Dr.

Rubi Li
Vs Spouses Reynaldo and Lina Soliman
GR 165279
June 7, 2011

Material Facts:

The respondent spouse were the parents of the Angelica Soliman, who is am eleven (11)
year old girl who underwent a biopsy of the mass located in her lower extremity at the St. Lukes
Medical Center (SLMC). Results showed that Angelica was suffering from osteosarcoma,
osteoblastic type. Angelicas right leg was amputated by Dr. Jaime Tamayo in order to remove
the tumor. A chemotherapy was then suggested by Dr. Tamayo and referred Angelica to another
doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.
On August 18, 1993, Angelica was admitted to SLMC. However, she died on September
1, 1993, just eleven (11) days after the (intravenous) administration of the first cycle of the
chemotherapy regimen. Because SLMC refused to release a death certificate without full
payment of their hospital bill, respondents brought the cadaver of Angelica to the Philippine
National Police (PNP) Crime Laboratory at Camp Crame for post-mortem examination. The
Medico-Legal Report issued by said institution indicated the cause of death as "Hypovolemic
shock secondary to multiple organ hemorrhages and Disseminated Intravascular Coagulation."
Respondents filed a damage suit for negligence and disregard of Angelicas safety, health
and welfare by their careless administration of the chemotherapy drugs, their failure to observe
the essential precautions in detecting early the symptoms of fatal blood platelet decrease and
stopping early on the chemotherapy, which bleeding led to hypovolemic shock that caused
Angelicas untimely demise.
The trial court was in favor of the petitioner but the Court of Appeals reversed the
decision supporting the respondents appeal.

Issue:
Whether or not the petitioner can be held liable for failure to fully disclose serious side
effects to the parents of the child patient who died while undergoing chemotherapy, despite the
absence of finding that petitioner was negligent in administering the said treatment.

Ruling:
The petition for review on certiorari is GRANTED. The Decision dated June 15, 2004
and the Resolution dated September 1, 2004 of the Court of Appeals in CA-G.R. CV No. 58013
are SET ASIDE.
The Decision dated September 5, 1997 of the Regional Trial Court of Legazpi City,
Branch 8, in Civil Case No. 8904 is REINSTATED and UPHELD.
Ratio Decidendi:
No, there are four essential elements a plaintiff must prove in a malpractice action based
upon the doctrine of informed consent: "(1) the physician had a duty to disclose material risks;
(2) he failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result
of the failure to disclose, the patient consented to treatment she otherwise would not have
consented to; and (4) plaintiff was injured by the proposed treatment." The gravamen in an
informed consent case requires the plaintiff to "point to significant undisclosed information
relating to the treatment which would have altered her decision to undergo it.
There was adequate disclosure of material risks inherent in the chemotherapy procedure
performed with the consent of Angelicas parents. Respondents could not have been unaware in
the course of initial treatment and amputation of Angelicas lower extremity, that her immune
system was already weak on account of the malignant tumor in her knee. When petitioner
informed the respondents beforehand of the side effects of chemotherapy which includes lowered
counts of white and red blood cells, decrease in blood platelets, possible kidney or heart damage
and skin darkening, there is reasonable expectation on the part of the doctor that the respondents
understood very well that the severity of these side effects will not be the same for all patients
undergoing the procedure. In other words, by the nature of the disease itself, each patients
reaction to the chemical agents even with pre-treatment laboratory tests cannot be precisely
determined by the physician. That death can possibly result from complications of the treatment
or the underlying cancer itself, immediately or sometime after the administration of
chemotherapy drugs, is a risk that cannot be ruled out, as with most other major medical
procedures, but such conclusion can be reasonably drawn from the general side effects of
chemotherapy already disclosed.
The element of ethical duty to disclose material risks in the proposed medical treatment
cannot thus be reduced to one simplistic formula applicable in all instances. Further, in a medical
malpractice action based on lack of informed consent, "the plaintiff must prove both the duty and
the breach of that duty through expert testimony. Such expert testimony must show the
customary standard of care of physicians in the same practice as that of the defendant doctor.