Cases in Legal Medicine:

1. Li v. Soliman (Doctrine of
informed consent
Chemotherapy)
Medical
Malpractice
or
more
appropriately, medical negligence, is that
type of claim/lawsuit which a victim has
available to him or her to redress a wrong
committed by a medical professional
which has caused bodily harm. In order to
successfully pursue such a claim, a
patient must prove that a health care
provider, in most cases a physician, either
failed to do something which a reasonably
prudent health care provider would have
done, or that he or she did something that
a reasonably prudent provider would not
have done and that that failure or action
caused injury to the patient.
Doctrine of informed consent Informed consent evolved into a general
principle of law that a physician has a
duty to disclose what a reasonably
prudent
physician
in
the
medical
community in the exercise of reasonable
care would disclose to his patient as to
whatever grave risks of injury might be
incurred from a proposed course of
treatment, so that a patient, exercising
ordinary care for his own welfare, and
faced with a choice of undergoing the
proposed
treatment,
or
alternative
treatment, or none at all, may intelligently
exercise his judgment by reasonably
balancing the probable risks against the
probable benefits.

Proficiency in diagnosis and therapy is not

the full measure of a physicians
responsibility The physician is not
expected to give the patient a short
medical education, the disclosure rule
only requires of him a reasonable
explanation, which means generally
informing the patient in nontechnical
terms as to what is at stake, the therapy
alternatives open to him, the goals
expectably to be achieved, and the risks
that may ensure from particular treatment
or no treatment.

Doctrine of Informed Consent requires

doctors, before administering treatment to
their patients, to disclose adequately the
material risks and side effects of the
proposed treatment it is distinct from the
doctors duty to skillfully diagnose and
treat the patient.
There are two standards by which courts
determine what constitutes adequate
disclosure of associated risks and side
effects of a proposed treatment:

In malpractice actions generally, there

must be a causal relationship between the
physicians failure to divulge and damage
to the patient.

Physician standard - a doctor is obligated

to disclose that information which a
reasonable doctor in the same field
of expertise would have disclosed to
his or her patient.

Four essential elements a plaintif

must prove in a malpractice action
based upon the doctrine of informed
consent.
(1) the physician had a duty to disclose
material risks
(2) he failed to disclose or inadequately
disclosed those risks
(3) as a direct and proximate result of the
failure to disclose, the patient consented
to treatment she otherwise would not
have consented to and
(4) plaintiff was injured by the proposed
treatment.

Patient standard of materiality - a doctor

is obligated to disclose that information
which a reasonable patient would
deem material in deciding whether to
proceed with a proposed treatment.
Expert testimony - is crucial, if not
determinative of a physicians liability in a
medical
negligence
case
Expert
testimony is, therefore, essential since the
factual issue of whether a physician or
surgeon exercised the requisite degree of
skill and care in the treatment of his
patient is generally a matter of expert
opinion.

The gravamen in an informed consent

case requires the plaintiff to point to
significant
undisclosed
information
relating to the treatment which would
have altered her decision to undergo it.

In order to determine what the associated

risks and side effects of proposed
treatment are, testimony by an expert
witness is necessary because these are

beyond the common

ordinary people.

knowledge

of

liability of the hospital for the negligence

of the doctor.

Court has recognized that medical

negligence cases are best proved by
opinions of expert witnesses belonging in
the same general neighborhood and in the
same general line of practice as
defendant physician or surgeon.

Even when no employment relationship

exists but it is shown that the hospital
holds out to the patient that the doctor is
its agent, the hospital may still be
vicariouslyliable under Article 2176 in
relation to Article 1431 and Article
1869 of the Civil Code or the principle
of
apparent
authority.
Moreover,
regardless of its relationship with the
doctor, the hospital may be held directly
liable to the patient for its own negligence
or failure to follow established standard of
conduct to which it should conform as a
corporation.

2. PSI v Agana (2 Missing gauze Negligence)

Court holds that Professional Services, Inc.
(PSI) is liable to the Aganas not under
the principle of respondent superior
for lack of evidence of an employment
relationship with Dr. Ampil but under the
principle of ostensible agency for the
negligence of Dr. Ampil and pro hac vice
under the principle of corporate
negligence for its failure to perform its
duties as a hospital.
While in theory a hospital as a juridical
entity cannot practice medicine, in reality
it utilizes doctors, surgeons and medical
practitioners in the conduct of its business
of facilitating medical and surgical
treatment.
Within that reality, three legal
relationships crisscross:
(1) between the hospital and the doctor
practicing within its premises
(2) between the hospital and the patient
being treated or examined within its
premises and
(3) between the patient and the doctor.
The exact nature of each relationship
determines the basis and extent of the

Under the control test, an employment

relationship exists between a physician
and a hospital if the hospital controls both
the means and the details of the process
by which the physician is to accomplish
his
task.
There is, however, ample evidence that
the hospital (PSI) held out to the patient
(Natividad) that the doctor (Dr. Ampil) was
its agent. Present are the two factors that
determine apparent authority: first, the
hospitals implied manifestation to the
patient which led the latter to conclude
that the doctor was the hospitals agent
and second, the patients reliance upon
the conduct of the hospital and the
doctor, consistent with ordinary care and
prudence.

Res ipsa loquitur means "the thing speaks

for itself." It is the rule that the fact of the
occurrence of an injury, taken with the
surrounding circumstances, may permit
an inference or raise a
presumption of negligence, or make out a
plaintiffs prima facie case, and present a
question of fact for defendant to meet
with an explanation. Stated differently,
where the thing which caused the injury,
without the fault of the injured, is under
the exclusive control of the defendant and
the injury is such that it should not have
occurred if he, having such control used
proper
care,
it affords
reasonable
evidence, in the absence of explanation
that the injury arose from the defendants
want of care, and the burden of proof is
shifted to him to establish that he has
observed due care and diligence.
From the foregoing statements of the rule,
the requisites for the applicability of the
doctrine of res ipsa loquitur are:
(1) the occurrence of an injury;
(2) the thing which caused the injury was
under the control and management of the
defendant;
(3) the occurrence was such that in the
ordinary course of things, would not have
happened if those who had control or
management used proper care; and
(4) the absence of explanation by the
defendant. Of the foregoing requisites, the
most instrumental is the "control and
management of the thing which caused
the injury."

*** No application of res ipsa loquitur on this

case

necessary to support the conclusion as to

causation.

3. Cruz v. CA and Umali (Myoma

Inadequacy of facilities)

Burden of Proof plaintiff has the burden of

establishing defendants negligence and for a
reasonable conclusion of negligence, there
must be proof of breach of duty on the part of
the surgeon as well as a causal connection of
such breach and the resulting death of his
patient. The negligence must be the
proximate cause of the injury.

The elements of reckless imprudence are:

(1) that the offender does or fails to do an
act
(2) that the doing or the failure to do that act
is voluntary
(3) that it be without malice
(4) that material damage results from the
reckless imprudence and
(5) that there is inexcusable lack of
precaution on the part of the offender,
taking into consideration his employment or
occupation, degree of intelligence, physical
condition, and other circumstances regarding
persons, time and place.

It is in this aspect of medical malpractice that

expert testimony is essential to establish not
only the standard of care of the
profession but also that the physicians
conduct in the treatment and care falls
below such standard. Further, inasmuch as
the causes of the injuries involved in
malpractice actions are determinable only in
the light of scientific knowledge, it has been
recognized that expert testimony is usually

4. Flores v. Pineda & United Medical Doctors

(Myoma + Diabetis)
There are four elements involved in a
medical negligence case, namely: duty,
breach,
injury,
and
proximate
causation.
Duty refers to the standard of behavior
which imposes restrictions on ones
conduct.
Standard in turn refers to the amount of
competence associated with the proper
discharge of the profession. A physician is
expected to use at least the same level of
care that any other reasonably competent
doctor would use under the same
circumstances.
Breach of duty occurs when the
physician fails to comply with these
professional standards. If injury results to
the patient as a result of this breach, the
physician is answerable for negligence.
To successfully pursue a claim, the plaintiff
must prove by preponderance of evidence
that, one, the physician either failed to do
something which a reasonably prudent health

care provider would have done, or that he did

something that a reasonably prudent provider
would not have done and two, the failure or
action caused injury to the patient.
Expert testimony is therefore essential since
the factual issue of whether a physician or
surgeon has exercised the requisite degree of
skill and care in the treatment of his patient is
generally a matter of expert opinion.
5. Solidum v People
imperforate anus)

(3

y/o

boy

with

*** Inappropriate application of res ipsa

loquitur
Negligence is defined as the failure to
observe for the protection of the interests of
another person that degree of care,
precaution,
and
vigilance
that
the
circumstances justly demand, whereby such
other person suffers injury.
Reckless imprudence, on the other hand,
consists of voluntarily doing or failing to do,
without malice, an act from which material
damage results by reason of an inexcusable
lack of precaution on the part of the person
performing or failing to perform such act.
It is puzzling, therefore, how the RTC and the
CA could have adjudged Ospital ng Maynila
jointly and severally liable with Dr. Solidum
for the damages despite the obvious fact that
Ospital ng Maynila, being an artificial entity,
had not been charged along with Dr.
Solidum. The lower courts thereby acted
capriciously and whimsically, which rendered
their judgment against Ospital ng Maynila

void as the product of grave abuse of

discretion amounting to lack of jurisdiction.
xxx Moreover, Ospital ng Maynila could be
held civilly liable only when subsidiary liability
would be properly enforceable pursuant to
Article 103 of the Revised Penal Code. But the
subsidiary liability seems farfetched here. The
conditions for subsidiary liability to attach to
Ospital ng Maynila should first be complied
with. Firstly, pursuant to Article 103 of the
Revised Penal Code, Ospital ng Maynila must
be shown to be a corporation "engaged in any
kind of industry." The term industry means
any department or branch of art, occupation
or business, especially one that employs labor
and capital, and is engaged in industry.
However, Ospital ng Maynila, being a public
hospital, was not engaged in industry
conducted for profit but purely in charitable
and humanitarian work. Secondly, assuming
that Ospital ng Maynila was engaged in
industry for profit, Dr. Solidum must be shown
to be an employee of Ospital ng Maynila
acting in the discharge of his duties during
the operation on Gerald. Yet, he definitely was
not such employee but a consultant of the
hospital. And, thirdly, assuming that civil
liability was adjudged against Dr. Solidum as
an employee (which did not happen here),
the execution against him was unsatisfied
due to his being insolvent.
6. Cayao-Lasam v. Sps. Ramolete (Vaginal
bleeding no more chance to bear a
baby)
*** failure to present any expert testimony
Based on the evidence presented in the
present case under review, in which no

negligence can be attributed to the

petitioner, the immediate cause of the
accident resulting in Edithas injury was
her own omission when she did not return
for a follow-up checkup, in defiance of
petitioners orders. The immediate cause
of Edithas injury was her own act; thus,
she cannot recover damages from the
injury.
The principle of double jeopardy finds no
application
in
administrative
cases.
Double jeopardy attaches only: (1) upon
a valid indictment (2) before a competent
court (3) after arraignment (4) when a
valid plea has been entered and (5) when
the defendant was acquitted or convicted,
or the case was dismissed or otherwise
terminated without the express consent of
the accused. These elements were not
present in the proceedings before the
Board of Medicine, as the proceedings
involved in the instant case were
administrative and not criminal in nature.
The Court has already held that
double jeopardy does not lie in
administrative cases.

The right to appeal from a decision of the

Board of Medicine to the Professional
Regulation Commission is available to
both complainants and respondents.
Section 35 of the Rules and Regulations
Governing the Regulation and Practice of
Professionals cited by petitioner was
subsequently amended to read: Sec. 35.
The complainant/respon dent may appeal
the order, the resolution or the decision of
the Board within thirty (30) days from

receipt thereof to the Commission whose

decision shall be final and executory.
Interlocutory order shall not be appealable
to the Commission. (Amended by Res.
174, Series of 1990). Whatever doubt was
created by the previous provision was
settled with said amendment. It is
axiomatic that the right to appeal is not a
natural right or a part of due process, but
a mere statutory privilege that may be
exercised only in the manner prescribed
by law.

It is an elementary rule that when the law

speaks in clear and categorical language,
there is no need, in the absence of
legislative intent to the contrary, for any
interpretation

The decision, order or resolution of the Board

shall be final and executory after the lapse of
fifteen (15) days from receipt of the decision,
order or resolution without an appeal being
perfected or taken by either the respondent
or the complainant. A party aggrieved by the
decision, order or resolution may file a notice
of appeal from the decision, order or
resolution of the Board to the Commission
within fifteen (15) days from receipt thereof,
and serving upon the adverse party a notice
of appeal together with the appellants brief
or memorandum on appeal, and paying the
appeal and legal research fees.

Batas Pambansa (B.P.) Blg. 129 conferred

upon the Court of Appeals (CA) exclusive
appellate jurisdiction over appeals from
decisions of the Professional Regulation
Commission (PRC).

7. Nogales v Capitol Medical Center (

Private hospitals, hire, fire and exercise real
control over their attending and visiting
"consultant" staff. While "consultants" are
not, technically employees, a point which
respondent hospital asserts in denying all
responsibility for the patient's condition, the
control exercised, the hiring, and the right to
terminate consultants all fulfill the important
hallmarks
of
an
employer-employee
relationship, with the exception of the
payment of wages. In assessing whether such
a relationship in fact exists, the control test is
determining. Accordingly, on the basis of the
foregoing, we rule that for the purpose of
allocating responsibility in medical negligence
cases, an employer-employee relationship in
effect exists between hospitals and their
attending and visiting physicians.
GENERAL RULE: A hospital is not liable for the
negligence of an independent contractorphysician. EXCEPTION: The hospital may be
liable if the physician is the "ostensible
agent of the hospital. This exception is also
known as the "doctrine of apparent
authority."
[U]nder the doctrine of apparent authority a
hospital can be held vicariously liable for the
negligent acts of a physician providing care
at the hospital, regardless of whether the
physician is an independent contractor,
unless the patient knows, or should have
known, that the physician is an independent
contractor. The elements of the action have
been set out as follows:

For a hospital to be liable under the doctrine

of apparent authority, a plaintiff must show
that: (1) the hospital, or its agent, acted in a
manner that would lead a reasonable person
to conclude that the individual who was
alleged to be negligent was an employee or
agent of the hospital; (2) where the acts of
the agent create the appearance of authority,
the plaintiff must also prove that the hospital
had knowledge of and acquiesced in them;
and (3) the plaintiff acted in reliance upon the
conduct of the hospital or its agent,
consistent with ordinary care and prudence."
The element of "holding out" on the part of
the hospital does not require an express
representation by the hospital that the person
alleged to be negligent is an employee.
Rather, the element is satisfied if the hospital
holds itself out as a provider of emergency
room care without informing the patient that
the care is provided by independent
contractors.
The element of justifiable reliance on the part
of the plaintiff is satisfied if the plaintiff relies
upon the hospital to provide complete
emergency room care, rather than upon a
specific physician.

restraint in adjudicating medical negligence

cases because physicians are not guarantor
of care and, they never set out to
intentionally cause injury to their patients.
However,
intent
is
immaterial
in
negligence
cases
because
where
negligence
exists
and
is
proven,
it
automatically gives the injured a right to
reparation for the damages caused.
Whether the injury was caused by the
droplight or by the blood pressure cuff is of no
moment. Both instruments are deemed within
the exclusive control of the physician in
charge under the captain of the ship
doctrine. This doctrine holds the surgeon in
charge of an operation liable for the
negligence of his assistants during the time
when those assistants are under the
surgeons control. In this particular case, it
can be logically inferred that petitioner, the
senior consultant in charge during the
delivery of Noras baby, exercised control
over the assistants assigned to both the use
of the droplight and the taking of Noras blood
pressure. Hence, the use of the droplight and
the blood pressure cuff is also within
petitioners exclusive control.

8. Cantre v. Sps. Go (Scar on Noras arm

caused by the droplight or by the blood
pressure cuff)

Clearly, under the law*, petitioner is obliged

to pay Nora for moral damages suffered by
the latter as a proximate result of petitioners
negligence.

The Hippocratic Oath mandates physicians to

give primordial consideration to the wellbeing
of their patients. If a doctor fails to live up to
this precept, he is accountable for his acts.
This notwithstanding, courts face a unique

* ART. 2176. Whoever by act or omission

causes damage to another, there being
fault or negligence, is obliged to pay for
the damage done. . . . ART. 2217. Moral
damages include physical suffering,

mental anguish, fright, serious anxiety,

besmirched
reputation,
wounded
feelings, moral shock, social humiliation,
and similar injury.
9. Ramos v. CA (gallstones - "ang hirap maintubate
nito,
mali
yata
ang
pagkakapasok. O lumalaki ang tiyan.")
Res ipsa loquitur is not a rule of substantive
law and, as such, does not create or
constitute an independent or separate ground
of liability. Instead, it is considered as
merely evidentiary or in the nature of a
procedural rule. It is regarded as a mode
of proof, or a mere procedural of
convenience
since
it
furnishes
a
substitute for, and relieves a plaintif of,
the burden of producing specific proof of
negligence.
In other words, mere invocation and
application of the doctrine does not
dispense with the requirement of proof
of negligence. It is simply a step in the
process of such proof, permitting the
plaintif to present along with the proof
of the accident, enough of the attending
circumstances to invoke the doctrine,
creating an inference or presumption of
negligence, and to thereby place on the
defendant the burden of going forward
with the proof.
When the res ipsa loquitur is availed by
the plaintif, the need for expert medical
testimony is dispensed with because the
injury itself provides
the proof of
negligence.

10. Jarcia v. People (A boy hit by a taxi)

PhysicianPatient Relationship When a patient
engages the services of a physician, a
physicianpatient relationship is generated
Thus, in treating his patient, a physician is
under a duty to exercise that degree of care,
skill and diligence which physicians in the
same general neighborhood and in the same
general line of practice ordinarily possess and
exercise in like cases.
While no criminal negligence was found in the
petitioners
failure
to
administer
the
necessary medical attention to Roy Jr., the
Court holds them civilly liable for the resulting
damages to their patient.
11.Atienza v. Board: (ACCEPTANCE OF
PHOTOCOPIED
DOCUMENTS
AS
EVIDENCE)
It is well-settled that the rules of evidence
are not strictly applied in proceedings
before administrative bodies such as the
BOM. [I]t is the safest policy to be
liberal,
not
rejecting
them
on
doubtful or technical grounds, but
admitting
them
unless
plainly
irrelevant,
immaterial
or
incompetent, for the reason that
their rejection places them beyond
the consideration of the court, if they
are thereafter found relevant or
competent on the other hand, their
admission, if they turn out later to be
irrelevant or incompetent, can easily
be
remedied
by
completely
discarding them or ignoring them.
Admissibility of evidence refers to the
question
of
whether
or
not
the

circumstance (or
considered at all.

evidence)

is

to

be

Probative value of evidence refers to the

question of whether or not it proves an
issue.
The rules of evidence are merely the
means
for
ascertaining
the
truth
respecting a matter of fact. Thus, they
likewise provide for some facts which are
established and need not be proved, such
as those covered by judicial notice, both
mandatory and discretionary.
12.Dela Torre v. Imbuido: (TESTIMONY
OF THE EXPERT WITNESS)
It is settled that a physicians duty to his
patient relates to his exercise of the
degree of care, skill and diligence which
physicians
in
the
same
general
neighborhood, and in the same general
line of practice, ordinarily possess and
exercise in like cases. There is breach of
this duty when the patient is injured in
body or in health. Proof of this breach
rests upon the testimony of an
expert witness that the treatment
accorded to the patient failed to
meet the standard level of care, skill
and diligence. To justify an award of
damages, the negligence of the doctor
must be established to be the proximate
cause of the injury
For the trial court to give weight to Dr.
Patilanos report, it was necessary to
show first Dr. Patilanos specialization and
competence to testify on the degree of
care, skill and diligence needed for the
treatment of Carmens case. Considering
that it was not duly established that Dr.
Patilano practiced and was an expert

inthe fields that involved Carmens

condition, he could not have accurately
identified the said degree of care, skill,
diligence and the medical procedures that
should have been applied by her
attending physicians.
13.Alano
v.
Magud-Logmao
(TRANSPLANT OF ORGANS IN THE
ABSENCE OF CONSENT FROM THE
FAMILY OF THE DECEASED)
[I]n civil cases, it is a basic rule that the
party making allegations has the burden
of proving them by a preponderance of
evidence. The parties must rely on the
strength of their own evidence and not
upon the weakness of the defense offered
by their opponent."9 Here, there is to
proof that, indeed, the period of around
24 hours from the time notices were
disseminated, cannot be considered as
reasonable under the circumstances. They
failed to present any expert witness to
prove that given the medical technology
and knowledge at that time in the 1980's,
the doctors could or should have waited
longer before harvesting the internal
organs for transplantation.
As to moral damages, it should be
emphasized that the internal organs of
the deceased were removed only after he
had been declared brain dead; thus, the
emotional pain suffered by respondent
due to the death of her son cannot in any
way be attributed to petitioner. Neither
can the Court find evidence on record to
show
that
respondent's
emotional
suffering at the sight of the pitiful state in
which she found her son's lifeless body be
categorically attributed to petitioner's
conduct.

14.Dr. Bondoc v. Manatala (A CASE OF

GRAVE
MISCONDUCT
BY
A
GOVERNMENT MEDICAL OFFICER)
Article II, Section 1 of the Code of Medical
Ethics of the Medical Profession in the
Philippines states: A physician should
attend to his patients faithfully and
conscientiously. He should secure for them
all possible benefits that may depend
upon his professional skill and care. As the
sole tribunal to adjudge the physician's
failure to fulfill his obligation to his
patients is, in most cases, his own
conscience, violation of this rule on his
part is discreditable and inexcusable
A doctor's duty to his patient is not
required to be extraordinary. The standard
contemplated for doctors is simply the
reasonable
average
merit
among
ordinarily good physicians, i.e. reasonable
skill and competence. Even by this
standard, petitioner fell short when he
routinely delegated an important task that
requires
his
professional
skill
and
competence to his subordinates who have
no requisite training and capability to
make
crucial
decisions
in
difficult
childbirths.
Jurisprudence is replete with cases
declaring that a grave offense cannot be
mitigated by the fact that the accused is a
first time offender or by the length of
service of the accused.
While in most cases, length of service is
considered in favor of the respondent, it is
not considered where the offense
committed is found to be serious or grave.
In Medina v. Commission on Audit, the
Court stressed that dishonesty and grave
misconduct have always been and should
remain anathema in the civil service. They

inevitably reflect on the fitness of a civil

servant to continue in office. When an
officer or employee is disciplined, the
object sought is not the punishment of
such officer or employee but the
improvement of the public service and the
preservation of the public's faith and
confidence in the government.
Note:
The Office of the Ombudsman acts against
official inaction or impropriety in the
performance of official
functions. It serves as a venue for redress
of grievance against public officials and
employees for an act or omission which do
not necessarily amount to an offense,
such as administrative cases which cover
medical practitioners in the government.
15.Sps.
Bontilao
(INAPPLICABILITY
LOQUITUR)

v.
OF

RES

Gerona
IPSA

Res ipsa loquitur is a rebuttable

presumption or inference that the
defendant
was
negligent.
The
presumption only arises upon proof that
the instrumentality causing injury was in
the defendants exclusive control, and
that the accident was one (1) which
ordinarily does not happen in the absence
of negligence. It is a rule of evidence
whereby negligence of the alleged
wrongdoer may be inferred from the mere
fact that the accident happened, provided
that the character of the accident and
circumstances
attending
it
lead
reasonably to the belief that in the
absence of negligence it would not have
occurred and that the thing which caused
injury is shown to have been under the
management and control of the alleged
wrongdoer.

Under this doctrine, the happening of an

injury permits an inference of negligence
where the plaintiff produces substantial
evidence that the injury was caused by an
agency or instrumentality under the
exclusive control and management of the
defendant, and that the injury was such
that in the ordinary course of things would
not happen if reasonable care had been
used.

However, res ipsa loquitur is not a rigid or

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

held in Ramos v. Court of Appeals,[14] the

real question is whether or not in the
process
of
the
operation,
any
extraordinary incident or unusual event
outside of the routine performance
occurred which is beyond the regular
scope of professional activity in such
operations, and which, if unexplained,
would themselves reasonably speak to the
average man as the negligent cause or
causes of the untoward consequence.