Medical Malpractice and Negligence

MEMBERS
Airah Vanne Burgos BSBA-Financial Management
Reynaldo Angelito Cortes Information and Communication Technology
Marjorie Guarino Public Administration
Stephanie Ann Ramos BS Nursing
Rejeane Louise Ignacio Education Major in Information Technology
Rhodora Ledesma, M.D./Nuclear Medicine

COVERAGE
RES IPSA LIQUITUR
PROXIMATE CAUSE
DOCTRINE OF CORPORATE RESPONSIBILITY
DOCTRINE OF RESPONDEAT SUPERIOR
DOCTRINE OF APPARENT AUTHORIT
CAPTAIN OF THE SHIP DOCTRINE
BORROWED SERVANT RULE
Medical Malpractice & Negligence:
DISTINCTIONS

Medical Malpractice general term
used when a medical practitioner
(Doctor) or an allied medical
practitioner (Dentist, Nurse,
Medical Technologist)
KNOWINGLY deviates from the
standard practice of medicine

Medical Negligence specific term
used when a medical practioner
does not exercise due diligence and
standard care required of him thus
resulting to injury to the patient.
Usually connotes accidental or
unintentional injury.


Duties of Doctors
GENERAL PRACTITIONER an M.D., board certified , goes into practice without
further training in any particular field of medicine.
Standard of care required is ORDINARY CARE and DILIGENCE in the application of his
knowledge and skill in the practice of medicine.
SPECIALIST an M.D., goes into further training in a particular field of medicine and is
certified as such after passing the specialization board (Diplomate or Fellow).
- FPCP
- FPCC
- FPCS
- FPPS
- FPSNM
- FACP
- ACNC
- ACS, etc.
Standard of care required is more than just ordinary care and diligence but a HIGHER
degree of care expected from an average physician or general practitioner.

Elements of Medical Negligence
1. Breach of such professional duty or improper performance thereof;
2. Injury is caused to the patient, constituting actionable malpractice;
3. Duty to perform at least the same level of care that any reasonably prudent doctor
would use to treat a condition under the same circumstances;
4. The doctors actions in fact caused the harm to the patient or the proximate cause
of the patients injury.



Proximate cause

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.
a legal concept of "cause-and-effect" relationships
determines whether an injury would have resulted from a particular cause.
In Malpractice - An element required to prove negligence; i.e., the plaintiffPatient
or Patient's estate must prove that the Patient's injury is reasonably connected to
the physician's action, through either the 'but for' test or the 'substantial factor
test.
Two pronged EVIDENCE

1. Evidence as to the recognized standards of the medical community in the particular
kind of case; AND
2. A showing that the physician DEVIATED from this standard in his treatment.
Note: It is a matter of expert opinion whether a physician or surgeon has exercised the
requisite degree of skill and care in the treatment of his patient. + Courts appreciation of
the facts and the significance of an experts opinion.
Obstacles to obtaining EVIDENCE
based on expert testimony
The Hippocratic Oath mandates physicians to give primordial consideration to the well-
being of their patients. If a doctor fails to live up to this precept, he is accountable for his
acts. This notwithstanding, courts face a unique restraint in adjudicating medical
negligence cases because physicians are not guarantors of care and, they never set out to
intentionally cause injury to their patients. However, intent is immaterial in negligence
cases because where negligence exists and is proven, it automatically gives the injured a
right to reparation for the damage caused.

Cantre vs Sps Go, G.R. No. 160889, April 27, 2007


Obstacles to obtaining EVIDENCE based on expert testimony

HIPPOCRATIC OATH - deterrent to getting a candid opinion from one physician who
knows that his testimony will pin down a fellow physician.
So if you cannot prove your case by means of an expert witness who is not very cooperative,
call Mr. RES IPSA LIQUITUR


Doctrine of
RES IPSA LIQUITUR
- Literally means: the thing speaks for itself.
- Its function is to aid the plaintiff in proving the elements of negligence by
circumstancial evidence.
- The doctrine can only be invoked when and only when, under the circumstances,
involved, direct evidence is absent and not readily available.
Medical malpractice can be established by the doctrine of res ipsa liquitur. It is
applicable to cases where the court, from its fund of knowledge, can determine the
standard of care or where an ordinary layman can conclude that there was negligence on
the part of the doctor.

Limitation: not available in a malpractice suit if the only showing is that the desired
result of an operation or treatment was not accomplished.






In cases involving medical negligence, the doctrine of RES IPSA LIQUITUR allows the
mere existence of an injury to justify the presumption of negligence on the part of the
person who controls the instrument causing the injury.

Cantre vs Sps Go, G.R. No. 160889, April 27, 2007


Cantre vs Sps Go,
G.R. No. 160889, April 27, 2007

Facts: Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the
Dr. Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora
S. Go, who was admitted at the said hospital on April 19, 1992.
Nora Go delivered a baby boy by normal vaginal delivery, with Dr. Cantre in attendance.
After the delivery, Nora had massive vaginal bleeding. Because of profuse bleeding, patient
went into hypovolemic shock.
The BP dropped to 0/0.
Dr. Cantre was able to stabilize the patient. She ordered a drop light to be placed near the
patient and her blood pressure monitored.
However, a gaping wound was caused by the blood pressure cuff that was used to monitor
the patients blood pressure.
Issues:
Is petitioner liable for the injury suffered by respondent Nora Go?
Injury gaping wound in the arm where the BP cuff was placed.
Cause - either the BP cuff or the drop light which was placed
too near the arm of the patient
Ruling:
The Hippocratic Oath mandates physicians to give primordial consideration to the well-
being of their patients. If a doctor fails to live up to this precept, he is accountable for his
acts. This notwithstanding, courts face a unique restraint in adjudicating medical
negligence cases because physicians are not guarantors of care and, they never set out to
intentionally cause injury to their patients. However, intent is immaterial in negligence
cases because where negligence exists and is proven, it automatically gives the injured a
right to reparation for the damage caused.

In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere
existence of an injury to justify a presumption of negligence on 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
defendants; and
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.

As to the first requirement, the gaping wound on Nora's arm is certainly not an
ordinary occurrence in the act of delivering a baby,
far removed as the arm is from the organs involved in the process of giving birth.
Such injury could not have happened unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by the blood pressure
cuff is of no moment. Both instruments are deemed within the exclusive control of
the physician in charge under the 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.
In this particular case, it can be logically inferred that petitioner, the senior
consultant in charge during the delivery of Nora's baby, exercised control over
the assistants assigned to both the use of the droplight and the taking of Nora's
blood pressure. Hence, the use of the droplight and the blood pressure cuff is also
within petitioner's exclusive control.
Third, the gaping wound on Nora's left arm, by its very nature and considering
her condition, could only be caused by something external to her and outside her
control as she was unconscious while in hypovolemic shock. Hence, Nora could
not, by any stretch of the imagination, have contributed to her own injury.
NO CONTRIBUTORY NEGLIGENCE ON THE PART OF THE PATIENT

Doctrine of Contributory Negligence
Definition
Doctrine of Common Fault.
It is the conduct on the part of the plaintiff, 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.


Legal Basis
Article 2179, Civil Code:
When the plaintiffs 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 defendants lack of due care, the
plaintiff may recover damages, but the court shall mitigate the damages to be awarded.
Article 2214, Civil Code
In quasi-delicts, the contributory negligence of the plaintiff shall reduce the damages that
he may recover.

Instances where there is contributory negligence
Failure to give the physician an accurate history (Mackey v. Greenview Hospital Inc. 587
SW 2d 589, Ky App. 1979)
Failure to follow the treatment recommended by the physician (Gerber v. day, 6 P 2d
535, Cal 1931; Ernest v. Schwartz, 445 SW 2d 337,

LIABILITY OF HOSPITALS

Professional Services, Inc. v Agana,
G.R. No. 126297, January 31, 2006

Facts: PSI, together with Dr. Miguel Ampil and Dr. Juan Fuentes was impleaded by
Enrique Agana and Natividad Agana (later substituted by her heirs), in a complaint for
damages filed in the RTC of QC for injuries suffered by Natividad when Dr. Ampil and Dr.
Fuentes neglected to remove from her body two gauzes which were used in the surgery they
performed on her on April 11, 1984 at the Medical City General Hospital . PSI was
impleaded as owner, operator and manager of the hospital.








As a consequence, the patient suffered pain, in the abdomen. She went abroad for further
tests but she came back still in pain, with no definite diagnosis as to what caused the pain.
After a few months from surgery she developed foul smelling vaginal discharge. 2 pieces of
surgical gauze were found stuffed in her vagina. Diagnosis: Recto-vaginal Fistula.






Issue: Liability of Hospitals

For the purpose of allocating responsibility in medical negligence cases, an employer-
employee relationship in effect exists between hospitals and their attending and visiting
physicians.
(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006.)

While consultants are not, technically employees, the control exercised, the hiring and right
to terminate consultants all fulfill the important hallmarks of an employer-employee
relationship, with the exception of wages. In assessing whether such relationship exists, the
control test is determining.
(Nograles v Capitol Medical Center, G.R.,No. 142625, December 19, 2006.)

The hospitals liability is also anchored upon the following doctrines:
agency principle of apparent authority or agency by estoppel
doctrine of corporate negligence/corporate responsibility
which have gained acceptance in the determination of a hospitals liability for negligent
acts of professionals because of the actions fo a principal or an employer .
(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006 )

Liability of Hospitals
APPARENT AUTHORITY

Where it is shown that a hospital, by its actions, has held out a particular physician as its
agent and/or employee and that a patient has accepted treatment from that physician in the
reasonable belief that it is being rendered in behalf of the hospital, the hospital will be
liable for physicians negligence.
(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)



Liability of Hospitals
BORROWED SERVANT DOCTRINE

BORROWED SERVANT RULE
The common law principle that the employer of a borrowed employee, rather
than the employees regular employer, is liable for the employees actions that
occur while the employee is under the control of the temporary employer.
Sometimes referred to as borrowed employee doctrine.

Liability of Hospitals
Doctrine of Corporate Responsibility
A hospital has the duty to see that it meets the standards of responsibilities for the
care of patients. Such duty includes the proper supervison of the members of its
medical staff.
If a hospital breached its duties to oversee or supervise all persons practicing
medicine within its walls and also failed to take an active step in fixing the
negligence committed, it will be vicariously liable for the negligence of the doctor
under Art. 2180, and directly liable for its own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31, 2006)


Liability of Hospital/Medical Director
/Dept. Head
Doctrine of Respondeat Superior
Means let the master answer for the acts of the subordinate.
Under this doctrine, the liability is expanded to include the master as well as the
employee.
The legal principle that the responsibility and accountability for patient care lie
with the supervising physician, regardless of whether that clinician has performed
the procedure in question.

(Medical Dictionary for the Health Professions and Nursing Farlex 2012)

Both employee and superior are liable; liability is expanded to the superior.

(JISTARRI V. NAPPI 378 Pa.Super. 583 (1988))




MEDICAL MALPRACTICE / NEGLIGENCE:
THE EXCEPTION RATHER THAN THE RULE

THE RULE IS THAT DOCTORS ARE COMPASSIONATE,
SINCERE AND TRUE TO THEIR CALLING,
BOUND BY THEIR HIPPOCRATIC OATH,
TO SERVE AND HEAL, AND NOT TO DO HARM OR INJURY.