PRC vs.

De Guzman
Facts: The respondents are all graduates of the
Fatima College of Medicine, Valenzuela City, Metro
Manila. They passed the Physician Licensure
Examination conducted in February 1993 by the
Board of Medicine (Board).
Petitioner Professional Regulation Commission
(PRC) then released their names as successful
examinees in the medical licensure examination.
Shortly thereafter, the Board observed that the
grades of the seventy-nine successful examinees
from Fatima College in the two most difficult
subjects in the medical licensure exam,
Biochemistry (Bio-Chem) and Obstetrics and
Gynecology (OB-Gyne), were unusually and
exceptionally high. Eleven Fatima examinees
scored 100% in Bio-Chem and ten got 100% in OBGyne, another eleven got 99% in Bio-Chem, and
twenty-one scored 99% in OB-Gyne.
For its part, the NBI found that the questionable
passing rate of Fatima examinees in the [1993]
Physician Examination leads to the conclusion that
the Fatima examinees gained early access to the
test questions.
Issue: Was the act pursuant to R.A. 2382 a valid
exercise of police power
Ruling: Yes, it is true that this Court has upheld the
constitutional right of every citizen to select a
profession or course of study subject to a fair,
reasonable, and equitable admission and academic
requirements. But like all rights and freedoms
guaranteed by the Charter, their exercise may be

so regulated pursuant to the police power of the

State to safeguard health, morals, peace,
education, order, safety, and general welfare of the
people. Thus, persons who desire to engage in the
learned professions requiring scientific or technical
knowledge may be required to take an examination
as a prerequisite to engaging in their chosen
careers.
DECS vs. San Diego
G.R. No. 89572 December 21, 1989
Facts: Respondent San Diego has flunked the
NMAT (National Medical Admission Test) three
times. When he applied to take again, petitioner
rejected his application based on the three-flunkrule. He then filed a petition before the RTC on the
ground of due process and equal protection and
challenging the constitutionality of the order. The
petition was granted by the RTC therefore this
petition.
Issue: Whether or not the NMAT three-flunk-rule
order is valid and constitutional.

guarantee of the Constitution but one must show

that he is entitled to it because of his preparation
and promise. Petition was granted and the RTC
ruling was reversed.

Dr. Milagros Cantre v. Sps. John David and

Nora Go
2007 / Quisumbing / Petition for review on
certiorari of CA decision and resolution
FACTS: Nora Go gave birth to her 4th child. Two
hours later, she suffered profuse bleeding inside
her womb due to some placenta parts which were
not completely expelled after delivery. She then
suffered hypovolemic shock, so her BP dropped to
40/0. Dr. Milagros Cantre, an Ob-Gyne specialist
and Nora's attending physician, together with an
assisting resident physician, performed various
medical procedures to stop the bleeding and to
restore Nora's BP. While Dr. Cantre was massaging
Nora's uterus for it to contract and stop bleeding,

Ruling: Yes. It is the right and responsibility of the

State to insure that the medical profession is not
infiltrated by incompetents to whom patients may
unwarily entrust their lives and health. The method
employed by the challenged regulation is not
irrelevant to the purpose of the law nor is it
arbitrary or oppressive. The right to quality
education is not absolute. The Constitution
provides that every citizen has the right to
choose a profession or course of study, subject to
fair, reasonable and equitable admission and
academic requirements. It is not enough to simply
invoke the right to quality education as a

she ordered a droplight to warm Nora and her baby.

At that time, she was unconscious.
While in the recovery room, Nora's husband John
David noticed a fresh gaping wound (2 1/2 x 3 1/2
in) in the inner portion of her left arm near the
armpit. When he asked the nurses about the cause
of the injury, he was informed that it was due to a
burn. John David filed a request for investigation.
Dr. Cantre said that what caused the injury was the
blood pressure cuff. John David brought Nora to the
NBI for a physical examination. The medico-legal

Wound
not
an
ordinary
occurrence in the act of delivering a baby;
could
not
have
happened
unless
negligence set in somewhere

said that the injury appeared to be a burn and that

Dr. Cantre's counsel admitted the existence of the

a droplight when placed near the skin for about 10

additional exhibits when they were formally offered

minutes could cause such burn. He dismissed the

for admission by the RTC. In any case, given the

likelihood that the wound was caused by a blood

circumstances of this case, a ruling on Dr. Cantre's

2.

pressure cuff since the scar was not around the

negligence may be made based on the res ipsa

within defendant's exclusive control

arm, but just on one side of the arm. Nora's injury

loquitur doctrine even in

was referred to a plastic surgeon for skin grafting.

additional exhibits.

Caused

the absence of the

However, her arm would never be the same--the

surgery left an unsightly scar, her movements are

Backgrounder

restricted, and the injured arm aches at the

The Hippocratic Oath mandates physicians to give

slightest touch.

primordial consideration to their patients' wellbeing, and if a doctor fails to live up to this precept,

Sps. Go filed a complaint for damages against Dr.

he

Cantre, the medical director, and the hospital. In

notwithstanding, courts face a unique restraint in

the RTC, parties have rested their respective cases,

adjudicating

but the court admitted additional exhibits [consist

cases because physicians are not guarantors of

mostly of medical records produced by the hospital

care, and they never set out to intentionally cause

during

injury

trial

pursuant

to

subpoena duces

is

accountable

to

for

his

acts.

medical

their

immaterial in

to by any witness. RTC ruled in favor of the

negligence exists and is proven, it automatically

spouses.

gives the injured a right to reparation for the

CA

affirmed

RTC

with

modification

(complaint dismissed with respect to the medical

cases

because where

damage caused.
Res ipsa loquitur x Medical negligence cases
In medical negligence cases, the doctrine of res

ISSUES AND HOLDING

ipsa loquitur allows the mere existence of an injury

1.

to justify a presumption of negligence on the part

WON the questioned additional exhibits

are admissible in evidence. YES

of the person who controls the instrument causing

2.

the

WON Dr. Cantre is liable for the injury

suffered by Nora Go. YES

RATIO:
Preliminary discussion

injury, provided

that

the

following requisites concur:

1.

Accident is of a kind which ordinarily does

not occur absent someone's negligence

Wound could only be caused by

something external to and outside the
control of Nora since she was unconscious
while in hypervolemic shock.

On Dr. Cantre's other arguments + what would

director and the hospital; only moral damages

awarded).

It doesn't matter WON the injury

was caused by the droplight or by the
blood pressure cuff, since both are within
the exclusive control of the physician in
charge [Dr. Cantre] under the captain of
the ship doctrine [surgeon in charge of an
operation is held liable for his assistants'
negligence during the time when they are
under the surgeon's control].
Possibility of contributing conduct which

is

tecum] offered by Sps. Go, which were not testified

an instrumentality

would make plaintiff responsible is eliminated

negligence

patients. HOWEVER, intent

these

3.

This

by

have been her saving grace

BP cuff defense does not afford her an
escape. The medical practice is to deflate the cuff
immediately after use, or else, it could cause an
injury similar to what happened to Nora. If the
wound was caused by the constant taking of BP, it
must have been done so negligently as to inflict a
gaping wound.

The argument that the failed plastic

surgery was a measure to prevent complication
(and not intended as a cosmetic procedure) does
not negate negligence on Dr. Cantre's part.

Dr. Cantre has been Nora's ob-gyne for her

past 3 deliveries, and this is the first time that Dr.
Cantre is being held liable for damages due to
negligence in the practice of her profession. She
promptly took care of the wound before infection
set in. Since Nora was in a critical condition at that
time, saving her life became Dr. Cantre's elemental

concern. Still, her good intentions

do not justify negligence.

characteristics

NCC provisions applied

NCC 2176. Whoever by act or omission
causes damage to another, there being fault or
negligence, is obliged to pay for the damage done.
[...]
NCC
2217. Moral
damages
include
physical suffering, mental anguish, fright, serious
anxiety, besmirched reputation, wounded feelings,
moral shock, social humiliation, and similar injury.
Though incapable of pecuniary computation, moral
damages may be recovered if they are the
proximate result of the defendant's wrongful act or
omission. [200k moral damages awarded]

BATIQUIN V CA (Villegas)
258 SCRA 334 DAVIDE; July 5, 1996
NATURE: Petition for review of the decision of the
Court of Appeals
FACST: Mrs. Villegas submitted to Dr. Batiquin for
prenatal care as the latter's private patient
sometime before September 21,1988. In the
morning of September 21, 1988 Dr. Batiquin, along
with other physicians and nurses, performed a
caesarean operation on Mrs. Villegas and
successfully delivered the latters baby. After
leaving the hospital, Mrs. Villegas began to suffer
abdominal pains and complained of being feverish.
She also gradually lost her appetite, so she
consulted Dr. Batiquin at the latter's polyclinic who
prescribed for her certain medicines. However, the
pains still kept recurring. She then consulted Dr.
Ma. Salud Kho. After examining her, Dr Kho
suggested that Mrs. Villegas submit to another
surgery.- When Dr. Kho opened the abdomen of
Mrs. Villegas she found whitish-yellow discharge
inside, an ovarian cyst on each of the left and right

ovaries which gave out pus, dirt and pus behind the
uterus, and a piece of rubber material on the right
side of the uterus, embedded on the ovarian cyst.
The piece of rubber appeared to be a part of a
rubber glove. This was the cause of all of the
infection of the ovaries and consequently of all the
discomfort suffered by Mrs. Villegas. The piece of
rubber allegedly found was not presented in court,
and Dr. Kho testified that she sent it to a
pathologist in Cebu City for examination. Aside
from Dr. Kho's testimony, the evidence which
mentioned the piece of rubber are a Medical
Certificate, a Progress Record, an Anaesthesia
Record, a Nurse's Record, and a Physician's
Discharge Summary. The trial court, however,
regarded these documentary evidence as mere
hearsay, "there being no showing that the person
or persons who prepared the mare deceased or
unable to testify on the facts therein stated- There
was also doubts as to the whereabouts of the piece
of rubber, as 2 versions arose from Dr. Khos
testimony: 1) that it was sent to the Pathologist in
Cebu as testified to in Court by Dr. Kho and (2) that
Dr. Kho threw it away as told by her to Defendant.
The failure of the Plaintiffs to reconcile these two
different versions served only to weaken their claim
against Defendant Batiquin. The trial court ruled in
favor of the defendants. The CA reversed the
decision.
ISSUES Procedural: WON the court can review
questions of fact
Substantive: WON Dr. Batiquin is liable
HELD Procedural: YES - While the rule is that only
questions of law may be raised in a petition for
review on certiorari , there are exceptions, among
which are when the factual findings of the trial
court and the appellate court conflict, when the
appealed decision is clearly contradicted by the

evidence on record, or when the appellate

court misapprehended the facts
Substantive- The focal point of the appeal is Dr.
Khos testimony. There were inconsistencies within
her own testimony, which led to the different
decision of the RTC and CA. The CA was correct in
saying that the trial court erred when it isolated the
disputed portion of Dr. Khos testimony and did not
consider it with other portions of Dr. Khos
testimony. Also, the phrase relied upon bythe trial
court does not negate the fact that Dr. Kho saw a
piece of rubber in private respondent Villegas'
abdomen, and that she sent it to a laboratory and
then to Cebu City for examination by a pathologist.
Furthermore, Dr. Kho's knowledge of the piece of
rubber could not be based on other than first hand
knowledge for, as she asserted before the trial
court.
Fe Cayao-Salam v. Sps. Ramolete (GR No.
159132)
FACTS: On July 28, 1994, respondent, three
months pregnant Editha Ramolete (Editha) was
brought to the Lorma Medical Center (LMC) in San
Fernando, La Union due to vaginal bleeding. Upon
advice of petitioner relayed via telephone, Editha
was admitted to the LMC on the same day. A pelvic
sonogram was then conducted on Editha revealing
the fetus weak cardiac pulsation.
The following day, Edithas repeat pelvic sonogram
showed that aside from the fetus weak cardiac
pulsation, no fetal movement was also appreciated.
Due to persistent and profuse vaginal bleeding,
petitioner advised Editha to undergo a Dilatation
and Curettage Procedure (D&C) or " raspa." The
procedure was performed by the petitioner and
Editha was discharged the next day. On September
16, 1994, Editha was once again brought at the
LMC, as she was suffering from vomiting and

severe abdominal pains. She was found to have a

massive intra-abdominal hemorrhage and a
ruptured uterus. Thus, Editha had to undergo a
procedure for hysterectomy and as a result, she
has no more chance to bear a child. Respondents:
first, petitioners failure to check up, visit or
administer medication on Editha during her first
day of confinement at the LMC; second, petitioner
recommended that a D&C procedure be performed
on Editha without conducting any internal
examination prior to the procedure; third, petitioner
immediately suggested a D&C procedure instead of
closely monitoring the state of pregnancy of Editha.
Petitioner: it was Edithas gross negligence and/or
omission in insisting to be discharged against
doctors advice and her unjustified failure to return
for check-up as directed by petitioner that
contributed to her life-threatening condition on;
that Edithas hysterectomy was brought about by
her very abnormal pregnancy known as placenta
increta, which was an extremely rare and very
unusual case of abdominal placental implantation;
that whether or not a D&C procedure was done by
her or any other doctor, there would be no
difference at all because at any stage of gestation
before term, the uterus would rupture just the
same.
RULING: 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 negligence cases: duty, breach, injury and
proximate causation.
In the present case, respondents did not present
any expert testimony to support their claim that
petitioner failed to do something which a
reasonably prudent physician or surgeon would

have done. Petitioner, on the other hand, presented

the testimony of Dr. Augusto M. Manalo, who was
clearly an expert on the subject. He testified that
the rupture occurred minutes prior to the
hysterectomy or right upon admission on
September 15, 1994 which is about 1 months
after the patient was discharged, after the D&C
was conducted. It is evident thatthe D&C procedure
was not the proximate cause of the rupture of
Edithas uterus. The defenses in an action for
damages, provided for under Article 2179 of the
Civil Code are: Art. 2179.

This being the case, the chain of continuity as

required in order that the doctrine of proximate
cause can be validly invoked was interrupted.

When the plaintiffs own negligence was the

immediate and proximate cause of his injury he
cannot recover damages.

Difficulty seems to be apprehended in deciding

which acts of the injured party shall be considered
immediate causes of the accident.

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 courts shall mitigate the
damages to be awarded. Proximate cause has been
defined as that which, in natural and continuous
sequence, unbroken by any efficient intervening
cause, produces injury, and without which the
result would not have occurred.

Where the immediate cause of an accident

resulting in an injury is the plaintiffs own act,
which contributed to the principal occurrence as
one of its determining factors, he cannot recover
damages for the injury.

An injury or damage is proximately caused by an

act or a failure to act, whenever it appears from the
evidence in the case that the act or omission
played a substantial part in bringing about or
actually causing the injury or damage; and that the
injury or damage was either a direct result or a
reasonably probable consequence of the act or
omission. The Court notes the findings of the Board
of Medicine: When complainant was discharged on
July 31,1994, herein respondent advised her to
return on August 4, 1994 or four (4) days after the
D&C. This advise was clear in complainants
Discharge Sheet.
However, complainant failed to do so.

Had she returned, the respondent could have

examined her thoroughly.
Contributory negligence is the act or omission
amounting to want of ordinary care on the part of
the person injured, which, concurring with the
defendants negligence, is the proximate cause of
the injury.

Nogales vs. Capitol Medical Center

Carpio, J.:G.R. No. 142625, Dec. 19, 2006 |
511 SCRA 204
FACTS:
Pregnant with her fourth child, Corazon Nogales
("Corazon"), who was then 37 years old, was under
the exclusive prenatal care of Dr. Oscar Estrada
("Dr. Estrada") beginning on her fourth month of
pregnancy or as early as December 1975. While
Corazon was on her last trimester of pregnancy, Dr.
Estrada noted an increase in her blood pressure
and development of leg edema5 indicating
preeclampsia, which is a dangerous complication of
pregnancy. Around midnight of 25 May 1976,
Corazon started to experience mild labor
painsprompting Corazon and Rogelio Nogales

("Spouses Nogales") to see Dr. Estrada at his home.

After examining Corazon, Dr. Estrada advised her
immediate admission to the Capitol Medical Center
("CMC"). On 26 May 1976, Corazon was admitted at
2:30 a.m. at the CMC after the staff nurse noted
the written admission request8 of Dr. Estrada. Upon
Corazon's admission at the CMC, Rogelio Nogales
("Rogelio") executed and signed the "Consent on
Admission Agreement and Admission
Agreement.
Corazon was then bought to the labor room of the
CMC. Dr. Rosa Uy ("Dr. Uy"), who was then a
resident physician of CMC, conducted an internal
examination of Corazon. Dr. Uy then called up Dr.
Estrada to notify him of her findings. Based on the
Doctor's Order Sheet, around 3:00 a.m., Dr. Estrada
ordered for 10 mg.of valium to be administered
immediately by intramuscular injection. Dr. Estrada
later ordered the start of intravenous
administration of syntocinon admixed with
dextrose,5%, in lactated Ringers' solution, at the
rate of eight to ten micro-drops per minute.
According to the Nurse's Observation Notes, Dr. Joel
Enriquez ("Dr. Enriquez"), an anesthesiologist at
CMC, was notified at 4:15 a.m. of Corazon's
admission. Subsequently, when asked if he needed
the services of an anesthesiologist, Dr. Estrada
refused. Despite Dr. Estrada's refusal, Dr. Enriquez
stayed to observe Corazons condition. At 6:00
a.m., Corazon was transferred to Delivery Room No.
1 of the CMC. At 6:10a.m., Corazon's bag of water
ruptured spontaneously. At 6:12 a.m., Corazon's
cervix was fully dilated. At 6:13 a.m., Corazon
started to experience convulsions. At 6:15 a.m., Dr.
Estrada ordered the injection of ten grams of
magnesium sulfate. However, Dr. Ely Villaflor ("Dr.
Villaflor"), who was assisting Dr. Estrada,
administered only 2.5 grams of magnesium
sulphate. At 6:22 a.m. Dr. Estrada, assisted by Dr.
Villaflor, applied low forceps to extract Corazon's
baby. In the process, a 1.0 x 2.5 cm. piece of

cervical tissue was allegedly torn. The baby came

out in an apnic, cyanotic, weak and injured
condition. Consequently, the baby had to be
intubated and resuscitated by Dr. Enriquez and Dr.
Payumo. At 6:27 a.m., Corazon began to manifest
moderate vaginal bleeding which rapidly became
profuse. Corazon's blood pressure dropped from
130/80 to 60/40 within five minutes. There was
continuous profuse vaginal bleeding. The assisting
nurse administered hemacel through a gauge 19
needle as a side drip to the ongoing intravenous
injection of dextrose. At 7:45 a.m., Dr. Estrada
ordered blood typing and cross matching with
bottled blood. Ittook approximately 30 minutes for
the CMC laboratory, headed by Dr. Perpetua
Lacson("Dr. Lacson"), to comply with Dr. Estrada's
order and deliver the blood. At 8:00 a.m., Dr. Noe
Espinola ("Dr. Espinola"), head of the ObstetricsGynecology Department of the CMC, was apprised
of Corazon's condition by telephone. Upon being
informed that Corazon was bleeding profusely, Dr.
Espinola ordered immediate hysterectomy. Rogelio
was made to sign a "Consent to Operation."13 Due
to the inclement weather then, Dr. Espinola, who
was fetched from his residence by an ambulance,
arrived at the CMC about an hour later or at 9:00
a.m. He examined the patient and ordered some
resuscitative measures to be administered. Despite
Dr.Espinola's efforts, Corazon died at 9:15 a.m. The
cause of death was "hemorrhage, postpartum."14
On 14 May 1980, petitioners filed a complaint for
damages15 with the Regional TrialCourt16 of
Manila against CMC, Dr. Estrada, Dr. Villaflor, Dr.
Uy, Dr. Enriquez, Dr.Lacson, Dr. Espinola, and a
certain Nurse J. Dumlao for the death of Corazon.
Petitioners mainly contended that defendant
physicians and CMC personnel were negligent in
the treatment and management of Corazon's
condition. Petitioners charged CMC with negligence
in the selection and supervision of defendant
physicians and hospital staff.

ISSUES & ARGUMENTS:

W/N CMC should be held liable
HOLDING & RATIO DECIDENDI: YES
The mere fact that a hospital permitted a
physician to practice medicine and use its facilities
is not sufficient to render the hospital liable for the
negligence of a physician who is an independent
contractor
o There is no proof that defendant physician was an
employee of defendant hospital or that the latter
had reason to know that any acts of malpractice
would take place
Borrowed Servant Doctrine
once the surgeon enters the operating room and
takes charge of the proceedings, the acts or
omissions of operating room personnel, and any
negligence associated with such acts or omissions,
are imputable to the surgeon. o While the assisting
physicians and nurses may be employed by
thehospital, or engaged by the patient, they
normally become the temporary servants or agents
of the surgeon in charge while the operation is in
progress, and liability may be imposed upon the
surgeon for their negligent acts under the doctrine
of respondent superior.
A hospital is the employer, master, or principal of a
physician employee, servant, or agent, and may be
held liable for the
physicians negligence
While "consultants" are not, technically
employees, a point which respondent hospital
asserts in denying all responsibility for the patient's
condition, the control exercised, the hiring, and the

right to terminate consultants all fulfill the

important hallmarks of an employer-employee
relationship, with the exception of the payment of
wages. O In assessing whether such a relationship
in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule
that 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.
After a thorough examination of the voluminous
records of this case, the Court finds no single
evidence pointing to CMC's exercise of control over
Dr.Estrada's treatment and management of
Corazon's condition. o It is undisputed that
throughout Corazon's pregnancy, she was under
the exclusive prenatal care of Dr. Estrada. At the
time of Corazon's admission at CMC and during her
delivery, it was Dr. Estrada, assisted by Dr. Villaflor,
who attended to Corazon. o There was no showing
that CMC had a part in diagnosing Corazon's
condition. o While Dr. Estrada enjoyed staff
privileges at CMC, such fact alone did not make
him an employee of CMC.42 CMC merely allowed
Dr.Estrada to use its facilities43 when Corazon was
about to give birth, which CMC considered an
emergency. Considering thesecircumstances, Dr.
Estrada is not an employee of CMC, but an
independent contractor .
Question now is whether CMC is automatically
exempt from liability considering that Dr. Estrada is
an independent contractor-physician. o General
Rule: Hospital is NOT liable for the negligence of an
independent contractor-physician o Exception:

Doctrine of Apparent Authority (DAA)

- a hospital can be held vicariously liable for the

negligent acts of a physician providing care at the
hospital, regardless of whether the physician is an
independent contractor, unless the patient knows,
or should have known, that the physician is an
independent contractor.
Elements:
Hospital, or its agent, acted in a manner that
would lead a reasonable person to conclude that
the individual who was alleged to be negligent was
an employee or agent of the hospital
Where the acts of the agent create the
appearance of authority, the plaintiff must also
prove that the hospital had knowledge of and
acquiesced in them ;and

CMC granted Dr. Estrada staff privileges Consent

forms were printed on CMC letterhead Dr. Estradas
referral of Corazons case with other physicians of
CMC gave the impression that he, as a member of
the CMCs medical staff, was collaborating with
other CMC-employed specialists Spouses Nogales
took Dr. Estrada as their physician inconsideration
of his connection with a reputable hospital(CMC)
Played a significant role in the Spouses decision
WHEREFORE, CMC is found liable to pay the
corresponding damages
Professional Services Inc. (PSI) v. Natividad
and Enrique Agana
Natividad and Enrique Agana v. Juan Fuentes
Miguel Ampil v. Natividad and Enrique Agana

The plaintiff acted in reliance upon the conduct of

the hospital or its agent, consistent with ordinary
care and prudence o 2 Factors to determine liability
of an independent contractor-physician:
Hospitals manifestations
Inquiry whether the hospital acted in a manner
which would lead a reasonable person to conclude
that the individual who was alleged to be negligent
was an employee or agent of the hospital
Patients
reliance
Inquiry on whether the plaintiff acted in reliance
upon the conduct of the hospital or its agent,
consistent with ordinary care and prudence o
Circumstances of the cases showing application of
DAA:

2007 / Sandoval-Gutierrez / Petition for

review on certiorari of CA decisions
Standard of conduct > Experts > Medical
professionals
FACTS: Natividad Agana was rushed to Medical
City because of difficulty of bowel movement and
bloody anal discharge. Dr. Ampil diagnosed her to
be suffering from cancer of the sigmoid. Dr. Ampil
performed an anterior resection surgery on her,
and finding that the malignancy spread on her left
ovary, he obtained the consent of her husband,
Enrique, to permit Dr. Fuentes to perform
hysterectomy on her. After the hysterectomy, Dr.
Fuentes showed his work to Dr. Ampil, who
examined it and found it in order, so he allowed Dr.
Fuentes to leave the operating room. Dr. Ampil was
about to complete the procedure when the
attending nurses made some remarks on the
Record of Operation: sponge count lacking 2;
announced to surgeon search done but to no avail

continue for closure (two pieces of gauze were

missing). A diligent search was conducted but
they could not be found. Dr. Ampil then directed
that the incision be closed.
A couple of days after, she complained of pain in
her anal region, but the doctors told her that it was
just a natural consequence of the surgery. Dr. Ampil
recommended that she consult an oncologist to
examine the cancerous nodes which were not
removed during the operation. After months of
consultations and examinations in the US, she was
told that she was free of cancer. Weeks after
coming back, her daughter found a piece of gauze
(1.5 in) protruding from her vagina, so Dr. Ampil
manually extracted this, assuring Natividad that
the pains will go away. However, the pain
worsened, so she sought treatment at a hospital,
where another 1.5 in piece of gauze was found in
her vagina. She underwent another surgery.
Sps. Agana filed a complaint for damages against
PSI (owner of Medical City), Dr. Ampil, and Dr.
Fuentes, alleging that the latter are liable for
negligence for leaving 2 pieces of gauze in
Natividads body, and malpractice for concealing
their acts of negligence. Enrique Agana also filed
an administrative complaint for gross negligence
and malpractice against the two doctors with the
PRC (although only the case against Dr. Fuentes
was heard since Dr. Ampil was abroad). Pending the
outcome of the cases, Natividad died (now
substituted by her children). RTC found PSI and the
two doctors liable for negligence and malpractice.
PRC dismissed the case against Dr. Fuentes. CA
dismissed only the case against Fuentes.
ISSUE AND HOLDING: WON CA erred in holding
Dr. Ampil liable for negligence and malpractice. NO;
DR. AMPIL IS GUILTY

WON CA erred in absolving Dr. Fuentes of any

liability. NO
WON PSI may be held solidarily liable for Dr.
Ampils negligence. YES
RATIO: DR. AMPIL IS LIABLE FOR NEGLIGENCE AND
MALPRACTICE.
His arguments are without basis [did not prove that
the American doctors were the ones who put / left
the gauzes; did not submit evidence to rebut the
correctness of the operation record (re: number of
gauzes used); re: Dr. Fuentes alleged negligence,
Dr. Ampil examined his work and found it in order].
Leaving foreign substances in the wound after
incision has been closed is at least prima facie
negligence by the operating surgeon. Even if it has
been shown that a surgeon was required to leave a
sponge in his patients abdomen because of the
dangers attendant upon delay, still, it is his legal
duty to inform his patient within a reasonable time
by advising her of what he had been compelled to
do, so she can seek relief from the effects of the
foreign object left in her body as her condition
might permit. Whats worse in this case is that he
misled her by saying that the pain was an ordinary
consequence of her operation.
Medical negligence; standard of diligence
To successfully pursue this case of medical
negligence, a patient must only prove that a health
care provider either failed to do something [or did
something] which a reasonably prudent health care
provider would have done [or wouldnt have done],
and that the failure or action caused injury to the
patient.

Duty to remove all foreign objects from the body

before closure of the incision; if he fails to do so, it
was his duty to inform the patient about it
Breach failed to remove foreign objects; failed to
inform patient
Injury suffered pain that necessitated
examination and another surgery
Proximate Causation breach caused this injury;
could be traced from his act of closing the incision
despite information given by the attendant nurses
that 2 pieces of gauze were still missing; what
established causal link: gauze pieces later
extracted from patients vagina
DR. FUENTES NOT LIABLE
The res ipsa loquitur [thing speaks for itself]
argument of the Aganas does not convince the
court. Mere invocation and application of this
doctrine does not dispense with the requirement of
proof of negligence.
Requisites for the applicability of res ipsa loquitur
Occurrence of injury
Thing which caused injury was under the control
and management of the defendant [DR. FUENTES]
LACKING SINCE CTRL+MGT WAS WITH DR. AMPIL
Occurrence was such that in the ordinary course of
things, would not have happened if those who had
control or management used proper care
Absence of explanation by defendant
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. That Dr. Ampil discharged such role is

evident from the following:
He called Dr. Fuentes to perform a hysterectomy
He examined Dr. Fuentes work and found it in
order
He granted Dr. Fuentes permission to leave
He ordered the closure of the incision
HOSPITAL OWNER PSI SOLIDARILY LIABLE WITH DR.
AMPIL [NCC 2180], AND DIRECTLY LIABLE TO SPS.
AGANAS [NCC 2176]
Previously, employers cannot be held liable for the
fault or negligence of its professionals. However,
this doctrine has weakened since courts came to
realize that modern hospitals are taking a more
active role in supplying and regulating medical care
to its patients, by employing staff of physicians,
among others. Hence, there is no reason to exempt
hospitals from the universal rule of respondeat
superior. Here are the Courts bases for sustaining
PSIs liability:
Ramos v. CA doctrine on E-E relationship
For purposes of apportioning responsibility in
medical negligence cases, an employer-employee
relationship in effect exists between hospitals and
their attending and visiting physicians. [LABOR
LESSON: power to hire, fire, power of control]
Agency principle of apparent authority / agency by
estoppel
Imposes liability because of the actions of a
principal or employer in somehow misleading the
public into believing that the relationship or the
authority exists [see NCC 1869]

PSI publicly displays in the Medical City lobby the

names and specializations of their physicians.
Hence, PSI is now estopped from passing all the
blame to the physicians whose names it proudly
paraded in the public directory, leading the public
to believe that it vouched for their skill and
competence.
If doctors do well, hospital profits financially, so
when negligence mars the quality of its services,
the hospital should not be allowed to escape
liability for its agents acts.
Doctrine of corporate negligence / corporate
responsibility
This is the judicial answer to the problem of
allocating hospitals liability for the negligent acts
of health practitioners, absent facts to support the
application of respondeat superior.
This provides for the duties expected [from
hospitals]. In this case, PSI failed to perform the
duty of exercising reasonable care to protect from
harm all patients admitted into its facility for
medical treatment. PSI failed to conduct an
investigation of the matter reported in the note of
the count nurse, and this established PSIs part in
the dark conspiracy of silence and concealment
about the gauzes.
PSI has actual / constructive knowledge of the
matter, through the report of the attending nurses
+ the fact that the operation was carried on with
the assistance of various hospital staff
It also breached its duties to oversee or supervise
all persons who practice medicine within its walls
and take an active step in fixing the negligence
committed
PSI also liable under NCC 2180

It failed to adduce evidence to show that it

exercised the diligence of a good father of the
family in the accreditation and supervision of Dr.
Ampil
G.R. NO. 124354

APRIL 11, 2002

ROGELIO E. RAMOS and ERLINDA RAMOS, in

their own behalf and as natural guardians of
the minors, ROMMEL RAMOS, ROY RODERICK
RAMOS, and RON RAYMOND RAMOS,
petitioners,
vs. COURT OF APPEALS, DE LOS SANTOS
MEDICAL CENTER, DR. ORLINO HOSAKA and
DR. PERFECTA GUTIERREZ, respondents.
FACTS:

Sometime in 1985, petitioner Erlinda Ramos, after

seeking professional medical help, was advised to
undergo an operation for the removal of a stone in
her

gall

bladder

(cholecystectomy).

She

was

referred to Dr. Hosaka, a surgeon, who agreed to

perform the operation on her. The operation was
scheduled for June 17, 1985 at 9:00 in the morning
at private respondent De Los Santos Medical
Center (DLSMC). Since neither petitioner Erlinda
nor her husband, petitioner Rogelio, knew of any
anesthesiologist, Dr. Hosaka recommended to them
the services of Dr. Gutierrez.

Petitioner Erlinda was admitted to the DLSMC the

more than three (3) hours after the scheduled

(ICU). The doctors explained to petitioner Rogelio

day before the scheduled operation. By 7:30 in the

operation.

that his wife had bronchospasm. Erlinda stayed in

morning of the following day, petitioner Erlinda was

already being prepared for operation. Upon the
request of petitioner Erlinda, her sister-in-law,
Herminda Cruz, who was then Dean of the College
of Nursing at the Capitol Medical Center, was
allowed to accompany her inside the operating

the ICU for a month. She was released from the

Cruz, who was then still inside the operating room,
heard about Dr. Hosakas arrival. While she held
the hand of Erlinda, Cruz saw Dr. Gutierrez trying to
intubate the patient. Cruz heard Dr. Gutierrez utter:
"ang

hirap

ma-intubate

nito,

mali

yata

hospital only four months later or on November 15,

1985.

Since

the

ill-fated

operation,

Erlinda

remained in comatose condition until she died on

August 3, 1999.1

ang

pagkakapasok. O lumalaki ang tiyan." Cruz noticed

Petitioners filed with the Regional Trial Court of

a bluish discoloration of Erlindas nailbeds on her

Quezon City a civil case for damages against

At around 9:30 in the morning, Dr. Hosaka had not

left hand. She (Cruz) then heard Dr. Hosaka instruct

private respondents. After due trial, the court a quo

yet arrived so Dr. Gutierrez tried to get in touch

someone

rendered

with him by phone. Thereafter, Dr. Gutierrez

anesthesiologist. When he arrived, Dr. Calderon

Essentially, the trial court found that private

informed Cruz that the operation might be delayed

attempted to intubate the patient. The nailbeds of

respondents were negligent in the performance of

due to the late arrival of Dr. Hosaka. In the

the patient remained bluish, thus, she was placed

their duties to Erlinda. On appeal by private

meantime, the patient, petitioner Erlinda said to

in a trendelenburg position a position where the

respondents, the Court of Appeals reversed the trial

Cruz, "Mindy, inip na inip na ako, ikuha mo ako ng

head of the patient is placed in a position lower

courts decision and directed petitioners to pay

ibang Doctor."

than her feet. At this point, Cruz went out of the

their "unpaid medical bills" to private respondents.

room.

to

call

Dr.

Calderon,

another

judgment

in

favor

of

petitioners.

operating room to express her concern to petitioner

By 10:00 in the morning, when Dr. Hosaka was still

Rogelio that Erlindas operation was not going well.

not around, petitioner Rogelio already wanted to

Petitioners filed with this Court a petition for review

on certiorari. The private respondents were then

pull out his wife from the operating room. He met

Cruz quickly rushed back to the operating room

required to submit their respective comments

Dr. Garcia, who remarked that he was also tired of

and saw that the patient was still in trendelenburg

thereon.

waiting for Dr. Hosaka. Dr. Hosaka finally arrived at

position. At almost 3:00 in the afternoon, she saw

promulgated

the hospital at around 12:10 in the afternoon, or

Erlinda being wheeled to the Intensive Care Unit

respondents now seek to be reconsidered.

On

December
the

29,

decision

1999,

this

which

Court
private

ISSUES:

1. WHETHER OR NOT DR. ORLINO HOSAKA

(SURGEON) IS LIABLE FOR NEGLIGENCE;

2) Dr. Gutierrez claim of lack of negligence on her

reasons, the Supreme Cord reverse the finding of

part is belied by the records of the case. It has

liability on the part of DLSMC for the injury suffered

been sufficiently established that she failed to

by petitioner Erlinda.

exercise the standards of care in the administration

2. WHETHER OR NOT DR. PERFECTA GUTIERREZ
(ANESTHESIOLOGIST) IS LIABLE FOR NEGLIGENCE;
AND

of anesthesia on a patient. Dr. Gutierrez omitted to

perform a thorough preoperative evaluation on

3. WHETHER OR NOT THE HOSPITAL (DELOS

SANTOS MEDICAL CENTER) IS LIABLE FOR ANY ACT
OF NEGLIGENCE COMMITTED BY THEIR VISITING
CONSULTANT SURGEON AND ANESTHESIOLOGIST.8

Erlinda. Further, there is no cogent reason for the

RULING:

condition. There is no question that Erlinda became

Court to reverse its finding that it was the faulty

intubation on Erlinda that caused her comatose

comatose after Dr. Gutierrez performed a medical

In the case at bar, the following issues were

procedure on her.

resolved as follows:

WHEREFORE,

the

assailed

Decision

is

hereby

modified as follows:

(1) Private respondent De Los Santos Medical

Center is hereby absolved from liability arising from
the injury suffered by petitioner Erlinda Ramos on
June 17, 1985;
(2) Private respondents Dr. Orlino Hosaka and Dr.
Perfecta Gutierrez are hereby declared to be
solidarily liable for the injury suffered by petitioner
Erlinda on June 17, 1985 and are ordered to pay
petitioners

3) After a careful consideration of the arguments

1) Dr. Hosaka's irresponsible conduct of arriving
very late for the scheduled operation of petitioner
Erlinda is violative, not only of his duty as a
physician "to serve the interest of his patients with
the greatest solicitude, giving them always his best
talent and skill,"44 but also of Article 19 of the Civil
Code which requires a person, in the performance
of his duties, to act with justice and give everyone
his due.

raised by DLSMC, the Court finds that respondent

hospitals position on this issue is meritorious.
There

is

no

employer-employee

relationship

(a) P1,352,000.00 as actual damages;

(b) P2,000,000.00 as moral damages;
(c) P100,000.00 as exemplary damages;

between DLSMC and Drs. Gutierrez and Hosaka

which would hold DLSMC solidarily liable for the
injury suffered by petitioner Erlinda under Article
2180 of the Civil Code.

urther, no evidence was

adduced to show that the injury suffered by

petitioner Erlinda was due to a failure on the part of
respondent DLSMC to provide for hospital facilities
and staff necessary for her treatment. For these

(d) P100,000.00 as attorneys fees; and

(e) the costs of the suit. SO ORDERED.
DR. PEDRO DENNIS CERENO, and DR. SANTOS
ZAFE, Petitioners, v. COURT OF APPEALS,
SPOUSES DIOGENES S. OLAVERE and FE R.
SERRANO, Respondents.
PEREZ, J.:

FACTS: At about 9:15 in the evening of 16

September 1995, Raymond S. Olavere (Raymond),
a victim of a stabbing incident, was rushed to the
Bicol Regional Medical Center (BRMC). Dr. Realuyo,
the emergency room resident physician,
recommended that Raymond should undergo blood
transfusion.
At 10:30 P.M., Raymond was brought inside the
operating room. During that time, the hospital
surgeons, Drs. Zafe and Cereno, were busy
operating on gunshot victim Charles Maluluy-on.
Assisting them in the said operation was Dr.
Rosalina Tatad (Dr. Tatad), who was the only senior
anesthesiologist on duty at BRMC that night. Just
before the operation on Maluluy-on was finished,
another emergency case involving Lilia Aguila, a
woman who was giving birth to triplets, was
brought to the operating room.
Drs. Zafe and Cereno, in the meantime, proceeded
to examine Raymond and they found that the
latters blood pressure was normal and "nothing in
him was significant." There being no other
available anesthesiologist to assist them, Drs. Zafe
and Cereno decided to defer the operation on
Raymond.
At 11:15 P.M., the relatives of Raymond brought the
bag of blood to be used for blood transfusion. Drs.
Cereno and Zafe immediately started their
operation on Raymond at around 12:15 A.M. of 17
September 1995. Upon opening of Raymonds
thoracic cavity, they found that 3,200 cc of blood
was stocked therein. Dr. Cereno did not
immediately transfuse the blood since the bleeders
had to be controlled first. Blood was finally
transfused on Raymond at 1:40 A.M. However,
during the operation, Raymond died due to
massive loss of blood.

Claiming that there was negligence on the part of

those who attended to their son, the parents of
Raymond (herein respondents) filed a complaint for
damages against Drs. Zafe and Cereno. The RTC
found Drs. Zafe and Cereno negligent for not
immediately conducting surgery on Raymond. On
appeal, the CA affirmed RTCs findings.
ISSUE: Whether or not Drs. Zafe and Cereno are
guilty of gross negligence in the performance of
their duties?
HELD: The petition is granted.
CIVIL LAW: medical negligence
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 the failure
or action caused injury to the patient.
Given that Dr. Tatad was already engaged in
another urgent operation and that Raymond was
not showing any symptom of suffering from major
blood loss requiring an immediate operation, We
find it reasonable that petitioners decided to wait
for Dr. Tatad to finish her surgery and not to call the
standby anesthesiologist anymore. There is, after
all, no evidence that shows that a prudent surgeon
faced with similar circumstances would decide
otherwise.
In medical negligence cases, it is settled that the

complainant has the burden of establishing breach

of duty on the part of the doctors or surgeons. It
must be proven that such breach of duty has a
causal connection to the resulting death of the
patient.
Upon opening of his thoracic cavity, it was
discovered that there was gross bleeding inside the
body. Thus, the need for petitioners to control first
what was causing the bleeding.
Petition is GRANTED. The CA is REVERSED and SET
ASIDE.
Jarcia v. People
(February 15, 2012)
Ponente: Mendoza, J.
FACTS: Private complainant Belinda Santiago
lodged a complaint with the National Bureau of
Investigation against the petitioners, Dr. Emmanuel
Jarcia, Jr. and Dr. Marilou Bastan, for their alleged
neglect of professional duty which caused her son,
Roy Alfonso Santiago, to suffer serious physical
injuries.
Upon investigation, the NBI found that Roy Jr. was
hit by a taxicab; that he was rushed to the Manila
Doctors Hospital for an emergency medical
treatment; that an X-ray of the victims ankle was
ordered; that the X-ray result showed no fracture as
read by Dr. Jarcia; that Dr. Bastan entered the
emergency room and, after conducting her own
examination of the victim, informed Mrs. Santiago
that since it was only the ankle that was hit, there
was no need to examine the upper leg. despite Mrs.
Santiago's protest the doctors did not examine the
upper portion of the leg of Roy. that eleven (11)
days later, Roy Jr. developed fever, swelling of the
right leg and misalignment of the right foot; that
Mrs. Santiago brought him back to the hospital; and
that the X-ray revealed a right mid-tibial fracture
and a linear hairline fracture in the shaft of the

bone.
After trial and applying the doctrine of res ipsa
loquitor the RTC found petitioners to be guilty of
simple negligence. The decision was affirmed in
toto by the CA.
ISSUES:
(1) Whether or not res ipsa loquitor is applicable
in this case.
(2) Whether or not the petitioner physicians are
negligent, hence liable for damages.
HELD: As to the first issue: 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 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.
However, the doctrine of res ipsa loquitur as a rule
of evidence is unusual to the law of negligence
which recognizes that prima facie negligence may
be established without direct proof and furnishes a
substitute for specific proof of negligence. Ergo, the
doctrine can be invoked when and only when,
under the circumstances involved, direct evidence
is
absent
and
not
readily
available.
Relative to the case, res ipsa loquitor does not
apply since 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 patients
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.
As to the second issue: Petitioners were
negligent in their obligation. It was proven that a
thorough examination was not performed on Roy Jr
since as residents on duty at the emergency room,
Dr. Jarcia and Dr. Bastan were expected to know
the medical protocol in treating leg fractures and in
attending to victims of car accidents.
Thus, simple negligence is resent if: (1) that there
is lack of precaution on the part of the offender,
and (2) that the damage impending to be caused is
not immediate or the danger is not clearly
manifest.
Dr. Jarcia and Dr. Bastan, explained the court,
cannot pass on the liability to the taxi driver who
hit the victim. It may be true that the actual, direct,
immediate, and proximate cause of the injury
(fracture of the leg bone or tibia) of Roy Jr. was the
vehicular accident when he was hit by a taxi. The
petitioners, however, cannot simply invoke such
fact alone to excuse themselves from any liability. If
this would be so, doctors would have a ready
defense should they fail to do their job in attending
to victims of hit-and-run, maltreatment, and other
crimes of violence in which the actual, direct,
immediate, and proximate cause of the injury is
indubitably the act of the perpetrator/s.
In failing to perform an extensive medical
examination to determine the extent of Roy Jr.s
injuries, Dr. Jarcia and Dr. Bastan were remiss of
their duties as members of the medical profession.

Assuming for the sake of argument that they did

not have the capacity to make such thorough
evaluation at that stage, they should have referred
the patient to another doctor with sufficient
training and experience instead of assuring him
and his mother that everything was all right.
Moreover, the contention of petitioners that they
cannot be held liable since Roy is not their patient,
since they are not the attending physicians but
merely requested by the ER does not hold water.
Physician-patient relationship exists when a patient
engages the services of a physician, a physicianpatient relationship is generated. And in accepting
a case, the physician, for all intents and purposes,
represents that he has the needed training and skill
possessed by physicians and surgeons practicing in
the same field; and that he will employ such
training, care, and skill in the treatment of the
patient. Thus, in treating his patient, a physician is
under a duty to exercise that degree of care, skill
and diligence which physicians in the same general
neighborhood and in the same general line of
practice ordinarily possess and exercise in like
cases. Stated otherwise, the physician has the
obligation to use at least the same level of care
that any other reasonably competent physician
would use to treat the condition under similar
circumstances.
There is a physician-patient relationship in this case
since the petitioner obliged themselves and
examined the victim, and later assured the mother
that everything was fine and that they could go
home. Their assurance that everything is fine
deprived the victim of seeking medical help.
Petitioners were absolved in the criminal charge for
the reason that a reasonable doubt existed but the
are liable for damages. There is no direct evidence
proving that it was their negligence that caused the
suffering of Roy.
Disposition: Petition is partly GRANTED.

Dr. Rubi Li, Petitioner, vs. Spouses Reynaldo

cause of death as "Hypovolemic shock secondary

plaintiff was injured by the proposed treatment."

and Lina Soliman, as parents/heirs of

to multiple organ hemorrhages and Disseminated

Informed consent case requires the plaintiff to

deceased Angelica Soliman, Respondents.

Intravascular Coagulation. The respondents filed

"point

G.R. No. 165279

charges against the SLMC and physicians involve

relating to the treatment that would alter her

for negligence and failure to observe the essential

decision to undergo. The physician is not expected

precautions in to prevent Angelicas untimely

to give the patient a short medical education, the

death. Petitioner denied the allegation for damages

disclosure rule only requires of him a reasonable

as she observed best known procedures, highest

general explanation in nontechnical terms.

June 7, 2011
Legal Issue: How is medical malpractice proven?
Legal Facts: Respondents 11-year old daughter,
Angelica Soliman, underwent a biopsy of the mass
located in her lower extremity at the St. Lukes
Medical Center (SLMC) on July 7, 1993 and results
showed that Angelica was suffering from
osteosarcoma, osteoblastic type, (highly malignant)
cancer of the bone because of that a necessity of
amputation was conducted by Dr, Tamayo on
Angelicas right leg in order to remove the tumor
and to prevent the metastasis that chemotherapy
was suggested by Dr. Tamayo, which he referred to
petitioner Dr. Rubi Li, a medical oncologist. The
respondent was admitted to SLMC on August 18,
1993; however, she died eleven (11) days after the
(intravenous) administration of chemotherapy first
cycle. Respondents brought their daughters body
to the Philippine National Police (PNP) Crime
Laboratory at Camp Crame for post-mortem
examination after the refusal of the hospital to
release the death certificate without full payment
of bills. The Medico-Legal Report showed that the

to

significant

undisclosed

information

skill and knowledge in the administration of

chemotherapy drugs despite all efforts the patient

Policy Formation: In all sorts of medical

died. The trial court was in favor of the petitioner

procedures either invasive or not, medical

and ordered to pay their unpaid hospital bill in the

institution must have a certificate of competency in

amount of P139, 064.43, but the Court of Appeals

rendering standards of care to delicate medical

reversed the decision supporting the respondents

procedures before initiating a general protocol that

pray.

would establish a guideline principle in a form of

proper disclosure of such procedure and presenting

Holding: In this case medical malpractice is

a consent or waiver to their patients so that

proven because the four essential elements of such

possible future medico-legal suits will be

action are present based upon the doctrine of

prevented.

informed consent.
Reasoning:

Synthesis: In Dr. Rubi Li, vs. Spouses Reynaldo

There are four essential elements a plaintiff must

and Lina Soliman, as parents/heirs of deceased

prove in a malpractice action based upon the

Angelica Soliman, Respondents, G.R. No. 165279,

doctrine of informed consent: "(1) the physician

promulgated on June 7, 2011, the Court ruled that

had a duty to disclose material risks; (2) he failed

medical malpractice is proved base on

to disclose or inadequately disclosed those risks;

lack/impaired informed consent, and reasonable

(3) as a direct and proximate result of the failure to

expert testimony subject a breach of duty causing

disclose, the patient consented to treatment she

gross injury to its patient.

otherwise would not have consented to; and (4)