GORDON, DENISE M. DR.

JIZ

11780622 LEGAL MEDICINE G04

ROSIT V DAVAO DOCTORS HOSPITAL

FACTS

Rosit figured in a motorcycle accident where he fractured his jaw. He was referred to Dr. Gestuvo, a specialist in mandibular
injuries, who operated on Rosit. As the operation required the smallest screws available, Dr.Gestuvo cut the screws on hand to make
them smaller. Dr. Gestuvo knew that there were smaller titanium screws available in Manila, but did not so inform Rosit supposing that
the latter would not be able to afford the same. Following the procedure, Rosit could not properly open and close his mouth and was
in pain. Xrays showed that his jaw was aligned by the screws used on him touched his molar. Dr. Gestuvo referred Rosit to Dr. Pangan,
a dentist who then opined that another operation is necessary and that it is to be performed in Cebu. Rosit went to Cebu and underwent the
operation successfully. On his return to Davao, Rosit demanded the Dr. Gestuvo reimburse him for the cost of the operation and the
expenses incurred in Cebu amounting to P140,000. Dr. Gestuvo refused to pay. Thus, Rosit filed a civil case for damages. RTC adjudged
Dr. Gestuvo negligent holding that res ipsa loquitur principle applies, thus, expert medical testimony may be dispensed with because the
injury itself provides the proof of negligence. CA reversed the decision. Hence, this appeal.

ISSUE: W/N not CA correctly absolved Dr. Gestuvo from liability

HELD: CA erred in absolving Dr. Gestuvo from liability.

A medical negligence is a type of claim to redress a wrong committed by a medical professional, that has caused bodily harm to or the
death of a patient. There are four elements involved in a medical negligence case, namely: duty, breach, injury, and proximate
causation. To establish medical negligence, the Court has held that an expert testimony is generally required to define the standard of
behaviour by which the court may determine whether the physician has properly performed the requisite duty toward the patient. But,
although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or
that he has deviated from the standard medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for
expert medical testimony is dispensed with because the injury itself provides the proof of negligence. The exception may be availed of if
the following requisites concur:
1. The accident was of a kind that does not ordinarily occur unless someone is negligent
2. The instrumentality or agency that caused the injury was under the exclusive control of the person charged
3. The injury suffered must not have been due to any voluntary action or contribution of the person injured.
In this case, the essential requisites for the application of the doctrine of res ipsa loquitur are present. The first element was sufficiently
established when Rosit proved that one of the screws installed by Dr.Gestuvo struck his molar. An average man of common intelligence
would know that striking a tooth with any foreign object much less a screw would cause severe pain. Anent the second element, it is
sufficient that the operation which resulted in the screw hitting Ros
it’s molar was, indeed, performed by Dr. Gestuvo. Lastly, the third element, it was not shown that Rosit’s lung disease could have
contributed to the pain. Whatis clear is that he suffered because one of the screws that Dr. Gestuvo installed hit Rosit’s molar. Clearly
then, the res ipsa loquitur doctrine finds application in the instant case and no expert testimony is required to establish the negligence of
defendant Dr. Gestuvo

SPS BONTILAO V GERONA

FACTS

On December 28, 1991, respondent Dr. Carlos Gerona, an orthopedic surgeon at the Vicente Gullas Memorial Hospital, treated
petitioner’s son, 8 y/o Allen Roy Bontilao, for a fractured right wrist. Respondent administered a “U-spint” and immobilized Allen’s wrist
with a cast, then sent Allen home. On June 4, 1992, Alen re-fractured the same wrist and was brought back to the hospital. The x-ray
examination showed a complete fractured and displacement bone, with the fragments overlapping each other. Respondent performed a
closed reduction procedure, with Dr. Vicente Jabagat as the anesthesiologist. Then he placed Allen’s arm in a plaster cast to immobilize
it. He allowed Allen to go home after the post reduction x-ray showed that the bones were properly aligned, but advised Allen’s mother,
petitioner Sherlina Bontilao, to bring Allen back for re-tightening of the cast not later than June 15, 1992. Allen was however, only
brought back after the said date. By then, because the cast had not be re-tightened, a rotational deformity had developed in Allen’s
arm. The x-ray examination showed that the deformity was caused by a re-displacement of the bone fragments, so it was agreed that
an open reduction surgery will be conducted on June 24, 1992 by the respondent, again with Dr. Jabagat as the anesthesiologist. On
the said date, Sherlina was allowed to observe the operation behind a glass panel. Dr. Jabagat failed to intubate the patient after 5
attempts so anesthesia was administered through a gas mask. Respondent asked Dr. Jabagat if the operation should be postponed
given the failure to intubate, but Dr. Jabagat said that it was alright to proceed. Respondent verified that Allen was breathing properly
before proceeding with the surgery. As respondent was about to finish the suturing, Sherlina decided to go out of the operating room to
make a telephone call and wait for her son. Later, she was informed that her son died on the operating table. The cause of death was
asphyxia due to the congestion and edema of the epiglottis. Hence, a criminal, administrative and civil case was filed by the parents of
Allen against the doctors for the negligence that caused Allen’s death.

ISSUE: Whether or not respondent is liable for medical negligence due to the death of Allen.

HELD: No. The trial court erred in applying the doctrine of res ipsa liquitor to pin liability on respondent for Allen’s death.
Res ipsa liquitor is a rebuttable presumption or influence that the defendant was negligent. The presumption only arises upon proof that
the instrumentality causing injury was in the defendant’s exclusive control, and that the accident was one which ordinarily does not happen
in the absence of negligence. It is a rule of evidence whereby negligence of the alleged wrong does 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 wrong doer.

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

Moreover, we note that in the instant case, the instrument which caused the injury or damage was not even within respondent’s exclusive
control and management as Dr. Jabagat was exclusively in control and management of the anesthesia and endotracheal tube. The
doctrine of res ipsa liquitor allows the mere existence of an injury to justify a presumption of negligence or the part of the person who
controls the instrument causing the injury, provided that the following requisites concur:

1. The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or co-defendants;
3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.

MANILA DOCTORS V SO UN CHUA AND VICKY TY

FACTS

Respondent Chua, mother of Ty, was admitted to petitioner hospital for hypertension and diabetes. While Chua was confined, another
daughter Judith Chua was admitted for treatment of injuries sustained after a vehicular accident. Ty shouldered the hospital bills for the
two. After Judith was discharged, respondent Chua remained confined. Ty was able to pay P435,800.00. The hospital bills eventually
totalled P1,075,592.95. When Ty was unable to pay the bills, the hospital allegedly pressured her, by cutting off the telephone line in
her room and removing the air-conditioning unit, television set, and refrigerator, refusing to render medical attendance and to change
the hospital gown and bed sheets, and barring the private nurses or midwives from assisting the patient, to settle the same through the
signing of a promissory note. Ty issued post-dated checks to pay the note. The checks bounced. The petitioner alleged that that as
early as one week after respondent Chua had been admitted to its hospital, Dr. Rody Sy, her attending physician, had already given
instructions for her to be discharged, but respondents insisted that Chua remain in confinement. It also alleged that Ty voluntarily
signed the agreement that she will pay the bills and that no undue pressure was exerted by them; and that the cutting-off of the
telephone line and removal of the air-conditioning unit, television set, and refrigerator cannot constitute unwarranted actuations, for the
same were resorted to as cost-cutting measures and to minimize respondents’ charges that were already piling up, especially after
respondent Ty refused to settle the balance notwithstanding frequent demands. Finally it alleged that this case was instituted by Ty to
provide leverage against the hospital for filing criminal charges against the latter for violation of BP 22.Both the trial court and the CA
rendered decisions in favor of the respondents finding that the removal of
the facilities led to the worsening of Chua’s condition.

ISSUE: W/N the hospital is liable for damages

HELD: No. The operation of private pay hospitals and medical clinics is impressed with public interest and imbuedwith a heavy social
responsibility. But the hospital is also a business, and, as a business, it has a right to institute allmeasures of efficiency commensurate
to the ends for which it is designed, especially to ensure its economicviability and survival. And in the legitimate pursuit of economic
considerations, the extent to which the public maybe served and cured is expanded, the pulse and life of the medical sector quickens,
and the regeneration of thepeople as a whole becomes more visibly attainable. In the institution of cost-cutting measures, the hospital
has aright to reduce the facilities and services that are deemed to be non-essential, such that their reduction or removalwould not be
detrimental to the medical condition of the patient.

The lower court’s decisions are results of misappreciation of

the uncorroborated and self-servingevidence presented by the respondents. The evidence in the record firmly establishes that the staff
of thepetitioner took proactive steps to inform the relatives of respondent Chua of the removal of facilities prior thereto,and to carry out
the necessary precautionary measures to ensure that her health and well-being would not beadversely affected. Also, the medical
condition of respondent Chua, as consistently and indisputably confirmed byher attending physician, Dr. Rody Sy, a cardiologist, who
was called as witness for both parties, whom evenrespondent Chua repeatedly praised to be "my doctor" and "a very good doctor" at
that, and whose statements attimes had been corroborated by other competent witnesses, had been "relatively well," "ambulatory,"
"walkingaround in the room," and that she was "able to leave the hospital on her own without any assistance;" that although she
complained of symptoms such as dizziness, weakness, and abdominal discomfort, Dr. Sy requestedseveral medical examinations,
such as the laboratory tests, renal tests, MRI, ultrasound, and CT scan, all of whichwere administered after procuring the consent
of respondent Chua's family as admitted by respondent Tyherself, and even called on other specialists, such as a neurologist,
endocrinologist, and gastroenterologist, to lookinto her condition and conduct other tests as well according to their fields of specialty, all
of which yielded noserious finding. Finally, her illnesses were "lifelong illnesses" at a stage where they cannot be totally removed
orabolished, making it clear to her family that "one hundred percent recovery is not possible" despite being givendaily medication in the
hospital. Her condition, nonetheless, is not serious, as the blood pressure is more or lesscontrolled and within acceptable limits, "not
that critical to precipitate any acute attack," nor likely to fall into anyemergency, nor yet does she require continuous or prolonged
hospitalization since she was stable enough to betreated at home and on an "out-patient" basis, so much so that Dr. Sy encouraged her
to exercise and avoidresting all the time, and recommended that "anytime she may be discharged" even in just "two weeks
afterconfinement," the propriety of his order of discharge concurred upon by the other specialists as well, had it notbeen for
respondents' insistence to stay in the hospital in view of their hope for absolute recovery despite theadmission of respondent Chua
herself that she cannot anymore be totally cured.Authorities explicitly declare that a patient cannot be detained in a hospital for non-
payment of thehospital bill. If the patient cannot pay the hospital or physician's bill, the law provides a remedy for them topursue, that is,
by filing the necessary suit in court for the recovery of such fee or bill. If the patient is preventedfrom leaving the hospital for his
inability to pay the bill, any person who can act on his behalf can apply in court forthe issuance of the writ of
habeas corpus
. The form of restraint must be total; movement must be restrained in alldirections. If restraint is partial, e.g., in a particular direction with
freedom to proceed in another, the restraint onthe person's liberty is not total. However, the hospital may legally detain a patient against
his will when he is adetained or convicted prisoner, or when the patient is suffering from a very contagious disease where his
releasewill be prejudicial to public health, or when the patient is mentally ill such that his release will endanger publicsafety, or in other
exigent cases as may be provided by law. Moreover, under the common law doctrines on tort, itdoes not constitute a trespass to the
person to momentarily prevent him from leaving the premises or any partthereof because he refuses to comply with some reasonable
condition subject to which he entered them. In allcases, the condition of this kind of restraint must be reasonable in the light of the
circumstances.At any rate, as stated above, the patient is free to leave the premises, even in the ostensible violation of these
conditions, after being momentarily interrupted by the hospital staff for purposes of informing him of thosereasonable conditions or
simply for purposes of making a demand to settle the bill. If the patient chooses toabscond or leave without the consent of the hospital
in violation of any of the conditions deemed to be reasonableunder the circumstances, the hospital may nonetheless register its protest
and may choose to pursue the legalremedies available under law, provided that the hospital may not physically detain the patient,
unless the case fallsunder the exceptions abovestated.Authorities are of the view that, ordinarily, a hospital, especially if it is a private
pay hospital, is entitled tobe compensated for its services, by either an express or an implied contract, and if no express contract
exists,there is generally an implied agreement that the patient will pay the reasonable value of the servicesrendered; when a hospital
treats a patient's injuries, it has an enforceable claim for full payment for its services,regardless of the patient's financial status. The
requirement to have the relative of respondent Chua to execute apromissory note as part of the arrangement to settle the unpaid
obligations is a formality that converts anyimplied contract into written form and, moreover, amounts to a reasonable condition, the non-
fulfillment of which, in itself, however, as discussed, cannot allow the hospital to detain the patient. Contrary to the findings of the courts
a quo
, that such an agreement embodied in a promissory note, as well as the Contract for Admission and Acknowledgment of Responsibility
for Payment dated October 30, 1990, do not become contracts of adhesionsimply because the person signing it was under stress that
was not the result of the actions of the hospital,especially taking into account that there is testimony to the effect that respondent Ty
signed the Promissory Notedated June 5, 1992 in the presence of counsel and acting under his advise