The most important goal of the medical profession is the

preservation of life and health of the people. But what happens

when a medical professional causes bodily harm or even death
to his or her patient? What is the remedy available to the
patient?

The remedy available is called a medical malpractice suit. In

the Philippines, a medical malpractice suit is primarily governed
by the Civil Law concept of damages. In order to successfully
pursue a medical malpractice suit, the patient must prove the
four (4) elements of medical negligence. The four (4) elements
are (1) duty; (2) breach; (3) injury; and (4) proximate causation.
Recent cases will illustrate how these 4 elements interact in
order to pursue a successful medical malpractice suit.

Is there a Physician-Patient Relationship?

Duty means that there is a professional relationship between
the doctor and the patient. This relationship is created when the
patient engages the services of the doctor and the doctor
agrees to provide care to the patient.
To illustrate, let us take the case of Jarcia v. People of the
Philippines (G.R. No. 187926, February 15, 2012) . In Jarcia, the
patient was hit by a taxicab and was rushed to the hospital. The
two doctors who attended the patient ordered an X-ray, which
showed no fracture. The doctors informed the mother of the
patient that since it was only the ankle of the patient that was
hit by the taxicab, there is no need to examine the upper leg.
Unfortunately, the patient subsequently developed fever,
swelling of the right leg, and misalignment of the right foot. A
new X-ray revealed a mid tibial fracture and a linear hairline
fracture in the shaft of the patient’s bone.
The two doctors raised the argument that there is no physician-
patient relationship in this case. They claim that they were
merely passing by the emergency room for lunch when the
nurse requested them to see the patient. The Supreme Court
struck down the arguments of the doctors and said that when
they examined the victim and gave assurances to the victim’s
mother, a clear physician-patient relationship existed between
the parties. Thus, the two doctors were under a duty to exercise
the same degree of care, skill and diligence which physicians in
the same line of practice ordinarily possess.
Standard of Breach
The breach referred to in medical malpractice cases is the
breach of the standard of care expected of other similarly
trained medical professionals acting under the same
circumstances.
Let us take the example of Borromeo v. Family Care Hospital,
Inc. (G.R. No. 191018, January 25, 2016) . In Borromeo, the
patient was complaining of acute pain and fever for two days.
The doctor suspected that the patient might be suff ering from
acute appendicitis. After several inconclusive tests, the doctor
decided to perform an exploratory laparotomy. After the
surgery, the patient’s blood pressure suddenly dropped.
Furthermore, the patient developed petechiae in various parts
of her body. The doctor suspected that the patient has
Disseminated Intravascular Coagulation, which is a blood
disorder. Unfortunately, attempts to resuscitate the patient
failed.
The Supreme Court held that there is no medical malpractice
since the cause of the uncontrollable bleeding was a medical
disorder, Disseminated Intravascular Coagulation. In this case
there is no proof that the doctor fell short of the expected
standard required under the circumstances.
Injury as a Result of Breach
The element of injury to the patient in medical malpractice
cases is straightforward – it is the direct result of the doctor’s
breach.
The case of Rosit v. Davao Doctors Hospital (G.R. No. 210445,
December 7, 2015) perfectly illustrates how an injury to the
patient can take place. In Rosit, the patient fi gured in a
motorcycle accident, which fractured his jaw. During the
operation, the doctor used a metal plate fastened to the jaw of
the patient with metal screws to immobilize his mandible.
However, despite the doctor’s knowledge that the operation
requires the smallest screws available, the doctor simply cut
the larger screws which were on hand. The doctor also knew
that the smaller screws were available in Manila, but he simply
assumed that the patient would not be able to aff ord the same.
Following the procedure, the patient could no longer properly
open or close his mouth and was in constant pain. X-rays done
on the patient revealed that the modifi ed screws placed by the
doctor reached the molar of the patient. The patient then had to
seek the services of another doctor to undo the damage. In this
case, the Supreme Court held that the doctor is liable for at
least three types of damages, namely: actual, moral and
exemplary damages. First, the patient was able to claim actual
damages since he was able to prove the defi nite expenses that
he incurred due to the negligence of the doctor. Second, the
patient was likewise able to claim moral damages because of
the unnecessary physical suff ering he endured as a
consequence of the doctor’ negligence. Third, the patient was
entitled to exemplary damages because the doctor acted in bad
faith or in a wanton, fraudulent, reckless, oppressive manner
when he did not inform the patient of the risks of using large
screws for the operation.
Proximate Cause
Proximate causation refers to the relation between the
negligence or breach of the doctor and the resulting injury of
the patient. The negligence or breach must have played an
integral part in causing the injury or damage. In other words,
the injury to the patient is either a direct result or a reasonably
probable consequence of the negligence or breach of the
doctor.
An illustration of proximate causation is provided for in the case
of Casumpang v. Cortejo (G.R. No. 171127, March 11, 2015) . In
Casumpang, the patient is an 11-year old boy who initially
complained of diffi culty in breathing, chest pain, stomach pain
and fever. The doctor who examined the patient diagnosed him
with bronchopneumonia. However, the mother of the patient
raised her doubts with the doctor’s diagnosis since her son had
a high fever but did not have any colds or cough.
The following day, the mother of the patient informed the
doctor that there were traces of blood in her son’s sputum.
However, the doctor simply nodded and reassured them that it
was due to bronchopneumonia. Later that morning, the patient
vomited phlegm with blood streaks. He was attended to by one
of the resident physicians. Several tests were ordered done on
the patient. When the tests came out, the results showed that
the patient was suff ering from Dengue Hemorrhagic Fever.
The Supreme Court held that the doctor is liable for medical
malpractice. In determining whether or not the negligence of
the doctor is the proximate cause for the patient’s death, the
court looked at the nature of Dengue. The court considered
expert testimony stating that with correct and timely diagnosis
and proper medical management, dengue fever is not a life
threatening disease and could easily be cured. In fact, the
mortality rate of dengue fever should fall to less than 2%. Thus,
the proximate cause of patient’ death is the failure of the
doctor to timely diagnose dengue, despite the presence of its
characteristic symptoms.
Captain of the Ship Doctrine
Aside from the four (4) elements of Medical Malpractice cases,
there are specifi c doctrines that should be taken into
consideration in determining physician’s liability.
Under the Captain of the Ship Doctrine, the operating surgeon
is the person in complete charge of the surgery room and all
personnel connected with the operation. In Professional
Services Inc. v. Agana (G.R. No. 126297, February 2, 2010) , the
patient was rushed to the hospital wherein a doctor diagnosed
her to be suff ering from cancer of the sigmoid. While
performing anterior resection surgery on the patient, the doctor
discovered that the malignancy in the patient’s sigmoid had
already spread to her ovary. This prompted the doctor to obtain
the consent of the patient’s husband, to permit another doctor
to perform hysterectomy.
After completion of the hysterectomy, the fi rst doctor took over
and decided to close the incision despite the fact that the
attending nurses informed him that there were missing gauzes.
After her release from the hospital, the patient complained of
excruciating pain in her anal region. Subsequently, the patient’s
daughter found a piece of gauze protruding from her vagina.
The doctor was able to remove the gauze but the pain did not
subside. Upon consulting other doctors, another gauze was
found inside the patient’s vagina, which was already causing
infection.
The Supreme Court applied the Captain of the Ship Doctrine in
upholding the liability of the doctor. The Court stressed that as
the lead surgeon, the doctor had the duty to remove all foreign
objects from the patient’s body before the closure of the
incision. At the very least, the doctor should have informed the
patient of his failure to do so. The act of ordering the closure of
the incision notwithstanding that the pieces of gauze remained
unaccounted for bolstered the application of the doctrine.
For victims of possible medical malpractice cases, we
recommend that you immediately seek the advice of a legal
counsel. A legal counsel should be able to provide advice on the
proper course of action to take, from initial consultations to the
possible fi ling of appropriate actions in court.