Legal medicine is considered to be the field of study and accumulation of materials that deals

with the application of medical knowledge to the administration of justice.

DR. RUBI LI, vs. SPOUSES SOLIMAN

FACTS: Angelica, daughter of respondents, underwent biopsy at SLMC. Results
showed that she was suffering from a high grade of cancer. Following the diagnosis,
her right leg was amputated by Dr. Tamayo in order to remove the tumor, and
chemotherapy was suggested to prevent the spread of disease. Dr. Tamayo referred
her to Dr. Rubi Li. On 18 August 1993 she was admitted but died on 1 September
1993 after the administration of the chemotherapy. Respondents brought the matter
to PNP Crime Laboratory for examination, and the report indicated that the cause of
death is Hypovelemic shock. Respondents then filed a damage suit against
Petitioner Li. The Trial dismissed the complaint, but was reversed upon appeal by
respondents before the CA ruling that Rubi Li failed to fully disclose serious side
effects to the parents of the child patient who died while undergoing chemotherapy.
ISSUE: Whether Rubi Li can be held liable for medical negligence.
RULING: NO. Medical negligence is that type of claim which a victim is available to
him to redress a wrong committed by a medical professional which has caused him
bodily harm. In order to 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 have not done, and that the
failure or action caused injury to the patient. The doctrine of informed consent within
the context of physician-patient relationships provides the right of a patient to give
consent to any medical procedure or treatment for the reason that every human
being of adult years and sound mind has a right to determine what shall be done with
his own body; and a surgeon who performs an operation without his patients
consent, commits an assault for which he is liable in damages. There are four
essential elements a plaintiff must prove in a malpractice action based upon the
doctrine of informed consent: The physician had a duty to disclose material risks; He
failed to disclose or inadequately disclosed the risks; As a direct and proximate result
of the failure to disclose, the patient consented to treatment she otherwise would not
have consented to; and Plaintiff was injured by the proposed treatment. There was
adequate disclosure of material risks inherent in the chemotherapy procedure
performed with the consent of Angelicas parents. That death can possibly result from
complications of the treatment or the underlying cancer itself immediately or
sometime after the administration of chemotherapy drugs, is a risk that cannot be
ruled out, as with most other major medical procedures, but such conclusion can be
reasonably drawn from the general side effects of chemotherapy already disclosed.

PROFESSIONAL SERVICES INC., vs. NATIVIDAD AND ENRIQUE AGANA

FACTS: Dr. Ampil, assisted by the medical staff of Medical City Hospital, performed
a surgery on Natividads ovary due to malignancy in her sigmoid area. Dr. Ampil
obtained the consent of Natividads husband, Enrique, to permit Dr. Fuentes to
perform hysterectomy on her. Thereafter, Dr. Ampil took over and completed the
operation and closed the incision. However, the operation appeared to be flawed as

there were two pieces gauze missing. Weeks after, Natividads daughter found a
piece of gauze protruding from her vagina, and another by Dr. Guitierrez when
Natividad seek treatment at PGH. Respondents filed with RTC a complaint for
damages against PSI, owner of Medical City, Ampil and Fuentes. They alleged that
the latter are liable for negligence for leaving two pieces of gauze inside Natividads
body and malpractice for concealing their acts of negligence. Pending the outcome
of the case, Natividad died.
ISSUE: Whether PSI, Fuentes and Ampil can be held liable for medical negligence.
RULING: As regards Dr. Ampil, YES. To successfully pursue this kind of case, a
patient must only prove that a health care provider 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 that failure
or action caused injury to the patient. Simply put, the elements are duty, breach,
injury and proximate causation. Dr. Ampil, as the lead surgeon, had the duty to
remove all foreign objects, such as gauzes, from Natividads body before closure of
the incision. When he failed to do so, it was his duty to inform Natividad about it. Dr.
Ampil breached both duties. Such breach caused injury to Natividad.
As regards Dr. Fuetes, No. 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. he 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." Also, under the
"Captain of the Ship" rule, the operating surgeon is the person in complete charge of
the surgery room and all personnel connected with the operation. Their duty is to
obey his orders. It was duly established that Dr. Ampil was the lead surgeon during
the operation of Natividad, and merely requested the assistance of Dr. Fuentes to
perform hysterectomy.
As regards PSI, Yes. Apparent authority, or what is sometimes referred to as the
"holding out" theory, or doctrine of ostensible agency or agency by estoppel, imposes
liability, not as the result of the reality of a contractual relationship, but rather
because of the actions of a principal or an employer in somehow misleading the
public into believing that the relationship or the authority exists. PSI publicly displays
in the lobby of the Medical City Hospital the names and specializations of the
physicians associated or accredited by it, including those of Dr. Ampil and Dr.
Fuentes. A hospital, following the doctrine of corporate responsibility, has the duty to
see that it meets the standards of responsibilities for the care of patients. Such duty
includes the proper supervision of the members of its medical staff.

DR. CRUZ vs. CA and UMALI

FACTS: Lydia was examined by Dr. Cruz who found a myoma in her uterus and
scheduled her for a hysterectomy operation. Lydia and her daughter, Rowena, slept
in the clinic on the evening prior to the operation. Rowena noticed that the hospital
was untidy and asked that the operation be postponed but Cruz told her that Lydia
must be operated as scheduled. Operation commenced however due to lack of
necessary equipment and medicines and supply of blood to be transfused to Lydia,
the latter was transferred to another hospital without the consent of the latters
relatives. Due to shock, Lydia died.
ISSUE: Whether Dr. Cruz is liable for medical negligence.
RULING: No. The circumstances are insufficient to sustain a judgment of conviction
against Cruz for the crime of reckless imprudence resulting in homicide. 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. Immediately apparent from a
review of the records of this case is the absence of any expert testimony on the
matter of the standard of care employed by other physicians of good standing in the
conduct of similar operations. The prosecution's expert witnesses in the persons of
Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of Investigation
(NBI) only testified as to the possible cause of death but did not venture to illuminate
the court on the matter of the standard of care that petitioner should have exercised.
For whether a physician or surgeon has exercised the requisite degree of skill and
care in the treatment of his patient is, in the generality of cases, a matter of expert
opinion. Expert testimony should have been offered to prove that the circumstances
cited by the courts below are constitutive of conduct falling below the standard of
care employed by other physicians in good standing when performing the same
operation. It must be remembered that when the qualifications of a physician are
admitted, as in the instant case, there is an inevitable presumption that in proper
cases he takes the necessary precaution and employs the best of his knowledge and
skill in attending to his clients, unless the contrary is sufficiently established. This
presumption is rebuttable by expert opinion which is so sadly lacking in the case at
bench.
Solidum vs People of the Philippines
GR No. 192123 March 10, 2014
Facts: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus.
Two days after his birth, Gerald under went colostomy, a surgical procedure to bring
one end of the large intestine out through the abdominal walls, enabling him to
excrete through a colostomy bag attached to the side of his body. On May 17, 1995,
Gerald was admitted at the Ospital ng Maynila for a pull-through operation. Dr.
Leandro Resurreccionheaded the surgical team, and was assisted by Dr. Joselito
Lucerio, Dr.Donatella Valeria and Dr. Joseph Tibio. The anesthesiologist included
Drs. Abella, Razon and Solidum. During the operation, Gerald experienced
bradycardia and went into a coma. His coma lasted for two weeks , but he regained
consciousness only after a month. He could no longer see, hear, or move. A
complaint for reckless imprudence resulting in serious physical injuries were filed by

Geralds parents against the team of doctors alleging that there was failure in
monitoring the anesthesia administered to Gerald.
Issues: Whether or not petitioner is liable for medical negligence.
Whether or not res ipsa liquitor can be resorted to in medical negligence cases.
Held: No. 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 to perform or failing to perform such act.
The negligence must be the proximate cause of the injury. For, negligence no matter
in what it consists, cannot create a right of action unless it is the proximate cause of
the injury complained of. And the proximate cause of an injury is that cause, which,
in natural and continuous sequence and unbroken by any efficient intervening cause,
produces the injury, and without which the result would not have occurred.
An action upon medical negligence whether criminal, civil or administrative calls
for the plaintiff to prove by competent evidence each of the following four elements
namely: a.) the duty owed by the physician to the patient, as created by the
physician-patient relationship, to act in accordance with the specific norms or
standards established by his profession; b.) the breach of the duty by the physicians
failing to act in accordance with the applicable standard of care; c.) the causation, is,
there must be a reasonably close and casual connection between the negligent act
or omission and the resulting injury; and d.) the damages suffered by the patient.
In the medical profession, specific norms on standard of care to protect the patient
against unreasonable risk, commonly referred to as standards of care, set the duty of
the physician in respect of the patient. The standard of care is an objective standard
which conduct of a physician sued for negligence or malpractice may be measured,
and it does not depend therefore, on any individuals physicians own knowledge
either. In attempting to fix a standard by which a court may determine whether the
physician has properly performed the requisite duty toward the patient, expert
medical testimony from both plaintiff and defense experts is required.
The doctrine of res ipsa liquitor means that where the thing which causes injury is
shown to be under the management of the defendant, and the accident is such as in
ordinary course of things does not happen if those who have management use
proper care, it affords reasonable evidence, in the absence of an explanation by
defendant that the accident arose from want of care.
Nevertheless, despite the fact that the scope of res ipsa liquitor has been
measurably enlarged, it does not automatically apply to all cases of medical
negligence as to mechanically shift the burden of proof to the defendant to show that
he is not guilty of the ascribed negligence. Res ipsa liquitor 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. It is generally restricted to situations in malpractice
cases 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. A distinction must be made
between the failure to secure results, and the occurrence of something more unusual
and not ordinarily found if the service or treatment rendered followed the usual
procedure of those skilled in that particular practice. It must be conceded that the
doctrine of res ipsa liquitor can have no application in a suit against a physician or

surgeon which involves the merits of a diagnosis or of a scientific treatment. The

physician or surgeon is not required at his peril to explain why any particular
diagnosis was not correct, or why any particular scientific treatment did not produce
the desired results. Thus, res ipsa liquitor is not available in a malpractice suit if the
only showing is that the desired result of an operation or treatment was not
accomplished. The real question, therefore, is whether or not in the process of the
operation any extraordinary incident or unusual event outside the routine
performance occurred which is beyond the regular scope of customary professional
activity in such operations, which if unexplained would themselves reasonably speak
to the average man as the negligent case or causes of the untoward consequence. If
there was such extraneous intervention, the doctrine of res ipsa liquitor may be
utilized and the dependent is called upon to explain the matter, by evidence of
exculpation, if he could.