CHAPTER I: Medical, Legal, and Hospital Jurisprudence

 Medical jurisprudence - Is the study of Medical Law and its applicable Jurisprudence,
that governs, regulates and defines the practice of medicine. It includes the rights, duties,
obligations and liabilities of both physician and patient to each other in a physician
patient professional contract.

 THE FOLLOWING ACTS CONSTITUTE THE PRACTICE OF LEGAL MEDICINE:

 To physically examine and diagnose a patient

 To physically examine and treat a patient
 To physically examine and perform surgery on a patient
 To physically examine and prescribe any remedy to a patient
 To offer or undertake by any means or method to diagnose, treat, operate or
prescribe any remedy for any human disease, injury, deformity, physical, mental
or physical condition
 To falsely use the title M.D., after one’s name

 RIGHTS INHERENT IN THE PRACTICE OF MEDICINE:

 The right to choose his patient
 The right to limit the practice of his profession
 The right to determine appropriate treatment procedures in discretion and
judgment of the physician
 The right to avail of hospital privileges after being qualified
 The right to receive just and fair compensation from his patients

 LIABILITIES OF A PHYSICIAN, WHICH MAY ARISE FROM HIS NEGLIGENCE OR WRONGFUL

ACTS OR OMISSIONS:
 Administrative Liability
 A complaint under oath can be filed before the Professional Regulation
Commission Board of Medicine, for reprimand, suspension, revocation or
termination of the license to practice medicine. After trial and hearing, or
Summary Proceeding, the Board of Medicine will impose the requisite
penalties if the physician is found guilty of the complaint charged. An
administrative complaint can also be filed before the Philippine Medical
Association Commission on Ethics for the suspension or termination of
the physician’s membership – in the Philippine Medical Association, if
found guilty.
 Criminal Liability
 When an act or omission constitutes a crime, the physician can be
imprisoned, fined or both, as any other profession.
 Civil Liability
 The aggrieved party can be awarded monetary damages for any wrongful
or negligent act or omission, when the professional is guilty.
 GROUNDS FOR REPRIMAND, SUSPENSION OR REVOCATION OF THE PHYSICIAN’S
LICENSE:
 Conviction by a court of competent jurisdiction of any criminal offense involving
moral turpitude
 Immoral or dishonorable conduct
 Insanity
 Fraud in the acquisition of the certificate of registration
 Gross negligence, ignorance or incompetence in the practice of his/her
profession resulting in an injury or death of the patient
 Addiction to alcoholic beverages or to any habit forming drug rendering him/her
incompetent to practice his/her profession, or to any form of gambling
 False or extravagant or unethical advertisements wherein other things than his
name, profession, limitation of practice, clinic hours, office and home address
 Performance of or aiding in any criminal abortion
 Knowingly issuing any false medical certificate
 Issuing any statement or spreading any news or rumor which is derogatory to the
character and reputation of another physician without justifiable motive
 Aiding or acting as a dummy of an unqualified or unregistered person to practice
medicine
 Violation of any provision of the Code of Ethics as approved by the Philippine
Medical Association

LEGAL JURISPRUDENCE

 CHAMPERTY –is the maintenance of a person in a lawsuit on condition that the

subject matter of the action is to be shared with the maintainer. Among
laypersons, this is known as “buying into someone else’s lawsuit.” Champertous
contracts are unethical and void on grounds of public policy.
 MAINTENANCE – is the intermeddling of a disinterested party to encourage a
lawsuit. It is “A taking in hand, a bearing up or upholding of quarrels or sides, to
the disturbance of the common right.”
 BARRATRY – is the bringing of vexatious litigation. It is creating legal business by
stirring up disputes and quarrels, generally for the benefit of the lawyer who sees
fees in the matter. Barratry is illegal and unethical and subjects the lawyer to
criminal punishment, fines and/or discipline by disbarment, but there must be a
showing that the resulting lawsuit was totally groundless.
 AMBULANCE CHASER – a colloquial phrase that is used derisively for a person
who is hired by an attorney to seek out Negligence cases at the scenes of
accidents or in hospitals were injured parties are treated, in exchange for a
percentage of the damages that will be recovered in the case.

MEDICAL JURISPRUDENCE: MEDICAL PRACTICE

 REYES, et. Al. v SISTERS OF MERCY HOSPITAL, et.al. G.R. No. 130547
 Facts: Petitioner, Leah Alesna Reyes, is the wife of the deceased patient,
Jorge Reyes. Five days before the latter’s death, Jorge has been suffering
from recurring fever with chills. The doctors confirmed through the
Widal test that Jorge has typhoid fever. However, he did not respond to
 the treatment and died. The cause of his death was “Ventricular
Arrythemia Secondary to Hyperpyrexia and typhoid fever.”
Consequently, petitioner filed the instant case for damages before the
Regional Trial Court of Cebu City, which dismissed the case and was
affirmed by the Court of Appeals. The contention was that Jorge did not
die of typhoid fever. Instead, his death was due to the wrongful
administration of chloromycetin. They contended that had respondent
doctors exercised due care and diligence, they would not have
recommended and rushed the performance of the Widal Test, hastily
concluded that Jorge was suffering from typhoid fever, and administered
chloromycetin without first conducting sufficient tests on the patient’s
compatibility with said drug.
 Legal Issue: Whether or not Sisters of Mercy Hospital is liable for the
death of Jorge Reyes. B.
 Ruling: Sisters of Mercy Hospital is not liable for the death of Jorge
Reyes.
 Reasoning of the Court There is no showing that the attending physician
in this case deviated from the usual course of treatment with respect to
typhoid fever. Jorge was given antibiotic choloromycetin and some dose
of triglobe after compatibility test was made by the doctor and found
that no adverse reactions manifested which would necessitate
replacement of the medicines. Indeed, the standard contemplated is not
what is actually the average merit among all known practitioners from
the best to the worst and from the most to the least experienced, but
the reasonable average merit among the ordinarily good physicians.
Here, the doctors did not depart from the reasonable standard
recommended by the experts as they in fact observed the due care
required under the circumstances.

 MEDICAL MALPRACTICE CASES

 GARCIA, JR. v SALVADOR G.R. No. 168512
 SIDAWAY v BOARD OF GOVERNORS OF THE BETHLEM ROYAL HOSPITAL (1985)

 APPLICABLE DOCTRINES TO MEDICAL MALPRACTICE

 Respondeat superior
• Independent Contractor Doctrine
• Borrowed Servant Doctrine
• Captain of the Ship Doctrine
 Res Ipsa Loquitor
 Good Samaritan Law/ Rescue Doctrine

Chapter II MEDICAL, LEGAL AND HOSPITAL JURISPRUDENCE

LEGAL MALPRACTICE

TO BE CONSIDERED MALPRACTICE UNDER THE LAW, THE CLAIM MUST HAVE THE FOLLOWING
CHARACTERISTICS:

 There was a violation of the standard of professional conduct - The law acknowledges
that there are certain legal standards that are recognized by the profession as being
acceptable conduct. These standards of professional conduct are largely determined by
the ethics rules of the state bar association.
 The negligence caused a negative legal outcome - It is not sufficient that an attorney
simply was negligent for a legal malpractice claim to be valid.
 The negligence resulted in significant damages - Legal malpractice lawsuits are
expensive to litigate. For a case to be viable, the plaintiff must show significant damages
that resulted from the negligence. If the damages are small, the cost of pursuing the case
might be greater than the eventual recovery.

LEGAL MALPRACTICE CASE, DECIDED BY THE SUPREME COURT

Pedro L. Linsangan vs. Atty. Nicomedes Tolentino

A.C. NO. 6672
September 4, 2009

FACTS:

• There was a complaint for disbarment filed by LINSANGAN against Atty. TOLENTINO for
solicitation of clients and encroachment of professional services.
– LINSANGAN alleged that TOLENTINO, with the help of a paralegal, LABIANO,
convinced his clients to transfer legal representation. TOLENTINO promised them financial
assistance and expeditious collection on their claims. To induce them to hire his services, he
persistently called them and sent them text messages.
• LINSANGAN presented an affidavit attesting that LABIANO tried to prevail upon a client to
sever his lawyer-client relations with LINSANGAN and utilize TOLENTINO's services instead, in
exchange for a loan of ₱50,000. 
• LINSANGAN also attached TOLENTINO's calling card.
• TOLENTINO denied knowing LABIANO and authorizing the printing and circulation of the
said calling card.
• The complaint was referred to the Commission on Bar Discipline (CBD) of the IBP.
• The CBD recommended that TOLENTINO be reprimanded as it found that he:
– had encroached on the professional practice of LINSANGAN, violating Rule 8.02 and
other canons of the Code of Professional Responsibility
– contravened the rule against soliciting cases for gain, personally or through paid
agents or brokers as stated in Section 27, Rule 138, Rules of Court

ISSUE/S:

• Whether or not Tolentino's actions warrant disbarment

RULING:
• SC adopts the findings of the IBP on the unethical conduct of TOLENTINO but modifies the
recommended penalty.
• The means employed by TOLENTINO in furtherance of the said misconduct constituted
distinct violations of ethical rules.
•  Canon 3, CPR provides:
– A lawyer in making known his legal services shall use only true, honest, fair,
dignified and objective information or statement of facts.
– The practice of law is a profession and not a business. To allow a lawyer to
advertise his talent or skill is to commercialize the practice of law, degrade the profession in
the publics estimation and impair its ability to efficiently render that high character of service
to which every member of the bar is called.
• Rule 2.03, CPR provides:
– A lawyer shall not do or permit to be done any act designed primarily to solicit legal
business.
– Lawyers are prohibited from soliciting cases for the purpose of gain, either
personally or through paid agents or brokers. Such actuation constitutes malpractice, a
ground for disbarment.
• Rule 1.03, CPR which provides:
– A lawyer shall not, for any corrupt motive or interest, encourage any suit or
proceeding or delay any man’s cause.
– This rule proscribes ambulance chasing (the solicitation of almost any kind of legal
business by an attorney, personally or through an agent in order to gain employment as a
measure to protect the community from barratry and champerty.
• TOLENTINO clearly solicited employment violating Rule 2.03, and Rule 1.03 and Canon 3 of
the CPR and Section 27, Rule 138 of the Rules of Court.
• TOLENTINO also committed an unethical, predatory overstep into another’s legal practice,
in violation of
• Rule 8.02, CPR
– A lawyer should not steal another lawyers client nor induce the latter to retain him
by a promise of better service, good result or reduced fees for his services.
• Moreover, by engaging in a money-lending venture with his clients as borrowers,
TOLENTINO violated:
• Rule 16.04, CPR
– A lawyer shall not borrow money from his client unless the clients interests are fully
protected by the nature of the case or by independent advice. Neither shall a lawyer lend
money to a client except, when in the interest of justice, he has to advance necessary
expenses in a legal matter he is handling for the client.
• The rule is intended to safeguard the lawyers independence of mind so that the free
exercise of his judgment may not be adversely affected. It seeks to ensure his undivided
attention to the case he is handling as well as his entire devotion and fidelity to the clients
cause. 
• Any act of solicitation constitutes malpractice which calls for the exercise of the Courts
disciplinary powers. 
• Considering the myriad infractions of respondent (including violation of the prohibition on
lending money to clients), the sanction recommended by the IBP, a mere reprimand, is a
wimpy slap on the wrist. The proposed penalty is grossly incommensurate to its findings.
• Atty. TOLENTINO for violating Rules 1.03, 2.03, 8.02 and 16.04 and Canon 3 of the Code of
Professional Responsibility and Section 27, Rule 138 of the Rules of Court is SUSPENDED from
the practice of law for a period of 1 year .
• Lawyers are only allowed to announce their services by publication in reputable law lists or
use of simple professional cards. Professional calling cards may only contain the following
details: lawyers name; name of the law firm with which he is connected; address; telephone
number and special branch of law practiced.

HOSPITAL JURISPRUDENCE

Medical jurisprudence, broadly defined, covers the relationship between a patient and a health-
care provider such as a doctor, nurse, dentist, physiotherapist, or even an institution such as
a HOSPITAL. The law has established standards, it regulates practice and provides a mechanism
for patients to claim compensation in the case of an injury.

Professional Services Inc. vs Agana

GR NO. 126297 and GR NO. 1266467

FACTS:

On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital
because of difficulty of bowel movement and bloody anal discharge. After a series of medical
examinations, Dr. Miguel Ampil diagnosed her to be suffering from Cancer of the sigmoid. On
April 11, 1984, Dr. Ampil assisted by the medical staff of the Medical City Hospital performed an
Anterior resection surgery on Natividad. He found that the malignancy on her sigmoid area had
spread on her left ovary, necessitating the removal of certain portions of it. Thus, Dr. Ampil
obtained the consent of Natividad’s husband, Enrique Agana, to permit Dr. Juan Fuentes to
perform hysterectomy on her. After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took
over, completed the operation and closed the incision after searching for the missing 2 gauzes as
indicated by the assisting nurses but failed to locate it. After a couple of days, Natividad
complained of excruciating pains in her anal region but Dr. Ampil said it is a natural consequence
of the operation/surgery and recommended that she consult an oncologist to examine the
cancerous nodes which were not removed during the operation. Natividad and her husband went
to the US to seek further treatment and she was declared free from cancer. A piece of gauze
portruding from Natividad’s vagina was found by her daughter which was then removed by hand
by Dr. Ampil and assured that the pains will vanished. However, it didn’t. The pains intensified
prompting Natividad to seek treatment at the Polymedic General Hospital. While confined there,
Dr. Ramon Guttierez detected the presence of another foreign object in her vagina – a foul
smelling gauze measuring 1.5 inches in width which badly infected her vagina. A recto-vaginal
fistula had forced stool to excrete through her vagina. Another surgical operation was needed to
remedy the damage.

ISSUE/S:

Whether or not Dr. Ampil and Fuentes are liable for medical malpractice and the
PSI for damages due to the negligence of the said doctors.
 RULING: Yes. No. Yes. An operation requiring the placing of sponges in the incision is
not complete until the sponges are properly removed and it is settled that the leaving of sponges
or other foreign substances in the wound after the incision has been closed is at least prima facie
negligence by the operating surgeon. To put it simply, such act is considered so inconsistent with
due care as to raise inference of negligence. There are even legions of authorities to the effect
that such act is negligence per se.

This is a clear case of medical malpractice or more appropriately, medical negligence. To

successfully pursue this kind of case, a patient must only prove that a health care provider either
failed to do something which a reasonably prudent health care provider would have done, or that
he did something that a reasonably prudent provider would not have done; and that failure or
action caused injury to the patient. Simply puts the elements are duty, breach, injury, and
proximate causation. Dr. Ampil, as the lead surgeon, had the duty to remove all foreign objects,
such as gauzes, from Natividad’s body before closure of the incision. When he failed to do so, it
was his duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused
injury to Natividad, necessitating her further examination by American doctors and another
surgery. That Dr. Ampil’s negligence is the proximate cause of Natividad’s injury could be traced
from his act of closing the incision despite the information given by the attending nurses that 2
pieces of gauze were still missing. That they were later on extracted from Natividad’s vagina
established the causal link between Dr. Ampil’s negligence and the injury. And what further
aggravated such injury was his deliberate concealment of this missing gauzes from the
knowledge of Natividad and her family.

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

• Occurrence of an injury;

• The thing which caused the injury was under the control and management of the
defendant;

• The occurrence was such that in the ordinary course of things would not have happened
if those who had control or management used proper care, and;

• The absence of explanation by the defendant

Of the foregoing, the most instrumental is the “Control and management of the thing
which caused the injury.” Under the “Captain of the ship” rule, the operating surgeon is the
person in complete charge of the surgery room and all personnel connected with the operation.

The knowledge of any of the staff of Medical City constitutes knowledge of PSI.

The doctrine of corporate responsibility, has the duty to see that it meets the standards
of responsibilities for the care of patients. Such duty includes the proper supervision of the
members of its medical staff. The hospital accordingly has the duty to make a reasonable effort
to monitor and oversee the treatment prescribed and administered by the physician practicing in
its premises.

A CASE OF GROSS MISCONDUCT

Priscilla Castillo Vda. De Mijares, complainant, versus Justice Onofre A. Villaluz (retired),
respondent.
Adm. Case No. 4431 June 19, 1997

Facts:

Complainant Judge Priscilla Castillo Vda. De Mijares is the presiding judge in Pasay City while
respondent Onofre A. Villaluz, a retired Justice of the Court of Appeals, is a consult at the
Presidential Anti-Crime Commission.

Judge Mijares is actually widowed by the death of her first husband, Primitivo Mijares. She
obtained a decree declaring her husband presumptively dead, after an absence of 16 years. Thus,
she got married to respondent in a civil wedding on January 7, 1994 before Judge Myrna Lim
Verano

They (complainant and respondent) knew each other when the latter, who was at that time the
Presiding Judge of the Criminal Circuit Court in Pasig, was trying a murder case involving the
death of the son of Mijares.

During their marriage, complainant judge discovered that respondent was having an illicit affair
with another woman. Respondent denied such rather he uttered harsh words to the complainant
judge. As a result, they lived separately and did not get in touch with one another and the
respondent did not bother to apologize for what happened.

Through Judge Ramon Makasiar, complainant knew that respondent married Lydia Geraldez.
Complainant then filed a complaint against respondent for disbarment for the latter immorally
and bigamously entered into a second marriage while having a subsisting marriage and distorted
the truth by stating his civil status as single.

In his defense, he contended that his marriage to the complainant judge was a “sham marriage”;
that he voluntarily signed the marriage contract to help her in the administrative case for
immorality filed against her by her legal researcher. Likewise, he maintained that when he
contracted his marriage with complainant, he had a subsisting marriage with his first wife
because the decision declaring the annulment of such marriage had not yet become final and
executory or published.

Judge Purisima the found respondent guilty of deceit and grossly immoral conduct and later on
affirmed by the Court.

Issue:

a. Whether or not marriage of complainant and respondent valid

b. Whether or not the marriage of complainant and respondent was a sham marriage

Ruling:

a. Yes. It was a valid marriage. All the essential and formal requisites of a valid marriage
under Articles 2 and 3 of the Family Code were satisfied and complied. Given the
circumstance that he was facing criminal case for bigamy and assuming for the sake of
argument that the judgment in civil case declaring the annulment of marriage between
respondent and the first wife had not attained complete finality, the marriage between
complainant and respondent is not void but only voidable.
b. As to the issue that it was a “sham” marriage is too incredible to deserve serious consideration.

Thus, former Justice Onofre Villaluz is found guilty of immoral conduct in violation of the Code
of Professional Responsibility; he is hereby suspended from practice of law for two years with the
specific warning.