Legal Medicine

Is that branch of medicine that applies,

medical and surgical concepts, scientific knowledge and
skills to medico legal issues, in order to assist the trier of
facts in the proper dispensation of justice.
Medical Jurisprudence
is the study of the Medical Law and its
applicable Jurisprudence that governs, regulates and
defines the practice of medicine.
I. INTRODUCTION: THE FILIPINO PHYSICIAN
Medical education in the Philippines is principally
ofered and developed by accredited and government
recognized me dical schools in the country. The Philippine
medical schools are graduate schools ofering the Do ctor o f
Me dicine (M.D.) degree. The M.D. is a four-year
profe ssional de gree program which qualifies the degree
holder to take the licensure exam for medical doctors in
the Philippines.
Professiona l med ical degree
The Doct or of Med ic ine (M.D.) is a four-year
profe ssio nal de gree program dealing with me dical
t heories, practices, technologies, and problem
solving.
The completion of the degree program with one-year
postgraduate internship qualifies a candidate to take the
licensure exam for medical doctors in the Philippines.
After becoming a licensed doctor, a Physician may choose
to stop there and start earning as a G.P. (general
physician), or be a residence doctor or take a speciality in
a field he or she wants which will take almost 4-5 years
(for training.)
Admiss ion t o medical schools
Before applying to any medical school, a candidate must
earn
a bache lor's de gree with credits in certain required
subjects. The most common pre-medical degrees
include
biology, pharmacy, me dical te chnology, biochemistry,
nursing,
and physical therapy.
In addition, a candidate must take the Nationa l Medical
Admission Test (NMAT), the national entrance exam for
all medical schools in the Philippines.
PRACTIC E OF MEDIC INE
1. PRC vs De Guzman (G.R. No. 144681, June 21,
2004) DOCTRINE: Until the moral and mental fitness of
the respondents could be ascertained, according to
petitioners, the Board has discretion to hold in abeyance
the administration of the Hippocratic Oath and the issuance
of the certificates to them. The writ of mandamus does not
lie to compel performance of an act which is not duly
authorized.
The respondents nevertheless argue that under Section 20,
the Board
shall not issue a certificate of registration only in the
following instances: (1) to any candidate who has been
convicted by a court of competent jurisdiction of any
criminal ofense involving moral turpitude; (2) or has been
found guilty of immoral or dishonorable conduct after the
investigation by the Board; or (3) has been declared to be
of unsound mind. They aver that none of these
circumstances are present in their case.

Petitioners reject respondents argument. Section

8 [30] of Rep. Act No. 2382 prescribes, among
others, that a person who aspires to practice
medicine in the Philippines, must have satisfactorily
passed the corresponding Board Examination. Section
22, in turn, provides that the oath may only be
administered to physicians who qualified in the
examinations. The operative word here is
satisfactorily, defined as suficient to meet a condition or
obligation or capable of dispelling doubt or ignorance.
Gleaned from Board Resolution No. 26, the licensing
authority apparently did not find that the respondents
satisfactorily passed the licensure examinations. The Board
instead sought to nullify the examination results obtained
by the respondents.
2. DECS vs San Diego (GRN 89572, December 21, 1989)
FACTS: Roberto Rey San Diego, the private respondent is a
graduate of the University of the East with a degree of
Bachelor of Science
in Zoology. The petitioner claims that he took the NMAT
three times and flunked it as many times.
ISSUE: Petition whether the private respondent who has
thrice failed the National Medical Admission Test(NMAT)
is entitled to take it again as it is a requirement for
admission to any Medical School in the Philippines. He
invoked of his constitutional rights to academic freedom
and quality education, squarely challenging the
constitutionality of MECS Order No. 12, Series of 1972.
HELD:The private respondent cannot take the NMAT
again and pursue his medical profession because of the
following grounds:
F o r t h e p ur p o se of g a u g i n g at l e a s t i n i t i a l l y b y
the
a d m i s s i o n t e s t a n d by t h e t h r e e - f l u n k r u l e , a
student shall
not be allowed to take the NMAT again after three
successive failures.
The State ensures that medical profession is not
permeated by incompetents to whom patients may
unwarily hand over their lives and health.
It is not enough to simply invoke the right to quality education as
a guarantee of the Constitution, while one has the right to
aspire to be a doctor, he does not have the constitutional
right to be a doctor; one must show that he is entitled to it
because of his preparation and promise.
The conflict that the challenged rule vi
o l a t e s t h e e q u a l p r o t e c t i o n c l a u s e is n o
t w e l l - t a k e n . Conformable to Article
III, Section 1 of the Constitution, a law does not have to
operate with equal force on all person or things
II. MEDICAL ACT OF 1959, CODE OF
ETHICS Objectives. This Act provides for
and shall govern
(a) the standardization and regulation of medical education;
(b) the examination for registration of physicians; and
(c) the supervision, control and regulation of the practice of
medicine in the Philippines.
For the purpose of implementing the provisions of this Act,
there are created the following agencies:
(1) the Board of Medical Education under the Department of
Education, and
(2) the Board of Medical Examiners (Board of
Medicine) under the Commissioner of Civil Service NOW
Professional Regulation Commission

The Board of Med ical Education Its Funct ions

The Board of Medical Education shall be composed of the
1. Secretary of Education or his duly authorized
representative, as chairman;
2. the Secretary of Health or his duly authorized
representative; 3. the Director of the Bureau of Private
Schools or his duly authorized representative;
4. the chairman of the Board of Medical Examiners or his
duly
authorized representatives;
5. a representative of the Philippine Medical Association;
6. the Dean of the College of Medicine, University of the
Philippines;
7. a representative of the Council of Deans of Philippine
Medical
Schools; and
8. a Representative of the Association of Philippine Medical
Colleges, as members.
The oficials acting as chairman and members of the Board
of Medical Education shall hold office during their
incumbency in their respective positions.
Funct ions: (Sect ion 5)
The functions of the Board of Medical Education shall be:
1. To determine and prescribe minimum requirements for
admission into a recognized college of medicine;
2. To determine and prescribe requirements for minimum
physical facilities of colleges of medicine, to wit: buildings,
including hospitals, equipment and supplies, apparatus,
instruments, appliances, laboratories, bed capacity for
instruction purposes, operating and delivery rooms,
facilities for out-patient services, and others, used for
didactic and practical instructions in accordance with
modern trends;
3. To determine and prescribe the minimum number and
the minimum qualifications of teaching personnel,
including student- teacher ratio and curriculum;
4. To determine and prescribe the number of students
who should be allowed to take up the preparatory course
taking into account the capacity of the diferent recognized
colleges of medicine.
5. To select, determine and approve hospitals or some
departments of the hospitals for training which comply
with the minimum specific physical facilities as provided
in subparagraph (b) hereof: and
6. To promulgate and prescribe and enforce necessary
rules and regulations for the proper implementation of
the foregoing functions.

(1) he is at least twenty-one years of age,

(2) has satisfactorily passed the corresponding Board of
Examination and
(3) is a holder of a valid Certificate of Registration duly
issued to him by the Board of Medical Examiners.
Acts Const itut ing Pract ice of Medic ine (Sect ion 10)
A person shall be considered as engaged in the practice of
medicine (1) who shall, for compensation, fee, salary or
reward in any form, paid to him directly or through
another, or even without the same, physical examine any
person, and diagnose, treat, operate or prescribe any
remedy for any human disease, injury, deformity,
physical, mental or physical condition or any ailment, real
or imaginary, regardless of the nature of the remedy or
treatment administered, prescribed or recommended; or
(2) who shall, by means of signs, cards, advertisements,
written or printed matter, or through the radio, television
or any other means of communication, either ofer or
undertake by any means or method to diagnose, treat,
operate or prescribe any remedy for any human disease,
injury, deformity, physical, mental or physical condition;
or
(3) who shall use the title M.D. after his name.
Exempt ions (Sect ion 11):
The preceding section shall not be construed to afect
1.

2.
3.

4.

5.
Admiss ion require ments (Sect ion 7)
The medical college may admit any student who has
not been convicted by any court of competent
jurisdiction of any offense involving moral turpitude
and who presents
1. a record showing completion of a bachelor's
degree in science or arts;
2. a certificate of eligibility for entrance to a
medical school from the Board of Medical
Education;
3. a certificate of good moral character issued by
two former professors in the college of liberal
arts; and
4. birth certificate. Nothing in this Act shall be
construed to inhibit any college of medicine from
establishing, in addition to the preceding, other
entrance requirements that may be deemed
admissible.
General practice of Medic ine (Art 3 Section 8)
No person shall engage in the practice of medicine in the
Philippines unless:

6.
7.

any medical student duly enrolled in an approved

medical college or school under training, serving
without any professional fee in any government or
private hospital, provided that he renders such
service under the direct supervision and control of
a registered physician;
any legally registered dentist engaged
exclusively in the practice of dentistry;
any duly registered masseur or physiotherapist,
provided that he applies massage or other
physical means upon written order or prescription
of a duly registered physician, or provided that
such application of massage or physical means
shall be limited to physical or muscular
development;
any duly registered optometrist who
mechanically fits or sells lenses, artificial eyes,
limbs or other similar appliances or who is
engaged in the mechanical examination of eyes
for the purpose of constructing or adjusting eye
glasses, spectacles and lenses;
any person who renders any service gratuitously
in cases of emergency, or in places where the
services of a duly registered physician, nurse or
midwife are not available;
any person who administers or recommends any
household remedy as per classification of existing
Pharmacy Laws; and
any psychologist or mental hygienist in the
performance of his duties, provided such
performance is done in conjunction with a duly
registered physician.

Limited practice wit hout any certif icate of registrat ion

( Section 12)
1.

Physicians and surgeons from other countries

called in consultation only and exclusively in
specific and definite cases, or those attached to
international bodies or organization assigned to
perform certain definite work in the Philippines
provided they shall limit their practice to the
specific work assigned to them and provided
further

they shall secure a previous authorization from

the Board of Medical Examiners.
2.

Commissioned medical officers of the United

States armed forces stationed in the Philippines
while rendering service as such only for the
members of the said armed forces and within the
limit of their own respective territorial jurisdiction.

3.

Foreign physicians employed as exchange

professors in special branches of medicine or
surgery whose service may in the discretion of
the Board of Medical Education, be necessary.

4.

Medical students who have completed the first

four years of medical course, graduates of
medicine and registered nurses who may be
given limited and special
authorization by the Secretary of Health to render
medical services during epidemics or national
emergencies whenever the services of duly
registered physicians are
not available. Such authorization shall
automatically cease when the epidemic or
national emergency is declared terminated by the
Secretary of Health.

Funct ions of t he Board of Med ical Examiners (B oard

of Med ic ine) The Board of Medical Examiners, with the
approval of the Professional Service Commission, shall
promulgate such rules and regulations as may be
necessary for the proper conduct of the examinations,
correction of examination papers, and registration of
physicians
Section 22. A dministrative invest igat ions .
In addition to the functions provided for in the preceding
sections, the Board of Medical Examiners shall perform
the following duties: (1) to administer oath to physicians
who qualified in the examination;
(2) to study the conditions afecting the practice of
medicine in all parts of the Philippines;
(3) to exercise the powers conferred upon it by this article
with the
view of maintaining the ethical and professional
standards of the medical profession;
(4) to subpoena or subpoena duces tecum witnesses for all
purposes required in the discharge of its duties; and
(5) to promulgate, with the approval of the Commissioner
of Civil Service, such rules and regulations as it may deem
necessary for the performance of its duties in harmony
with the provisions of this Act and necessary for the proper
practice of medicine in the Philippines.

DUE PR OCESS: Sect ion 23. Pr ocedure and rules .

Within five days after the filling of written charges under
oath, the respondent physician shall be furnished a copy
thereof, without requiring him or her to answer the same,
and the Board shall conduct the
investigation within five days after the receipt of such
copy by the respondent. The investigation shall be
completed as soon as practicable.
SECT ION 24. GR OU NDS FOR REPR IMA ND,
SU SPE NSION OR REVOCAT ION OF REGIS TRAT ION
CERT IFICA TE.
(1) Conviction by a court of competent jurisdiction of any
criminal ofense involving moral turpitude;
(2) Immoral or dishonorable conduct;

(3) Insanity;
(4) Fraud in the acquisition of the certificate of registration;
(5) Gross negligence, ignorance or incompetence in the
practice of his or her profession resulting in an injury to or
death of the patient;
(6) Addiction to alcoholic beverages or to any habit
forming drug rendering him or her incompetent to
practice his or her profession, or to any form of gambling;
(7) False or extravagant or unethical advertisements wherein
other
things than his name, profession, limitation of practice,
clinic hours, ofice and home address, are mentioned.
(8) Performance of or aiding in any criminal
abortion; (9) Knowingly issuing any false
medical certificate;
(10) Issuing any statement or spreading any news or rumor
which is derogatory to the character and reputation of
another physician without justifiable motive;
(11) Aiding or acting as a dummy of an unqualified or unregistered
person to practice medicine;
(12) Violation of any provision of the Code of Ethics as
approved by the Philippine Medical Association.
Refusal of a physician to attend a patient in danger of
death is not a sufficient ground for revocation or
suspension of his registration certificate if there is a risk to
the physician's life.
Section 26. A ppeal from judgment. The decision of
the Board of Medical Examiners (Board of Medicine)
shall automatically become final thirty days after the date
of its promulgation unless the respondent, during the same
period, has appealed to the Professional Regulation
Commission and later to the Court of Appeals. If the
final decision is not satisfactory, the respondent may ask
for a review of the case, or may file in court a petition for
certiorari.
Section 27. Re instatement . After two years, the Board
may order the reinstatement of any physicians whose
certificate of registration has been revoked, if the
respondent has acted in an exemplary manner in the
community wherein he resides and has not committed any
illegal, immoral or dishonorable act.
III. LIABILITIES OF
PHYSICIANS Kinds of
Liabilit ies of P hys ic ians :
1. Administrative liabilities
2. Civil liabilities
3. Criminal liabilities
i. Administrative Liability
A practice of medicine is a privilege and not a
right; hence it could be taken away from the physician.
In administrative liabilities, a physicians
profession is temporarily withdrawn from him to protect
future patients.
Penalty: Reprimand, Suspension or revocation of license
Quantum of Evidence: Substantial
Evidence
Jurisdiction: Board of Medicine, Professional Regulatory
Commission (Quasijudicial body); Philippine Medical Association
Example: Non-compliance of National and Local laws which
include
Sanitary Code, Fire Code etc
ii. Criminal Liability

-For Acts or Omissions constituting a crime.

Acts or omissions constituting a crime can be done with
deceit (deliberate intent) and fault (negligence,
imprudence, lack of skill/foresight).
Penalty: Imprisonment, fines (from Special Laws/
RPC)
Quantum of Evidence: Proof beyond reasonable
doubt
Jurisdiction: Regular Courts
iii. Civil Liability
Civil liabilities make a physician liable to
compensate the patient for the injury he sufered on
account of his wrongful act or breach of contract. It may
include moral or punitive damages.
Penalty: Damages (NCC Arts 19-21 or Article
2176 Torts)
Quantum of Evidence: Preponderance of
Evidence
Jurisdiction: Regular Courts
IV. HUMAN BODY
V. MEDICAL NEGLIGENCE CASES
LEGAL MEDIC INE A ND T HE LEGAL S YSTEM
Courts routinely call upon physicians to give
expert testimony in a trial, especially concerning the
findings of an autopsy and the results of laboratory tests.
As an expert witness he is allowed to express
an opinion about the validity of the evidence in a case
and may quote the statements of other experts in
support of an opinion.
Ordinary testimony is restricted to statements
concerning
what the witness actually saw or heard.
The evidence to be presented by the legal
medicine expert must signify a relation between the facts
called the Factum Probandum or proposition to be
established and the factum Probans which is the
material evidencing the proposition.
The Physician must present RELEVANT,
MATERIAL AND COMPETENT EVIDENCE.

If physician is an employee, the hospital may

be held liable.
Physicians are not employees but are
considered as individual contractors.
Key elements (Employeremployee relationship):
1.
Hiring
2.
Firing
3.
Wages
4.
Control
How to make a hospital under the doctrine
of apparent authority liable
General Rule: A hospital is not liable
for the negligence of an inde pende nt
contractor-physician.
XPT: When physician is the "ostensible"
agent of the hospital (doctrine of apparent
authority)
Requisites for the doctrine to apply:
(1) the 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;

(2) where the acts of the agent create the

appearance of authority, the plaintif must also
prove that the hospital had knowledge of and
acquiesced in them; and
(3) the plaintif acted in reliance upon the conduct
of the hospital or its agent, consistent with
ordinary care and prudence.
o

LEGAL BASIS:

Law on Agency
Negligent Act of an agent, principal may be
held liable.

Acting as an agent of the hospital

1.
Forms
2.
Waiver
3.
Prescription pad
4.
List of physicians
5.
Corporate Negligence: How to make physician liable
o Captain of the Ship Doctrine
Still applicable in the Philippines
though western countries are not applying
the same.
Mistakes not automatically
negligence
Negligence is not sufficient; it must be
gross negligence.
Standard of care: failure to follow it
must be established

Pre-operative
procedure
Expert witness: to establish failure to
follow standard of care
o Same expertise as the accused
o Preferably from the same locality

EXCEPTION: res ipsa loquitur

The injury of the patient is suficient
Common sense will tell you that there was negligence
Four (4) elements:
(1) the accident was of a kind which does not
ordinarily occur unless someone is negligent;
(2) the instrumentality or agency which cause d
the injury was under the exclusive control of the
person in charge; and
(3) the injury sufered must not have been due
to any voluntary action or contribution of the
person injured.
(4) Matter of convenience on the part of the injured party

MEDICAL NEG LIGENC E CASES

3. Dr. Cantre vs. Go (G.R. No. 160889, April 27,
2007) FACTS: Hours after giving birth to her fourth child.
Nora experienced hypoglemic shock. The attending
physician and her team performed the necessary steps to
stop the bleeding. He used a droplight to warm Nora and
her baby. After the operation, Noras husband noticed a
gaping wound on Noras left arm, about four (4) inches
long. He asked the physician what caused the wound and
he replied that it was due to the blood pressure cuf.
The spouses went to the NBI for physical
examination and found out that it was a burn caused by
the droplight. A droplight
can cause burn on the skin even just for ten (10) minutes.
Thye filed a complaint for damages against the doctor and
the hospital.
The doctor said it was the nurses fault. The nurse forgot to
remove
the droplight.

ISSUE: Is the petitioner liable for the injury sustained by

Nora Go?
HELD: YES.
Res ipsa loquitur x Medical negligence cases
In medical negligence cases, 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:
Accident is of a kind which ordinarily does not occur absent
someone's negligence
The wound not an ordinary occurrence in the act of
delivering a baby; could not have happened unless
negligence set in somewhere caused by an instrumentality
within defendant's exclusive control It doesn't matter WON
the injury was caused by the droplight or by
the blood pressure cuf, 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].
The doctrine of [r]es ipsa loquitur as a rule of evidence is
peculiar to the law of negligence which recognizes that
prima facie negligence may be established without direct
proof and furnishes a substitute for specific proof of
negligence. In the instant case, all the requisites for
recourse to the doctrine are present. First, the entire
proceedings of the cesarean section were under the
exclusive control of Dr. Batiquin. In this light, the private
respondents were bereft of direct evidence as to the actual
culprit or the exact cause of the foreign object finding its
way into private respondent Villegas' body, which,
needless to say, does not occur unless through the
intervention of negligence. Second, since aside from the
cesarean section, private
respondent Villegas underwent no other operation which
could have caused the ofending piece of rubber to appear
in her uterus, it
stands to reason that such could only have been a byproduct of the cesarean section performed by Dr. Batiquin.
The petitioners, in this regard, failed to overcome the
presumption of negligence arising from resort to the
doctrine ofres ipsa loquitur. Dr. Batiquin is therefore liable
for negligently leaving behind a piece of rubber in private
respondent Villegas' abdomen and for all the adverse
efects thereof.. Still, her good intentions characteristics
do not justify negligence.
4. Batiquin vs Court of Appeals (GRN 118231, July
5, 1996) FACTS: On Sept 1988, Petitioner Dr. Batiquin
performed a simple
caesarean section on Respondent Mrs. Villegas when the
latter gave
birth. Soon after leaving the hospital, respondent began to
sufer abdominal pains and complained of being feverish.
The abdominal pains and fever kept on recurring and this
prompted respondent to consult with another doctor, Dr.
Kho. When Dr. Kho opened the abdomen of respondent to
check her out respondents infection, she discovered that a
piece of rubber material, which looked like a piece of rubber
glove and was deemed a foreign body, was the cause of the
respondents infection. Respondent then sued petitioner for
damages. RTC held in favor of petitioner. CA reversed,
ruling for the respondent.
ISSUES: Whether petitioner is liable to respondent.
HELD: YES, UNDER THE RULE OF RES IPSA LOQUITUR,
DR. BATIQUIN IS LIABLE.
Res ipsa loquitur. The thing speaks for itself. Rebuttable

presumption or inference that defendant was negligent,

which arises upon proof that the instrumentality causing
injury was in
defendant's exclusive control, and that the accident was
one which

ordinary does not happen in absence of negligence. Res ipsa

loquitur is a rule of evidence whereby negligence of the
alleged wrongdoer may be inferred from the mere fact that
the accident happened provided the character of the
accident and circumstances attending it lead reasonably to
belief that in the absence of negligence it would not have
occurred and that thing which caused injury is shown to have
been under the management and control of the alleged
wrongdoer. Under this doctrine the happening of an injury
permits an inference of negligence where plaintif produces
substantial evidence that the injury was caused by an
agency or instrumentality under the exclusive control and
management of defendant, and that the occurrence was
such that in the ordinary course of things would not happen
if reasonable care had been used.

direct evidence as to the actual culprit or the exact cause

of the foreign object finding its way into private
respondent Villegas's body, which, needless to say, does
not occur unless through the intersection of negligence.
Second, since aside from the caesarean section, private
respondent Villegas underwent no other operation which
could have caused the ofending piece of rubber to appear
in her uterus, it stands to reason that such could only have
been a by-product of the caesarean section performed by
Dr. Batiquin. The petitioners, in this regard, failed to
overcome the presumption of negligence arising from
resort to the doctrine of res ipsa loquitur. Dr. Batiquin is
therefore liable for negligently leaving behind a piece of
rubber in private respondent Villegas's abdomen and for
all the adverse efects thereof.

The doctrine of res ipsa loquitur as a rule of evidence is

peculiar to the law of negligence which recognizes that
prima facie negligence may be established without direct
proof and furnishes a substitute for specific proof of
negligence. The doctrine is not a rule of substantive law,
but merely a mode of proof or a mere procedural
convenience. The rule, when applicable to the facts and
circumstances of a particular case, is not intended to and
does not dispense with the requirement of proof of culpable
negligence on the party charged. It merely determines and
regulates what shall be
prima facie evidence thereof and facilitates the burden of
plaintiff of proving a breach of the duty of due care. The
doctrine can be invoked when and only when, under the
circumstances involved, direct evidence is absent a n d n o
t readily available.

5. Fe Lasam vs. Ramolete (G.R. No. 159132,

December 18, 2008) FACTS: On July 28, 1994,
respondent, three months pregnant Editha Ramolete 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 sufering 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.

In the instant case, all the requisites for recourse to the

doctrine are present. First, the entire proceedings of the
caesarean section were under the exclusive control of Dr.
Batiquin. In this light, the private respondents were bereft of

Respondents:
Petitioners failure to check up, visit or administer
medication on
Editha during her first day of confinement at the LMC;
Petitioner recommended that a D&C procedure be
performed on Editha without conducting any internal
examination prior to the procedure;
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 diference at all because at any stage of
gestation before term, the uterus would rupture just the
same.
HELD: 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 that
the 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: 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 plaintif 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 eficient
intervening cause, produces injury, and without which the
result would not have occurred.
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) day s after the D&C. This advice was clear in
complainants Discharge Sheet. However, Complainant
failed to do so. This being the case, the chain of continuity
as required in order that the doctrine of
proximate cause can be validly invoked was interrupted.
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. Dificulty
seems to be apprehended in deciding which acts of the
injured party shall be considered immediate causes of the
accident. Where the immediate cause of an accident
resulting in an injury is the plaintifs own act, which
contributed to the principal occurrence as one of its
determining factors, he cannot recover damages for the
injury.
6. Rogelio Nogales vs. Capitol Medical Center
(G.R. No. 142625, December 19, 2006)
FACTS: Dr. Estrada applied low forceps to extract
Corazon's baby. In the process, a cervical tissue was
allegedly torn. The baby came out in an apnic, cyanotic,
weak and injured condition. The bab survived, but the
mother died of profuse vaginal bleeding. The husband
sued CMC and the doctors.
ISSUES:
1) Whether an employee-employer relationship existedbetween
CMC and Dr. Estrada
2) whether CMC is vicariously liable for the
negligence of Dr. Estrada
HELD:
In Ramos vs. CA, weheld:
In other words, private hospitals, hire, fire and exercise real
control over their attending and visiting "consultant" staf.
While "consultants" are not, technically employees, 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. 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 neglige
nce cases, an employer-employee relationship in efect
exists between hospitals and their attending and visiting
physicians.
Dr. Estrada is an independent contractor. Applying the
control test, SC did not find evidence pointing to CMC's
exercise of control over Dr. Estrada's treatment and
management of Corazon's condition. The patient was
under the exclusive prenatal care of Dr. Estrada. CMC
merely allowed Dr. Estrada to use its facilities when
Corazon was about to give birth, which CMC considered an
emergency.
But while SC held that Dr. Estrada is not CMCs employee,
CMC is vicariously liable under the doctrine of apparent
authority. General Rule: A hospital is not liable for the
negligence of an inde pe nde nt contractor-physician.
XPT: When physician is the "ostensible" agent of the
hospital (doctrine of apparent authority)
Requisites for the doctrine to apply:
(1) the 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;
(2) where the acts of the agent create the appearance of
authority, the plaintif must also prove that the hospital had
knowledge of and acquiesced in them; and
(3) the plaintif acted in reliance upon the conduct of the hospital
or
its agent, consistent with ordinary care and prudence.
Two Factors to consider:
1) An inquiry on 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. The hospital need not
make express representations to the

patient that the treating physician is an employee of the

hospital;
rather a representation may be general and implied.
2) An inquiry on whether the plaintif acted in reliance
upon the conduct of the hospital or its agent, consistent
with ordinary care and prudence.
Application of these factors to this case:
1) CMC impliedly held out Estrada as a member of its
medical staf. a) CMC granted staf privileges to Dr.
Estrada. CMC extended its medical staf and facilities to
Dr. Estrada.
b) CMC made Rogelio sign consent forms printed on CMC
letterhead. These forms did not indicate that he was an
independent contractor-physician. No one from CMC
informed the
Spouses
c) Dr. Estrada's referral of Corazon's profuse vaginal
bleeding to Dr. Espinola, who was then the Head of the
Obstetrics and Gynecology Department of CMC, gave the
impression that
Dr. Estrada as a member of CMC's medical staff was
collaborating with other CMCemployed specialists in
treating Corazon.
2) Rogelio testified that he and his wife specifically chose
Dr. Estrada to handle Corazon's delivery not only because
of their friend's recommendation, but more importantly
because of Dr. Estrada's "connection with a reputable
hospital, the CMC." In other words, Dr. Estrada's
relationship with CMC played a significant role in the
Spouses Nogales' decision in accepting Dr. Estrada's
services
7. Professional Services vs. Agana (G.R. No. 126297,
February 2,
2010)
In this case, the Court, while affirming the existing doctrine
that hospitals as a general rule are not civilly liable for the
tortuous acts of their medical consultants in view of the
absence of an employer- employee relationship between,
nonetheless made the following pro hac vice doctrinal
pronouncements on the liability of the respondent hospital
based on the doctrines of ostensible agency and
corporate negligence, thus:
FACTS: Professional Services, Inc. (PSI) filed a second
motion for reconsideration urging referral thereof to the
Court en banc and seeking modification of the decision
dated January 31, 2007 and resolution dated February
11, 2008 which affirmed its vicarious and direct liability for
damages to respondents Enrique Agana and the heirs of
Natividad Agana (Aganas). Manila Medical Services, Inc.
(MMSI), Asian Hospital, Inc. (AHI), and Private Hospital
Association of the Philippines (PHAP)
all sought to
intervene in these cases invoking the common ground
that, unless modified, the assailed decision and resolution
will jeopardize the financial viability of private hospitals and
jack up the cost of health care.
ISSUE: Whether or not Professional Services Inc. has been
erred to be held liable for the Negligence of Dr. Miguel
Ampil.
HELD:
YES, after gathering its thoughts on the issues,
this Court holds that PSI is liable to the Aganas, not under
the principle of respondeat
superior
for
lack
of
evidence of an employment relationship with Dr. Ampil
but under the principle of ostensible agency for the
negligence of Dr. Ampil and, pro hac vice, under the
principle of corporate negligence for its failure to perform
its duties as a hospital.
While in theory a hospital as a juridical entity
cannot practice medicine, in reality it utilizes doctors,
surgeons and medical practitioners in the conduct of its
business of facilitating medical and surgical treatment.

**Where an employment relationship exists, the

hospital may be held vicariously liable under Article 2176
in relation to Article 2180 of the Civil Code or the principle
of respondeat superior. Even when no employment
relationship exists but it is shown that the hospital holds
out to the patient that the doctor is its agent, the hospital
may still be vicariously liable under Article 2176 in relation
to Article 1431 and Article 1869 of the Civil Code or the
principle of apparent authority. Moreover, regardless of its
relationship with the doctor, the hospital may be held
directly liable to the patient for its own negligence or
failure to follow established standard of conduct to which it
should conform as a corporation.
**Under the "control test", an employment
relationship exists between a physician and a hospital if
the hospital controls
both the means and the details of the process by which the
physician is to accomplish his task.
As priorly stated, private respondents maintained specific
work-schedules, as determined by petitioner through its
medical director, which consisted of 24-hour shifts totaling
forty-eight hours each week and which were strictly to be
observed under pain of administrative sanctions.
**That petitioner exercised control over respondents gains
light from the undisputed fact that in the emergency room,
the operating room, or any department or ward for that
matter, respondents' work is monitored through its nursing
supervisors, charge nurses and orderlies. Without the
approval or consent of petitioner or its
medical director, no operations can be undertaken in those
areas. For control test to apply, it is not essential for the
employer to actually supervise the performance of duties
of the employee, it being
enough that it has the right to wield the power.
8. Ramos vs. Court of Appeals (G.R. No. 124354 ,
April 11, 2002) FACTS: 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
day before the scheduled operation. By 7:30 in the 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
room.
At around 9:30 in the morning, Dr. Hosaka had
not yet arrived so Dr. Gutierrez tried to get in touch with
him by phone. Thereafter, Dr. Gutierrez informed Cruz that
the operation might be delayed due to the late arrival of
Dr. Hosaka. In the meantime, the patient, petitioner
Erlinda said to Cruz, "Mindy, inip na inip na ako, ikuha mo
ako ng ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still
not around, petitioner Rogelio already wanted to pull out
his wife from the operating room. He met Dr. Garcia, who
remarked that he was also tired of waiting for Dr. Hosaka.
Dr. Hosaka finally arrived at the hospital at around 12:10 in
the afternoon, or more than three (3)
hours after the scheduled operation.
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
ang pagkakapasok. O lumalaki ang tiyan." Cruz noticed a
bluish discoloration of Erlindas nailbeds on her left hand.
She (Cruz) then heard Dr. Hosaka instruct someone to call
Dr. Calderon, another anesthesiologist. When he arrived,
Dr. Calderon attempted to intubate the patient. The
nailbeds of the patient remained bluish, thus, she was
placed in a trendelenburg position a position where the
head of the patient is placed in a position lower than her
feet. At this point, Cruz went out of the operating room to
express her concern to petitioner Rogelio that Erlindas
operation was not going well.

3) After a careful consideration of the arguments raised by

DLSMC, the Court finds that respondent hospitals position
on this issue is meritorious. There is no employeremployee relationship between DLSMC and Drs. Gutierrez
and Hosaka which would hold DLSMC solidarily liable for
the injury sufered by petitioner Erlinda under Article 2180
of the Civil Code. urther, no evidence was adduced to
show that the injury sufered by petitioner Erlinda was due
to a failure on the part of respondent DLSMC to provide for
hospital facilities and staf necessary for her treatment. For
these reasons, the Supreme Cord reverse the finding of
liability on the part of DLSMC for the injury sufered by
petitioner Erlinda.

Cruz quickly rushed back to the operating room

and saw that the patient was still in trendelenburg
position. At almost 3:00 in the afternoon, she saw Erlinda
being wheeled to the Intensive Care Unit (ICU). The
doctors explained to petitioner Rogelio that his wife had
bronchospasm. Erlinda stayed in the ICU for a month. She
was released from the 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.

9. Cereno vs. CA (G.R. No. 167366 September 26, 2012)

FACTS: At 10:30 P.M., Raymond was brought inside the
operating room. For During that time, the hospital
surgeons, Drs. Zafe and Cereno, were busy operating on
gunshot victim. Meanwhile, another emergency case, a
woman who was giving birth to triplets and was brought to
the operating room with the only anaesthesiologist, Dr
Tatad.

Petitioners filed with the Regional Trial Court of

Quezon City a civil case for damages against private
respondents. After due trial, the court a quo rendered
judgment in favor of petitioners. Essentially, the trial court
found that private respondents were negligent in the
performance of their duties to Erlinda. On appeal by
private respondents, the Court of Appeals reversed the
trial courts decision and directed petitioners to pay their
"unpaid medical bills" to private respondents.
Petitioners filed with this Court a petition for review on
certiorari. The private respondents were then required to
submit their respective comments thereon. On December
29, 1999, this Court promulgated the decision which
private respondents now seek to be reconsidered.
ISSUES:
1. WHETHER OR NOT DR. ORLINO HOSAKA (SURGEON)
IS LIABLE FOR NEGLIGENCE;
2. WHETHER OR NOT DR. PERFECTA GUTIERREZ
(ANESTHESIOLOGIST) IS LIABLE FOR NEGLIGENCE; AND
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.
RULING: In the case at bar, the following issues were
resolved as follows:
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.
2) Dr. Gutierrez claim of lack of negligence on her part is
belied by the records of the case. It has been sufficiently
established that she failed to exercise the standards of
care in the administration of anesthesia on a patient. Dr.
Gutierrez omitted to perform a thorough preoperative
evaluation on Erlinda. Further, there is no cogent
reason for the Court to reverse its finding that it was the
faulty intubation on Erlinda that caused her comatose
condition. There is no question that Erlinda became
comatose after Dr. Gutierrez performed a medical
procedure on her.

After some time, Drs. Zafe and Cereno, 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, Drs. Cereno and
Zafe
started their operation on Raymond at around 12:15 A.M.,
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.
Parents of Raymond filed a case against the doctors.
The doctors were found negligently liable. Hence this
appeal.
ISSUE: Whether or not Drs. Zafe and Cereno are guilty
of gross negligence in the performance of their duties.
HELD: NO. 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 sufering 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.
10. Jarcia vs. People (G.R. No. 187926 February 15,
2012) FACTS: Roy Alfonso Santiago Jr after being hit by a
taxicab was brought by her mother to the Manila Doctors
Hospital for an emergency treatment. Dr. Emmanuel
Jarcia, Jr. (Dr. Jarcia) and Dr. Marilou Bastan (Dr. Bastan)
junior (general) residents of the said hospital conducted
an X-ray of the victims ankle and it was alleged that the
X-ray result showed no fracture (as read by Dr. Jarcia);
that Dr. Bastan entered the emergency room(ER) 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; 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.
The NBI indorsed the matter to the Office of the City
Prosecutor of Manila for preliminary investigation. Probable
cause was found and a criminal case for reckless
imprudence resulting to serious physical injuries, was filed
against Dr. Jarcia, Dr. Bastan and Dr. Pamittan, before the
RTC. They were found guilty beyond reasonable doubt of
the crime of Simple Imprudence Resulting to Serious
Physical Injuries.
That the negligence exhibited by the two doctors
does not approximate negligence of a reckless nature but
merely amounts to simple imprudence. Simple imprudence
consists in the lack of precaution displayed in those cases
in which the damage impending to be caused is not the
immediate nor the danger clearly manifest. The elements
of simple imprudence are as follows.
1.
that there is lack of precaution on the part of the
ofender; and
2.
that the damage impending to be caused is not
immediate of the danger is not clearly manifest.
Dissatisfied, the petitioners appealed to the CA.
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 criminally
negligent
RULING: As to the first issue: The doctrine of res ipsa
loquitur 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 sufered 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 ofender, and (2)
that the damage impending to be caused is not immediate
or the danger is not clearly manifest.
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 physician-patient
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 sufering of Roy.
11. Rubi Li vs. Soliman (G.R. No. 165279 June 7 2011)
An Application of the Common-Law Doctrine of Informed
Consent in a Medical Malpractice (Medical Negligence)
Case under Article 2176 of the Civil Code
The ponencia enumerated the four essential elements that
a plaintif must prove in a medical malpractice action
based on the doctrine of informed consent, paraphrased
as follows: (1) the physicians duty to disclose
material risks; (2) the physicians failure to
disclose, or inadequate disclosure, of those risks;
(3) the patients consent to
the treatment she otherwise would not have
consented to, which is a direct and proximate result
of the physicians failure to disclose; and (4)
plaintifs injury as a consequence the proposed
treatment. The gravamen in an informed consent
case requires the plaintiff to point to significant
undisclosed information relating to the treatment
which would have altered her decision to undergo it.

Applying the foregoing to this case, it was held that

petitioner Dr. Rubi Li, an oncologist who performed
chemotherapy on respondents daughter, who was sick
with malignant bone cancer, adequately disclosed
material risks inherent in the chemotherapy procedure
performed with respondents consent. When petitioner
informed the respondents beforehand of the side efects
of chemotherapy, which includes lowered counts of white
and red blood cells, decrease in blood platelets, possible
kidney or heart damage and skin darkening, there is
reasonable expectation on the part of the doctor that the
parents of the child understood very well that the severity
of these side efects will not be the same for all patients
undergoing the procedure.
As a physician, Dr. Li can reasonably expect the childs
parents to have considered the variables in the
recommended treatment for their daughter aflicted with a
life-threatening illness. On the other hand, it is dificult to
give credence to the parents claim that petitioner Dr. Li
told them of 95% chance of recovery for their daughter, as
it was unlikely for doctors like petitioner who were dealing
with grave conditions such as cancer to have falsely
assured patients of chemotherapys success rate.
Besides, informed consent laws in other countries
generally require only a reasonable explanation of
potential harms, so specific disclosures such as statistical
data, may not be legally necessary.

VII. PHYSICAL INJURIES

Diferent kinds of
injuries:
o Contrusion
discoloration
o Humatona bukol
(elevation)

Regions of the body:

Head

Hands

Ankle

Fingers

Toes

Thighs

Legs

Forearms

Face
o Frontal
o Zygomatic cheeks
o Mandible mouth/jaw
o Maxillam ilalim ng ilong
o Temporal side
o Parietal lalamunan
o Occipital batok
o Orbit eyes
Body
o Chest (L/R)

Quite incongruously, however, the ponencia went on to declare

that
in the absence of expert testimony on the standard of care in
obtaining consent in chemotherapy treatment [since the witness
for respondents-parents was not an expert, not being an
the
oncologist
but
a mere Medical Specialist of the Department of Health charged
with receiving complaints against hospitals], the Court felt
hesitant
in defining the scope of mandatory disclosure in cases of
malpractice based on lack of informed consent such as this
case involving chemotherapy treatment.
Petitioner Dr. Li was found NOT liable to pay damages to
the suing parents.
VI. MEDICO-LEGAL ASPECTS OF DEATH
o

Clinically dead; no BP, no respiration, no

heartbeat, no heart rate
o Temperature drop (3 hours) cooling
o Changes of muscle (3 stages)

Primary flaccidity (lupaypay)

Immediately ||
mainit pa

Rigor Mortis rigidity

3-6
hours-12
hours

complete rigor
mortis

Secondary Flaccidity (lupaypay

ulit)

24-36 hours ||
malamig na
o Putrefaction 24-36 hours
o Post mortem lividity gravitating of the
blood
(3 hours) while cooling || tells
the position of the dead
o Cadaveric spasm local/certain
Portion of the muscle becomes
rigid, not the entire body

Does not happen to all

o Cannot give time of death but give clue if
suicide
o Stomach contents (3-4 hours)
o Presence of flies/maggots (24hours)

o Abdomen
Right upper

quadrant
Right lower

Left upper

Left lower

Epigastrro gitna

Injuries
o Laceration blunt
o Incision sharp-edged instrument
o Abrasion gasgas
o Stab knife
o Punctured ice pick, screw driver (pointed objects)
VIII. GUNSHOT WOUNDS
o Gunshot

Bullet
Flame (Singeing)- 6
Smoke- (Smudging)-12
Unburned powder (asdfghjkl;)-24

IX. SEX CRIMES

o Sex crimes
Defense wounds
Document laceration
Position
clock
Extent/degree
o
Incomplete
o Complete
o compound
12. People vs. Alverio (G.R. No. 194259, March 16, 2011)
FACTS: Alverio was found guilty of the crime of rape. He
appealed and questioned the decision on the ground that
his guilt was not proved beyond reasonable doubt. Alverio
raises three (3) grounds in support of his argument. First,
he assails the trial court for giving credence to the sole
testimony of the victim. He claims that the prosecution
should have presented other witnesses to corroborate the
testimony of the victim. Second, he contends that the
medical
certificate presented as evidence was not testified to by the
signatory

himself and should therefore not be considered as

corroborative evidence. Lastly, he claims that the trial
court gravely erred in convicting him of the crime of rape
for failure of the prosecution to prove his guilt beyond
reasonable doubt.
After a careful perusal of the records of this case,
however, the Court is satisfied that the prosecutions
evidence suficiently established Alverios guilt with moral
certainty.
In addition, Alverio submits that although the
medical
certificate was presented as evidence, its contents were
never testified to by the signatory himself and, as such,
cannot be considered as corroborative of the claim of the
victim that she was raped.
Such argument, however, cannot prosper. Medical evidence
is dispensable and merely corroborative in proving the
crime of rape. Besides, a medical certificate is not even
necessary to prove the crime of rape. The gravamen of
rape is carnal knowledge of a woman through force and
intimidation.
The elements needed to prove the crime of rape under
paragraph
1(a) of Article 266-A of the Revised Penal Code are: (1) the
ofender is a man; (2) the ofender had carnal knowledge of
a woman; and (3) the act is accomplished by using force or
intimidation. All these elements were sufficiently proved by
the prosecution. The testimony of AAA overwhelmingly
proves that Alverio raped her with the use of force and
intimidation.
Furthermore, Alverios defense of alibi cannot stand
versus the positive identification of AAA. Nothing is more
settled in criminal law jurisprudence than the rule that
alibi and denial cannot prevail over the positive and
categorical testimony and identification of the accused by
the complainant.
Accordingly, We find that the prosecution has discharged
its burden of proving the guilt of Alverio beyond reasonable
doubt. WHEREFORE, the appeal is DENIED. The CA Decision
in CA-G.R. CR-H.C. No. 00020 finding accused-appellant
Jimmy Alverio guilty of the crime charged is AFFIRMED
13. People vs. Domantay (G.R. No. 130612 May 11,
1999)
FACTS: Domantay was found guilty with the crime of
Rape with Homicide. Domantay appealed. Among his
arguments was the fact thereis no sufficient evidence to
hold him guilty of raping Jennifer Domantay.
As the victim here was six years old, only carnal
knowledge had to be proved to establish rape. Carnal
knowledge is defined as the act of a man having sexual
intercourse or sexual
bodily connections with a woman. 52 For this purpose, it is
enough if there was even the slightest contact of the male
sex organ with the labia of the victim's genitalia. 53
However, there must be proof, by direct or indirect
evidence, of such contact.
Dr. Ronald Bandonill's report on the genital examination he
had
performed on the deceased reads:
GENITAL EXAMINATION; showed a complete laceration of
the right side of the hymen. The surrounding genital area
shows signs of infammation. xxx xxx xxx
REMARKS: 1) Findings at the genital area indicate the
probability of penetration of that area by a hard, rigid
instrument.
Hymenal laceratio n is not nece ssary to prove rape; ne ither
doe s it s pre se nce prove it s co mmission . As held in People
v. Ulili, a medical certificate or the testimony of the
physician is presented not to prove that the victim was
raped but to show that the latter had lost her virginity.
Consequently, standing alone, a physician's finding that
the hymen of the alleged victim was lacerate d does not
prove rape. It is only when this is corroborated by other

evidence proving carnal knowledge that rape may be

deemed to have been established.

This conclusion is based on the medically accepted fact that

a hymenal tear may be caused by objects other than the
male sex organ or may arise from other causes. Dr. Bandonill
himself admitted this. He testified that the right side of the
victim's hymen had been completely lacerated while the
surrounding genital area showed
signs of inflammation. He opined that the laceration had
been inflicted within 24 hours of the victim's death and that
the inflammation was due to a trauma in that area. When
asked by the private prosecutor whether the lacerations of
the hymen could have been caused by the insertion of a
male organ he said this was possible. But he also said when
questioned by the defense that the lacerations could have
been caused by something blunt other than the male organ.
In contrast, in the case at bar, t here is no
circumst ant ial evidence f rom which to infer that accuse dappellant se xually abuse d the victim. The only circumstance
from which such inference might be made is that accusedappellant was seen with the victim walking toward the place
where the girl's body was found. Maybe he raped the girl.
Maybe he did not. Maybe he simply inserted a blunt object
into her organ, thus causing the lacerations in the hymen.
Otherwise, there is no circumstance from which it might
reasonably be inferred that he abused her, e.g., that he was
zipping up his pants, that there was spermatozoa in the girl's
vaginal canal.
Indeed, the very autopsy report of Dr. Bandonill militates
against the finding of rape. In describing the stab wounds on
the body of the victim, he testified:
[A]fter examining the body I took note that were
several stab wounds . . . these were all found at the
back area sir . .
. extending from the back shoulder down to the lower
back area from the left to the right.
Considering the relative physical positions of the accused
and the victim in crimes of rape, the usual location of the

external bodily injuries of the victim is on the face, neck,

and anterior portion of her body. Although it is not
unnatural to find contusions on the posterior side, these
are usually caused by the downward pressure on the
victim's body during the sexual assault. It is
unquestionably diferent when, as in this case, all the stab
wounds (except for a minor cut in the lower left leg) had
their entry points at the back running from the upper left
shoulder to the lower right buttocks.
It is noteworthy that the deceased was fully clothed in
blue shorts and white shirt when her body was
immediately after it was found.
Furthermore, there is a huge bloodstain in the back portion
of her shorts. This must be because she wearing this piece
of clothing when the stab wounds were inflicated or
immediately thereafter, thus allowing the blood to seep
into her shorts to such an extent.
Even assuming that Jennifer had been raped, there is no
sufficient proof that it was accused-appellant who had
raped her. He did not confess to having raped the victim.
From the foregoing, we cannot find that accusedappellant also committed rape. In the special complex
crime of rape with homicide, both the rape and the
homicide must be established beyond reasonable doubt.
14. Union Motor vs. NLRC (G.R. No. 159738 December
9, 2004) FACTS: Respondent Alejandro A. Etis was hired
by petitioner as an automotive mechanic. On 22 September
1997, the respondent made a phone call to the company
nurse and informed her that he had to
take a sick leave as he had painful and unbearable
tootache. Etis then consulted a dentist who scheduled him
for a tooth extraction but the

same was rescheduled for several times due to

inflammation. As a result, respondent was not able to
report for work for 10 days.
The petitioner considered respondents consecutive
absences as abandonment of office under the Company
Rules and terminated the services of the respondent. The
respondent then filed a complaint for illegal dismissal
before the arbitration branch of the NLRC against
the petitioner.
The Labor Arbiter rendered a Decision dismissing the
complaint. The Labor Arbiter ruled that the respondents
failure to report for work for ten (10) days without an
approved leave of absence was equivalent to gross neglect
of duty, and that his claim that he had been absent due to
severe toothache leading to a tooth extraction was
unsubstantiated. The Labor Arbiter stressed that
"unnotarized medical certificates were self-serving and had
no probative weight. Respondent then appealed to the
NLRC. NLRC reversed the Labor Arbiters Decision. CA
affirmed NLRCs Decision.
ISSUE: Do medical certificates need to be notarized in
order to be admissible as evidence?
RULING: NO. Nowhere in our jurisprudence requires that
all medical certificates be notarized to be accepted as a
valid evidence. Verification of documents is not necessary
in order that the said documents could be considered as
substantial evidence. The medical certificates were
properly signed by the physicians; hence, they bear all the
earmarks of regularity in their issuance and are entitled to
full probative weight. Common sense dictates that an
ordinary worker does not need to have these medical
certificates to be notarized for proper presentation to his
company to prove his ailment; hence, the Labor Arbiter a
quo, in cognizance with the liberality and the appreciation
on the rules on evidence, must not negate the
acceptance of these medical certificates as valid pieces of
evidence.
15. People vs. Colorado (G.R. No. 200792 November
14, 2012) FACTS: Neil Colorado was convicted by the RTC
for raping his full- blood sister AAA who was then 12-year
old when the crime was committed. Colorado appealed
from the RTCs decision to the CA, reiterating in his appeal
the defenses of denial and alibi. The CA affirmed
Colorados conviction.
Colorado also questions the weight of Dr. Sanchezs
medico-legal certificate, arguing that AAAs hymenal
lacerations could have resulted from the sexual
aggressions allegedly committed against her by DDD
and their brother-in-law.
ISSUE: Is a medical certificate necessary to prove the
commission of rape?
RULING: NO. As explained by the Court in People v.
Balonzo, a medical certificate is not necessary to prove the
commission of rape, as even a medical examination of the
victim is not indispensable in a prosecution for rape. Expert
testimony is merely corroborative in character and not
essential to conviction. An accused can still be convicted of
rape on the basis of the sole testimony of the private
complainant. Furthermore, laceration of the hymen, even if
considered the most telling and irrefutable physical
evidence of sexual assault, is not always essential to
establish the consummation of the crime of rape. In the
context that is used in the RPC, "carnal knowledge," unlike
its ordinary connotation of sexual intercourse, does not
necessarily require that the vagina be penetrated or that
the hymen be ruptured. Thus, even granting that AAAs
lacerations
were not caused by Colorado, the latter could still be
declared guilty of rape, after it was established that he
succeeded in having carnal knowledge of the victim.

16. Atienza vs. Sioson (G.R. No. 177407 February 2011)

FACTS: Private respondent Editha Sioson wen to Rizal
Medical Center for check-up. The tests revealed that her
left kidney is normal but the left is non-functioning and
non-visualizing. Thus she underwent kidney operation.
After the operation, Editha and her husband filed a
complaint for gross negligence and/or incompetence
committed by petitioner Atienza which consists of the
removal of Edithas fully functional right kidney, instead of
the left non - functioning and non-visualizing kidney.
To prove that her kidneys were both in their proper
anatomical locations at the time she was operated, she
offered as evidence photocopied medical documents.
Petitioner filed his comments/objections to private
respondents [Editha Siosons] formal ofer of exhibits. He
alleged that said exhibits are inadmissible because the
same are mere photocopies, not properly identified and
authenticated, and intended to establish matters which are
hearsay. He added that the exhibits are incompetent to
prove the purpose for which they are ofered. BOM,
however, admitted the said documents as evidence.
ISSUE: Should the introduction of photocopied
documents as evidence be allowed?
RULING: YES. The introduction of secondary evidence,
such as copies of the exhibits, is allowed. Witness Dr.
Nancy Aquino testified that the Records Office of RMC no
longer had the originals of the exhibits because [it]
transferred from the previous building, x x x to the new
building . Ultimately, since the originals cannot be
produced, the BOM properly admitted Edithas formal
ofer of evidence and, thereafter, the BOM shall
determine the probative value thereof when it decides
the case.
Furthermore, the fact sought to be established by the
admission of Edithas exhibits, that her kidneys were both in
their proper anatomical locations at the time of her
operation, need not be proved as it is covered by
mandatory judicial notice.
17. Custodio vs. Sandiganbayan (G.R. No. 96027-28, March
08,
2005)
The report of the forensic group may not be considered
as newly discovered evidence as petitioners failed to
show that it was impossible for them to secure an
independent forensic study of the physical evidence
during the trial of the double murder case. It appears
from their report that the forensic group used the same
physical and testimonial evidence proferred during the
trial, but made their own analysis and interpretation of
said evidence. They cited the materials and methods that
they used for their study, viz:
MATERIALS AND METHODS
MATERIALS:
a. Court records of the case, especially photographs of: a)
the stairway where the late Sen. Aquino and his escorts
descended; b) the part of the tarmac where the lifeless
bodies of the late Sen. Aquino and Galman fell; and c) the
autopsy conducted by the NBI Medico-legal team headed
by Dr. Mu[]oz; and the autopsy report of the late Sen.
Benigno Aquino[,] Jr. signed by Dr. Mu[]oz and Dr. Solis;
b. The gun and live ammunitions collected at the crime scene;
c. A reference human skull photos and X-rays of the
same to demonstrate wound location and bullet
trajectory

d. The reports of interviews and statements by the

convicted military escorts, and other witnesses;
e. Re-enactment of the killing of Aquino based on the
military escorts[] version, by the military escorts
themselves in the Bilibid Prison and by volunteers at the
NAIA Tarmac;
f. Various books and articles on forensic and the medico
-legal field[;] g. Results of Forensic experiments conducted
in relation to the case. METHODS:
a. Review of the forensic exhibits presented in the court;
b. Review of TSNs relevant to the forensic review;
c. Study of and research on the guns, slugs and
ammunitions allegedly involved in the crime;
d. Interviews/re-enactment of the crime based on the
militarys accounts, both in the Bilibid Prison where the
convicts are confined and the MIA (now NAIA) stairway
and tarmac;
e. Conduct of ocular inspection and measurements on
the actual crime scene (stairway and tarmac) at the old
Manila International Airport (now NAIA);
f. Retracing the slugs trajectory based on the autopsy
reports and experts testimonies using an actual human
skull;
g. X-rays of the skull with the retraced trajectory
based on the autopsy report and experts
testimonies;
h. Evaluation of the presented facts and opinions of local
experts in relation to accepted forensic findings in
international publications on forensic science, particularly
on guns and [gunshot] wound injuries;
i. Forensic experiments and simulations of events in
relation to this case.[18]