilegal practice of medicine anc Te elon tenn Tee Both are m viclationy of the Medical veadry the saarie ity. ate mertly different: ‘meats of ‘cotimnitting the vase clfeewe and beth of these means en nea aa each other and unudlly employed togethes, 2812 PAL 175 (L908, tb 47 Phi 336 (L929).2011) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 933 KEx Under the seovnd enigament of error the appellant 9 in subytance that chisopriotic has noththg to do with medicine anc tht the perctice of that prafeation nan therfore not be regarded a# practice of medicine, There is tio mest whatever in this contention, Assuming sathenit cunctding that chirepmetic does nit fill within the wm “praetice of medicine” in its ctddnary acceptation, We have the stanitsry definition combined in section TMi af the Adkittistrative Cade wid which clearly inchides the mampulations emplojed in chiropnietie, The astanitory defitition necessanly preveily ever the urdinary one Under the ame sssigrmetit of error the defendant also adgucs that the examination pteseritied by section 776 of the Adminigtrative Code for #eimission to the practice of merdicing, embraces subiewte Which have no conection with chiropricte and thal to kecpuire chitopracters to take that cxaiination is unrtaronable and, in btftct amounts to prohibition of the pmctice of their profession and therefore violates the venehitational printiple that all men have the nyht to life, liberty sad the purmuit of hupisiness and are entiled t6 the eqiial protection of the hw There is very little forve if thik argument. The eubjrets in whic an chomination is required by sections 778 af the Administentivn Code, amended by Act No, S411, mlite to matiers of which a thes knowledge secs nevessary for the proper diagnosis of diseases of Twanian body and if it within the pelle power of the State (esi that penne who devow theniselves to the airing of hud dle poasest such kaiowledge 27 In Prope 1. Vike De Gale?" tho Supreme Court, albeit by way of wbiter ditene®, pronounced that a potion whe treats another despite the fact that he or ahe does not possess the neveesary teclusieal knowledge er skill te do vo and caves the latter's death may be convicted of hemiide through reckless itbprudence, mtiocinating, w+ fellows: ‘We agive with appellant thit the ordet cf cistnissal is etrerieatis, in that the ensie of legal practice of iedveine # 8 rtenitoty cifties Wherein cristal inteist ty taken for pruned, so that a petron may be convicted thereof ee eect ss ee uth and ithout malice: L6. even if he wie not motivard by an evil derive 10 lmajsete ot Tart ances, belt by as honest desire to cute vt alleviate the piss of A patient, In fuel, ae defined ty Section 267% Gf the Revued eeenceteneenatnttamnsaaiet 2 Th, a $39-54l. on 0d Ee eS ey. ets Dewpus finding the order uf duerueral ‘faust to be etenesns, the ulpteld as ite ‘ere wed le the cotton Baht ofthe snes agus able epee mane,934 PHILIPPINE Law JOURNAL [VoL 85 Adtainintestioe Code (the live then in fone), the atines seas ope mmste act of practicing cardiewte at vtlation of the Medica Law, even if ma inguy tc another, mitch Jere desth, sents from suck walpeactice, When, therefore, te patient die, the egal practitioner shoukt be expeslly Sesame: for the death sf bie puient, an offence independent of anc chstinet fron the legal practice of medicine In Prope : Weagnn®" accused who claims himself tw be « “haturopathic physician” and toutinely heals pahents without the use of dings and nibdicines was hikewie convicted for treating human ailments without the license to practice meccine wader the Medical Lay, The Court rejected his claim that countless peuple inclading roedical Praetitionet, members of Congeers, provincial yevemors, city mayors and municipal board members and even the Chaiman of the Board of Medical Examiner impliedly assented to his prtctice without the requisite icehse as they all salicited his setvices for the reason that: We cannot allow the ba away of public health and sifety for the temblanee of benetit to « few goverment official, peuple or tven municipalities. Similadly, there is ne sve thing as imphed hieeiee te pravtice ‘oy the mere fhet that the Chairman of the Board of Metlieal Rxaminees had pemitied appellant to serve free in the Contes! Litzon Sanitarian in Tala, Caleeean, Rival, br dit countless peraizted an engaging his services, For one thing, these people my we contracted his services on the mistaken hetion that he was duly oy fon for another, & repetition of illegal acts exe never make Purthermore, the Supreme Coutt rejected his elain ef acquittal based on the Medical Act recognizing phyrivtherpy as a science antl that he does ro upon the teconmendation of eegittered physicians, The Court found evidence to the effect that the avcused slone diagnoses his patients’ ailments and apphes the remedies therefor without written otder of presciiption by a registered physician. 8 Cremeew® jt a case of recent vintage, which involyed the eneantaeliet ation sts ahh sacohaltiieg tap hier od an possessed by a “bad apis”, In attempting to exorcise dhe spit, the accused ey eae Me Nor feet Sri tit of wanes flows Facing, hein: to tink a gallon of water while tied to a bench aid thereafter cepeatedly 2% People ®. Vda Tos Geles, 108 Mul at 958, md SRA 28 190). 3 GR Ne, 137208, 355 SCRA 207, bar. 26, 200.211) DISSECTING PHILIPPINE LAW AND JURBPRUDENCE 935 pounding tie boy’s head agar the aaitl beach. The bey died finin the severe tena sulfered trom the aftenapted exorcism. The accused were convicted by the teial court tor murder and wae accordingly sentenced with the penaliy of reehuiow feqieme O8 appeal, the Supreme Court modified the verdier tw reckless tiprucence tesulting to homisitle, In oaliiyy that the lack of tnedical ekill amounts te vecklets imsprudence, the Court anid: Article 308 of the Revised Penal Code, a amenvled, stives that fockloet imprucenee vonmiste in vohintadly, but witheut mules, deine or thiltigy to do an act fain which ninterinl damage reaults by reason of ineseutable lack of precaution an thé part of the persen perforining each act, Compared to intentional felonies, wich as homicide vt antdes, what taker the place of the element of inalize of intention fa E@menit a wrong or evil ® the failure of the offender fo wke precautions die te leek of skill takilig into account hes eniployment, or occupation, degese st intelligence, physical condition, and other cicuntstances regarding persons, time, and place The elements of reckless impnudence are rat ink fhe act done by accused-appellents which, hetaure of their lack of medical skill in lreating the victim of his alleged ailment, resulted in the latter's denth, Ae already stated, acaued-appellints, hohe of whom is « medival practiticner, to 4 religious group, known as the Missiouanies of Our Lady of Patina, which ss engaped iss fiith healliye Citing United States « Bisine22* the Supreme Court ititfied wich ruling on the ground that the accused had ne intent cause evil aguinst the boy 9 they therely aftempied to treat him of bis ailment notwithstanding their lack of medical training. The Supreme Cuvnt luther drew parallel with the ease Paap « Vda, De Gobre whore the penalty impered was likewise homicide theatigh reckless imprudence: Tt is clear from the forgoing that criminal prospention will Ke against those whe violate the law governing the pietice of medicine af if negligence is of #8 chamectet a5 to constitute criminal neglipence. Notwithstandiig the repeal OF the Medial Law its 1959, the Medical Act likewise prohibite under the pain of fine or imprisonment, the “egal Proctice of medicine” snd stich eoveiction will be setained regardless of whether or not the illegal ptacisee wow done for a fee27 ‘Thus, the jutieprudential wake of the foregoitig precedente temnsins, Aa wits said in People Vorera, onder the inimitable pulce power of the State, it may prescribe Zia is 7 sears, SPR exec‘OL. BS 936 PHILIPPINE Law JOURNAL val welfare wach ceyulations as in ite judgment will secure ot tend to soccer oa and of the people and te pyotmet them agamet the consequalicee eure compliance incapacity 4 well s¢ of deeaplien ane fate ane logeally, to wots consplatte with nick lawe the State may impuse penalties as omy be pronuiertn’ a tultilment of euch goal aubject to the exlepuarde under the Gonetaition: B. How is an setionable malpractice enforced: Civil Ldability ‘The tard and mest conanon xemedy available 1¢ a envil ae a camages based on a quaai-eliet. The legal basis therefore ix article 2176 of the Cewil Carle which provides, A wit Whoever by act ot omission enusee dimage to another, tere being fault of ssepligenee, 4 obliged ta pay for the damage done. Such fault of nephigence, af Hvine Ws to poe-existirys conitzactial felation between the purties, i# ealled eqiasi-celict mel is govened by the provisions of this Chapter. Bartel on the fomguing provision, the elements for an action based on quasi-delict ain: (9) daniages sullesed by the plaintift, (b) fault or negligence of the defendant, and {c) the connection of cate and effect between the fault or negligence of the defenslant and tha dandges inflicted on the planttt,* However, for medical malpractice, the Supseme Court has enunciated the following four eszeritial elements that corstitute an action for medical malpractice nantely: duty, breach, initily, and proxinate eausatios.° ‘The concurence of the foregoing slernents is essential to justify w recovery lux damages based on the negligent act. Ag war mentioned eaitiet, there is currently no law that guvems medical malpractice, Purthetttore, there is a deatth of cases featunng thie novel concept of law.) Noteworthy however if the fct that the Supreme Court has taken the opportunity of laying dows the dectrine in rhedical malptactice eases th the several conto versie! brought before its attention by expanding the scope of our law ott quaat-delicts ax a means to sectice rehef in caves of actionable tnalperctice. From 8 4 BORA 218 (1082), ‘ WF Phil. His of Sumamstet ». Comet appeal OR. No, 97626, 268 AGRA 485, 203-703, March 14, IDET, POU tnniance Gidp, +, Gout of Appeat, OR. No, 118889, 267 GRA TB, 1207, March 23, 1889, si Pisteb, $71 ICRA Ka #1, Now 14, 2008, Reapsa, 356 Phil 87, 96, Cut 5, 200% Garcia Rueda, 346 A aie ade ashy Waser, medical malpractice Was tes cage of 8m Lapa» Se Y of * Late’: Ropite (10S. Repate 418 fase tha Cet of Aogeeh te dering i plete ot held what the meghyerse ot phe phynicyan must be the prosimnat: catee of the anjwty, Chix Lape was cited a atottvasity in the tawep of Phab 87, 126, New 18, 1997), and Lava (S86 SCRA 123, 202, Ape 2. SA ke cf He wating of Aloe paper, these havs been only thuteen (13) cives that reiched the Suprem= Count iwc vias isons of snedical neghgener.211) DISSECTING PHOLIPPINE LAW AND JURPRUDENCE 937 theee cases, it ts observed that the Supeetne Court has tuled gidh unifisrntty that 2 hyacun-patiert relationship’ and expert medical testimonial evidence? are i. eletients of a suit far medical malpractice. In cases of mudical neghgence, jutenst (> wtuttatenal because where neghgence exists and ix proven, it automatically gives the injured a tight te neparahen fbr the damage eatieed, provided that all other elemerits of a case for medical malptuctice are mat , How is an actionable malpractice enforced: Administrative Liability A state, in the exercige of its police power, has the power to regulate the practice medicine within reasonable and constitutional linutations.>* The license to praetice medicine is a privilege or franchise granted by the government. * Az such, it may be validly cevoked by the goverment pursuant to such grounds as may be provided by law. ‘The administrative grounds fer tepuimand, suspension cr revocation of a plipncian’s certificate of regituation are provided for by section 24 of the Medical Act. The mibst applicable provision of the said section if paragraph 5 theseof which provitles that: “gross neghgence, ignorance, or incompetence i the practice ot hig er het profession resulting in an winuy or death of the patient” 2 # ground for disciplinary sanction against a physicion or surgeon, Likewise applicable is paragsaph 13 thereof which provides that » violation of any provision of the Code of Ethies fie Physicians av approved by the Philippine Medical Avsiwciation may hkewine be penulized with repomand, suspension, of teveeation a physician's certificate of cegistration. Purtheumore, the Code of Bithies of the Medical Profession provides for the ditlerent duties cf physicans iw their patients, to the pi rlenig Ph gtg Sacha ed retary a Pe festivnals. A waclation ve duties constitites unethical and unprofesmenal conduct which may subject an erting member of the medical profession te ether a reprimand, Rapension Gf, of revocation of the heense to practice mediane.2? 28 fe Capec-Lngam, 574 ‘Dace Runtn BA Pa as Sasa Peet EM DOE Reyes, 6 Pad 3,95, Ge 3, 200, ma 2 Sin Lacs, SEG SCRA 173, 2%, cape. 31, 2060; Ploree, S71 SCRA. 1k IO Ropes Ua £9 Se 3, eS, GarioNanda ta Pd Sah 3a tp. IY es ee POA Heese Te mate EDA 7 $56 ap 2. 00% at 141, aa Repilatios Comm, # De Gusta, GR Ne. £44061, 432 SCRA STS, $25, Jun 21, O CODE Ce BTICR OF Tom MumicaL, PROPESSICN, xt VII, §2VOL. 85 PHILIPPINE LAW JOURNAL f 938 hysician on the ground of An aggieved party may we an erting phy tHe Pru fesnanal sdtninistranve lability befor the Board of Medicine of the ore Regulatoty Commmiaiot (PRE) The PRC is att administrative apse e ete Premelennal Decive Nu, 428 whuch is vested by law with « blanket authosty for the Alpervision, regulation and hcensing of the dilfeneyt eee is administrative cegulation of the medical profession it enercinedd pan ly Ber Beard of Medicine subject to the appellate review of the PRG? Likewise, of BS erting or uegligent medical practitioners, such as byt not limited to Sale tadiclogsts and laboustory technicians ahd the like, may be held acttunistratively fable in an action fex the suspension of revocation of their license to practice, betore the appropriate protessienal Board. Ie 4s interesting to note that in Pasa! n Board of Medien! Examiners, the Supreme Colt held that in an adnsinistuitive hearing againat 4 medical ptactitioner tor alleged malpractice, the Board of Medical Examiners eannct, consistently with the self-inctimmation clause, compel tht person proceeded againet to take the ‘witness stand without Ins consent, Vi DEFENSES AVAILABLE, A Presumption of Due Diligence Performed Dactots am protected by special mule of law. They are nat gharantors of eae. They ave not insurers against atishaps or unusual consequences.) In. addition, physician is preeumed 1 have conformed to the standard of care and diligence required of the cieurnstances? He is also presumed te have the ntcormry knowledge to practice his protetsion® When the qualifications of a physician are admitted, there is an inevitable presumption tat in ptoper cases, he takes the necessary precaution aid employe the best of his knowledge and skill in attending te his patients These presumptions axise from the judicial tecognition that “the prictce of medicine (s already conditioned upon the highest degtee of diligence," According to the Supreme Court thete exist aufficent takeguatds to 3% Pres. Docene Ne, 233 (1978, $5. Sd wok we LOMAM, ZBORA 4a, Kay 26, 1986, “ S74 SCRA 430, 461, Dec 18, 2008; Crus, 346 Phil. 17, #75976, Now. 98, 1967. 28 Sa Laeas, 8 SORA 535, 200, a 21, 209, Cruz, 345 Phil 873, #76, Now. 18, 159% 61 Are tee 2A YIOP, sting yore, Parey, 193 F-24 18F (2d Ce. 191}; Rhodes v. Ds Haan, Lda Vean. 473, 337 Bg 194d (2595, 2° Se) Aas, 18x, 2 $209 satiny Beklabeny ¥. Kaiser Foundation Notthan Heepitale, 236 Or. 616, 359 P2810. 64 AL RSL LSD! 081). Cra, $46 Phil 670, 95, Nov. $3, 1997 8 Reyes 396 Phu 87, 107, Oct. 3, 20.wii) DISSECTING PHILIPPINE Law AND JURBPRUDENCE 939 eneaee that the medical piesraan R govemed high stundamts of quality and diligence, A met The perchct of meclicine it 4 proftysion engaged in only by epialified arcbeictials Tris a ght eared through gears of echmsahan, Taitung, ariel by fit obtuning a heenée from Hi etate through prifeasional toned fxaminations. Such heeuse may, at airy time and for enise, be revoked by the government. In additten to etate regulation, the porte af doctor i alto ttrictly governed by the Hippoctitic Oath, an ancient code of eiteipline andl ethical miles whieh duetory have imposed upon themselves in fecagnition and acceptance of their prtat responsibility te society >” With the foregoing pieawnptiohs in their favour, it is the general rule medical malpractice cases that the plaintiff bears the oa of proving the standard of diligence and care impoxed on the physician and that sad standard was breached in onder for recovery ef damages to be decreed by the coust. B. —_Coinpliance with the Requisite Sundard of Diligence Indisputably, the beat defense it a case founded on a quasi-delict is the Peesentation of proof that the reqisite standard of diligence demanded by the eueumstaneés has been satisfied by the medical practitioner upon whom feghgence of a breach of duty is imputed, It may be well te cecal] that the fiest and foremost element of a medical malprctive tuit is a breach of duty of a hyscian. ‘The breech of chity more often than not is wi the form of at act casera we another conimitted through either fault or negligence ef the medical practitioner See Gah ce ese ee ee a oe physician cotsist of The duty ef a physician is a celative osiwept that partakes of "cane bya tt digesta moan ky be cee ‘The essence of lability against a physician fer medical is the we of ay os cea fei trai ead apn ae ee cam Pan, Reliance where meh act is ether the immediate or proximate cause of the injury, 4 was discussed at Jengtl eater, the standard or force eee eab oF cate sill and gence tht oudirwnly chatctenaes the semonable average ment amung ovdinanly in the sghbodec sed in the sane punatal Ine oreo de aerate eo ES ae940 PHILIPPINE LAW JOURNAL {VOL. 85 tate the advanced state of the profession at the time of tmathent ov the present »1 oF medical seiente. As tu what conshintes stich prool, again we book eer es a guide, Wall-settled ts the nde that in oelet to settle the faetual isase et eth oe not a medical practitioner has @xpreised the tequisite degeee ef skill antl cave in e treatment of hie patient in inecical inalpeactice eases, expert fretimony 1 estential 7 ‘The best oxse that Uhustyntes the efficacy of this defense iz the case of Rees b Sistiry of Mercy Hoghitw®™* wherein the patient was admitted into respondent expital two (2) daye beste his untunely death complaining ef vecunnng fever and convulsion? symptomatic of typhoid fever which was then prevalent in the area, The teapoadent physician followed notmal diagnostic procedures fot typhoid fever which yielded @ pesitive remult thus, oronpeetin, s common antibiotic used to treat typhoid teves, was adnunigtered to the patient. However, despitt treatment, the patient died barely two (2 days fiom admission to the hospital, Hix here filed a cave for damages apainat the phyzician and hospital. The hes claimed that the Proxinnate eaite of death was not typhoid fever but the wrongtul administration of siterempertin, To support their clan, thee invoked the dectune af ri spar elairing that the mene fact that the patient died within two (2 days of being admitted uste the hospital gives ase ta presumption that there was nbyligence on the past of the physician and the hospital, The Supteme Gourt ejected the claims of the plaintiffs elairmung: the doctrine of fer shut oguitur cannot sol Citing the in Rawes %. Cont of Appeals, the Court held that doctrine of ws ise loquinwy ean have tie application in 8 suit against @ physician oF @ sugeon which involves the mveeite of a chagnosis ot of « ecientifie treatment. The physician vt murgton is tot cequined at his peril to lain why any partiedar diagnosis was not conmect, ox why articular shulse ioe did not ete the desined result Anent the ree wets of neghgrice ly committed the respondent physican, the Supieme Cor shvolved hee from any babiliy chiming that not only did the placate Aa aelduce expert testimony {6 prove ni eon the pitt of the respondent phyvician.s Hf Ftoges, B91 SORA BS, 92, New 14 2006 356 PRL 8, 102, Oct 22000. be Kaanoe y Gate of Appeal Cestes Famer. Cost of Appeal (etches. ia 1303, 28 Reyes, 396 Phil 8, 100, Oct. $, S000wt} DISSECTING PHILIPPINE LAW AND JURISPRUDENCE O41 Fustheomore, the Cetus found that the abeuhition ef the reepondent physciat wa? more than justilled in light of the expett evidence prevented in her favour. Thus, the Supreme Conirt ended ite analysis of the vase as tollowe: Indeed, the standard costemplatet! is oot what ié actually the Avethge iherit among ell lalaw practihoners ftom the het ty the woter and fron the most to dhe feast expetionctel, but the reasonable average alesit Amott the ordinanly govt physicians. Here, Dr. Maripn Ries did net depart from the reasonable standard reecmmended by the experts 48 she in fact ubvctved the due care rsigairedl under the circumstances. Theaigh the Widal fest ® not conchasive, it remain a staridard diagnostic test fo typhoid fever and, a the present cai, greater sevusary through repeatved Weting war fendered unobtainable by the early death of the patent. The reeulte of dhe Widil test and the patient's history of fever with chille fur five days, trhen With the fact that typhoid fover wat then prevalent a8 indicated by the fact that the clinic had been gettye about 15 to 20 typhord eases & month, were sufficient to give aay deetor of reasonable skill the wnprrarion that Jonge Reyes had yield fever. Dr. Rico was alse justified by recommending the adevinisteation of the dig chloromycetin, the dm of choice for typhiul fever The dueden of proving tut Jone Reyer wae ruffering trom ary other ilies rested with the petitioners. As they failed to present expert 6 ‘ots this, Prepandeniot evdenve te Support felt contention is clearly te ‘The foteguing cleady emphasizes the cole of expert medical testimony in medical mulpsichee suit as the law requires expert Spimon of medical professionalé for parties to prove their respective cause of action or defense. However, i order for the so-ealled inedical expects’ testimony fe have any prubative value, the said expert must be bo qualified, Philippine junsprudence requires that the witness tertifying befote the court naist belong te “the same general neighborhood aad in the atme general line of prtetice wn defendant physician or "253 Thus itt the afortarientioned ease of Rypny Site's of Mery Hogital™, the plaittiff wae based! from tecovenng because they did not present An expert withess oft infectious diseaves wher the disease that cated the untimely deiise of the patient was typhoid fever. In contrast, the ente of Rawr © Caut of Appeal” involved the testimony of a pulmonologist which wae preseuted by the deteodant physiciams to counter the claim of thé plaintiff that the anaesthesivlogsst involved in the botched opemtion was negligent causing the patient to suter massive brain datage. The Supreme Covie rejected the testimony as the anesthetic accident was caused by a vare drug-induced byeneho¢pasm which Siok at LEM ccondtrses, 3 Lacag S86 SCRA U79, 29.200, ape. 22, 2008, % Reyes, $465 Pha ¥2, 100, Oct, 3 ke Ramct +. Court uf Appeals (Decimen); Ramot +. Cenat of appeals (Retchiticn).y 85 942 PHILIPPINE LAW JOURNAL [Vou. falls within the felds of anesthesalogy, allergology, and cliewcal pores ae Aer within pulmonary mediewye which was the field ul expertise of the - - Moreover, the disqualitiention af the witnevs to render expert eet ea Matter is emphasized by his own admiseion that he does not posves at ie a SShehence gained by a spepialiat of eitpert ip the adniiniatmatict an fh ‘Thiopertal Sodiuns which allegedly triggved the allergy leading to thé devastating bronchospasn.vt Sechon 4 of Role 150 vf the Rules of Court provides that “opinion of a SAINGes On A matter cequaitieye special knowledge, skill, expenence or titining which he is shown to postoss, may be meeived in evidence.” Thus, the qualitication of a mecheal pmetitionet te textily ax an expest witness will pivot depending on the facts and antecedents uf the case particularly the nature of the injury suffered, the Prnceduce involved, the type of digs administered and othet analogous cueunstances, The admisibility of expert opinions in médical mulpiactice cases sarmet be evereraphasixed ay it ia indeed the “the critteal anc clinchwyg factor” in theee cases? Without such evidence it favour of the defendant physician, the Prsmumption of due diligence enjoyed by a physician ot medical practitioner will be whutted if the evidence on record fulficiently sustains a conclusion that the tequittte standart af diligence demanded by law has not bean complied with and mere often than not, auch a conelusion may be amply suppurted by the mere proof ef injury eupled eth the application OF fs ipsa loguitay, G. Negligence of the Plaindff us Prosimate Cause of the Injury Metinen must be made however, in cases where both pacties are negligent, In these casos, the doctrine df contubutory negligence comes to the fate, Amicle 2179 of the Civil Code! bouvides thar the ayured party bears ore damages cased by the injury when his own act is the peosimate couse thereof However, af the injured party's negligence ts merely conttibutury, it does aoe absolve the tottfensor of any liability but sather only mitigates the award of damages in firewur of the Kermnbt, Contibutory negligence iv the act or omission ainounting to want of ordinwy care of the patt of the Person injied, which, ing wih the delendaat' argigente isthe pronimatt care of te aay Tn general, negligesice by the iniucedl pavty is considered as sontiiburoty, However, i id we 12H, 205 Jd oe 29 ang St Ar fu 4385 ab 837. 28 A 28 Wn tanto es he memset s dy eanet iret mags te nagenom tly onktaaesy, terme st ony, he esy lyfe Sr co hs cae, ham map Fcens ones oe svatigate the danagee ts Se awarded, “Sapa Linaty $74 SRA MO ABA, Doe 1,2, Baao Signe Conley ie. 9.6 ‘cee oe tim ae aa Sn out11) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 943 tie ploven by the defendant that the waimediate cause of! wo acctderit resulting in at inytuy is the plaintfPs own act, which contbited to the peineipal decuimence as ane of its detetmining factors, the bitter cannot recover daniages tar the injury.25° The case of Capon-Lasinae Retmnlte61 cleatly illwtenter the chstinctiots between the situation where the asjured party is the ProMiMAte caute of the injury and where the injured party's negligence is merely contributory, The said case iowalved @ patient who was admitted to the hospital due te vomplications acising tram pregnancy. A Dilatation and Curettaye (D&C) Procedure was fone on the pationt. The patient was then discharged the next day, Barely two months later however, the patient came back with orse symptoms fexeing the doctors to Perform a hysterectomy. The patient then sued the surgeons and the hospital for negligence In tesolving that case, the Court stumised that a patient hag 6 certain level of diligence ns demanded by the eitcumetinces as follows! Tis uncheputed that [the plaintiff) did not retam fora follow-up evaludtion, ‘n defiance of the petitioner's advise [The plaintii} canitied the diligence fequired by the citcumelanees which could have avonded the injury. ‘The ‘oMIBION in Hot re fot s fellowup evaluation played » substantial fart in bringing about tw pints) own innuy, Had (the plat] renikued, petitioner cad have eonrdieted the proper viediesl testy andl prottelite necessary wo determine [the plhinters heat eondition, ase applied the co: Veeatinerit which could have prevented the muptore of {the phinttte] wrens, The D&C procechie having been din accotclane wath the étindrd medical hee, it ts cleag that {the plaitwifs) omitsion was the proximate cause off 89H injury and not medly 4 contibutory neglyenes on Wer part. 25 ‘The Court therefore conchided that the plamtitY in the said case was not entitled to recovery, What the naling in the Lauam cite teaches un is thr while 4 hysicran is Mince SAY provide care and triient with « dagen of cate any diligence which physiciane in the vane gener neighborhood and in the same, Freee renga: tes» cceusent duty or ebgvtion oe ti pence From thar er cay the Pmsctbed couse of tratnent pied by the icity. “roo tue we cai thatthe culpable Fass on the ptt of te paras 25 1k coy Tape v. Marla Blecwic Rao a u Zool Seseeaetog esta Sees °° Canic-Lasum v. Ramnolete, ST493RA a0, eo oe 18, oe.{VOL. 85 pes PHILIPPINE LAW JOURNAL { by the physicatn constitutes contabutory add failure on the part of dant that the iE Bae aio ak the the couse uf treatment piraccibes Reghgeonce Wit is proven by the defend the patent i the prosainate eause of the batter's mnputy, Gtoil Code will bar recovery by the plaintift D, Independent Contractor Given the highly specialized and highly technical nature of eee teday, hospitals have moved fivtn ther tixditional role a? mere providers medic: Semmices which ean be operated with lets capital. In fact, until the mid-nineteenth Century, hospitals were generully charitable institutions, providing metlical services to the lowest claises of eociely, without tegned for a patient's ability to pay. Its PURMary funchen way te fumish cvom, fuod, facilities for treatment aid operation and attendants te patents, However, the great stndes of development by Civilisation in the field of medicine and inedical care, harked the end of chantable and pervonal nature at the medical prictice. It has aince emenged as a protit- euented industry offeang nunerwux medical services under tugh quality standards of cate te iH patients, Such nature prevents hospitals to be spemted by a single Prepnetcr, Nownolly hospitals ave operated by jundival persone such as partnerships and cerporations which have the capacity fe raise and maintain the Hecesmuy amount of capital mdispensable to the operations af a hospital, While in theory, « hoapital, aé operated by a juridical editity, cannot prreticn medicine’, in ceahty it ubihikes doctors, styyeone ahd medical Pectitioners in the conduct Bf ite budihers of facibtating medical and surgical teeatinent.? "Thus, within that ceality, there are thee {3} relationships that intertwine and co-edst it the daily opetations: (1) between the pe anid the ductar practicing within ite premirer; (2) between the hospital the patient being treated or examined within ity premises and (3) berween the patent ad the doctor* Under the present state of out law, « hospital is summnully held liable for the hegligerice of its employed physiowns through the viewsious lability of einployers as provided tor by article 21B0 of the Crvil Cede. The said provision holds persotie epecitically employers, accountable not only for hiv own acts but 4 Se er ehanane Lani Negi bs ng chtrete Pies A Sow a for Naw Piney UML L Rew, 221 nian ed Gone, ¥. Cast cf GR No. 10152, 314 BORA 215, Mat 34, 2000. st Professional Services, Inc. v. Agana (Be14) DISSECTING PHILIPPINE LAW AND JURIPRUDENCE 945 aleo for those of others haved ob the former's tesponvilidity wach a telationship ‘ok atria parentins.*5* It i apparent fram a cussoty vending of the pertinent law that an employer-eiriployee relationshiy ys an estential element tie weariaua liability to attach te hospitals under asticls 2186, As metitioned eauliey the traditional notion of the profetsienal status and calling of « physician precludes the pxttence of an employer-wniployee relationship berween a physician and the hospitd in the pertsemance cf a physicmn’s profesmunal capacity” This view war espoused in the care of Sebloendorff ». Suctty of New Yuk Hospital) Menetheless, the doctrine emunciated ih the case Remar Cot of Appeals”? hog settled that there is an eoployereniployee relationship petween hospitals and doctors, However, such finding of ah employer-enqloyee relationship is founded upun the presence of control exercised by the purported snyployer over the purported emploree.29 In the absence of such element of contrdl, there can be ne employer-employee télaticnship, instead what is present is an principal-independent contractor velatenship, An independent contractor i} defined in tha ease of Chawy #: National Latur Rekitions Commisso#’ a¢ follows one who eases an a distinct and independent business and undertakes te perform the job, work, ev atevice on its SW accauAt ane under ita even teapondbility according ts its ewn Mwnner and method, frep from the contesl and direction of the principal ity all matters cernmected with the pecfounanee af the werk except as ta the results deseo, ‘Thug, where there i¢ ne empliyeremployee relationship but rather a painvipalandependent continetor telaticriship, there can be ne finding of liability plirsuanst to Article 2180 oF the peinciple of fypendeat seperior. However, the defense that an ering physician i an independerst contractor of the huspital does sot by iteelf bax xecovery. Pursuant te the decttines of apparent authority atid corporate negligence, 4 hospital may be held liable For the nepligent act of an independent conteactor, Ramus % Geist of Appeals (Deeiaon) at Ua, odie look Wrie, Gokitinoral ov Crem Law ee St Alanon hk Ge Pe 2 &u} MLR Ge, v, Pemen 08 daly 44d, 143 SY $95 (591 1}, Rewipan @, Gotha, 147 Atk 281 ads OY 9PT, 13 ALR 1403 (1921); Roem © yee ets 312 Aupetasded by eats ob vier groundy, Maun v. Mercy Huspital. 160 Cel. a36, 323 P, 24 944 (I58ap Amin x, Litvak, O82 F. 2d 41, wowcas (1984), Westar Ine, Gs. ¥, Brechineh, $82 P24 1213. (198) Rasdigpace 2. Denver, 702 P. & MEANY. 125, 105 NUE. 92, 62 LARA, WS, 305 (19t OF Ramee 9. Court of Appeaie (Pitsmien, Raney, Coust Appeals (Raschuhon, of , 3” Sa Chanda Medical lo. SORA S35 Noe Bs ho Cantar, tie. #. Natrona Labor Relations Cummisaun, G.R. No. 176484, $71 MGR Ne, 140890, 448 SCRA 473, fan. 17, 2005,OL, BS 946 PHILIPPINE Law JOURNAL [ve E. Waivers, Release or Comment Porins Waivers, ieheive or consent Kotme ace commanplace in ead Rereutcn of which have lung toemed past of standard operaling procedure before satinente and surgieal pracachutes. A typical example of uch datuitent is a Sensent for seeking the patient's consmnt to oF authariging the hogpital and its mecheal stall in aduvnistesing any form of recognized medics! treatrient while wing confined with the hospital era consent form sesking the patient's consent to be subjected ta a eextain Spermtion or diagnostic procedure ae pact of treatment.2”> These conseht fore are hournally accompanied by waivers at release forms which, seek te held tree the hospital and ite employees from “any and all chiions” arising tram of by reason of the treatment or operation. These cacuments are in the fuatuze uf contracts uf adhesion which oe strictly conetrued against the drafters theteot, in this cass, hovpitals.2 Persons it desperate need of medical care for their very suevival ave literally at the morty of the hospital thus clessly illustrating the nature of wch contracts ax contracts of adhesion”? The charditet of such blanket releare in favour cf hospitals “frum any and all elainy” hay bene chanteterized as contiuy to public poley and thus void for ineluding a waiver of elaine atising fiom bad faith avd grows neghgence.** Likewise, tht Court was quick ty add that waivers and veleases fsin claims ansing die to ample negli may be valid but nanetheless will not opente to bar recovery but rathet will merely siutyette lability deepeding te the eixcumsatances. VI, GONELUSION Tn thie article, the author hopes to have iustoited the existence of a working frainework insular av medical malpractice i» concemed despite the absence of enabling legislation, The Supreme Court has, and will tontinie, te make binding precedents further enti this budding field of aw in the Philippine jurisdiction, Notwithstanding the lack of « low goveming medical malpractice, the flexibility of the existing laws coupled with the kesourcefidness tod lngenidty of both the bar and the bench have, to the mind of the author, iced to provide Philippine suciety with a viable legal frmmmwork by which it ean. cnt acathintabiityFcotn thate wha cals to well-read fhe csat of heating 31S Negalas, 511 BORA 2M, 290, Pevernbes 49, 2066, 2 Id a Sd we 2d amegenvt, Cope, at 11722011) DISSECTING PHILIPPINE LAW AND JURISPRUDENCE 947 By no imeans hewever, should this mean that the feed for a law govemting thedical malpractice rnay he dispensed sith, On the contrary, the unportace DF an effective medical malptactice law cannot be veremphasixed. Ins a would wheve technology has niade and continues to make exponential strides, the low can spate no time im eatehing-up it order to properly protect the society for which i existe and seeks te protest. It cannot be denied that the framework borrowed fiom Amencan precedents hat and will serve az valuable guidance for the bar, the bench, and the executive bench in the regwation of the practice of mecheine anil ultimately the pestection uf the general publie. However, just as it is the province of the courte te say what the law is, it is equally the province of Gengres: to lay down what chall be the law of the land. While aur juidieiacy must be landed fer dispensing juatice despite the silence and ambiguity of our laws, thes is an inherent danger in absogating the function of lawmaking to those beholden orily to the law. Thus, Congresé niust be called ts fulfill ite dutr, not only te ensure that our laws remain just and apace with the complexities which pervade Philippine dociety, but more importantly to serve az a check off a pethaps uversealous judiciary especially in a fell 40 imbued with public policy. Alas, a sursory pental of the bills pending debate on the Congressional floor appear to have overlooked the sheer impartince of setting a clear out standard fer our medical practitioners that guarantees to the public an adequate, reasonable, if not superb medical service. Whether Congress shall adopt the wisdom of the precedents 6 elaquently lnd dawn by our magistrates of justice is for it to decide. But what ewnot be denied iz that our society necessitates a framework of scceuntability tiilored to meet the exigencine of the practice of medicine in the Philippines especially in a distressing age fetmented by a culture of impumity. ‘Though it can be said that the piactice of medicine is already conditioned upon the highest degree of diligence,*** iothing better eneuies the quility of one’s practict thas the Sword of Damocles ef accountability. With every consultation, AWeiMon, examination, diagnavis and prescnption made, a phyncum, surgeon, hospital, ov any entity engaged in the profession of life and death must be scriitisized andl tested under oiw suciety’y most stringent standards. At the same tite, accountability serves As the mom compelling incentive being nately ittestwined ith the human instinct of selt-preservation. ‘Thus, with every disease cured, lite saved, and well-beung ensitved the faithtul arthetence to etandatde of the highe: ao eee oitly verver public interest not the ptofersion, but ultimately, himself: Physicians, surgeons, and other medical at and staff ase but huunan aod are cleady emanot be expected to be However, neither can they be expected to be (6 Reyes, 196 Phil 87, 107, Oct. 5, 2600PHILIPPINE Law JOURNAL [VoL. 85 eartlevs, wr slipshorl, A (rake, theo BF theompetence Teron tae nay ed be cece’ loess Uh ed boats ele oon hie prationt’s fate.2% = lhe =