Res ipsa loquitur is a Latin phrase
Legal Medicine- branch of which deals with
application of medical knowledge to the
purposes of law and in the administration of
justice. It is the application of basic and
clinical, medical and paramedical sciences to
elucidate legal matters.
Medical Jurisprudence- knowledge of law in
relation to the practice of medicine. It concerns
with the study of the rights, duties and
obligations of medical practitioner with
particular reference to those arising from
doctor-patient relationship.
Forensic Medicine- That sciencewhich
teaches the application of every branch of
medical knowledge to the purposes ofthe law;
hence its limits are, on the one hand, the
requirements of the law, and, on theother, the
whole range of medicine
Doctrines in Legal Medicine
1. Res Ipsa Loquitor or “the Thing Speaks
for Itself”
A doctrine of law that one is
presumed to be negligent if he/she/it
had exclusive control of whatever
caused the injury even though there is
no specific evidence of an act of
negligence, and without negligence
the accident would not have
Requisites
happened.
Doctrine:
Its function is to aid the plaintiff in
proving the elements of a negligence
case by circumstantial evidence.
As discussed in different
jurisprudence:
In the case of Jarcia vs. People (GR
No. 187926, Feb,. 15, 2012)
which literally means “the thing or the
transaction speaks for itself. The
doctrine of res ipsa loquitur is simply a
recognition of the postulate that, as a
matter of common knowledge and
experience, the very nature of certain
types of occurrences may justify an
inference of negligence on the part of
the person who controls the
instrumentality causing the injury in
the absence of some explanation by
the accused-appellant who is charged
with negligence. It is grounded in the
superior logic of ordinary human
experience and, on the basis of such
experience or common knowledge;
negligence may be deduced from the
mere occurrence of the accident
itself. Hence, res ipsa loquitur is
applied in conjunction with the
doctrine of common knowledge.
Layugan vs. IAC (167 SCRA 376)
Where the thing which causes injury
is shown to be under the
management of the defendant, and
the accident is such as in the ordinary
course of thing does not happen if
those who have the management use
proper case, it affords reasonable
evidence, in the absence of an
explanation by the defendant, that
the accident arose from want of care.
for the application of the
i. The accident is of a kind
which ordinary does not
occur in the absence of
someone’s negligence;
ii. It is caused by an
instrumentality within the
exclusive control of the
 defendant or defendants;
and
iii. The possibility of
contributing conduct
which would make the
plaintiff responsible is
eliminated.
In the above requisites, the fundamental
element is the “Control of the
Instrumentality” which caused the damage.
Such element of control must be shown to be
within the dominion of the defendant. In
order to have the benefit of the rule, a
plaintiff, in addition to proving injury or
damage, must show a situation where it is
applicable, and must establish that the
essential elements of the doctrine were
present in a particular incident,
Res Ipsa Loquitor as a rule of Evidence
Is peculiar to the law of negligence
which recognizes that prima facie
negligence may be established
without direct proof and furnishes for
specific proof of negligence. The
doctrine is not a rule of substantive
law but merely a mode of proof or a
mere procedural convenience.
The doctrine can be invoked when
and only when, under circumstances
involved, direct evidence is absent
and not readily available.
The res ipsa loquitor is not a rule of
substantive law and, as such, does not
create or constitute an independent
or separate ground for liability. It is
considered as merely as evidentiary
or in the nature of procedural rule.
The res ipsa loquitor doctrine is a rule
of necessity, in that it proceeds on the
theory that under the peculiar
circumstances in which the doctrine
to apply, it must appear that the
injured party had no knowledge or
means of knowledge as to the cause
of accident, or that the party to be
charged negligence has superior
knowledge or opportunity for
explanation of the accident.
When Res ipsa loquitor is not applicable:
The doctrine of res ipsa loquitor is not
applicable if there is direct proof of
absence and presence of negligence.
It is not applicable when an
unexplained accident may be
attributed to one of several causes,
for some of the defendant could not
be responsible.
2. 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 surgeon’s control.
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.
An adaption from the “borrowed
servant rule”, as applied to an
operating room, holding the person in
charge-e.g., a surgeon- responsible
for all those under his supervision,
regardless of whether the ‘captain’ is
directly responsible for an alleged
error or act of alleged negligence.
Same as:
1. Vicarious Liability (Article 2176 in
relation to article 2180, NCC)
Vicarious liability is a legal doctrin
e that assigns liability for an injury
to a person who did not cause th
e injury but who has aparticular le
gal relationship to the person who
did act negligently.
Article 2176: Whoever by act or
omission causes damage to
another, there being fault or
negligence, is obliged to pay for
the damage done. Such fault or
negligence, if there is no pre-
existing contractual relation
between the parties, is called
quasi-delict and is governed by
the provisions of this Chapter.
Article 2180: The obligation
imposed by article 2176 is
demandable not only for one's
own acts or omissions, but also
for those of persons for whom
one is responsible.
2. Respondeat Superior
[Latin, Let the master answer.] A
common-law doctrine that makes
an employer liable for the actions
of an employee when the actions
take place within the scope of
employment.
An employee is an agent for her
employer to the extent that the
employee is authorized to act for
the employer and is partially
entrusted with the employer’s
business. The employer controls,
or has a right to control the time,
place and the method of doing
work. When the facts show that
an employer-employee
relationship exists, the employer
can be held responsible for the
injuries caused by the employee
in the course of employment.
Article 2176. Whoever by act or
omission causes damage to
another, there being fault or
negligence, is obliged to pay for
the damage done. Such fault or
negligence, if there is no pre-
existing contractual relation
between the parties, is called a
quasi-delict and is governed by
the provisions of this Chapter.
Article 2180: The obligation
imposed by article 2176 is
demandable not only for one's
own acts or omissions, but also
for those of persons for whom
one is responsible.
3. Doctrine of Imputed Liability
The doctrines of imputed liability
and vicarious liability permit the
personal injury plaintiff to hold an
‘innocent’ person liable for the
wrongful conduct of another. The
inactive defendant did not
commit any wrongful conduct;
rather, her relationship to the
active wrongdoer renders her
liable. Control over the
wrongdoer is a common element.
Courts and legislatures impose
imputed and vicarious liability as
a matter of public policy.
Situations include: (1) an
 employer’s liability for an
employee’s conduct during the
course and scope of her
employment, (2) a principle’s
responsibility for the conduct of
an agent when carrying out the
agency (3) a parent’s
responsibility for his child’s
conduct, and (4) the mutual
liability of members of a joint
enterprise or partnership.
3. Master –Servant Rule
Employers: Master
a. Owner and Manager of
establishment or enterprises are
liable for damage caused by their
employees in the service of
employment or on the occasion of
their functions.
b. Employer of household helper
though not engaged in any business
or industry are liable for damages
caused by helper acting within the
scope of their assigned tasks.
Basis of Liability is not “Respondent
Superior (Anglo-American doctrine where
the negligence of the employee is
conclusively presumed to be the
negligence of the employer) but on the
relationship of Pater-Familias, (master-
servant) a theory basing the liability of the
master ultimately on his own negligence
and not that of the servant as manifested
in his negligence in the selection of their
employee-servant (culpa eligiendo) or in
the supervision over their employee-
servants (culpa in vigilando). This
negligence is prima facie presumption
juris tantum- overcome or rebutted by
proof that they have observed and
exercised all the diligence of a good father
of a family (diligantissimi bonus fater
familias). The theory is deduced from the
last par of Art 2180 NCC providing the
responsibility shall cease upon proof of
exercise of the diligence of a good father
of a family to prevent the damage.
4. Borrowed Servant Rule
The common law principle that the
employer of a borrowed employee, rather
than the employee’s regular employer, is
liable for the employee’s actions that
occur while the employee is under the
control of the temporary employer.
Sometimes referred to as borrowed
employee doctrine.
5. Contributory Negligence
It is a conduct on the part of the
injured party, contributing as a legal
cause to the harm he has suffered,
which falls below the standard which
he is required to conform for his own
protection. It is an act or omission
amounting to want of ordinary care
on the part of the person injured
which, concurring with the
defendant’s negligence, is the
proximate cause of the injury.
Art. 2179 of the New Civil Code is
clear that if the plaintiff’s negligence
is merely contributory, the plaintiff is
not barred from recovering from the
defendant. This statutory rule is
reiterated in Article 2214 which states
that “in quasi-delicts, the contributory
negligence of the plaintiff shall be
reduced damages that he may
recover.”
Contributory negligence of the
plaintiff merely results to mitigation
of liability. Under this rule,
contributory negligence is defined as
conduct on the part of the injured
 party, contributing as a legal cause to
the harm he has suffered, which falls
below the standard to which he is
required to conform for his own
protection.
The court is free to determine
the extent of the mitigation of the
defendant’s liability depending on the
circumstances.
6. Proximate Cause
Proximate cause has been defined as
“that cause, which, in natural and
continuous sequence, unbroken by any
efficient intervening cause, produces the
injury, and without which the result
would not have occurred.”
Proximate cause vs. contributory negligence.
In the tort-related case of LAMBERT S. RAMOS
vs. C.O.L. REALTY CORPORATION, G.R. No.
184905, August 28, 2009, the issue for
resolution by the Philippine Supreme Court
was whether petitioner could be held
solidarily liable with his driver, Rodel
Ilustrisimo, to pay respondent C.O.L. Realty
the amount of P51,994.80 as actual damages
suffered in a vehicular collision. It declared
the following doctrines on proximate cause
and contributory negligence, thus:
1. Articles 2179 and 2185 of the Civil Code on
quasi-delicts apply in this case, viz:
Article 2179. When the plaintiff’s own
negligence was the immediate and
proximate cause of his injury, he
cannot recover damages. But if his
negligence was only contributory, the
immediate and proximate cause of
the injury being the defendant’s lack
of due care, the plaintiff may recover
damages, but the courts shall mitigate
the damages to be awarded.
Article 2185. Unless there is proof to
the contrary, it is presumed that a
person driving a motor vehicle has
been negligent if at the time of the
mishap, he was violating any traffic
regulation.
2. If the master is injured by the negligence of
a third person and by the concurring
contributory negligence of his own servant or
agent, the latter’s negligence is imputed to his
superior and will defeat the superior’s action
against the third person, assuming of course
that the contributory negligence was the
proximate cause of the injury of which
complaint is made.
3. Applying the foregoing principles of law to
the instant case, Aquilino’s act of crossing
Katipunan Avenue via Rajah Matanda
constitutes negligence because it was
prohibited by law. Moreover, it was the
proximate cause of the accident, and thus
precludes any recovery for any damages
suffered by respondent from the accident.
4. Proximate cause is defined as that cause,
which, in natural and continuous sequence,
unbroken by any efficient intervening cause,
produces the injury, and without which the
result would not have occurred. And more
comprehensively, the proximate legal cause is
that acting first and producing the injury,
either immediately or by setting other events
in motion, all constituting a natural and
continuous chain of events, each having a
close causal connection with its immediate
predecessor, the final event in the chain
immediately effecting the injury as a natural
and probable result of the cause which first
acted, under such circumstances that the
person responsible for the first event should,
as an ordinary prudent and intelligent person,
have reasonable ground to expect at the
moment of his act or default that an injury to
some person might probably result
therefrom.
5. If Aquilino heeded the MMDA prohibition
against crossing Katipunan Avenue from Rajah
Matanda, the accident would not have
happened. This specific untoward event is
exactly what the MMDA prohibition was
intended for. Thus, a prudent and intelligent
person who resides within the vicinity where
the accident occurred, Aquilino had
reasonable ground to expect that the accident
would be a natural and probable result if he
crossed Katipunan Avenue since such crossing
is considered dangerous on account of the
busy nature of the thoroughfare and the
ongoing construction of the Katipunan-Boni
Avenue underpass. It was manifest error for
the Court of Appeals to have overlooked the
principle embodied in Article 2179 of the Civil
Code, that when the plaintiff’s own
negligence was the immediate and proximate
cause of his injury, he cannot recover
damages.
6. Hence, we find it unnecessary to delve into
the issue of Rodel’s contributory negligence,
since it cannot overcome or defeat Aquilino’s
recklessness which is the immediate and
proximate cause of the accident. Rodel’s
contributory negligence has relevance only in
the event that Ramos seeks to recover from
respondent whatever damages or injuries he
may have suffered as a result; it will have the
effect of mitigating the award of damages in
his favor. In other words, an assertion of
contributory negligence in this case would
benefit only the petitioner; it could not
eliminate respondent’s liability for Aquilino’s
negligence which is the proximate result of
the acciden
CASES:
Dr. Jarcia and Dr. Bastan vs. People
GR No. 187926, February 15, 2012
(Res ipsa Loquitor)
Facts: Roy was hit by a taxicab and was rushed
to Manila Doctors Hospital for emergency
medical treatment. X-ray result of his ankle
showed no fracture as per Dr. Jarcia. Dr.
Bastan upon her own examination informed
the mother, Mrs. Santiago, that it was only
the ankle that was hit and no need to
examine the whole leg. Eleven (11) days after,
Roy developed fever, swelling upper right leg
and misalignment of foot. X-ray then revealed
a right mid-tibial fracture and linear hairline
fracture in the shaft of the bone, thus, this
case for simple imprudence resulting to
serious physical injuries. RTC found
petitioners guilty beyond reasonable doubt.
CA affirmed applying the doctrine res ipsa
loquitur.
Issue: Whether or not the doctrine of res ipsa
loquitur is applicable in this case.
Held: No. This doctrine of res ipsa
loquitur means "Where the thing which
causes injury is shown to be under the
management of the defendant, and the
accident is such as in the ordinary course of
things does not happen if those who have the
management use proper care, it affords
reasonable evidence, in the absence of an
explanation by the defendant, that the
accident arose from want of care."
The Black's Law Dictionary defines the said
doctrine. Thus:
The thing speaks for itself. Rebuttable
presumption or inference that defendant was
negligent, which arises upon proof that the
instrumentality causing injury was in
defendant's exclusive control, and that the
accident was one which ordinarily does not
happen in absence of negligence. Res ipsa
loquitur is a rule of evidence whereby
negligence of the alleged wrongdoer may be
inferred from the mere fact that the accident
happened provided the character of the
accident and circumstances attending it lead
reasonably to belief that in the absence of
negligence it would not have occurred and
that 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 plaintiff
produces substantial evidence that the injury
was caused by an agency or instrumentality
under the exclusive control and management
of defendant, and that the occurrence was
such that in the ordinary course of things
would not happen if reasonable care had
been used.
The requisites for the application of the
doctrine of res ipsa loquitur are: (1) the
accident was of a kind which does not
ordinarily occur unless someone is
negligent; (2) the instrumentality or agency
which caused the injury was under the
exclusive control of the person in charge;
and (3) the injury suffered must not have
been due to any voluntary action or
contribution of the person injured.
In this case, the circumstances that caused
patient Roy Jr.’s injury and the series of tests
that were supposed to be undergone by him
to determine the extent of the injury suffered
were not under the exclusive control of Drs.
Jarcia and Bastan. It was established that they
are mere residents of
the Manila Doctors Hospital at that time who
attended to the victim at the emergency
room. While it may be true that the
circumstances pointed out by the courts
below seem doubtless to constitute reckless
imprudence on the part of the petitioners,
this conclusion is still best achieved, not
through the scholarly assumptions of a
layman like the patient’s mother, but by the
unquestionable knowledge of expert
witness/es. As to whether the petitioners
have exercised the requisite degree of skill
and care in treating patient Roy, Jr. is
generally a matter of expert opinion.
Rogelio Ramos and Erlinda Ramos vs. CA
GR. No. 124354, April 2002
(Captain-of-the-ship Doctrine)
Facts: Erlinda Ramos was scheduled for an
operation for the removal of her gall bladder
on June 17, 1985 to be performed by Dr.
Hosaka, a surgeon, and Dr. Guiterrez, an
anesthesiologist at De Los Santos Medical
Center (DLSMC). Dr. Hosaka arrived late,
three hours after the scheduled operation; on
the other hand, Dr. Guiterrez did the
intubation. After the operation, Erlinda Ramos
was in a comatose condition until she died in
1999. It was found that the faulty intubation
was the proximate cause of Erlinda’s
comatose condition.
RTC found the doctors negligent in the
p0erformance of their duties. On appeal, CA
reversed, thus, this petition alleging that Dr.
Hosaka was liable under the doctrine of
Captain-of-the-Ship.
Issue: Whether or not Dr. Hosaka was liable
on the basis of the captain-of-the-ship
doctrine.
Held: Yes. As the so-called “captain of the
ship”, it is the surgeon’s responsibility to see
to it that those under him perform their task
in the proper manner. Respondent Dr.
Hosaka’s negligence can be found in his
failure to exercise the proper authority (as the
“captain” of the operative team) in not
determining if his anesthesiologist observed
proper anesthesia protocols. In fact, no
evidence on record exists to show that
respondent dr. Hosaka verified if respondent
Dr. Guiterrez properly intubated the patient.
Rogelio Nogales vs. Capitol Medical Center
GR. No. 142625, December 2006
(Borrowed Servant Doctrine)
Facts: Corazon Nogales was under the
exclusive prenatal care of Dr. Estrada for her
pregnancy with her fourth child. Because of
her increased blood pressure and
development of leg edema indicating
preeclampsia which is a dangerous
complication of pregnancy, she was advised
to be immediately admitted to CMC. Other
doctors, resident physicians and
anesthesiologist, aside from Dr. Estrada
attended to her delivery but the latter
eventually died due to “hemorrhage, post
partum.”
RTC found Dr. Estrada solely liable for
damages as he was an independent
contractor-physician. CA affirmed but on the
liability of other respondents applied the
doctrine of “borrowed-servant.”
Issue: Whether or not the doctrine is
applicable.
Held: Yes. In general, hospital is not liable for
the negligence of an independent contractor-
physician except under the doctrine of
“apparent authority.” In the instant case, CMC
impliedly held out Dr. Estrada as a member of
its medical staff. Through CMC’s acts, CMC
clothed Dr. Estrada with apparent authority
thereby leading the spouses Nogales to
believe that dr. Estrada was an employee or
agent of CMC. CMC cannot now repudiate
such authority.
Borrowed-servant doctrine states that the
employer of a borrowed employee, rather
than employee’s regular employer, is liable
for the employee’s actions that occur while
the employee is under the control of the
temporary employer.
Teodoro Umali vs. hon. Angel Bacani
GR. No. L-40570, January 1976
(Proximate Cause and Contributory
Negligence)
Facts: On May 14, 1972, a storm with strong
rain hit the Municipality of Alcala Pangasinan.
During the storm, the banana plants standing
near the transmission line of the Alcala
Electric Plant (AEP) were blown down and fell
on the electric wire. The live electric wire was
cut, one end of which was left hanging on the
electric post and the other fell to the ground.
The following morning, barrio captain saw
Cipriano Baldomero, a laborer of the AEP,
asked him to fix it, but the latter told the
barrio captain that he could not do it but that
he was going to look for the lineman to fix it.
Sometime thereafter, a small boy of 3 years
and 8 months old by the name of Manuel P.
Saynes, whose house is just on the opposite
side of the road, went to the place where the
broken line wire was and got in contact with
it. The boy was electrocuted and he
subsequently died. It was only after the
electrocution that the broken wire was fixed.
Issues: (1) WON the proximate cause of the
boy's death is due to a fortuitous event-
storm; (2) WON boy’s parents’ negligence
exempts petitioner from liability.
Ruling: Decision affirmed.
(1) A careful examination of the records
convinces the SC that a series of negligence
on the part of defendants' employees in the
AEP resulted in the death of the victim by
electrocution. With ordinary foresight, the
employees of the petitioner could have easily
seen that even in case of moderate winds the
electric line would be endangered by banana
plants being blown down.
(2) Art. 2179 CC provides that if the
negligence of the plaintiff (parents of the
victim in this case) was only contributory, the
immediate and proximate cause of the injury
being the defendants' (petitioners’) lack of
due care, the plaintiff may recover damages,
but the courts shall mitigate the damages to
be awarded. This law may be availed of by the
petitioner but does not exempt him from
liability. Petitioner's liability for injury caused
by his employees’ negligence is well defined
in par. 4, of Article 2180 of the Civil Code.
DNA as Evidence
To warrant the issuance of the DNA testing
order, there must be a show cause hearing
wherein the applicant must first present
sufficient evidence to establish a prima facie
case or a reasonable possibility of paternity or
“good cause” for the holding of the test.
"x x x.
Clearly then, it was also not the opportune
time to discuss the lack of a prima facie case
vis-à-vis the motion for DNA testing since no
evidence has, as yet, been presented by
petitioner. More essentially, it is premature to
discuss whether, under the circumstances, a
DNA testing order is warranted considering
that no such order has yet been issued by the
trial court. In fact, the latter has just set the
said case for hearing.
At any rate, the CA’s view that it would be
dangerous to allow a DNA testing without
corroborative proof is well taken and deserves
the Court’s attention. In light of this
observation, we find that there is a need to
supplement the Rule on DNA Evidence to aid
the courts in resolving motions for DNA
testing order, particularly in paternity and
other filiation cases. We, thus, address the
question of whether a prima facie showing is
necessary before a court can issue a DNA
testing order.
The Rule on DNA Evidence was enacted to
guide the Bench and the Bar for the
introduction and use of DNA evidence in the
judicial system. It provides the “prescribed
parameters on the requisite elements for
reliability and validity (i.e., the proper
procedures, protocols, necessary laboratory
reports, etc.), the possible sources of error,
the available objections to the admission of
DNA test results as evidence as well as the
probative value of DNA evidence.” It seeks “to
ensure that the evidence gathered, using
various methods of DNA analysis, is utilized
effectively and properly, [and] shall not be
misused and/or abused and, more
importantly, shall continue to ensure that
DNA analysis serves justice and protects,
rather than prejudice the public.”[35]
Not surprisingly, Section 4 of the Rule on DNA
Evidence merely provides for conditions that
are aimed to safeguard the accuracy and
integrity of the DNA testing. Section 4 states:
SEC. 4. Application for DNA Testing
Order. – The appropriate court may, at any
time, either motu proprio or on application of
any person who has a legal interest in the
matter in litigation, order a DNA testing. Such
order shall issue after due hearing and notice
to the parties upon a showing of the
following:
(a) A biological sample exists that is relevant
to the case;
(b) The biological sample: (i) was not
previously subjected to the type of DNA
testing now requested; or (ii) was previously
subjected to DNA testing, but the results may
require confirmation for good reasons;
(c) The DNA testing uses a scientifically valid
technique;
(d) The DNA testing has the scientific potential
to produce new information that is relevant
to the proper resolution of the case; and
(e) The existence of other factors, if any,
which the court may consider as potentially
affecting the accuracy or integrity of the DNA
testing.
This Rule shall not preclude a DNA testing,
without need of a prior court order, at the
behest of any party, including law
enforcement agencies, before a suit or
proceeding is commenced.
This does not mean, however, that a DNA
testing order will be issued as a matter of
right if, during the hearing, the said conditions
are established.
In some states, to warrant the issuance of the
DNA testing order, there must be a show
cause hearing wherein the applicant must first
present sufficient evidence to establish
a prima facie case or a reasonable possibility
of paternity or “good cause” for the holding of
the test.[36] In these states, a court order for
blood testing is considered a “search,” which,
under their Constitutions (as in ours), must be
preceded by a finding of probable cause in
order to be valid. Hence, the requirement of
a prima facie case, or reasonable possibility,
was imposed in civil actions as a counterpart
of a finding of probable cause. The Supreme
Court of Louisiana eloquently explained —
Although a paternity action is civil, not
criminal, the constitutional prohibition against
unreasonable searches and seizures is still
applicable, and a proper showing of sufficient
justification under the particular factual
circumstances of the case must be made
before a court may order a compulsory blood
test. Courts in various jurisdictions have
differed regarding the kind of procedures
which are required, but those jurisdictions
have almost universally found that a
preliminary showing must be made before a
court can constitutionally order compulsory
blood testing in paternity cases. We agree,
and find that, as a preliminary matter, before
the court may issue an order for compulsory
blood testing, the moving party must show
that there is a reasonable possibility of
paternity. As explained hereafter, in cases in
which paternity is contested and a party to
the action refuses to voluntarily undergo a
blood test, a show cause hearing must be held
in which the court can determine whether
there is sufficient evidence to establish
a prima facie case which warrants issuance of
a court order for blood testing.[37]
The same condition precedent should be
applied in our jurisdiction to protect the
putative father from mere harassment suits.
Thus, during the hearing on the motion for
DNA testing, the petitioner must
present prima facie evidence or establish a
reasonable possibility of paternity.
Notwithstanding these, it should be stressed
that the issuance of a DNA testing order
remains discretionary upon the court. The
court may, for example, consider whether
there is absolute necessity for the DNA
testing. If there is already preponderance of
evidence to establish paternity and the DNA
test result would only be corroborative, the
court may, in its discretion, disallow a DNA
testing.
Difference of Medical
Malpractice and
Negligence
Medical malpractice is a particular form of
negligence which consists in the failure of a
physician or surgeon to apply to his practice of
medicine that degree of care and skill which is
ordinarily employed by the profession
generally, under similar conditions, and in like
surrounding circumstances
There are Four Elements involved in
medical negligent cases:
1. Duty
2. Breach
3. Injury
4. Proximate Causation – It has been
recognized that expert testimony is
usually necessary to support the
conclusion as to causation.
Medical malpractice is the breach of the duty
of care by a medical provider or medical
facility. It has an element of “intent” that
medical negligence does not have in it. The
doctor or provider knew he should have done
something to treat the patient but he failed to
do so knowing that his failure may result in
harm to the patient. It was not intentional in
that he wanted to harm the patient but it was
intentional because he knew that by doing so
the risk of harm was present. For example, a
doctor decides to forego an expense
diagnostic test because the person’s
insurance company will not pay for the
expense of running the test; therefore, the
doctor would bear the financial burden if he
the test.
On the other hand, medical negligence does
not involve intent. Medical negligence applies
when a medical provider makes a “mistake” in
treating patient and that mistake results in
harm to the patient. While the act or omission
is definitely negligence, it does not rise to the
point of medical malpractice because the
medical provider did not commit the action
either with the intent to cause harm or the
knowledge that the patient might suffer harm.
An example of medical negligence may be
when a nurse accidentally leaves a sponge
inside a surgical wound. She did not intend to
harm the patient but her action may not rise to
the level of medical malpractice. Only an
experienced medical malpractice attorney is
qualified to evaluate the case based on the
facts to determine whether a medical
malpractice lawsuit is required or a medical
negligence lawsuit would be better given the
set of facts in your case.
Proving medical malpractice in the Philippines
one of the more difficult civil cases in the
Philippines. Medical procedures involve, to a
great degree, technical matters, which must be
clearly understood first, prior to pursuing a
claim that a treatment was attended with
malpractice. Moreover, in order to prove the
existence of medical malpractice in any case,
the legal requirements of the law must be
completely satisfied.
Medical malpractice suits fall into the genre of
claims based on tort, called quasi-delicts. In
general, negligence suits require proof that a
party failed to observe, for the protection of the
interest of another person, that degree of care,
precaution, and vigilance which the
circumstances justly demand, whereby such
other person suffers injury. It is the omission to
do something which a reasonable man, guided
by those considerations which ordinarily
regulate the conduct of human affairs, would
do, or the doing of something which a prudent
and reasonable man would not do. (Layugan
vs. Intermediate Appellate Court, citing Black’s
Law Dictionary, Fifth Edition, 930).
The Supreme Court, in a case, also had
occasion to explain that doctors, because of
their training and the very nature of their work,
doctors or physicians are required to exercise
utmost diligence in the performance of their
tasks, to wit:
Throughout history, patients have consigned
their fates and lives to the skill of their doctors.
For a breach of this trust, men have been
quick to demand retribution. Some 4,000 years
ago, the Code of Hammurabi then already
provided: “If a physician make a deep incision
upon a man with his bronze lancet and cause
the man’s death, or operate on the eye socket
of a man with his bronze lancet and destroy
the man’s eyes, they shall cut off his hand.”
Subsequently, Hippocrates wrote what was to
become part of the healer’s oath: “I will follow
that method of treatment which according to
my ability and judgment, I consider for the
benefit of my patients, and abstain from
whatever is deleterious and mischievous. . . .
While I continue to keep this oath unviolated
may it be granted me to enjoy life and practice
the art, respected by all men at all times but
should I trespass and violate this oath, may
the reverse be my lot.” At present, the primary
objective of the medical profession is the
preservation of life and maintenance of the
health of the people.
Needless to say then, when a physician strays
from his sacred duty and endangers instead
the life of his patient, he must be made to
answer therefor. Although society today
cannot and will not tolerate the punishment
meted out by the ancients, neither will it and
this Court, as this case would show, let the act
go uncondemned.
xxx xxx
As a final word, this Court reiterates its
recognition of the vital role the medical
profession plays in the lives of the people, and
the State’s compelling interest to enact
measures to protect the public from “the
potentially deadly effects of incompetence and
ignorance in those who would undertake to
treat our bodies and minds for disease or
trauma.” Indeed, a physician is bound to serve
the interest of his patients “with the greatest of
solicitude, giving them always his best talent
and skill.” Through her tortious conduct, the
petitioner endangered the life of Flotilde
Villegas, in violation of her profession’s rigid
ethical code and in contravention of the legal
standards set forth for professionals, in
general, and members of the medical
profession, in particular.” (Dr. Victoria L.
Batiquin and Allan Batiquin vs. Court of
Appeals, G.R. No. 118231, 05 July 1996.)
If the application of the foregoing rulings of the
Supreme Court to an incident will show the
presence of negligence, i.e., when a doctor,
hospital or medical professional failed to
perform the necessary medical services on a
patient according to the degree of skill
required from an ordinary practitioner of their
respective professions, then a cause of action
arising from negligence or quasi-delict exists.
However, being a distinct type of tort, the
Supreme Court stated that, to prove medical
malpractice or medical negligence, four (4)
elements have to be established, to wit:
A word on medical malpractice or negligence
cases.
In its simplest terms, the type of lawsuit which
has been called medical malpractice or, more
appropriately, medical negligence, is that type
of claim 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. Hence, there are four
elements involved in medical negligence
cases: duty, breach, injury and proximate
causation.
As with any civil case, substantial evidence
must be presented to establish the liability of
the responsible party. If the elements of duty,
breach, injury and proximate causation are
established with substantial evidence, then a
hospital, doctor, or other medical professional
will be held liable for malpractice. Civil liability,
in the form of damages, may be awarded by
the court in such instances.
When a doctor or hospital accepts a patient for
treatment, a physician-patient relationship is
created. The first element of duty arises at this
stage. By accepting a case, the doctor or
hospital commenced the duty to render
medical service in favor of the patient in
accordance with the expected training and skill
of a medical practitioner. This is in line with the
ruling of the Supreme Court in the case
of Leonila Garcia-Rueda v. Wilfred L. Pacasio,
et. al, to wit:
Evidently, when the victim employed the
services of Dr. Antonio and Dr. Reyes, a
physician-patient relationship was created. In
accepting the case, Dr. Antonio and Dr. Reyes
in effect represented that, having the needed
training and skill possessed by physicians and
surgeons practicing in the same field, they will
employ such training, care and skill in the
treatment of their patients. They have a duty to
use at least the same level of care that any
other reasonably competent doctor would use
to treat a condition under the same
circumstances. The breach of these
professional duties of skill and care, or their
improper performance, by a physician surgeon
whereby the patient is injured in body or in
health, constitutes actionable malpractice.
Consequently, in the event that any injury
results to the patient from want of due care or
skill during the operation, the surgeons may be
held answerable in damages for negligence.
The second element of breach is present
when the hospital or doctor does treatment in
breach of professional duties. An example of
this would be a doctor that applies treatment
without consulting the patient’s history. It is a
standard operating procedure for all doctors to
apprise themselves about the medical history
of a person before they decide on taking
him/her as a patient. This process is
necessary so that the doctor can gauge
whether he/she is capable of successfully
helping the patient and also for the doctor to
make the proper preparations and decisions
with respect to how to treat said patient.
It is also worthy to note that under Section 2
Article II of the Code of Ethics promulgated by
the Board of Medicine to govern the conduct of
doctors practicing medicine in the Philippines,
a physician has the obligation not to abandon
a patient under any circumstance, to wit:
Section 2. A physician is free to choose whom
he will serve. He may refuse calls, or other
medical services for reasons satisfactory to his
professional conscience. He should, however,
always respond to any request for his
assistance in an emergency. Once he
undertakes a case, he should not abandon nor
neglect it. If for any reason he wants to be
released from it, he should announce his
desire previously, giving sufficient time or
opportunity to the patient or his family to
secure another medical attendant.
Thus, it can be said that when a doctor or
hospital unjustifiably refuses to proceed with
treatment, or just suddenly abandons his or
her patient, the act can be considered as
breach of duty.
The presence of the third element arises
where injury, liability or even death arises as a
consequence of a negligent medical treatment
or procedure.
The last element to establish medical
malpractice or medical negligence, is however,
the most difficult one to prove. Medical
procedures are fraught with varying
consequences, and affected by innumerable
factors such as the environment, personal
health, health of the other members of the
family, food intake, medicine, activities of the
patient, such that it would be difficult to
establish, to a convincing degree, whether the
injury is the proximate result or directly arose
from the procedure conducted.
However, there are instances of medical
malpractice or medical negligence that involve
the application of the familiar doctrine res ipsa
loquitur. The doctrine of res ipsa loquitur,
which directly translates to “the thing speaks
for itself”, governs cases where negligence is
clear by a simple examination of the injury or
the circumstances surrounding the medical
treatment given, such as where a gauze or a
pair of scissors are left inside the body cavity
after it has been sutured, or blood of a
different type is infused to a patient.
In sum, the difficulty in successfully
prosecuting medical negligence lies in the fact
that medicine is not an exact science. There
are numerous life-saving procedures that are
experimental, or even not experimental, but
are fraught with consequences, such that even
the best doctors cannot predict the outcome of
the treatment. Also, countless environmental
variable play a direct hand in the effectiveness
of a treatment.
All that any medical professional or hospital
has to do to avoid medical malpractice is to
study the procedure well including the patient’s
history, keep the patient well-informed of the
procedure which the doctor or hospital intends
to perform, conduct the treatment in good
faith, and with the required degree of
competence, diligence and skill. This way, any
claim of malpractice may be avoided.