Li vs Spouses Soliman

GR No. 165279 June 7, 2011

Facts: On July 7, 1993, 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). Results showed that Angelica was suffering from
osteosaucoma, ostiobiostic type, a high-grade (highly malignant) cancer of the bone which usually affects teenage
children. Following this diagnosis, Angelica’s right leg was amputated by Dr. Tamayo in order to remove the tumor.
As a adjuvant treatment to eliminate any remaining cancer cells, and hence minimizing the chances of recurrence and
prevent the decease from spreading to other parts of the patient’s body, chemotherapy was suggested by Dr. Tamayo
and referred Angelica to another doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.

On July 23, 1993, petitioner saw the respondents at the hospital after Angelica’s surgery and discussed with them
Angelica’s condition. Petitioner told respondents that Angelica should be given 2-3 weeks to recover from the
operation before starting the chemotherapy. Respondents were apprehensive due to financial constraints as Reynaldo
earns only from P70,000-150,000 a year from his jewelry and watching repair business. Petitioner, however, assured
them not to worry about her professional fee and told them to just save up for medicines to be used.

As the chemotherapy session started, day by day, Angelica experience worsening condition and other physical effect
on the body such as discoloration, nausea, and vomiting.

Petitioner claimed, that she explained to respondents that even when a tumor is removed, there are still small lesions
undetectable to the naked eye and that adjuvant chemotherapy is needed to clean out the small lesions in order to
lessen the chance of cancer to recur. She did not give the respondents any assurance that chemotherapy will cure
Angelica’s cancer. During these consultations with respondents, she explained the following side effects of
chemotherapy treatment to respondents: 1.) Falling hair; 2.) nausea and vomiting; 3.) loss of appetite; 4.) low count
of WBC, RBC, and platelets; 5.) possible sterility due to the effects on Angelica’s ovary; 6.) Damage to kidney and
heart; 7.) darkening of the skin especially when exposed to sunlight. She actually talked to the respondents four times,
once at the hospital after the surgery, twice at her clinic and fourth when Angelica’s mother called her through long
distance. This was disputed by respondents who countered that petitioner gave them assurance that there is 95% chance
of healing for Angelica if she undergoes chemotherapy and that the only side effects were nausea, vomiting and hair
loss. Those were the only side effects of chemotherapy mentioned by petitioner.

Issue: Whether or not petitioner committed medical malpractice.

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 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 health care provider would not have done; and that
failure or action caused injury to the patient.

Medical negligence cases are best proved by opinions of expert witnesses belonging in the same general neighborhood
and in the same general line of practice as defendant physician or surgeon. The deference of courts to the expert
opinion of qualified physicians stems from the former’s realization that the latter possess unusual technical skills
which layman in most instances are incapable of intelligently evaluating, hence the indispensability of expert
testimonies.

The doctrine of informed consent within the context of physician-patient relationships goes as far back into english
common law. As early as 1767, doctors were charged with the tort of battery if they have not gained the consent of
their patients prior to performing a surgery or procedure. In the United States, the seminal case was Schoendorff vs
Society of New York Hospital which involved unwanted treatment performed by a doctor. Justice Bejamin Cardozo
oft-quoted opinion upheld the basic right of a patient to give consent to any medical procedure or treatment; every
human being of adult year and sound mind has a right to determine what shall be done with his own body; and a
surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages.
From a purely ethical norm, informed consent evolved into a general principle of law that a physician has a duty to
disclose what a reasonably prudent physician in the medical community in the exercise of reasonable care would
disclose to his patient as to whatever grave risk of injury might be incurred from a proposed course of treatment, so
that a patient, exercising ordinary care for her own welfare and faced with a choice of undergoing the proposed
treatment, as alternative treatment, or none at all, may intelligently exercise his judgement by reasonably balancing
the probable risk against the probable benefits.

There are four essential elements a plaintiff must proved in a malpractice action based upon the doctrine of informed
consent: 1.) the physician had a duty to disclose material risks; 2.) he failed to disclose or inadequately disclosed those
risks; 3.) as a direct and proximate result of the failure to disclose, the patient consented to treatment she otherwise
would not have consented to; and 4.) plaintiff was injured by the proposed treatment. The gravamen in an informed
consent requires the plaintiff to point to significant undisclosed information relating to the treatment which could have
altered her decision to undergo it.

Examining the evidence, we hold that there was adequate disclosure of material risks inherent in chemotherapy
procedure performed with the consent of Angelica’s parents. Respondents could not have been unaware in the course
of initial treatment and amputation of Angelica’s lower extremity that her immune system was already weak
on account of the malignant tumor in her knee. When petitioner informed the respondents beforehand of the side
effects 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
respondents understood very well that the severity of these side effects will not be the same for all patients undergoing
the procedure. In other words, by the nature of the disease itself, each patients reaction to the chemical agents even
with pre-treatment laboratory tests cannot be precisely determined by the physician. That death can possibly result
from complications of the treatment or the underlying cancer itself, immediately or sometime after the administration
of chemotherapy drugs, is a risk that cannot be ruled out, as with most other major medical procedures, but such
conclusion can be reasonably drawn from the general side effects of chemotherapy already disclosed.

JARCIA VS PEOPLE (GR NO. 187926 FEBRUARY 15, 2012)

Jarcia vs People of the Philippines
GR No. 187926 February 15, 2012

Facts: Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI) against the petitioners,
Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their alleged neglect of professional duty which caused her son, Roy
Alfonso Santiago, to suffer 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 victim’s 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; that 11 days later, Roy 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. A complaint for reckless imprudence
resulting physical injuries was filed against the petitioners for the alleged misconduct in the handling of the illness of
Roy.

Issue: Whether or not the petitioners failed to exercise the degree of care expected of them as doctors and are liable
for negligence to the private respondent.

Held: Yes. The doctrine of res ipsa liquitor as a rule of evidence is unusual to the law of negligence which recognizes
that prima facie negligencce may be established without direct proof and furnishes a substitute for specific proof of
negligence. The doctrine however, 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 given case, is not meant 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 helps the plaintiff in proving a breach of duty. The doctrine can be
invoked when and only when, under the circumstances involved, direct evidence is absolute and not readily available.

The requisites for the application of the doctrine of res ipsa liquitor 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.

Negligence is defined as the failure to observe for the protection of the interests of another person that degree of care,
precaution and vigilance which the circumstances justly demand whereby such other person suffers injury.

Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act from which material damage
results by reason of an inexcusable lack of precaution on the part of the person performing or failing to perform such
act.

In failing to perform an extensive medical examination to determine the extent of Roy’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

SOLIDUM VS PEOPLE (GR NO. 192123 MARCH 10, 2014)

Solidum vs People of the Philippines
GR No. 192123 March 10, 2014

Facts: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus. Two days after his birth, Gerald
under went colostomy, a surgical procedure to bring one end of the large intestine out through the abdominal walls,
enabling him to excrete through a colostomy bag attached to the side of his body. On May 17, 1995, Gerald was
admitted at the Ospital ng Maynila for a pull-through operation. Dr. Leandro Resurreccionheaded the surgical team,
and was assisted by Dr. Joselito Lucerio, Dr.Donatella Valeria and Dr. Joseph Tibio. The anesthesiologist included
Drs. Abella, Razon and Solidum. During the operation, Gerald experienced bradycardia and went into a coma. His
coma lasted for two weeks , but he regained consciousness only after a month. He could no longer see, hear, or move.
A complaint for reckless imprudence resulting in serious physical injuries were filed by Gerald’s parents against the
team of doctors alleging that there was failure in monitoring the anesthesia administered to Gerald.

Issues: Whether or not petitioner is liable for medical negligence.

Whether or not res ipsa liquitor can be resorted to in medical negligence cases.

Held: No. Negligence is defined as the failure to observe for the protection of the interests of another person that
degree of care, precaution, and vigilance that the circumstances justly demand, whereby such other person suffers
injury. Reckless imprudence, on the other hand, consists of voluntarily doing or failing to do, without malice, an act
from which material damage results by reason of an inexcusable lack of precaution on the part of the person to perform
or failing to perform such act.
The negligence must be the proximate cause of the injury. For, negligence no matter in what it consists, cannot create
a right of action unless it is the proximate cause of the injury complained of. And the proximate cause of an injury is
that cause, which, in natural and continuous sequence and unbroken by any efficient intervening cause, produces the
injury, and without which the result would not have occurred.

An action upon medical negligence – whether criminal, civil or administrative – calls for the plaintiff to prove by
competent evidence each of the following four elements namely: a.) the duty owed by the physician to the patient, as
created by the physician-patient relationship, to act in accordance with the specific norms or standards established by
his profession; b.) the breach of the duty by the physician’s failing to act in accordance with the applicable standard
of care; c.) the causation, is, there must be a reasonably close and casual connection between the negligent act or
omission and the resulting injury; and d.) the damages suffered by the patient.

In the medical profession, specific norms on standard of care to protect the patient against unreasonable risk,
commonly referred to as standards of care, set the duty of the physician in respect of the patient. The standard of care
is an objective standard which conduct of a physician sued for negligence or malpractice may be measured, and it
does not depend therefore, on any individual’s physician’s own knowledge either. In attempting to fix a standard by
which a court may determine whether the physician has properly performed the requisite duty toward the patient,
expert medical testimony from both plaintiff and defense experts is required.

The doctrine of res ipsa liquitor means that where the thing which causes injury is shown to be under the management
of the defendant, and the accident is such as in ordinary course of things does not happen if those who have
management use proper care, it affords reasonable evidence, in the absence of an explanation by defendant that the
accident arose from want of care.

Nevertheless, despite the fact that the scope of res ipsa liquitor has been measurably enlarged, it does not
automatically apply to all cases of medical negligence as to mechanically shift the burden of proof to the defendant to
show that he is not guilty of the ascribed negligence. Res ipsa liquitor is not a rigid or ordinary doctrine to be
perfunctorily used but a rule to be cautiously applied, depending upon the circumstances of each case. It is generally
restricted to situations in malpractice cases where a layman is able to say, as a matter of common knowledge and
observation, that the consequences of professional care were not as such as would ordinarily have followed if due care
had been exercised. A distinction must be made between the failure to secure results, and the occurrence of something
more unusual and not ordinarily found if the service or treatment rendered followed the usual procedure of those
skilled in that particular practice. It must be conceded that the doctrine of res ipsa liquitor can have no application in
a suit against a physician or surgeon which involves the merits of a diagnosis or of a scientific treatment. The physician
or surgeon is not required at his peril to explain why any particular diagnosis was not correct, or why any particular
scientific treatment did not produce the desired results. Thus, res ipsa liquitor is not available in a malpractice suit if
the only showing is that the desired result of an operation or treatment was not accomplished. The real question,
therefore, is whether or not in the process of the operation any extraordinary incident or unusual event outside the
routine performance occurred which is beyond the regular scope of customary professional activity in such operations,
which if unexplained would themselves reasonably speak to the average man as the negligent case or causes of the
untoward consequence. If there was such extraneous intervention, the doctrine of res ipsa liquitor may be utilized and
the dependent is called upon to explain the matter, by evidence of exculpation, if he could.