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LEGAL MEDICINE

It is also important to determine the position and distance of the
assailant.

Ben Dela Cruz, UST – 2C

WITHIN 3 INCHES (FLAME) – there is Singeing in the victim
Captain of the Ship Doctrine – principle of medical malpractice
law holding a surgeon liable for the actions of assistants who are
under the surgeon’s control but who are employees of the hospital,
not the surgeon. The surgeon as the captain of the ship, is directly
responsible for an alleged error or negligence because he or she
controls and directs the actions of those in assistance.
INJURIES:
1.
2.
3.
4.

Stab wound – by pointed and sharp edge object (Ex. Knife)
Puncture wound – by pointed object (Ex. Icepick)
Hacked Wound – by bladed object (Ex. Katana, Bolo, Axe)
Incised wound – by sharp edge instrument, clear cut, hair
valves are cut, linear.
5. Lacerated wound – by blunt instrument, hair valves not cut.
6. Avulsions – by explosions
7. Hematoma – elevation of the skin, accumulation of Blood
vessels. “Bukol”
8. Abraision – scratch wounds “ gasgas”
9. Contusion – “pasa”
10. Gunshot wound – by firearms.
Pasa + Bukol = Contusion hematoma
Entry wound – generally round
Exit wound – linear wound
Determining the exit wound is important to ascertain whether the
bullet is still inside the victim.
ODD-EVEN RULE
Even – no bullet is left
Odd – bullet is still inside the victim

WITHIN 6 INCHES (SMOKE) – there is Sumdging
WITHIN 12 INCHES (UNBURNED POWDER) – there is peppering on
the skin of the victim.

Medical Aspects of Death
Death – is the termination of life, the complete cessation of vital
functions without possibility of resuscitation.
1.

2.

Clinical death – death as pronounced by physician in the
hospital, no vital signs and the respiratory rate as well as
the blood pressure is zero.
Cellular death – death of the individual cells
a. 3 HRS – complete cellular death in which there is a
sudden decrease in temperature.

Changes in the body of the person:
ALGOR MORTIS – Temperature drops/ cools down, before cells die.
(3 Hours)
Then there would be changes in the muscle of the deceased.



Muscle becomes flaccid (lantang gulay) 3 Hours from
temperature drop
Then Rigor Mortis, slow process, stiffness 12 Hours upon
death
Then the muscles become completely flaccid 12 Hours
from complete Rigor Mortis, 24-36 Hours from death.
Decomposition, there is foul odor, at least 24 hours dead.

POST MORTEM LIVIDITY – blood goes down to the most dependent
parts of the body, 3 Hours from death.
It is important to determine the position of the body when the
victim died.

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CA upheld the trial court’s ruling. regardless of whether the physician is an independent contractor. Corazon’s blood pressure dropped. all become rigid. Rogelio executed and signed the “Consent Admission and Agreement” and “Admission Agreement”. At the time of Corazon's admission at CMC and during her delivery. but an independent contractor. Capitol Medical Center Facts: Corazon Nogales. Considering these circumstances. In the instant case. rendering him solely liable for damages. she died at 9:15 a. Estrada as a member of its medical staff. Estrada with apparent authority thereby leading the Spouses Nogales to believe that Dr. Estrada enjoyed staff privileges at CMC. CMC clothed Dr. Hence. CMC cannot now repudiate such authority. Estrada did not appeal the findings of CA. Issue: Whether or not CMC is vicariously liable for the negligence of Dr. CMC impliedly held out Dr. was administered hemacel and undergone immediate hysterectomy. 3. a hospital is not liable for the negligence of an independent contractor-physician except under the “doctrine of apparent authority”. a dangerous complication of her pregnancy. Estrada's treatment and management of Corazon's condition. For failure to answer. with “hemorrhage. Estrada was assisted by doctors of CMC. CASES: Nogales v. Estrada is not an employee of CMC. Estrada. The elements of the action have been set out as follows: "For a hospital to be liable under the doctrine of apparent authority. or should have known. it is due to tension. Oscar Estrada with her fourth child. it was Dr. was under exclusive prenatal care of Dr.Homicide or Suicide in Slit/cut throat: Homicide – below Adam’s apple. It usually stiffens 3 Hours from temperature drop.m. Through CMC’s acts. Dr. Kinds of laceration of hymen: 1. 2176 of the Civil Code. Superficial Laceration Complete Hymenal Laceration Complex Laceration Medical Examination is not needed in convicting rape cases. Estrada to use its facilities when Corazon was about to give birth. assisted by Dr. adrenaline. Estrada. Ruling: Under the control test. that the physician is an independent contractor. unless the patient knows. Eventually. 2180 in relation to Art. acted in a manner that would lead a reasonable person to conclude 2 | Page . Dr. [Note: * Doctrine of Apparent Authority: a hospital can be held vicariously liable for the negligent acts of a physician providing care at the hospital. Enriquez and Payumo. a plaintiff must show that: (1) the hospital. who attended to Corazon. In general. CMC is liable for damages. In Traumatic death. Estrada. which CMC considered an emergency. she had continuous vaginal bleeding. 2. It is undisputed that throughout Corazon's pregnancy. The Court finds no single evidence pointing to CMC's exercise of control over Dr. post partum”. cyanotic. Estrada was an employee or agent of CMC. a complaint for damages was filed. Suicide – above Adam’s apple and it is diagonal. she was under the exclusive prenatal care of Dr. weak and injured condition and had to be incubated and resuscitated by Drs. an employer-employee relationship between hospitals and their attending and visiting physicians must exist in allocating responsibility in medical negligence cases. There is stiffening of muscles in case of suicide by shooting (the trigger finger). Dr. While Dr. there is cadaveric spasm. Villaflor. 37. CMC merely allowed Dr. trial ensued. The baby came out in an apnic. Corazon was admitted to CMC after the staff nurse noted the written admission request for Dr. During the operation. Estrada under Art. CADAVERIC SPASM – only a group of muscles become rigid where as in Rigor Mortis. On 26 May 1976. or its agent. There was no showing that CMC had a part in diagnosing Corazon's condition. An increase in her blood pressure and development of leg edema indicating preeclampsia was noted during her last trimester of pregnancy. such fact alone did not make him an employee of CMC.

gauze (1. Rather. consistent with ordinary care and prudence. so he allowed Dr. Ampil diagnosed CA dismissed only the case against Fuentes. Dr. her to be suffering from cancer of the sigmoid. she complained of pain in her anal region. Dr. Natividad died (now substituted by her children). but the doctors told her that it was just a natural WON CA erred in holding Dr. Dr. Fuentes. Weeks after coming back. Dr. rather than upon a specific physician. She underwent another surgery. Enrique Agana also filed an administrative complaint for gross negligence and malpractice against the two doctors with the PRC (although only the case against Dr. RTC FACTS found PSI and the two doctors liable for negligence and Natividad Agana was rushed to Medical City because of difficulty of malpractice. Sps. and finding that the malignancy spread on her left ovary. Dr. Ampil recommended that she The element of "holding out" on the part of the hospital does not require an express representation by the hospital that the person alleged to be negligent is an employee. where another 1. Enrique. A couple of days after. did not submit evidence to rebut the correctness of the operation record (re: 3 | Page . After months of consultations and examinations in the US. Fuentes to perform hysterectomy on her. Dr. After the hysterectomy. her daughter found a piece of extracted this. A "diligent search" was conducted but they could not be found. Fuentes ISSUE AND HOLDING showed his work to Dr. the plaintiff must also prove that the hospital had knowledge of and acquiesced in them. WON CA erred in absolving Dr. Pending the outcome of the cases.that the individual who was alleged to be negligent was an employee or agent of the hospital. Ampil. and malpractice. AMPIL IS GUILTY Ampil was about to complete the procedure when the attending 2. NO 3. Ampil's nurses made some remarks on the Record of Operation: "sponge count lacking 2. to permit Dr. order. she was told that she was free of cancer. so Dr. Ampil liable for negligence negligence. Agana was heard since Dr. (2) where the acts of the agent create the appearance of authority.5 in) protruding from her vagina.5 in piece of gauze was found in her vagina. he obtained the consent of her husband. Ampil." consequence of the surgery. Agana filed a complaint for damages against PSI (owner of Medical City). Ampil was abroad). so she sought treatment at a hospital. Fuentes to leave the operating room. the pain worsened. Ampil manually The element of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff relies upon the hospital to provide complete emergency room care. who examined it and found it in 1. and (3) the plaintiff acted in reliance upon the conduct of the hospital or its agent. consult an oncologist to examine the cancerous nodes which were not removed during the operation. Ampil performed an anterior resection surgery on her. and malpractice for concealing their acts of negligence. Dr. the element is satisfied if the hospital holds itself out as a provider of emergency room care without informing the patient that the care is provided by independent contractors. AMPIL IS LIABLE FOR NEGLIGENCE AND MALPRACTICE His arguments are without basis [did not prove that the American doctors were the ones who put / left the gauzes. Fuentes of any liability. alleging that the latter are liable for negligence for leaving 2 pieces of gauze in Natividad's body. DR. However. announced to surgeon search done but to no avail continue for closure" (two pieces of gauze were missing). and Dr. YES RATIO DR. PRC dismissed the case against Dr. Ampil then directed that the incision be closed. WON PSI may be held solidarily liable for Dr. bowel movement and bloody anal discharge. assuring Natividad that the pains will go away. NO. Fuentes PSI vs. Fuentes.

AND DIRECTLY LIABLE TO SPS. surgeon was required to leave a sponge in his patient's abdomen would not have happened if those who had control or management because of the dangers attendant upon delay. That Dr. there is no reason to exempt hospitals from the universal  sustaining PSI's liability: Ramos v. still.  is evident from the following: He called Dr. 2.number of gauzes used). standard of diligence  He examined Dr. However. CA doctrine on E-E relationship For purposes of apportioning responsibility in medical negligence cases. Ampil discharged such role operation. AMPIL by the operating surgeon. what established causal link: gauze pieces later extracted from patient's vagina rule of respondeat superior. Dr. a patient  He granted Dr. FUENTES NOT LIABLE The res ipsa loquitur [thing speaks for itself] argument of the Aganas' does not convince the court. Occurrence of injury Ampil examined his work and found it in order]. What's worse in this case is that he misled her by person in complete charge of the surgery room and all personnel saying that the pain was an ordinary consequence of her connected with the operation. it was his duty to inform the patient about it 2176] Previously. Thing which caused injury was under the control and Leaving foreign substances in the wound after management of the defendant [DR. by employing staff of physicians.failed to remove foreign objects. Here are the Court's bases for  DR. re: Dr. Duty . an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. this doctrine has Breach . fire. Even if it has been shown that a 3. failed to inform weakened since courts came to realize that modern hospitals are patient taking a more active role in supplying and regulating medical care  Injury . Fuentes permission to leave must only prove that a health care provider either failed to do  He ordered the closure of the incision something [or did something] which a reasonably prudent health HOSPITAL OWNER PSI SOLIDARILY LIABLE WITH DR. Fuentes' alleged negligence.to remove all foreign objects from the body before closure of the incision.suffered pain that necessitated examination and another surgery to its patients. 1. if he fails to do so. employers cannot be held liable for the fault or negligence of its professionals. [LABOR LESSON: power to hire. so she can seek relief from Absence of explanation by defendant the effects of the foreign object left in her body as her condition Under the Captain of the Ship rule. Fuentes' work and found it in order To successfully pursue this case of medical negligence. the operating surgeon is the might permit. Requisites for the applicability of res ipsa loquitur Imposes liability because of the actions of a principal or employer in somehow misleading the public into believing that the relationship or the authority exists [see NCC 1869] 4 | Page .breach caused this injury. power of control] Agency principle of apparent authority / agency by estoppel application of this doctrine does not dispense with the requirement of proof of negligence. could be traced from his act of closing the incision despite information given by the attendant nurses that 2 pieces of gauze were still missing. AGANAS [NCC the failure or action caused injury to the patient. it is his legal used proper care duty to inform his patient within a reasonable time by advising her 4. and that [NCC 2180]. Fuentes to perform a hysterectomy Medical negligence. Mere invocation and Hence.LACKING incision has been closed is at least prima facie negligence SINCE CTRL+MGT WAS WITH DR. among others.  Proximate Causation . FUENTES] -.  Occurrence was such that in the ordinary course of things. AMPIL care provider would have done [or wouldn't have done]. of what he had been compelled to do.

PSI publicly displays in the Medical City lobby the names and specializations of their physicians. PSI failed to perform the duty of exercising reasonable care to protect from harm all patients admitted into its facility for medical treatment. on the day of the operation at Delos Santos Medical Center. Hence. O. Dr. who advised that she should undergo cholecystectomy. At 7:30 a. and heard the latter say “Ang hirap ma-intubate nito." The phrase "res ipsa loquitur'' is a maxim for the rule that the fact of the occurrence of an injury. leading the public to believe that it vouched for their skill and competence. addressing him as Atty. The trial court ruled in his favor. Doctrine of corporate negligence / corporate responsibility This is the judicial answer to the problem of allocating hospital's liability for the negligent acts of health practitioners. PSI is now estopped from passing all the blame to the physicians whose names it proudly paraded in the public directory. should be made liable for the unfortunate comatose condition of a patient scheduled for cholecystectomy Held: Res Ipsa Loquitor Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for itself. The petitioner filed the instant petition for certiorari. On the procedural issue. Calderon was able to intubate the patient. She and her husband Rogelio met Dr. petitioner filed a Motion for Reconsideration. She was advised to undergo an operation for its removal. In this case. Rather. Dr. m. Dr. Herminda knew and told Rogelio that something wrong was happening. an anaesthesiologist. it was sent to the petitioner. which indicates a decrease of blood supply in the brain. Perfecta Gutierrez was to administer the anaesthesia. If doctors do well. or make out a plaintiff's prima facie case. Gutierrez intubating the patient. Hosaka. Hosaka assured them that he will get a good anaesthesiologist. Herminda saw Dr. Rogelio Ramos. it was found that the notice of the decision was never sent to the petitioner’s counsel. and present a question of fact for defendant to meet with an explanation. and the hospital. Where the thing which caused the injury complained of is shown to be under the management of the defendant or his servants and the accident is 5 | Page . Calderon. Ampil Ramos v. which the Court of Appeals denied for having been filed beyond the reglementary period. the Supreme Court rules that since the notice did not reach the petitioner’s then legal counsel. was there to provide moral support. one of the defendants. However. Hosaka issue an order for someone to call Dr. lumalaki ang tiyan. but the Court of Appeals reversed the decision. may permit an inference or raise a presumption of negligence. Rogelio filed a civil case for damages. The doctor arrived and placed the patient in trendelenburg position. The results in the examinations she underwent indicate that she was fit for the operation. through the report of the attending nurses + the fact that the operation was carried on with the assistance of various hospital staff It also breached its duties to oversee or supervise all persons who practice medicine within its walls and take an active step in fixing the negligence committed PSI also liable under NCC 2180 It failed to adduce evidence to show that it exercised the diligence of a good father of the family in the accreditation and supervision of Dr. Dr.m.” Herminda saw bluish discoloration of the nailbeds of the patient. Hosaka. Dr. so when negligence mars the quality of its services. Hosaka arrived only at 12:15 p. She heard Dr. CA Facts: Erlinda Ramos. a 47-year old robust woman. Hence. wherein the head of the patient is positioned lower than the feet. hospital profits financially. This provides for the duties expected [from hospitals]. Erlinda’s sister-in-law and the dean of the College of Nursing in Capitol Medical Center. taken with the surrounding circumstances. Erlinda was taken to the ICU and became comatose. Gutierrez. and this established PSI's part in the dark conspiracy of silence and concealment about the gauzes. PSI has actual / constructive knowledge of the matter. mali yata ang pagkakapasok. the motion was filed on time. finding Dr. guilty of negligence. and a hospital. absent facts to support the application of respondeat superior. as if he was the legal counsel. was normal except for her experiencing occasional pain due to the presence of stone in her gall bladder. Issue: Whether a surgeon. Herminda Cruz. PSI failed to conduct an investigation of the matter reported in the note of the count nurse. the hospital should not be allowed to escape liability for its agents' acts.

including the endotracheal tube. under usual and ordinary conditions. Mere invocation and application of the doctrine does not dispense with the requirement of proof of negligence. therefore.such as in ordinary course of things does not happen if those who have its management or control use proper care. that the accident arose from or was caused by the defendant's want of care. much has been said that res ipsa loquitur is not a rule of substantive law and. The real question. was likewise physically fit in mind and body. the instruments used in the administration of anesthesia. in cases where the res ipsa loquitur is applicable. which. all that the patient must do is prove a nexus between the particular act or omission complained of and the injury sustained while under the custody and management of the defendant without need to produce expert medical testimony to establish the standard of care. it affords reasonable evidence. depending upon the circumstances of each case. Erlinda's case was elective and this was known to respondent Dra. permitting the plaintiff to present along with the proof of the accident. We find the doctrine of res ipsa loquitur appropriate in the case at bar. Thus. petitioner Erlinda could not have been guilty of contributory negligence because she was under the influence of anesthetics which rendered her unconscious. Although generally. Resort to res ipsa loquitur is allowed because there is no other way. which Erlinda sustained. and (3) The possibility of contributing conduct which would make the plaintiff responsible is eliminated. creating an inference or presumption of negligence. does not create or constitute an independent or separate ground of liability. brain damage. who are the physicians-in-charge. Respondent Dra. the need for expert medical testimony is dispensed with because the injury itself provides the proof of negligence. In fact. before resort to the doctrine may be allowed. Erlinda submitted herself for cholecystectomy and expected a routine general surgery to be performed on her gall bladder. Gutierrez. expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or that he has deviated from the standard medical procedure. Medical malpractice cases do not escape the application of this doctrine. except for a few minor discomforts. Erlinda was neurologically sound and. she had all the time to make a thorough evaluation of Erlinda's case prior to the operation and prepare her for anesthesia. Thus. Thus. However. as such. (1) The accident is of a kind which ordinarily does not occur in the absence of someone's negligence. At the time of submission. Her failure to follow this medical procedure is. is an injury which does not normally occur in the process of a gall bladder operation. On that fateful day she delivered her person over to the care. were all under the exclusive control of private respondents. When the doctrine is appropriate. custody and control of private respondents who exercised complete and exclusive control over her. res ipsa loquitur has been applied when the circumstances attendant upon the harm are themselves of such a character as to justify an inference of negligence as the cause of that harm. Obviously. and to thereby place on the defendant the burden of going forward with the proof. without the aid of expert testimony. an act of exceptional negligence and professional irresponsibility. this kind of situation does not in the absence of negligence of someone in the administration of anesthesia and in the use of endotracheal tube. Hence. therefore. where the court from its fund of common knowledge can determine the proper standard of care. Negligence of the Anaesthesiologist The pre-operative evaluation of a patient prior to the administration of anesthesia is universally observed to lessen the possibility of anesthetic accidents. therefore. the following requisites must be satisfactorily shown. she never saw the patient at 6 | Page . is whether or not in the process of the operation any extraordinary incident or unusual event outside of the routine performance occurred which is beyond the regular scope of customary professional activity in such operations. However. negligence may be deduced from the mere occurrence of the accident itself. (2) It is caused by an instrumentality within the exclusive control of the defendant or defendants. when the doctrine of res ipsa loquitur is availed by the plaintiff. Likewise. Furthermore. It is grounded in the superior logic of ordinary human experience and on the basis of such experience or common knowledge. if unexplained would themselves reasonably speak to the average man as the negligent cause or causes of the untoward consequence. enough of the attending circumstances to invoke the doctrine. during the administration of anesthesia and prior to the performance of cholecystectomy she suffered irreparable damage to her brain. Gutierrez' act of seeing her patient for the first time only an hour before the scheduled operative procedure was. by which the patient can obtain redress for injury suffered by him. she went out of the operating room already decerebrate and totally incapacitated. It is simply a step in the process of such proof. 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. a clear indicia of her negligence. However. Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied. without undergoing surgery. Still. the court is permitted to find a physician negligent upon proper proof of injury to the patient. A distinction must be made between the failure to secure results. in the absence of explanation by the defendant.

that the act or omission played a substantial part in bringing about or actually causing the injury or damage. with the exception of the payment of wages. respondent hospital. no evidence on record exists to show that respondent Dr. failed to adduce evidence showing that it exercised the diligence of a good father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard to the degree of supervision which it exercised over its physicians. Clearly. or proof of a similar nature. Proximate Cause Proximate cause has been defined as that which. On the basis of the foregoing transcript. either by the study of recognized authorities on the subject or by practical experience. we rule that for the purpose of allocating responsibility in medical negligence cases. Hosaka had scheduled another procedure in a different hospital at the same time as Erlinda's cholecystectomy. and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. Accordingly. her attempt to exculpate herself must fail. Jamora's field. and without which the result would not have occurred. and clinical pharmacology. Hosaka's negligence can be found in his failure to exercise the proper authority in not determining if his anesthesiologist observed proper anesthesia protocols. Entry into the esophagus would certainly cause some delay in oxygen delivery into the lungs as the tube which carries oxygen is in the wrong place. respondent hospital 7 | Page . skill. Oddly. and was in fact over three hours late for the latter's operation. whenever it appears from the evidence in the case. a point which respondent hospital asserts in denying all responsibility for the patient's condition. the control exercised. internal medicine-allergy. An injury or damage is proximately caused by an act or a failure to act. to qualify as an expert witness. Responsibility of the Hospital Hospitals hire. That abdominal distention had been observed during the first intubation suggests that the length of time utilized in inserting the endotracheal tube (up to the time the tube was withdrawn for the second attempt) was fairly significant. During intubation. As such. many bronchospastic-mediated pulmonary diseases are within the expertise of pulmonary medicine. Dr. one must have acquired special knowledge of the subject matter about which he or she is to testify. allergology and pharmacology. While admittedly. Thus. The resulting anoxic encephalopathy belongs to the field of neurology. Because of this.the bedside. he shares equal responsibility for the events which resulted in Erlinda's condition. Responsibility of the Surgeon As the so-called "captain of the ship. private respondents' intentionally avoided providing testimony by competent and independent experts in the proper areas. unbroken by any efficient intervening cause. on the basis of the foregoing. In the instant case. The basis for holding an employer solidarily responsible for the negligence of its employee is found in Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also for those of others based on the former's responsibility under a relationship of patria potestas. Generally. Gutierrez properly intubated the patient. Hosaka verified if respondent Dra. and only on the actual date of the cholecystectomy. the anesthetic drug-induced." it is the surgeon's responsibility to see to it that those under him perform their task in the proper manner. Instead of the intended endotracheal intubation what actually took place was an esophageal intubation. In assessing whether such a relationship in fact exists. apart from submitting testimony from a specialist in the wrong field. Jamora does not qualify as an expert witness based on the above standard since he lacks the necessary knowledge. and training in the field of anesthesiology. produces injury. Furthermore. the control test is determining. In fact. Opinion of Expert Witness An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within the fields of anesthesia. Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of cyanosis. it does not escape us that respondent Dr. fire and exercise real control over their attending and visiting "consultant" staff. the hiring. Such responsibility ceases when the persons or entity concerned prove that they have observed the diligence of a good father of the family to prevent damage. in natural and continuous sequence. Respondent Dr. an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. allergic mediated bronchospasm alleged in this case is within the disciplines of anesthesiology. and the right to terminate consultants all fulfill the important hallmarks of an employer-employee relationship. apart from a general denial of its responsibility over respondent physicians. While "consultants" are not. it is clear that the appellate court erred in giving weight to Dr. technically employees. Jamora's testimony as an expert in the administration of Thiopental Sodium. She negligently failed to take advantage of this important opportunity. She herself admitted that she had seen petitioner only in the operating room. In neglecting to offer such proof. in which the pulmonologist himself admitted that he could not testify about the drug with medical authority. he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his professional duties towards his patient. such distention indicates that air has entered the gastrointestinal tract through the esophagus instead of the lungs through the trachea. Dr.

The calculated amount was not even arrived at by looking at the actual cost of proper hospice care for the patient. and. They. the amount of actual damages recoverable in suits arising from negligence should at least reflect the correct minimum cost of proper care. it would be now much more in step with the interests of justice if the value awarded for temperate damages would allow petitioners to provide optimal care for their loved one in a facility which generally specializes in such care. while certain to occur.000.000. Given these considerations.00 in moral damages would be appropriate.thereby failed to discharge its burden under the last paragraph of Article 2180. an award of P1. 3) P1.000. as in this case.500. For the foregoing reasons. emotional and financial cost of the care of petitioner would be virtually impossible to quantify. not the respondents. Finally.temperate damages are appropriate. and solidarily against private respondents the following: 1) P1.000. though to a certain extent speculative. not the cost of the care the family is usually compelled to undertake at home to avoid bankruptcy. by way of example. Dr.00 are hereby awarded.00 as moral damages. respondent hospital is consequently solidarily responsible with its physicians for Erlinda's condition. The amount given as temperate damages. As it would not be equitable .00 as actual damages computed as of the date of promulgation of this decision plus a monthly payment of P8. The husband and the children. exemplary damages in the amount of P100. in the intervening years have been deprived of the love of a wife and a mother. Our rules on actual or compensatory damages generally assume that at the time of litigation. 4) P100. Court of Appeals. are difficult to predict. Temperate damages can and should be awarded on top of actual or compensatory damages in instances where the injury is chronic and continuing. Olavere and Serrano Facts: 8 | Page . Damages At current levels.352. WHEREFORE. Meanwhile.00 each as exemplary damages and attorney's fees. these provisions neglect to take into account those situations. who. And yet ideally. where the resulting injury might be continuing and possible future complications directly arising from the injury. Even the temperate damages herein awarded would be inadequate if petitioner's condition remains unchanged for the next ten years. will have to live with the day to day uncertainty of the patient's illness. 2) P2.000. The family's moral injury and suffering in this case is clearly a real one. They should not be compelled by dire circumstances to provide substandard care at home without the aid of professionals. Having premised our award for compensatory damages on the amount provided by petitioners at the onset of litigation. a comatose patient should remain in a hospital or be transferred to a hospice specializing in the care of the chronically ill for the purpose of providing a proper milieu adequate to meet minimum standards of care. all petitioners in this case. no incompatibility arises when both actual and temperate damages are provided for.00 in temperate damages would therefore be reasonable. Cereno & Dr.and certainly not in the best interests of the administration of justice .000.00 as temperate damages. Petitioner Erlinda Ramos was in her mid-forties when the incident occurred. the actual physical. the decision and resolution of the appellate court appealed from are hereby modified so as to award in favor of petitioners. And because of the unique nature of such cases. the injury suffered as a consequence of an act of negligence has been completed and that the cost can be liquidated.000. petitioners were able to provide only home-based nursing care for a comatose patient who has remained in that condition for over a decade. 5) the costs of the suit. The burden of care has so far been heroically shouldered by her husband and children.000. Having failed to do this. knowing any hope of recovery is close to nil. The reason is that these damages cover two distinct phases.000. They have fashioned their daily lives around the nursing care of petitioner. What it reflected were the actual expenses incurred and proved by the petitioners after they were forced to bring home the patient to avoid mounting hospital bills. Under the circumstances. Considering the length and nature of the instant suit we are of the opinion that attorney's fees valued at P100. However.000. altering their long term goals to take into account their life with a comatose patient.500. In the instant case. Zafe vs. She has been in a comatose state for over fourteen years now.for the victim in such cases to constantly come before the courts and invoke their aid in seeking adjustments to the compensatory damages previously awarded . Sps. should take into account the cost of proper care. an award of P2.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives.00 are likewise proper. for anything less would be grossly inadequate. are charged with the moral responsibility of the care of the victim. the P8000/monthly amount established by the trial court at the time of its decision would be grossly inadequate to cover the actual costs of home-based care for a comatose individual.000.

Santiago went to the NBI in which the latter endorsed the matter to the Office of the prosecutor and found such probable cause. Zafe. Zafe and Dr. Jarcia made an X-ray of Roy’s ankle and the result showed no fracture. Jarcia and Dr. He was attended by a nurse and Dr. a victim of a stabbing incident. The petition is granted. Zafe and Dr. The doctor. Cereno) The petitioners are not responsible for the alleged delay in blood cross-matching. 9 | Page . They found out that there is a right mid-tibial fracture and a linear hair line fracture on the shaft of the bone of Roy. Mrs. the complainant has the burden of proof to establish a breach of duty on the part of the doctor and such accusation must be proved. ISSUE: WON the petitioners were negligent. Since Raymond was not suffering from a major blood loss. Cereno to wait for Dr. Roy Santiago was hit by a taxicab and he was immediately rushed to the Manila Doctors Hospital for an emergency treatment. Zafe and Dr. Bestan vs. (Dr. Bestan also conducted her own examination and told Mrs. Cereno liable. Dr. the Hospital surgeons were busy operating a gunshot victim. it is reasonable for Dr. Realuyo (resident physician). they started operating Raymond and they found 3. Jarcia & Dr. Tatad was engaged under another operation. Dr. The SC found out that the petitioners were not negligent. he suffered a cardiac arrest. 2:40am – Raymond died. It is unreasonable if the petitioners were to be sanctioned for lapses in procedure that does not fall within their duties. Dr.9:15pm. Such act/omission proximately caused the injury/death of the patient. 1:40am – blood was transfused on Raymond. 11 days later. He was brought back to the hospital and a new x-ray was conducted. Cereno examined Raymond and they found that the latter’s blood pressure was normal. either by his act/omission had been negligent. HELD: The SC laid down requisites to prove medical negligence: 1. was rushed to the ER of Bicol Regional Medical Center. Cereno for damages. Dr. 2. In medical negligence cases. Zafe and Dr. They found that Raymond’s BP was normal and the fluid inside his body was around 200-300 cc. The prosecutor filed a criminal case for reckless imprudence resulting to serious physical injuries.200cc of blood that was stocked in. CA’s decision was reversed. Dr. 10:30pm. Bestan guilty of simple imprudence resulting to SPI. Tatad to finish his 1 st operation. Raymond Olavere. Roy developed a fever and there was a swelling on his right foot. At 12:15am. RTC found out that Dr. Santiago that there is no need to examine the upper leg of Roy. 1:50am – the operation ended. The CA affirmed the TC’s decision. during that time. Dr. People of the Philippines The parents of Raymond filed this case against Dr. Raymond was brought to the operating room. Facts: The Trial court dismissed the case against the Resident physician and the nurse and rendered a decision making Dr.

she died eleven (11) days after the (intravenous) their daughter’s body to the Philippine National Police (PNP) Crime refusal of the hospital to release the death certificate without full payment of bills. Luke’s Medical Center (SLMC) on July 7. Respondents brought 1. they are liable. the metastasis that chemotherapy was suggested by Dr. Tamayo on Angelica’s right leg in order to remove the tumor and to prevent Under this doctrine. Tamayo. 1993 and results showed that Angelica was suffering from osteosarcoma. They should have referred the patient to another doctor with sufficient training. Dr. however. Angelica Soliman. Requisites: administration of chemotherapy first cycle. Reynaldo and Lina Soliman Legal Issue: How is medical malpractice proven? ISSUE: WON the petitioners are liable. “Res Ipso Liquitor” – the thing speaks for itself Where the thing which causes injury is under the management of the defendant and the accident is such as in the ordinary course of things does not happen if those who have the management used proper care. highest skill and knowledge in the administration of chemotherapy drugs despite all efforts the patient died. as resident physicians. osteoblastic type.CA affirmed the decision of RTC. Petitioner denied the allegation for damages as she observed best known procedures. The instrumentality/agency which caused the injury was under the exclusive control of the person charged. it affords reasonable evidence. 1993. 10 | P a g e . 3.43. (highly malignant) cancer of the bone because of that a necessity of amputation was conducted by Dr. underwent a biopsy of the mass located in her lower extremity at the St. 064. Rubi Li vs. a medical oncologist. The trial court was in favor of the petitioner and ordered to pay their unpaid hospital bill in the amount of P139. Injury suffered must not have been due to any voluntary action of the person injured. HELD: YES. The respondents filed charges against the SLMC and physicians involve for negligence and failure to observe the essential precautions in to prevent Angelica’s untimely death. but the Court of Appeals reversed the decision supporting the respondents pray. which he referred to petitioner Dr. they are not criminally negligent. are expected to know the medical protocol. Rubi Li. Tacata – Bone specialist Thorough examination was not performed on Roy and the petitioners. The petitioner’s defense is that NO cause in connection with such injury and the taxicab driver was the one liable. Sps. the happening of an injury permits an inference of negligence on the part of the plaintiffs and produces substantial evidence that such injury would not have occurred if reasonable care was exercised. The Medico-Legal Report showed that the cause of death as "Hypovolemic shock secondary to multiple organ hemorrhages and Disseminated Intravascular Coagulation. The accident was of a kind. Petitioners were negligent. The respondent was admitted to SLMC on August 18. The elements of Reckless imprudence resulting to SPI were not proved. Holding: They are acquitted of the criminal charge but held civilly liable. however. Laboratory at Camp Crame for post-mortem examination after the 2. which does not ordinarily occur unless someone is negligent. Legal Facts: Respondents’ 11-year old daughter. The testimony of Dr.

Synthesis: point to significant undisclosed information relating to the treatment which would have altered her decision to undergo it. which is a direct and initiating a general protocol that would establish a guideline proximate result of the physician’s failure to disclose. Rubi Li. As Justice Brion noted in his to. this case is of first impression in the Philippine Informed consent case requires the plaintiff to "point to significant jurisdiction. petitioner Dr. as Applying the foregoing to this case. The physician is not expected to give the patient a short medical education. (2) In all sorts of medical procedures either invasive or not. paraphrased as follows: (1) Policy Formation: the physician’s duty to disclosematerial risks. it was held that parents/heirs of deceased Angelica Soliman. Rubi Li. and cancer. an oncologist who performed chemotherapy 165279. the disclosure rule only requires of him a reasonable general explanation in nontechnical terms. Spouses Reynaldo and Lina Soliman. No.In this case medical malpractice is proven because the four essential elements of such action are present based upon the doctrine of informed consent. of medical institution must have a certificate of competency in those risks. Respondents. the Court ruled that medical on respondents’ daughter. the physician’s failure to disclose. presenting a consent or waiver to their patients so that possible The gravamen in an informed consent case requires the plaintiff to future medico-legal suits will be prevented. her decision to undergo. In Dr. the patient Rubi Li vs. No. (2) he failed to disclose or inadequately disclosed those risks. Rubi vs. the Supreme Court of the Philippines resolved an issue on the application of the common-law doctrine of informed consent in a medical malpractice (medical negligence) casesbased on consented to treatment she otherwise would not have consented Article 2176 of the Civil Code. promulgated on June 7. (3) as a direct and proximate result of the failure to disclose. and principle in a form of proper disclosure of such procedure and (4) plaintiff’s injury as a consequence the proposed treatment. especially so since informed consent litigation is undisclosed information relating to the treatment that would alter not an ordinary medical negligence case. vs. and (4) plaintiff was injured by the proposed treatment. Spouses Reynaldo and Lina Soliman. 2011. adequately disclosed material risks inherent in the reasonable expert testimony subject a breach of duty causing chemotherapy procedure performed with respondents’ consent. The ponencia enumerated the four essential elements that a plaintiff must prove in a medical malpractice action based on the doctrine of informed consent.R. G. which includes lowered counts of white and red blood cells. decrease in blood platelets." Separate Opinion. Soliman : An Application of the Common-Law Doctrine of Informed Consent in a Medical Malpractice (Medical Negligence) Case under Article 2176 of the Civil Code Reasoning: In Dr. G. (3) the patient’s consent to the treatment she rendering standards of care to delicate medical procedures before otherwise would not have consented to. 2011. or inadequate disclosure. who was sick with malignant bone malpractice is proved base on lack/impaired informed consent. possible kidney or 11 | P a g e . 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. When petitioner informed the respondents beforehand of the side effects of chemotherapy.R.165279 promulgated last June 7. gross injury to its patient.

left arm near the armpit. but just on treatment [since the witness for the respondents-parents was not one side of the arm. Milagros Cantre v. she suffered same for all patients undergoing the procedure. Go. surgery left an unsightly scar.heart damage and skin darkening. When he asked the nurses about the cause of the injury. profuse bleeding inside her womb due to some placenta parts which were not completely expelled after delivery. She then As a physician. Sps. her arm would never be the same--the care in obtaining consent in the Department of Health charged with receiving complaints against hospitals]. it is difficult to give credence to the Nora's BP. Dr. John David brought Nora to the NBI for a physical examination. 12 | P a g e . parties have rested their respective cases. not being an oncologist but a mere Medical Specialist of for skin grafting. may not be legally necessary. she ordered a droplight to warm Nora recovery for their daughter. On the other hand. John David filed a request for investigation. However. The medico-legal said that the injury appeared to be a burn and that a droplight when Quite incongruously. Dr. petitioner who were dealing with grave conditions such as cancer While in the recovery room. so her BP dropped to 40/0. together with an assisting resident physician. RTC ruled in favor of the spouses. her movements are restricted. Petitioner Dr. however. Nora's injury was referred to a plastic surgeon an expert. the Court felt hesitant in defining the scope of mandatory disclosure in cases of malpractice based on lack of informed consent such as this case involving chemotherapy treatment. Cantre was massaging Nora's uterus for it to parents’ claim that petitioner Dr. declare that in the absence of expert testimony on the standard He dismissed the likelihood that the wound was caused by a blood of chemotherapy pressure cuff since the scar was not around the arm. Li can reasonably expect the child’s parents to have considered the variables in the recommended suffered hypovolemic shock. performed treatment for their daughter afflicted with a life-threatening various medical procedures to stop the bleeding and to restore illness. but the court admitted additional exhibits [consist mostly of medical records produced by the hospital during trial pursuant to a subpoena duces tecum] offered by Sps. Sps. which were not testified to by any witness. so specific disclosures such as statistical data. Go filed a complaint for damages against Dr. Li was found NOT liable to pay damages to the suing parents. Dr. In the RTC. the medical director. she was unconscious. and the injured arm aches at the slightest touch. At that time. Milagros Cantre. the ponencia went on to placed near the skin for about 10 minutes could cause such burn. Cantre. he was informed that it was due to a burn. only moral Dr. Nora's husband John David noticed to have falsely assured patients of chemotherapy’s success a fresh gaping wound (2 1/2 x 3 1/2 in) in the inner portion of her rate. While Dr. John David and Nora Go damages awarded). informed consent laws in other countries generally require only a reasonable explanation of potential harms. there is reasonable expectation on the part of the doctor that the parents of the child understood FACTS: very well that the severity of these side effects will not be the Nora Go gave birth to her 4th child. Two hours later. as it was unlikely for doctors like and her baby. CA affirmed RTC with modification (complaint dismissed with respect to the medical director and the hospital. and the hospital. Li told them of 95% chance of contract and stop bleeding. an Ob-Gyne specialist and Nora's attending physician. Cantre said that what caused the injury was the blood pressure cuff. Besides.

[. the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the part of the person who controls the instrument causing the injury. intent because where injury is negligence to immaterial in exists and is their these it automatically gives the injured a right to reparation for the The argument that the failed plastic surgery was a measure to prevent complication (and not intended as a cosmetic procedure) does not negate negligence on Dr. and similar injury. could not have happened unless negligence set in somewhere Caused by an instrumentality exclusive control WON Dr. since both are within the exclusive control of the physician in charge [Dr. Wound not an ordinary occurrence in the act of delivering a baby. Still. he is accountable for his acts. Backgrounder live up to this precept. Wound could only be caused by something external to and outside the control of Nora since she was unconscious while in hypervolemic shock. Whoever by act or omission causes damage to another. Res ipsa loquitur x Medical negligence cases In medical negligence cases. moral damages may be recovered if they are the proximate result of the 13 | P a g e . serious anxiety. Cantre's plaintiff responsible is eliminated negligence may be made based on the res ipsa loquitur doctrine even in the absence of the additional exhibits. and they never set out to intentionally cause patients. given the circumstances of this case. her good intentions characteristics do not justify negligence. Cantre is being held liable for damages due to negligence in the practice of her profession. Cantre's part. She promptly took care of the wound before infection set in.. HOWEVER. Moral damages include physical suffering. Accident is of a kind which ordinarily does not occur absent someone's negligence saving grace BP cuff defense does not afford her an escape. is obliged to pay for the damage done. and this is the first time that Dr. evidence. fright. there being fault or negligence.. a ruling on Dr. ISSUES AND HOLDING: 1.  Dr. YES RATIO Preliminary discussion Dr. saving her life became Dr. it could cause an injury similar to what happened to Nora. YES 2. On Dr. The medical practice is to deflate the cuff immediately after use. it must have been done so negligently as to inflict a gaping wound. This face a unique restraint  in adjudicating medical negligence cases because physicians are not guarantors of care. courts Possibility of contributing conduct which would make  consideration to their patients' well-being. WON the questioned additional exhibits are admissible in 2. Though incapable of pecuniary computation. It doesn't matter WON the injury was caused by the droplight or by the blood pressure cuff.  cases proven. Since Nora was in a critical condition at that time. Cantre] under the captain of the ship doctrine [surgeon in charge of an operation is held liable for his assistants' negligence during the time when they are under the surgeon's control]. and if a doctor fails to within defendant's  NCC provisions applied NCC 2176.] NCC 2217. Cantre's counsel admitted the existence of the additional exhibits when they were formally offered for admission by the RTC. Cantre has been Nora's ob-gyne for her past 3 deliveries. 3. moral shock. or else. Cantre's other arguments + what would have been her The Hippocratic Oath mandates physicians to give primordial notwithstanding. Cantre's elemental concern. social humiliation. besmirched reputation. provided that the  following requisites concur: 1. Cantre is liable for the injury suffered by Nora  Go. wounded feelings. damage caused. mental anguish. If the wound was caused by the constant taking of BP. In any case.

[200k moral damages awarded] 14 | P a g e .defendant's wrongful act or omission.