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SPOUSES REYNALDO AND LINA SOLIMAN, AS PARENTS/HEIRS OF DECEASED ANGELICA SOLIMAN G.R. NO. 165279 JUNE 7, 2011 FACTS: 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) on July 7, 1993 and results showed that Angelica was suffering from osteosarcoma, osteoblastic type, (highly malignant) cancer of the bone because of that a necessity of amputation was conducted by Dr, Tamayo on Angelicas right leg in order to remove the tumor and to prevent the metastasis that chemotherapy was suggested by Dr. Tamayo, which he referred to petitioner Dr. Rubi Li, a medical oncologist. The respondent was admitted to SLMC on August 18, 1993; however, she died eleven (11) days after the (intravenous) administration of chemotherapy first cycle. Respondents brought their daughters body to the Philippine National Police (PNP) Crime Laboratory at Camp Crame for post-mortem examination after the refusal of the hospital to release the death certificate without full payment of bills. The Medico-Legal Report showed that the cause of death as "Hypovolemic shock secondary to multiple organ hemorrhages and Disseminated Intravascular Coagulation. The respondents filed charges against the SLMC and physicians involve for negligence and failure to observe the essential precautions in to prevent Angelicas untimely death. Petitioner denied the allegation for damages as she observed best known procedures, highest skill and knowledge in the administration of chemotherapy drugs despite all efforts the patient died. The trial court was in favor of the petitioner and ordered to pay their unpaid hospital bill in the amount of P139, 064.43, but the Court of Appeals reversed the decision supporting the respondents prayer. ISSUE: How is medical malpractice proven? HOLDING: In this case medical malpractice is proven because the four essential elements of such action are present based upon the doctrine of informed consent. There are four essential elements a plaintiff must prove 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." Informed consent case requires the plaintiff to "point to significant undisclosed information relating to the treatment that would alter her decision to undergo. The physician is not expected to give the patient a short medical education, the disclosure rule only requires of him a reasonable general explanation in nontechnical terms.

In all sorts of medical procedures either invasive or not, medical institution must have a certificate of competency in rendering standards of care to delicate medical procedures before initiating a general protocol that would establish a guideline principle in a form of proper disclosure of such procedure and presenting a consent or waiver to their patients so that possible future medico-legal suits will be prevented. Thus, the Court ruled that medical malpractice is proved base on lack/impaired informed consent, and reasonable expert testimony subject a breach of duty causing gross injury to its patient. Notes: Common-Law Doctrine of Informed Consent in a Medical Malpractice (Medical Negligence) Case under Article 2176 of the Civil Code As Justice Brion noted in his Separate Opinion, this case is of first impression in the Philippine jurisdiction, especially so since informed consent litigation is not an ordinary medical negligence case. The ponencia enumerated the four essential elements that a plaintiff 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) plaintiffs 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 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 parents of the child understood very well that the severity of these side effects 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 afflicted with a life-threatening illness. On the other hand, it is difficult to give credence to the parents claim that pet itioner 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.