SC Holds Hospital, Doctor Liable for Medical Negligence

The Supreme Court has upheld the solidary liability of the owners of the Medical City General Hospital and Dr. Miguel Ampil, a member of its surgical staff, in the amount of over PhP3 million for medical negligence for leaving behind two pieces of gauze inside a patients body during surgery in 1984.In a 26-page decision penned by Justice Angelina Sandoval-Gutierrez, the Courts First Division affirmed the Court of Appeals September 6, 1996 decision affirming with modification the March 17, 1993 decision of the Quezon City Regional Trial Court, Branch 96 and nullifying the RTCs order dated September 21, 1993. The Court held both the Professional Services, Inc. (PSI), owner of the Medical City Hospital, and Dr. Ampil liable for the injury sustained by Natividad Agana. The Court said Dr. Ampils negligence was the proximate cause of Natividads injury, which could be traced from his act of closing the incision despite the information given by the attending nurses that two pieces of gauze were still missing. It found that Dr. Ampil did not inform Natividad about the two missing pieces of gauze. Worse, he even misled her that the pain she experienced after the procedure was the ordinary consequence of her operation. Natividad died in 1986. To our mind, what was initially an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patientThis is a clear case of medical malpractice or more appropriately, medical negligence, the Court said. The Court noted that it is not blind to the reality that there are times when danger to a patients life precludes a surgeon from further searching missing sponges or foreign objects left in the body. Such, however, does not leave him free from any obligation, the Court stressed. Citing Ramos v. CA, the Court said that PSI was liable since an employer-employee relationship exists between PSI and Dr. Ampil. Likewise, it added that PSIs liability is anchored upon the agency principle of apparent authority or agency by estoppel and the doctrine of corporate negligence which have gained acceptance in the determination of a hospitals liability for negligent acts of health professionals. The present case serves as a perfect platform to test the applicability of these doctrines, thus, enriching our jurisprudence, the Court said. By accrediting Dr. Ampil and Dr. Juan Fuentes, who performed additional surgery on Natividad, and publicly advertising their qualifications, the hospital created the impression that they were its agents, authorized to perform medical or surgical services for its patients, it added.

The Court upheld the trial courts finding holding PSI directly liable for breach of duty based on the doctrine of corporate negligence. It noted that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of Medical City Hospitals staff. As such, it is reasonable to conclude that PSI, as the operator of the hospital, has actual or constructive knowledge of the procedures carried out, particularly the report of the attending nurses that the two pieces of gauze were missing. By its failure to investigate and inform Natividad despite the attending nurses report, PSI not only breached its duties to oversee or supervise all persons who practice medicine within its walls but also failed to take an active step in fixing the negligence committed, the Court stressed. The Court however said that the CA did not err in absolving Dr. Fuentes who assisted Dr. Ampil in the operation. It stressed that Dr. Ampil was the lead surgeon during Natividads operation and that Dr. Ampil had examined Dr. Fuentes work and finding it to be in order allowed him to leave the operating room. In 1984, Natividad underwent surgery for cancer of the sigmoid. The sigmoid colon joins the rectum, which in turn joins the anus, or the opening where waste matter, or stool, passes out of the body. Dr. Ampil, who performed the surgery, found that the cancer had spread to her left ovary, necessitating the removal of certain portions of it through a hysterectomy by Dr. Fuentes. After Dr. Fuentes performed the surgery, Dr. Ampil completed operation and closed the incision. Operation records showed that the attending nurses entered among remarks, sponge count lacking 2, and announced to surgeon searched (sic) done but to no avail continue for closure. After her subsequent discharge from the hospital, Natividad complained of pains but were told by Dr. Ampil and Dr. Fuentes that the pain was the natural consequence of the surgery. She later sought further treatment in the United States and was told she was free of cancer.In August 1984, Natividad went back to Philippines. Later, her daughter found a piece of gauze protruding from her reproductive organ. Dr. Ampil subsequently extracted by hand a piece of gauze and assured Natividad that the pain would vanish.When the pain intensified, Natividad sought treatment at Polymedic General Hospital where a doctor found another foul smelling gauze which badly infected her vaginal vault. She underwent another surgery and subsequently filed a complaint for damages with the RTC. On March 17, 1993, the RTC ruled in Natividads favor finding PSI, Dr. Ampil, and Dr. Fuentes liable for negligence and malpractice.On appeal, the CA dismissed the case against Fuentes and held both PSI and Dr. Ampil liable for medical negligence. Dr. Ampil elevated the case to the High Court when the CA denied his motion for reconsideration. Concurring were Division Chair Chief Justice Reynato S. Puno and members Renato C. Corona and Adolfo S. Azcuna. Justice Cancio C. Garcia did not take part in the deliberations.

2 Davao Doctors Face Negligence Charges

DAVAO Two medical doctors stand accused of recklessness and negligence of duty in a case filed by the husband of a patient they operated on in March 2003.Manuel Te of A-9 Kalamansig, Barangay Pelo in Polomolok, South Cotabato alleged his wife suffered even more and was brought to "the brink of death" because of the operations.Charged before the Municipal Trial Court in Cities are James Soriano and Silvestre Gonzales, both of the Davao Doctors Hospital (DDH).DDH president Dr. Herminio Villano, however, said Friday that the Philippine Society of Neuro-Surgeons conducted an investigation on the case and found nothing wrong with the operations conducted on the patient by the two respondents."Dr. Soriano and Dr. Gonzales did their best but it was hard to operate because the patients brain was swollen. It was a case of a ruptured aneurysm," Villano said."Although hindi na-relieve ang pasyente, hindi naman nag-worsen ang condition ng pasyente," he added. (Although the operation did not bring relief to the patient, her condition also did not worsen.)He insists the two doctors did their best, and attributed the worsening of the patients condition to her illness.In his complaint, Te claimed he took his wife Jane to DDH for consultation on February 18 after she complained of severe headache that later diagnosed as "saccular aneurysm."After the diagnosis, Te decided to have his wife airlifted to Manila for treatment but the two respondents allegedly told him there was no need to do so because the illness was a minor one and they could easily conduct the surgery.Tes wife underwent two operations: the first on February 18, 2002 and the other on March 7, 2003.But Te claimed that after the operations, his wife became comatose and her condition worsened.He claimed he was billed by DDH a total of P850,000 and he incurred another P500,000 for medicines bought outside the hospital.He said he had his wife transferred to the San Pedro Hospital for further treatment where he was billed P3.6 million plus an additional P520,000 for medicines.He claimed he had to hire the services of three nurses on an eight-hour shift to take care of his wife.He allegedly paid each nurse P500 everyday for eight months, or a total of P1,500 a day as wages and P360,000 for the eight months his wife was in the care of the nurses.He claimed he spent a total of P5,830,000 on hospital bills and medicines.

Negligence cases concerning positioning injuries

The plaintiff in Logsdon v Miller (Lexis/Nexis no 2055 [Tex App 2002] unpublished) developed reflex sympathetic dystrophy in her left arm and hand after a seven-hour reconstructive jaw surgery in 1999. On the day of surgery, the anesthesiologist and the circulating nurse positioned, supported, and padded the plaintiff. She was placed supine with her arms at her sides, her elbows straight, and the palms of her hands facing her hips. Postoperatively, the plaintiff woke with numbness and pain in her left arm and hand. The anesthesiologist's postoperative note attributed these symptoms to antecubital tendon stretch secondary to prolonged wrist extension. The underlying question in this suit was whether the plaintiff's wrists were placed in a joint-neutral or extended position. The plaintiff sued the anesthesiologist and the nurse's employer hospital, alleging that the anesthesiologist and circulating nurse were negligent in failing to properly pad, tuck, position, and monitor her during the procedure. The attorneys for both the anesthesiologist and the hospital moved for summary judgment--they claimed there was no reason to go to trial because the plaintiff had supplied no evidence to support her claim that the standard of care had been violated or that the reflex sympathetic dystrophy actually was caused by the positioning. The trial court judge granted these motions, and the plaintiff appealed. The appellate court noted that the plaintiff had produced an affidavit and deposition testimony from her treating neurologist and another medical expert. The medical expert's opinion was that the positioning of the left arm with the elbow straight and the left wrist extended for a prolonged period of time constituted negligence. The anesthesiologist responded that the expert could not refute the anesthesiologist's own interpretation of the words he had documented in the medical record and that positional injuries occur despite proper positioning. To decide that a case should not go to trial, an appellate court must find more that a scintilla (ie, trace) of evidence on the plaintiff's side. The court found that the anesthesiologist's note and the plaintiff's expert's affidavit provided more than a scintilla and allowed the case against the anesthesiologist to proceed. The court failed to find more than a scintilla of evidence, however, regarding the appropriate standard of care for the circulating nurse. They accepted the defendant employer's assertion that this type of injury can occur in this type of prolonged case even if the patient is positioned correctly and in a way that is consistent with the standard of care. The plaintiff's medical expert had opined that the nurse was negligent in the positioning, but the court did not find his conclusion sufficient to warrant a trial because he never set forth the appropriate nursing standard of care, how he was familiar with it, or how it differed from that for an anesthesiologist

Hospital, Doctor Face Suit

A CAMERAMAN of RPN-TV 8 will file charges against a physician of Corazon Locsin Montelibano Memorial Regional Hospital in Bacolod for medical negligence.Elizalde "Nonoy" Calinao of Purok Mahigugma-on, Barangay Pahanocoy told Sun.Star Bacolod he will file charges against Dr. Sharon Soguilon, an obstetrician-gynecologist whom he said placed his wifes life in danger after the doctor administered the delivery of their first child last July 26.His wife suffered from high fever and constant bleeding three days after she was discharged.The situation prompted Calinao to call up their family doctor Dr. Susana Wee at the Bacolod Our Lady of Mercy Specialty Hospital (BOLOMSH).When rushed to BOLOMSH, Calinaos wife was immediately placed under laboratory examination where it was found that parts of the placenta or "several brown friable tissue fragment with an aggregate diameter of 66cms" was left in her womb.Wee, in her medical certification dated August 14, also attested that Calinaos wife was admitted at BOLOMSH on August 8 for high fever, hypogastric pain and vaginal bleeding.A Dilatation and Cutterage (D and C) was done and Mrs. Calinao was diagnosed as having retained a portion of placenta (inunan) in her uterus.Mrs. Calinao was admitted for seven days at BOLOMSH that incurred a total of about P20,000 of hospital bills.Calinao said his wife had approached Dr. Domingo Vega, CLMMRH chief of the hospital, regarding the case but was told that it was "just normal" for any doctor to commit such mistake.Vega also reportedly admonished Mrs. Calinao for seeking medical attention from a private hospital, instead of going back to them.Calinao, however, stressed what they wanted CLMMRH or Dr. Soguilon to replenish their hospital bill at BOLOMSH and nothing more."In case they wont assume our bill, I have no choice but to file legal charges against CLMMRH or Dr. Soguilon," stressed Calinao.Sun.Star Bacolod tried to contact Vega and Soguilon for comment but to no avail.

Doctor Guilty of Medical Negligence

A Health Ministry disciplinary committee has found a local doctor who prescribed steroids for "Mr. World" guilty of serious medical negligence. This is the first time that an Israeli doctor has been charged with medical negligence for prescribing bodybuilding drugs, and the first time the Health Ministry has officially declared that high dosages of such drugs may cause bodily harm. Dr. Yehuda Chen gave Eli Hanna, Israels leading bodybuilder, six prescriptions for unusually large amounts of medications, steroids and growth hormones. Hanna, 35, has won several international bodybuilding titles including "Mr. World," "Mr. Universe" and "Mr. Europe" as well as numerous "Mr. Israel" titles. Hanna used the prescriptions to import the drugs to Israel in 2002, but they were intercepted by customs officials at Ben-Gurion airport. Consequently, the Health Ministry launched an investigation against the doctor who issued the prescriptions. The ministrys disciplinary committee recently concluded, after two years of debate, that "administering steroids and growth hormones could cause the user bodily harm both in the long term and short term." Dr. Naama Constantini, the director of the Center for Sport Medicine Sciences and Research at the Wingate Institute, provided the medical opinion and main testimony that led to Chens conviction. She told the disciplinary committee that the quantities of chemical substances that Chen prescribed for Hanna "require a permit from the district veterinarian." She added: "Its a crime A doctors job is not to make someone world champion but to heal him. A doctor must not cause his patient damage. The dosages are up to five times the customary amount for bodybuilders." The committee presented its recommendations to Health Minister Dan Naveh, stating that Chens conduct was improper and constituted a breach of the accepted norms of a doctor. The drugs, which are not registered for use in Israel, were prescribed ostensibly for anemia and for asthma. In fact, Hanna did not suffer from these, and the medication was not intended to cure him, but to be used to enhance his bodybuilding qualities. Hanna testified that he had filled in the drugs quantities on the forms while the doctor had only signed them. He said he had already won the world championship three times and had "ample experience in this field, more than many doctors." Hanna said he takes five prescribed pills a day and injects growth hormone three times a day.

He told Haaretz that he consults doctors and nutritionists abroad, explaining "a man who deals with bodybuilding is like a woman who wants to be a beauty queen. She will do anything to be more beautiful, and a bodybuilder will do anything to be bigger and more muscular even if he is told the treatment may cause liver problems." "There is no `Mr. World who has not used steroids. Arnold Schwarzenegger, who won the title of `Mr. Universe five times and `Mr. Olympia seven times, used them all his life. If youre using it already, its better to do it under a doctors supervision," Hanna said. Hanna added that he does not see what the problem is with using a growth hormone "because all the rich Israelis know a senior doctor in Tel Aviv, who works in Ichilov Hospital and prescribes growth hormone as part of his anti-ageing treatments." Chen signed the prescriptions as part of his work for the Meuhedet health maintenance organization (HMO) in Tel Aviv. In the next few weeks the ministrys committee is expected to determine his punishment. Chens license as a senior police doctor was revoked for a year (which ended a few months ago), after he was convicted for commiting an indecent act on a female patient who came to him for slimming treatments. In another case he was rebuked for giving unusual prescriptions to drug addicts. Chen denied all the claims against him, saying that Hanna had convinced him that the quantities he prescribed were the ones he was taking. Chen admitted that he "erred in giving the prescriptions," but said he tried to calculate the dosages on the basis of Internet data and had nothing to compare them to "since Hanna is the only one in Israel who takes such quantities of drugs." Chen said in answer to a question that it was possible that he "felt threatened" and that he "could not turn down Hannas request." The Health Ministry committee established that although "Chen found that the subject was not within his expertise, he did not refer Hanna to sports medicine experts or steroid experts, as a reasonable doctor who is not familiar with a subject brought to his treatment is expected to do." The committee also concluded that although Chen did not fill in the details on the prescriptions, he "signed them without exercising judgement. His search into his sources was not deep or comprehensive enough."

Medical Malpractice at Eastern Visayas Regional Medical Center (EVRMC) Leyte Philippines
Sometime of June 4,2008, I was admitted at Eastern Visayas Regional Medical Center (EVRMC) Leyte, Philippines due to labor pains (pregnancy) and eventually delivered a twin baby girls in normal delivery. I had no bleeding,no rise in blood pressure and no bad manifestation. After 2 days I was scheduled for Bilateral Tubal Ligation (BTL) I go forth with the procedure thinking that it was safe. at the ligation room I was asked by my attending physician if I have cough, I said yes. however they did not tried to listen to my chest w/ the use of stethescope and proceeded w/ the procedure, while the procedure was going on, I was complaining to them that i was in pain, I told them "doc I think the anesthesia is not taking effect yet because I can still feel the pain" but they just told me it is already working, but then again the pain is still there so i kept on complaining to them that i'm really in pain. Then they told me that they will inject anoter anesthesia that will make me only drowsy but not put me to sleep. i did not know what happened next.i just woke up and heared them say ligation is finished.shortly thereafter i already had difficulty of breathing. i complain to them but they just told me that its just because of the anesthesia, (DEMEROL) they did not do anything abuot it.i was really in need of air because i could no longer breath and i already shouted "let me out of this room i will die here". then eventually everything was dark and after that i did not know what happened next.It took about 3 days for me to regain full conciousness only then when i came to realized that I was already confined at the ICU w/ assisted breathing attached to the ventalator,sad to say that I am a victim of medical malpractice and negligence by my attending physicians at EVRMC.

I was poisoned by Levaquin!

In December of 2007, I became ill with pneumonia. My doctor prescribed z-pack but that didn't help. So, he prescribed Levaquin 500 mg once a day for ten days. The only reaction he said I might notice is nightmares. Well, that was an understatement! After I took the first pill, I reacted very negatively. I went to bed that night with severe heart palpitations and I had the most terrifying panic attacks of my life. I really believed that I might die that night. I could not fall asleep. I kept hearing someone screaming in my ear every time I was almost ready to go to sleep, and I was having double vision. I was tossing and turning and freaking out. I finally went downstairs and laid on the couch so my husband could get some sleep. I got terrible sleep for only about 2 hours that night. I also had a terrible headache which was more like a sharp pain in the back of my head that lasted the entire time I was on the Levaquin. In the morning, I called my doctor to tell him that I had a reaction. His response to me (through the nurse) was that I had anxiety. He said I should keep taking the Levaquin and also take the ativan he was going to prescribe for me. At the time, I figured he knew best and that this reaction would be temporary. I had to somehow get through this course of Levaquin. Within two weeks of stopping the Levaquin, I began having a burning pain in my left arm on the inside of my elbow. I wondered if I had a blood clot. That lasted a few days before it started to spread throughout my whole arm. I was experiencing agonizing, throbbing pain. Within another couple of days, my other arm was affected. I couldn't bend or straighten my arms. In addition, I was still experiencing heart palpitations and insomnia. Soon the pain spread to my legs. My knees hurt so bad, I couldnt bend them to go up or down the stairs. All I could do was to sit and cry. Within the next few days and weeks I had the following adrs: blurry vision, dry eyes, dry mouth, ear pain, neck pain, shoulder tendonitis, popping, cracking joints, dizziness, nausea, diarrhea (I lost 6 pounds in two weeks), headaches, muscle twitching, muscle cramping, muscle jerking (myoclonic jerks), joint pain, EXTREME muscle weakness and soreness. My legs could barely hold me up and I was walking very slowly and stiffly. I couldnt stand for more than a few minutes. I had pulsating, tingly neuropathy in my legs and feet that was very uncomfortable. My ankles were aching, my fingers were stiff, I had burning pain in my knees, I was even having spasms in my eyes. I had terrible pain and achiness in my lower back, I became very sensitive to noises (if things were quiet and I heard a noise, the right side of my face would spasm). Early on in my reaction, I went to my doctor to tell him what was happening to me. I went armed with a lot of information that I had found on the internet. He told me that I was not having a reaction to the Levaquin, and that he did not need to see the information I brought, he had all the information he needed in his PDR. He pretty much dismissed me and I have not gone back since. I now have another doctor who admits that she thinks I could have toxicity from the Levaquin. I am now almost seven months out from the initial reaction, and things have gotten a little better, but I am still experiencing many of my original ADRS, just not as intensely as I was experiencing them. My worst problems are still pain in my left leg, stiffness in my knee and my feet, lower back pain, nervousness and internal tremors, blurry vision in my right eye, gastro-intestinal problems, intermittent tinnitus, and tachycardia.

Heparin holocaust
I am an R.N.I was healthy at 59 and not taking any meds except vitamins and B-12. I was diagnosed with an early case of Colon Cancerwhich required chemo, and I began using the contaminated Tyco prefilled syringes to flush a P.I.C. line daily. From the second day of use in February 08, I knew something was wrong. I began feeling a sensation like heart burn in my right chest, where the P.I.C. line entered my superior vena cava. Along with difficulty taking a deep breath I ran low grade temps and often felt flushed. In the next 6 weeks things escalated to the point that I had excrutiating chest pain with burning sensation, progressively worse joint pain on the right side of my body, shoulder pain on the right side, palpitations, increased blood pressure,swelling in my left arm, neck and thyroid area along with redness.I felt like an elephant was on my chest and I had trouble breathing with every breath. My thymus made an appearance within ten days of the start of flushing on a P.E.T. scan.That didn't show on a previous C.T. Scan, therefore, indicating an inflamatory response. At my age, I shouldn't have had a thymus. I had stranding of tissue. My Sed rate was elevated to the point comparable to that of a person with rheumatoid arthritis. Finally, 6 weeks later the pain was worse than I had seen with any end stage Cancer patient. Because of the swelling in my left arm, I decided to have my P.I.C. line pulled. I had seen several doctors telling them about this pain and these events. No one suspected the Heparin or knew what was happening with me. Luckily, I blamed my pic line. Thank God for the swelling and the severe pain that made me listen to my body and have the P.I.C. line pulled. This stopped the flushing of the poison Heparin into my body. Then two days later the hospital discovered that I had blood clots in my brachial, axillary, internal juglar and subclavian veins. I spent two visits in I.C.U., 2 visits on a Med. /Surg unit, and was released in early April. Finally April 15th, I was notified that I had been using the contaminated Heparin daily for 6 weeks.That explained everything! However, it doesn't explain, why these syringes weren't recalled much sooner since the crude Heparin was made at the same facility in China that Baxters was made. If they had been recalled in a timely fashion, all this would have been avoided. I thank God daily that I survived the heparin, and I feel badly for those that didn't. I now have hypothyroidism, am on synthroid, and may need to take coumadin for the rest of my life. I have had to delay my chemo three times and unable to take the regular chemo protocal normally used for colon cancer. Many questions remained about the ongoing effects of heparin on our bodies.We probably can never take any kind of Heparin again. Although, I appear to be healthy now, my future is uncertain and so is the future of the survivors of the heparin holocaust.

3 Docs of St. Lukes Face Malpractice Complaints

THREE doctors are facing charges of criminal negligence and medical malpractice before the Quezon City Prosecutors Office for an allegedly failed retina surgery they performed on a executive of the Viva Entertainment Co., at the St. Lukes Medical Center. Rolando Ferrer, a brand manager of the entertainment firm and barangay councilman of Teachers Village West in Quezon City, accused Dr. Jose Mario Pelea, opthalmologist, Dr. Benjamin So and Dr. Abondino Yunque Jr., a cardiologist, of violating Article 365 of the Revised Penal Code for negligence and medical malpractice that resulted in his blindness. In his seven-page complaint-affidavit, Ferrer, who is suffering from diabetes, said Pelea operated on his left eye at the St. Lukes Medical Center on November 25, 2002, after he complained of severe pain. The physicians examined the complainant before he underwent surgery. Yunque allegedly issued the clearance to Pelea to perform the retina detachment. Ferrer noted that the three doctors did not explain to him the predicament as well as the medical treatment to be undertaken following the operation. After the surgery, the complainant said the pain in his eye got worse and he was taken to the emergency room of the hospital. The pain was temporarily relieved with anesthesia. Ferrer later learned from another doctor, Dr. Albert Mamaril, that the retina surgery done on him allegedly failed. The Manila Times tried unsuccessfully to get in touch with the three respondents. It turned out they are connected with St. Lukes only as consultants.

Stiff Penalty vs Medical Malpractices Sought

QUEZON CITY Determined to leave no room for negligence in medical practice, senior administration congressmen have urged Speaker Jose de Venecia to place on priority bills seeking to establish a Medical and Health Care Liability law that would impose stiff penalty on medical malpractice and illegal medical practice.The appeal was aired by Reps. Rozzano Rufino B. Biazon (LP, Muntinlupa City); Danton Bueser (LP, Laguna) and Rodriguez Dadivas (Lakas, Capiz) in the wake of reports that medical malpractice has become rampant in many private and government hospitals in the country. Only last Thursday, a young mother, identified as Victoria De Raco Duque, died after being comatose 14 days when a wrong blood type was transferred to her at the East Avenue Medical Center. She was admitted in the hospital last Dec. 17 to deliver a baby. Bueser is studying the possibility of calling for a House investigation into the incident. He said bills protecting patients against illegal and negligent practice of medicine should be placed high in the list of priority measures to be acted upon by Congress. Biazon and Dadivas are authors of House Bill No. 226 and 261, respectively, which pushes stiff penalties against medical malpractice and establishing rights and obligations of patients. Cebu Rep. Antonio Yapha, chairman of the House Committee on Health, said he supports the passage of the two measures. He pointed out that a medical malpractice bill had already been approved by his committee during the 12th Congress but was never taken up on plenary due to time constraints. Yapha, a doctor of medicine, said he has sent HB 226 and 261 to a subcommittee in his panel for further study. However, committee vice chairman Rep. Jesus Reynaldo Aquino (Lakas, Pampanga) warned that approval of the so-called medical malpractice law may not be advisable at this time when the country is suffering from economic hardship. "If such bill is approved, many doctors may be forced to take out professional insurance and pass on the cost to their patients. Even volunteer doctors might think twice giving free service to the poor, Aquino, a surgeon turned lawmaker said. The Pampanga lawmaker pointed out that there are enough laws that may protect patients against incompetent and negligent practice of medicine.He added that the Philippine Medical Association and the Professional Regulations Commission are likewise duty-bound to weed out the medical profession of undesirables.Reacting to Duques case, Aquino said that it was possible that the fatal error of transfusing the wrong type of blood to the victim may have been committed by the medical technologist or nurse.