Garcia, Regina Via G. // Jaraplasan, Chelin Monica B. // Militar, Natasha Czarina A.

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Oriesga, Matt Rose Louie C. // Sabella, Christine Faith R.


MEDICAL MALPRACTICE

Whether or not medical malpractice can be proven.

The Supreme Court has decided five cases regarding medical malpractice.

In the case of Cruz vs. CA, G.R. No. 122445, November 18, 1997, the Supreme
Court ruled that due to the insufficiency of the evidence, this Court was not able to render a
sentence of conviction of negligence and reckless imprudence. 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.

In the case of Flores vs. Pineda, G.R. No. 158996, November 14, 2008, the Supreme
Court ruled that there are four elements involved in a medical negligence case,
namely: duty, breach, injury, and proximate causation. Breach of these elements would
make the medical practitioner liable for medical negligence. The burden of proof lies on the
plaintiff, thus he must prove that the health provider failed to do something a competent
health provider would have done and that such failure caused an injury to the patient.
In the case of Lucas vs. Tuao, G.R. 178763, April 21, 2009, the Supreme Court
ruled that a medical expert as a witness is essential to prove medical malpractice. The
medical expert presents the standard to which the court can gauge the basic issue of breach
thereof by the physician or surgeon.

In the case of Mendoza vs. Casumpang, G.R. No. 197987, March 19, 2012, the
Supreme Court ruled that it is the responsibility of the surgeon to personally ascertain counts
of instruments and materials before and after the surgical operation. The petitioner of this
case failed to perform this duty which put his patients life in danger.

From the above cases, the Supreme Court has laid down essential requirements to
prove medical malpractice. The four elements involved in medical malpractice are duty,
breach, injury, and proximate causation (Flores case). Another requirement is that a medical
expert must be presented as a witness to set a standard for the court to base their decision on
(Lucas case).
Medical malpractice is connected to reckless imprudence to which the elements 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 (Cruz case). Therefore,
in order to avoid medical malpractice, people involved in the medical field should practice
necessary cautions (Mendoza case).
Through synthesis of the above cases, requirements to prove medical malpractice
and examples of what constitutes medical practice were presented.



CRUZ vs. CA
G.R. No. 122445 (November 18, 1997)

A. Legal Issue

Whether or not a physician has committed an "inexcusable lack of precaution" in the
treatment of his patient.

B. Legal Facts

Private respondent examined by the petitioner in the Perpetual Help Clinic and
General Hospital who found a "myoma" in her uterus, and scheduled her for a hysterectomy
operation on March 23, 1991.
The present case against petitioner is in the nature of a medical malpractice suit,
which in simplest term is the type of claim which a victim has available to him or her to
redress a wrong committed by a medical professional which has cause bodily harm.
When the operation was finished after a lapse of a few hours, Rowena, the
respondents daughter, noticed that her mother was gasping for breath and but at around
10:00 o'clock P.M. she went into shock and her blood pressure dropped to 60/50. Lydia's
was then transferred to the San Pablo District Hospital. Upon her arrival at the hospital, she
was wheeled into the operating room and the petitioner and Dr. Ercillo re-operated on her.
The attending physicians summoned Dr. Bartolome Angeles, head of the Obstetrics and
Gynecology Department of the San Pablo District Hospital. However, when Dr. Angeles
arrived, Lydia was already in shock and possibly dead as her blood pressure was already 0/0.
Her death certificate states "shock" as the immediate cause of death and "Disseminated
Intravascular Coagulation (DIC)" as the antecedent cause.

C. Ruling

No. The physician has not committed an "inexcusable lack of precaution" in the
treatment of his patient.

D. Reasoning

This court has no recourse but to rely on the expert testimonies rendered by both
prosecution and defense witnesses that substantiate rather than contradict petitioner's
allegation that the cause of Lydia's death was DIC which, as attested to by an expert witness,
cannot be attributed to the petitioner's fault or negligence. The probability that Lydia's death
was caused by DIC was unrebutted during trial and has engendered in the mind of this Court
a reasonable doubt as to the petitioner's guilt. Thus, her acquittal of the crime of reckless
imprudence resulting in homicide.

E. Policy

The society will benefit from the law used to answer the legal issue in a way that
while the family of Lydia Umali grieves for her death, we are bound by the dictates of
justice and fair dealing which hold inviolable the right of an accused to be presumed
innocent until proven guilty beyond reasonable doubt. Nevertheless, one can still be civilly
liable on a case, for while a conviction of a crime requires proof beyond reasonable doubt,
only a preponderance of evidence is required to establish civil liability.




FLORES vs. PINEDA
G.R. No. 158996 (November 14, 2008)

A. Legal Issue

Whether or not spouses Dr. Fredelicto Flores and Dr. Felisima Flores are guilty of
medical negligence.

B. Legal Facts

Teresita Pineda consulted Dr. Fredelicto Flores for her medical condition, where the
latter ordered the former to undergo an on-call D&C operation to be performed by Dr.
Felicisima Flores, Fredelictos wife. After the operation, Teresitas condition worsened and
she died eventually. Believing that it was the negligence of Dr. Felicisima and Dr.
Fredelicto, Teresitas family filed a medical negligence case against the doctors.
The trial court and the Court of Appeals ruled in favour of Teresitas family. The
spouses appealed. UMDC, the spouses co-defendant, filed a petition for a review on
certiorari.
The factual settings of the case presented that Teresita Pineda consulted Dr.
Fredelicto Flores, where she complained of general body weakness, loss of appetite,
frequent urination and thirst, and on-and-off vaginal bleeding. Dr. Fredelicto interviewed
Teresita and subsequently advised her to return the next week for a general check-up. She
failed to return the next week as advised, but when her condition persisted, she further
consulted Dr. Fredelicto at his UMDC clinic. The latter did a routine check-up and ordered
her to undergo an on-call D&C operation to be performed by his wife, Dr. Felisima
Flores. Teresita was taken to the operating room and had undergone a series of medical
examinations. The preliminary laboratory results indicated that her blood sugar was high.
After the operation, Teresitas condition worsened. She had difficulty in breathing and was
rushed to the intensive care unit. Tests confirmed that she was suffering from Diabetes
Mellitus Type H. Insulin was administered on her but the medications were already too late
and Teresita died eventually.

C. Ruling

Yes. Dr. Fredelicto Flores and Dr. Felisima Flores are guilty of medical negligence.

D. Reasoning

Medical negligence occurs when a medical provider deviates from the recognized
standard of care in the treatment of a patient. A negligence claim exists if a doctors
negligence causes injury or damages to a patient.
The attending physician should have postponed the D&C operation in order to
conduct a confirmatory test to make a conclusive diagnosis of diabetes and to refer the case
to an expert. This clearly shows breach of duty. The act of the doctors in proceeding the
D&C operation without adequately preparing the victim is the logical cause of the Teresita's
death. Experts stated that "stress, whether physical or emotional, is a factor that can
aggravate diabetes; a D&C operation is a form of physical stress. In Teresita's case, her
laboratory test showed that her blood sugar level was way above the normal blood sugar
range. Thus, between the D&C and death was the diabetic complication that could have
been prevented with the observance of standard medical precautions.

E. Policy

The award for damages resulting from medical negligence must be very high, so
these health-providers would be more cautious and careful in providing medical help to their
patients. After all, life is so expensive no one can afford it. It is already considered
priceless.
LUCAS vs. TUAO
G.R. 178763 (April 21, 2009)
A. Legal Issue

Whether or not the respondent, Dr. Prospero Ma. C. Tuao, is guilty of medical
malpractice.

B. Legal Facts

The petitioners, Peter Lucas and his family, is suing respondent, Dr. Prospero Ma. C.
Tuao, for damages due to medical malpractice on the grounds that Tuao was negligent in
treating Lucas conjunctivitis or sore eyes which led to glaucoma which in turn made him
irritable and unable to support his family. Lucas consulted Tuao when he had severe pain
in his right eye to which the respondent performed an ocular routine examination where he
diagnosed Lucas to be suffering conjunctivitis or sore eyes which developed Epidemic
Kerato Conjunctivitis (EKC), a viral infection to which Tuao prescribed a steroid-based
eye drop called Maxitrol which Lucas was using before. Lucas couldnt get a hold of
Maxitrol so Tuao suggested Blephamide instead which was also steroid-based and Lucas
later used Maxitrol when it became available. Later on, Fatima Lucas, the wife, found out
from the accompanying literature of the medicine that prolonged use of steroid-based
medication can result to glaucoma. Lucass right eye pain reduced for a while but later on
returned and it became severe that Tuao referred him to another ophthalmologist, Dr.
Manuel B. Agulto, for a second opinion to which Dr. Maniel Agulto wrote a letter to Tuao
stating the Lucas sustained significant glaucoma damage.
The Regional Trial Court denied the petitioners claim for damages due to
insufficient evidence proving Tuaos medical malpractice in treating Lucas because they
failed to present a medical expert that could support their claim that what Tuao did was
indeed medical malpractice. Petitioners appealed to the Court of Appeals to which the court
affirmed the Regional Trial Courts decision. Hence, the petitioners appealed to the Supreme
Court.

C. Ruling

The Supreme Court ruled that respondent, Dr. Prospero Ma. C. Tuao, is not guilty
of medical malpractice.

D. Reasoning

The Supreme Court emphasizes that in order for medical malpractice to be proven, a
medical expert should be a witness to attest to the accuseds medical malpractice.
Petitioners complaint for damages is merely based on a statement in the literature of
Maxitrol identifying the risks of its use and Dr. Agultos comment. The medical expert sets
a standard and when there is failure to present one, the courts have no standard by which to
gauge the basic issue of breach thereof by the physician or surgeon.

E. Policy

The qualifications of a physician are taken into account and there is inevitable
presumption that 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. Therefore,
a medical expert as a witness in essential in medical malpractice cases to give light to the
errors of the accused. Also, it serves as a reminder for people in the medical field to be
cautious and take the necessary precautions when attending to their clients to avoid medical
malpractice.


MENDOZA vs. CASUMPANG
G.R. No. 197987 (March 19, 2012)

A. Legal Issue

Whether or not there was a gross negligence on the part of the petitioner, Dr. Mariter
Mendoza.

B. Legal Facts

Josephine Casumpang, who died before the trial could end, was substituted by her
respondent, husband, Adriano and their children Jennifer and John, filed an action for
damages against petitioner Dr. Mendoza in 1993 before the Regional Trial Court of Iloilo
City. Josephine underwent hysterectomy and myomectomy that Dr. Mendoza performed and
after operation, Josephine experienced recurring fever, nausea and vomiting. Three months
after the operation when she noticed something protruding from her genital while taking a
bath and she went to see Dr. Jamandre-Guban since Dr. Mendoza was unavailable. Dr.
Jamandre-Guban extracted a foul smelling, partially expelled rolled gauze from her cervix.
The RTC rendered judgment, finding Dr. Mendoza guilty of neglect and reinstated by the
Court of Appeals, thus, prompted her to file the present petition.

C. Ruling

Yes, the petitioner is guilty of gross negligence.

D. Reasoning

Gross negligence is a flagrant failure to exercise the care that a reasonably prudent
person would exercise. A surgical operation is the responsibility of surgeon performing it.
He must personally ascertain that the counts of instruments and materials used before the
surgery and prior to the sewing the patient up has been correctly done.

E. Policy

In this kind of jurisprudence, it will provide an example to the medical profession
and to stress the need for constant vigilance in attending to patients health.