NOT WARRANTORS OR INSURERS

X not guarantors of care

X do not warrant good results

X not insurers against mishaps or unusual consequences

X not liable for honest mistake of judgement

Q: WHAT ARE THEY LIABLE FOR

WHEN CAN THEY BE LIABLE

WHAT IS THE TEST TO DETERMINE WON THERE WAS NEGLIGENCE (Garcia vs. Salvador)

TWO WAYS ESTABLSIHING MEDICAL NEGLIGENCE

1. 4 elements
2. Res ipsa loquitour

1.

*DUTY

*BREACH

*NEGLIGENCE

*PROXIMATE CAUSATION

1. There was a duty which the medical practitioner owed to the patient;

- 1. There is a physician-patient relationship. A physician-patient relationship is formed when a patient

engages the services of a physician.

2. There was a breach of duty;

-. There is a duty on the part of the physician to observe the same level of care that any reasonably
competent doctor would use to treat the condition under the same circumstances

3. The breach resulted in injury to the patient.;

-3. There is a breach of duty and injury. The injury contemplated by the law is a bodily injury to or
death of the patient.

4. The injury resulted in causing damages.

- There is a causation between the breach and the injury. The act or omission complained of is the
proximate cause of the injury suffered. The proximate cause of an injury is that cause that, in the natural
and continuous sequence, unbroken by any efficient intervening cause, produces the injury, and without
which the result would not have occurred. (Vda. de Bataclan v. Medina, 102 Phil. 181, 186 [1957].)

(Garcia-Rueda vs. Pascasio)

4 elements

TN Claims under medical negligence can be bought out from Art. 2176 of the NCC,and in some instances
Article 365 of the RPC

PROOF

TWO WAYS ESTABLSIHo ING MEDICAL NEGLIGENCE

3. 4 elements
4. Res ipsa loquitour

PLAINTIFF has the burden of proof of establishing negligence

Q: How?

A: proving the presence of the 4 elements

Most importantly the proximate causation such that the plaintiff must prove that the physician or doctor
failed to exercise the required degree of skill and care in the treatment of his patient

However, as a rule of evidence, thiss must be proved through EXPERT TESTIMONY

Why? Because as a GR: when the qualifications of a physician are admitted, it is PRESUMED THAT IN
PROPER CASESNHE TAKES THE NECESSARY PRECAUTION AND EMPLOYS THE BEST OF HIS KNOWLEDGE
AND SKILL IN ATTENDING TO HIS CLIENTS

EXC: IF THE CONTRARY IS PROVED (through expert opinion)

*The GR is rebuttab;e by expert opinion.

But why the need of an EXPERT?

“Inasmuch as the causes of the injuries involved in malpractice actions are determinable only in the light
of scientific knowledge, it has been recognized that expert testimony is usually necessary to support the
conclusion as to causation”

-Only physicians and surgeons of skills and experience are competent to testify as to wheter a patient
has been treated or operated upon with a reasonable degree of care

What is an expert witness?

-
RES IPSA LOQUITOUR

Q: Should expert testimony always be resorted to before negligence may be proved?

A: No

Res ipsa loquitour

“the thing speaks for itself”

-the need for expert testimony can be dispensed with

-Limited to cases where the court from its fund of common knowledge can determine the standard of
care

- these are the cases where an ordinary layman can conclude that there was negligence on the part of
the doctor. Situations where a layman is able to say, as a matter of common knowledge and
observation, that the consequences of professional care were not assuvh as would ordinarily havr
followed due care had been exercised (Reyes vs. Sisters of Mary)

-resorted to when there is no other way, under the usual and ordinary conditions, by which the patient
can obtain redress for the injuries suffered

(Ramos vs. CA)

Causation divided into two inquiries:

1. Whether the doctor’s actions in fact caused harm to the patient

2. whether these were the proximate cause of the patient’s injury

You do not have to prove all the elements of medical malpractice then. The elements of duty and breach
are presumed under the doctrine of res ipsa loquitur.

The breach of duty is presumed under the doctrine of res ipsa loquitur. Where the thing that caused the
injury complained of is shown to be under the management of the defendant or his servants and the
accident was such as in ordinary course of things does not happen if those who have its management or
control used proper care, it affords reasonable evidence, in the absence of explanation by the
defendant, that the accident arose from or was caused by the defendant’s want of care. This shifts the
burden of proof to the defendant to establish that he has indeed observed due care and diligence.
(Batiquin v. Court of Appeals, G.R. No. 118231, 327 Phil. 965, 968, July 5, 1996.)
The doctrine can be invoked only when under the circumstances, direct evidence is absent and not
readily available. This is based in part upon the theory that the defendant in charge of the
instrumentality which causes the injury either knows the cause of the accident or has the best
opportunity of ascertaining it while the plaintiff has no such knowledge and is therefore compelled to
allege negligence in general terms and rely upon the proof of the happening of the accident in order to
establish negligence. The inference which the doctrine permits is grounded upon the fact that the chief
evidence of the true cause, whether culpable or innocent, is practically accessible to the defendant but
inaccessible to the injured person. (Macalinao v. Ong et al., G.R. NO. 146635, December 14, 2005.
Citations omitted.)

In res ipsa loquitur, direct evidence is not necessary. (Jarcia, Jr. et al. v. People, G.R. No. 187926,
February 15, 2012.)

Expert witnesses are dispensed with. (Solidum v. People, G.R. No. 192123, March 10, 2014.) A layman’s
testimony is enough if he “would be able to say, as a matter of common knowledge and observation,
that the consequences of professional treatment were not as such as would ordinarily have followed if
due care had been exercised.” (Ramos v. Court of Appeals, G.R. No. 124354, April 11, 2002.)

What are the elements of res ipsa loquitur?

1. The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence.

2. It is caused by an instrumentality within the exclusive control of the defendant or defendants.

3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.
(Cantre v. Go, G.R. No. 160889, 522 SCRA 547, 556, Apr. 27, 2007.)

Give examples of the application of res ipsa loquitur.

Ending up in a comatose does not ordinarily arise from a simple operation unless someone is negligent.
The administration of anaesthesia does not ordinarily result in decerebration, let alone death. (Ramos v.
Court of Appeals, G.R. No. 124354, April 11, 2002. See also Voss vs. Bridwell, Kansas Supreme Court
In accepting a case, a doctor in effect represents that, having the needed training and skill possessed by
physicians and surgeons practicing in the same field, he will employ such training, care and skill in the
treatment of his patients. He therefore has a duty to use at least the same level of care that any other
reasonably competent doctor would use to treat a condition under the same circumstances.

It is in this aspect of medical malpractice that expert testimony is essential to establish not only the
standard of care of the profession but also that the physician's conduct in the treatment and care falls
below such standard. Further, inasmuch as the causes of the injuries involved in malpractice actions are
determinable only in the light of scientific knowledge, it has been recognized that expert testimony is
usually necessary to support the conclusion as to causation