Li vs Spouses Soliman

GR No. 165279 June 7, 2011

Facts: On July 7, 1993, 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). Results showed that Angelica was suffering from
osteosaucoma, ostiobiostic type, a high-grade (highly malignant) cancer of the
bone which usually affects teenage children. Following this diagnosis, Angelica’s
right leg was amputated by Dr. Tamayo in order to remove the tumor. As a adjuvant
treatment to eliminate any remaining cancer cells, and hence minimizing the
chances of recurrence and prevent the decease from spreading to other parts of
the patient’s body, chemotherapy was suggested by Dr. Tamayo and referred
Angelica to another doctor at SLMC, herein petitioner Dr. Rubi Li, a medical
oncologist.

On July 23, 1993, petitioner saw the respondents at the hospital after Angelica’s
surgery and discussed with them Angelica’s condition. Petitioner told respondents
that Angelica should be given 2-3 weeks to recover from the operation before
starting the chemotherapy. Respondents were apprehensive due to financial
constraints as Reynaldo earns only from P70,000-150,000 a year from his jewelry
and watching repair business. Petitioner, however, assured them not to worry
about her professional fee and told them to just save up for medicines to be used.

As the chemotherapy session started, day by day, Angelica experience worsening

condition and other physical effect on the body such as discoloration, nausea, and
vomiting.

Petitioner claimed, that she explained to respondents that even when a tumor is
removed, there are still small lesions undetectable to the naked eye and that
adjuvant chemotherapy is needed to clean out the small lesions in order to lessen
the chance of cancer to recur. She did not give the respondents any assurance
that chemotherapy will cure Angelica’s cancer. During these consultations with
respondents, she explained the following side effects of chemotherapy treatment
to respondents: 1.) Falling hair; 2.) nausea and vomiting; 3.) loss of appetite; 4.)
low count of WBC, RBC, and platelets; 5.) possible sterility due to the effects on
Angelica’s ovary; 6.) Damage to kidney and heart; 7.) darkening of the skin
especially when exposed to sunlight. She actually talked to the respondents four
times, once at the hospital after the surgery, twice at her clinic and fourth when
Angelica’s mother called her through long distance. This was disputed by
respondents who countered that petitioner gave them assurance that there is 95%
chance of healing for Angelica if she undergoes chemotherapy and that the only
side effects were nausea, vomiting and hair loss. Those were the only side effects
of chemotherapy mentioned by petitioner.
Issue: Whether or not petitioner committed medical malpractice.

Held: No. The type of lawsuit which has been called medical malpractice or more
appropriately, medical negligence, is that type of claim which a victim has available
to him or her to redress a wrong committed by a medical professional which has
caused bodily harm. In order to successfully pursue such claim, a patient must
prove that a health care provider in most cases a physician, either failed to do
something which a reasonably prudent health care provider would have done or
that he or she did something that a reasonably health care provider would not have
done; and that failure or action caused injury to the patient.

Medical negligence cases are best proved by opinions of expert witnesses

belonging in the same general neighborhood and in the same general line of
practice as defendant physician or surgeon. The deference of courts to the expert
opinion of qualified physicians stems from the former’s realization that the latter
possess unusual technical skills which layman in most instances are incapable of
intelligently evaluating, hence the indispensability of expert testimonies.

The doctrine of informed consent within the context of physician-patient

relationships goes as far back into english common law. As early as 1767, doctors
were charged with the tort of battery if they have not gained the consent of their
patients prior to performing a surgery or procedure. In the United States, the
seminal case was Schoendorff vs Society of New York Hospital which involved
unwanted treatment performed by a doctor. Justice Bejamin Cardozo oft-quoted
opinion upheld the basic right of a patient to give consent to any medical procedure
or treatment; every human being of adult year and sound mind has a right to
determine what shall be done with his own body; and a surgeon who performs an
operation without his patient’s consent commits an assault, for which he is liable
in damages. From a purely ethical norm, informed consent evolved into a general
principle of law that a physician has a duty to disclose what a reasonably prudent
physician in the medical community in the exercise of reasonable care would
disclose to his patient as to whatever grave risk of injury might be incurred from a
proposed course of treatment, so that a patient, exercising ordinary care for her
own welfare and faced with a choice of undergoing the proposed treatment, as
alternative treatment, or none at all, may intelligently exercise his judgement by
reasonably balancing the probable risk against the probable benefits.

There are four essential elements a plaintiff must proved 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. The gravamen in an informed consent
requires the plaintiff to point to significant undisclosed information relating to the
treatment which could have altered her decision to undergo it.

Examining the evidence, we hold that there was adequate disclosure of material
risks inherent in chemotherapy procedure performed with the consent of Angelica’s
parents. Respondents could not have been unaware in the course of initial
treatment and amputation of Angelica’s lower extremity that her immune system
was already weak on account of the malignant tumor in her knee. 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 respondents understood very well
that the severity of these side effects will not be the same for all patients
undergoing the procedure. In other words, by the nature of the disease itself, each
patients reaction to the chemical agents even with pre-treatment laboratory tests
cannot be precisely determined by the physician. That death can possibly result
from complications of the treatment or the underlying cancer itself, immediately or
sometime after the administration of chemotherapy drugs, is a risk that cannot be
ruled out, as with most other major medical procedures, but such conclusion can
be reasonably drawn from the general side effects of chemotherapy already
disclosed.

JARCIA VS PEOPLE (GR NO. 187926 FEBRUARY 15, 2012)

Jarcia vs People of the Philippines

GR No. 187926 February 15, 2012

Facts: Belinda Santiago lodged a complaint with the National Bureau of

Investigation (NBI) against the petitioners, Dr. Emanuel Jarcia and Dr. Marilou
Bastan, for their alleged neglect of professional duty which caused her son, Roy
Alfonso Santiago, to suffer physical injuries. Upon investigation, the NBI found that
Roy Jr. was hit by a taxicab; that he was rushed to the Manila Doctors Hospital for
an emergency medical treatment; that an X-ray of the victim’s ankle was ordered;
that the X-ray result showed no fracture as read by Dr. Jarcia; that Dr. Bastan
entered the emergency room and, after conducting her own examination of the
victim, informed Mrs. Santiago that since it was only the ankle that was hit there
was no need to examine the upper leg; that 11 days later, Roy developed fever,
swelling of the right leg and misalignment of the right foot; that Mrs. Santiago
brought him back to the hospital; and that the x-ray revealed a right mid-tibial
fracture and a linear hairline fracture in the shaft of the bone. A complaint for
reckless imprudence resulting physical injuries was filed against the petitioners for
the alleged misconduct in the handling of the illness of Roy.
Issue: Whether or not the petitioners failed to exercise the degree of care
expected of them as doctors and are liable for negligence to the private
respondent.

Held: Yes. The doctrine of res ipsa liquitor as a rule of evidence is unusual to the
law of negligence which recognizes that prima facie negligencce may be
established without direct proof and furnishes a substitute for specific proof of
negligence. The doctrine however, is not a rule of substantive law, but merely a
mode of proof or a mere procedural convenience the rule when applicable to the
facts and circumstances of a given case, is not meant to and does not dispense
with the requirement of proof of culpable negligence on the party charged. It merely
determines and regulates what shall be prima facie evidence thereof and helps the
plaintiff in proving a breach of duty. The doctrine can be invoked when and only
when, under the circumstances involved, direct evidence is absolute and not
readily available.

The requisites for the application of the doctrine of res ipsa liquitor are:

1. The accident was of a kind which does not ordinarily occur unless someone
is negligent;
2. The instrumentality or agency which caused the injury was under the
exclusive control of the person in charge; and
3. The injury suffered must not have been due to any voluntary action or
contribution of the person injured.

Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution and vigilance which the
circumstances justly demand whereby such other person suffers injury.

Reckless imprudence consists of voluntarily doing or failing to do, without malice,

an act from which material damage results by reason of an inexcusable lack of
precaution on the part of the person performing or failing to perform such act.

In failing to perform an extensive medical examination to determine the extent of

Roy’s injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as members
of the medical profession. Assuming for the sake of argument that they did not
have the capacity to make such thorough evaluation at that stage they should have
referred the patient to another doctor with sufficient training and experience instead
of assuring him and his mother that everything was all right
SOLIDUM VS PEOPLE (GR NO. 192123 MARCH 10, 2014)

Solidum vs People of the Philippines

GR No. 192123 March 10, 2014

Facts: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus.
Two days after his birth, Gerald under went colostomy, a surgical procedure to
bring one end of the large intestine out through the abdominal walls, enabling him
to excrete through a colostomy bag attached to the side of his body. On May 17,
1995, Gerald was admitted at the Ospital ng Maynila for a pull-through operation.
Dr. Leandro Resurreccionheaded the surgical team, and was assisted by Dr.
Joselito Lucerio, Dr.Donatella Valeria and Dr. Joseph Tibio. The anesthesiologist
included Drs. Abella, Razon and Solidum. During the operation, Gerald
experienced bradycardia and went into a coma. His coma lasted for two weeks ,
but he regained consciousness only after a month. He could no longer see, hear,
or move. A complaint for reckless imprudence resulting in serious physical injuries
were filed by Gerald’s parents against the team of doctors alleging that there was
failure in monitoring the anesthesia administered to Gerald.

Issues: Whether or not petitioner is liable for medical negligence.

Whether or not res ipsa liquitor can be resorted to in medical negligence cases.

Held: No. Negligence is defined as the failure to observe for the protection of the
interests of another person that degree of care, precaution, and vigilance that the
circumstances justly demand, whereby such other person suffers injury. Reckless
imprudence, on the other hand, consists of voluntarily doing or failing to do, without
malice, an act from which material damage results by reason of an inexcusable
lack of precaution on the part of the person to perform or failing to perform such
act.

The negligence must be the proximate cause of the injury. For, negligence no
matter in what it consists, cannot create a right of action unless it is the proximate
cause of the injury complained of. And the proximate cause of an injury is that
cause, which, in natural and continuous sequence and unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have
occurred.

An action upon medical negligence – whether criminal, civil or administrative –

calls for the plaintiff to prove by competent evidence each of the following four
elements namely: a.) the duty owed by the physician to the patient, as created by
the physician-patient relationship, to act in accordance with the specific norms or
standards established by his profession; b.) the breach of the duty by the
physician’s failing to act in accordance with the applicable standard of care; c.) the
causation, is, there must be a reasonably close and casual connection between
the negligent act or omission and the resulting injury; and d.) the damages suffered
by the patient.

In the medical profession, specific norms on standard of care to protect the patient
against unreasonable risk, commonly referred to as standards of care, set the duty
of the physician in respect of the patient. The standard of care is an objective
standard which conduct of a physician sued for negligence or malpractice may be
measured, and it does not depend therefore, on any individual’s physician’s own
knowledge either. In attempting to fix a standard by which a court may determine
whether the physician has properly performed the requisite duty toward the patient,
expert medical testimony from both plaintiff and defense experts is required.

The doctrine of res ipsa liquitor means that where the thing which causes injury is
shown to be under the management of the defendant, and the accident is such as
in ordinary course of things does not happen if those who have management use
proper care, it affords reasonable evidence, in the absence of an explanation by
defendant that the accident arose from want of care.

Nevertheless, despite the fact that the scope of res ipsa liquitor has been
measurably enlarged, it does not automatically apply to all cases of medical
negligence as to mechanically shift the burden of proof to the defendant to show
that he is not guilty of the ascribed negligence. Res ipsa liquitor is not a rigid or
ordinary doctrine to be perfunctorily used but a rule to be cautiously applied,
depending upon the circumstances of each case. It is generally restricted to
situations in malpractice cases where a layman is able to say, as a matter of
common knowledge and observation, that the consequences of professional care
were not as such as would ordinarily have followed if due care had been exercised.
A distinction must be made between the failure to secure results, 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. It must be conceded that the doctrine of res ipsa liquitor can have no
application in a suit against a physician or surgeon which involves the merits of a
diagnosis or of a scientific treatment. The physician or surgeon is not required at
his peril to explain why any particular diagnosis was not correct, or why any
particular scientific treatment did not produce the desired results. Thus, res ipsa
liquitor is not available in a malpractice suit if the only showing is that the desired
result of an operation or treatment was not accomplished. The real question,
therefore, is whether or not in the process of the operation any extraordinary
incident or unusual event outside the routine performance occurred which is
beyond the regular scope of customary professional activity in such operations,
which if unexplained would themselves reasonably speak to the average man as
the negligent case or causes of the untoward consequence. If there was such
extraneous intervention, the doctrine of res ipsa liquitor may be utilized and the
dependent is called upon to explain the matter, by evidence of exculpation, if he
could.