Lim, Ekeena O.

Medicine is imbued with public

interest
MEDICAL MALPRACTICE NOTES
2. Board of Medicine vs Alfonso, GR
PART I – OCTOBER 26-27, 2019 No. 88259, August 10, 1989

The Medical Practice  Philippine-Muslim Christian College

of Medicine Foundation, Inc. was
1. Medical Education System founded in 1981 for the avowed
2. Laws of Medical Practice purpose of producing physicians
3. Medical Licensure who will emancipate Muslim citizens
4. Post-Grad Medical Educ. Training from age-old attitudes on health
5. Acts Constituting Practice of Medicine  Investigation was conducted as to
6. Illegal Practice of Medicine the poor performance of the
7. Physician-Patient Contractual institution and was ordered to be
Relationship closed down.
 RTC does not have the power to
PART II – NOVEMBER 16-17, 2019 order its closure but only affirming
1. Medical Malpractice the decision of DECS
2. Medical Negligence  The institution’s closure was made
permanent.
Liabilities of a Physician
1. Administrative 3. Tablarin vs Gutierrez, GR No. 78164,
2. Civil July 31, 1981
3. Criminal
 Tablarin, et al failed to pass the
 Negligence – form of Malpractice NMAT required by the Board of
Medical Education.
4 ELEMENTS OF NEGLIGENCE  Filed Petition for Declaratory
Judgment and Prohibition with a
1. Duty prayer for Temporary Restraining
2. Breach Order (TRO) and Preliminary
3. Injury Injunction against DECS to stop the
4. Proximate Causation conduct NMAT; allegedly violative
of the right to education under the
 CASES constitution
 ISSUE: Whether NMAT requirement
1. PRC vs De Guzman, GR No. 144681 for admission to medical colleges
contravenes the Constitutional
 11 graduates of Our Lady of Fatima guarantee for the accessibility of
got unusual who took the Physician education to all, and whether such
Licensure Examination and received regulation is invalid and/or
unusually high grades in two of the unconstitutional.
most difficult subjects of the exam  HELD: Petition is DISMISSED.
 PRC investigated and cheating was  Thus, prescribing the NMAT and
established; only confined to requiring certain scores as a
graduates of OLFU condition for admission to medical
 PRC did not allow them to take their schools do not constitute
oath as doctors unconstitutional imposition.
 ISSUE: WON PRC can be compelled
by Mandamus to administer the oath 4. DECS vs San Diego, GR No. 89572,
for the said exam takers despite December 21, 1989
cheating issue
 HELD: NO. Practice of profession is a  FACTS: Roberto Rey San Diego, a
privilege not a right; Practice of graduate of the University of the East

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 with a degree of B.S. Zoology, had
taken and flunked 4 National Medical
Admission Tests and was applying to
take another test.
 NMAT Rule provides that a student
shall be allowed only three (3)
chances to take the test. San Diego
failed three times.
 Regional Trial Court held that the
petitioner had been deprived of his
right to pursue a medical education
through an arbitrary exercise of the
police power.
 ISSUE: Whether or not the
respondent has been deprived of his
right to quality education.
 HELD: The regulation of practice of
medicine is a reasonable method of
protecting the health and safety of the
public. This regulation includes the
power to regulate admission to the
ranks of those authorized to practice
medicine.
 The right to quality education is not
absolute. The Constitution provides
that every citizen has the right to
choose a profession or course of
study, subject to fair, reasonable, and
equitable admission and academic
requirement.
 The equal protection requires equality
among equals. There would be
unequal protection if some applicants
who have passed the tests are
admitted and others who have also
qualified are denied entrance.
 The petition has been granted and the
decision of the respondent court has
been reversed.
5. Reyes and UP Faculty of Medicine
vs CA, G.R. No. 94961. February 25,
1991
 FACTS: Parties to this case are
students to the UP Medicine obtained
scores higher than 70% in the NMAT
which was the cutoff score by the
UPCM Faculty in 1986 which was
approved by the University Council.
However, their scores were lower than
the 90% cut-off score for 1987.
 At the time the students took the
NMAT, the new UPCM Faculty
prescribed NMAT cut-off score of 90
percentile was without the UC'S
approval.
 The UPCM Faculty denied the appeal
of the students because they were not
qualified for admission to the UPCM.
 ISSUE: WON the Med Faculty can
enforce the cut-off that they set without
the approval of University Council.
 HELD: NO. The faculty cannot invoke
academic freedom because the under
the UP Charter, the power to fix the
requirements for admission to any
college of the university is vested in
the University Council.
6. People vs Hatani, GR Nos. 78813-14,
Nov 08, 1993
 FACTS: Without the corresponding
certificate of registration issued by the
Board of Medical Examiners, accused
Hatani knowingly treated and
examined private respondents for
compensation constituting illegal
practice of medicine.
 Also, accused with lewd designs, and
while she was deprived of reason or
unconscious after having been
drugged or administered medicine,
did then and there, willfully, unlawfully
and feloniously have sexual
intercourse with Priscila without her
consent.
 ISSUE: WON accused is guilty of
illegal practice of medicine
 HELD: Yes. The evidence is
overwhelming that appellant actually
treated and diagnosed Priscila and
Wilma Borja. The positive testimony of
Agustina, Priscila, Wilma, and
Josefina Borja; the medico-legal
report, which attests to the needle
marks, the handwriting identification
report; the photographs showing
assorted drugs and medical
equipment in appellants room; and
the chemistry reports proved that
appellant was engaged in the practice
of medicine. And as to his allegation
that there was no proof of payment,
the law specifically punishes said act
whether or not done for a fee.
7. Crisostomo vs SEC, GR No. 89095,
November 06, 1989
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 FACTS: United Doctors Medical
Center
8. People vs Ventura, GR No. L-15079,
January 31, 1962
 FACTS: Lower court found Guillermo I.
Ventura guilty of illegal practice of
medicine under Section 770 in
connection with Section 2678 of the
Revised Administrative Code, and
sentencing him, this being his second
offense.
 Willfully, unlawfully and feloniously and
for compensation and reward, practice
medicine in the said City (Pasay) by
treating and applying electrical
appliances to patients for the purpose
of curing them with their ailments,
diseases, pains, and physical defects
from which they are suffering and by
holding out himself to the public by
means of signs, advertisements, and
other means, to be a Doctor of
Medicine.
 Appellant claims that his act of
stimulating the affected nerves of the
patients without use of any drug or
medicine is not practice of medicine;
that "practice of medicine" is confined
only to the systems taught by the
medical schools, namely, the regular,
the homeopathic and the electric
schools or systems.
 Section 770 of the Revised
Administrative Code in no uncertain
terms covers appellant's acts. The
statutory definition as to what acts
constitute illegal practice of medicine
as provided in said Section 770
includes the acts and practices
performed by appellant.
9. People vs Buenviaje, GR No. 22945,
March 3, 1925
 FACTS: Defendant Buenviaje was
accused of having violated the Medical
Act for practicing medicine without
obtaining certificate of registration
 Advertised herself as a `doctor of
chiropractic.
 ISSUE: WON chiropractor is a form of
medicine regulated by law.
 HELD: YES. Chiropractor is
considered as a practice of medicine
under the statutory definition of
practice of medicine under the Admin.
Code.
10. People vs Degolez, GR No. 14560,
June 30, 1960
 FACTS: Without being duly licensed to
practice medicine, accused diagnose,
prescribe, and treat one Susana Tarn
which resulted homicide through
reckless imprudence.
 DOUBLE JEOPARDY
 The failure of the accused to file a brief
and raise the question of double
jeopardy in this appeal does not mean
that section 2, Rule 118, providing that
the People can not appeal if the
defendant would be placed in double
jeopardy would no longer apply.
11. People vs Quebral, G.R. No. 46094.
September 27, 1939
 FACTS: Accused diagnosed, treated
and prescribed for certain diseases
suffered by certain patients, from
whom he received money as
compensation;
 But it is contended that no evidence
has been adduced to the effect that
the accused had thus practiced
medicine "without having previously
obtained the proper certificate of
registration issued by the Board of
Medical Examiners.
 NEGATIVE AVERMENT
 HELD: Section 770 of the
Administrative Code provides that "no
person shall practice medicine in the
Philippine Islands without having
previously obtained the proper
certificate of registration issued by the
Board of Medical Examiners . . .."
 This provision clearly includes the
want of certificate as an essential
element of the offense charged.
 The negative fact is not separable
from the offense as defined. It is,
therefore, incumbent upon the
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 prosecution to prove that negative Physical Therapy
fact, and failure to prove it is a ground
for acquittal.  process of rehabilitation
 focuses on issues with body
functionality
 issues stem from accidents or surgical
procedures
 common injuries physical therapists can
help with are arthritis, sprains, muscle
strains, back and neck pain, and
RA No. 2382, fractures
THE MEDICAL ACT OF 1959
NATURE OF PHYSICIAN-CLIENT
RELATIONSHIP
Section 10. Acts constituting practice of
medicine. A person shall be considered as  consensual
engaged in the practice of medicine  fiduciary

(a) who shall, for compensation, fee, salary or CASE

reward in any form, paid to him directly or
through another, or even without the same,  Enriquez vs Sun Life (40 PHIL 269)
physical examine any person, and diagnose,
treat, operate or prescribe any remedy for  ISSUE: WON Herrer received the
any human disease, injury, deformity, notice of acceptance of his application
physical, mental or physical condition or any for insurance.
ailment, real or imaginary, regardless of the  HELD: Court hold that the contract for
nature of the remedy or treatment a life insurance in the case was not
administered, prescribed or recommended; or perfected
 Because it has not been proved
(b) who shall, by means of signs, cards, satisfactorily that the acceptance of
advertisements, written or printed matter, or the application came to the knowledge
through the radio, television or any other of the applicant.
means of communication, either offer or
undertake by any means or method to NO CONTRACTUAL RELATIONSHIP
diagnose, treat, operate or prescribe any
remedy for any human disease, injury, 1. EE Relationship
deformity, physical, mental or physical 2. Immunity
condition; or 3. Court order
4. Autopsy
(c) who shall use the title M.D. after his 5. Casual questioning
name.
FREEDOM TO CONSENT
QUESTION: OCCUPATIONAL THERAPY
VS PHYSICAL THERAPY Limitations:
1. Law (abortion)
Occupational therapy 2. Morals (euthanasia)
3. Good customs
 holistic approach to long-term care 4. Public order
 focuses not only on body movement 5. Public policy
and function but on the environment
as well.
 goal of occupational therapy is to RA 2832, as amended (Administrative
make a patient as comfortable and Liabilities)
able as possible in their day-to-day
activity.

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Section 24. Grounds for reprimand, suspension or
revocation of registration certificate. Any of the
following shall be sufficient ground for reprimanding
a physician, or for suspending or revoking a
certificate of registration as physician:
(1) Conviction by a court of competent
jurisdiction of any criminal offense involving
moral turpitude;
(2) Immoral or dishonorable conduct;
(3) Insanity;
(4) Fraud in the acquisition of the certificate
of registration;
(5) Gross negligence, ignorance or
incompetence in the practice of his or her
profession resulting in an injury to or death
of the patient;
(6) Addiction to alcoholic beverages or to
any habit forming drug rendering him or her
incompetent to practice his or her
profession, or to any form of gambling;
(7) False or extravagant or unethical
advertisements wherein other things than
his name, profession, limitation of practice,
clinic hours, office and home address, are
mentioned.
(8) Performance of or aiding in any criminal
abortion;
(9) Knowingly issuing any false medical
certificate;
(10) Issuing any statement or spreading any
news or rumor which is derogatory to the
character and reputation of another
physician without justifiable motive;
(11) Aiding or acting as a dummy of an
unqualified or unregistered person to
practice medicine;
(12) Violation of any provision of the Code of
Ethics as approved by the Philippine
Medical Association.
TIPS FOR EXAM
 Medical Malpractice vs Illegal
Practice of Medicine
 Malpractice vs Negligence
Liabilities of Physician
1. Administative – PMA, PRC
2. Civil
3. Criminal
Medical Negligence
1. Duty
2. Dereliction
3. Direct Injury
4. Damage
Threat to life of Physician – exception to
perform duties (whether government or
private)
Exception to exception: Military doctor
 Refusal of a physician to attend a
patient in danger of death is not a
sufficient ground for revocation or
suspension of his registration
certificate if there is a risk to the
physician's life.
I.
 JARCIA VS PEOPLE, GR NO. 187926,
2012
“ONLY X-RAYTHE ANKLE; MID-TIBIAL
FRACTURE”
FACTS:
 Belinda Santiago complained with the
NBI against petitioners for their alleged
neglect of professional duty which
caused her son to suffer physical
injuries.
 Santiago’s soon was hit by a taxicab
driver and was rushed to Manila
Doctor’s Hospital for emergency
medical treatment.
 X-ray result showed no fracture as
read by Dr. Jarcia.
 Dr. Bastan entered the ER and
conducted her own examination and
informed Santiago that there was no
need to examine the upper leg since it
was the only the ankle was hit.
 11 days after: Santiago’s son
developed fever, swelling of the right
leg and misalignment of the right foot
and was brought back to the hospital.
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  X-ray revealed a right mid-tibial
fracture and a linear hairline fracture in
the shaft of the bone.
 Complaint for reckless imprudence
resulting to physical injuries was filed
against petitioners.
ISSUE:
WON 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 loquitor
applies.
The requisites for the application of the
doctrine of res ipsa loquitor 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.
DOCTRINE OF INFORMED CONSENT
4 Elements 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
case requires the plaintiff to "point to
significant undisclosed information
relating to the treatment which would
have altered her decision to undergo it.
DERILICTION OF DUTY
 Standard of care can be adduced by
presenting expert witness
 Standard guidelines in the practice of
medicine
Factum Probans vs Factum Probandum
 Factum Probandum refers to the
ultimate fact to be proven, or the
proposition to be established. e.g.
medical negligence, guilt
 Factum Probans refers to the
evidentiary facts by which the factum
probandum will be proved. (e.g.
breach of duty, other elements of
malpractice
Extraordinary Care
TEST OF THE SUBJECT MATTER –
EXPERTS, SKILLS AND EXPERIENCE –
EXPERT WITNESS, FAMILIARITY TO THE
STANDARD OF CARE
II
 Borromeo vs. Family Care Hospital and
Dr. Inso, G. R. 191018 Jan. 25, 2016
“DISSEMINATED INTRAVASCULAR
COAGULATION/APPENDICITIS”
 FACTS: Lilian experienced acute pain
at the lower stomach area and fever for
2 days and was brought to the hospital
and was placed under the care of Dr.
Inso.
 DX: Appendicitis; Surgery was
successful
 Patient became restless, blood
pressure drop.
 NO ICU; patient died.
 Autopsy: died due to hemorrhage and
concluded that the internal bleeding
was caused by .5 x .5 cm opening in
the repair site.
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  Double suturing instead of single
continuous suturing
 ISSUE: WON res ipsa loquitor applies?
 HELD: No. Petitioner’s failure to
present expert witnesses resulted in his
failure to prove petitioners' negligence.
Reyes found to be not an expert in the
subject matter having no training
residency in pathology nor in surgery.
III
 ROSIT vs DAVAO DOCTORS
HOSPITAL GR No. 210445, December
7, 2015
“TITANIUM SCREW/JAW SURGERY”
 FACTS: Rosit figure in a motorcycle
accident and sustained a jaw fracture.
 Dr. Gestuvo used a metal plate
fastened to the jaw with metal screws
to immobilize the mandible. No
available small titanium screw; he cut
the big screw to make it smaller.
 Smaller titanium screws available in
Manila, but did not so inform Rosit
supposing that the latter would not be
able to afford the same
 2 days after the operation showed that
the fracture in his jaw was aligned but
the screws used on him touched his
molar.
 RTC: Res ipsa loquitor; CA: reversed
 HELD: res ipsa loquitur as an
exception to the requirement of an
expert testimony in medical negligence
cases may be availed of if the
following essential requisites are
satisfied.
IV
 NOEL CASUMPANG v. NELSON
CORTEJO, GR No. 171127, 2015-03-11
“DENGUE FEVER”
 FACTS: Petitioning doctors' failure to
read even the most basic signs of
"dengue fever" expected of an ordinary
doctor as medical negligence.
 GUIDELINES IN QUALIFYING AN
EXPERT WITNESS: Has the required
professional knowledge, learning and
skill of the subject under inquiry
sufficient to qualify him to speak with
authority on the subject; and (2) is
familiar with the... standard required of
a physician under similar
circumstances
V
 RAMOS v. CA, G.R. No. 124354,
December 29, 1999
 FACTS: Erlinda Ramos was
experiencing occasional pains
allegedly caused by stones in her gall
bladder. She was told to undergo an
operation and after some tests and
exams, she was indicated fit for
surgery.
 Dr. Orlino Hozaka, defendant, decided
that Erlinda should undergo a
“cholecystectomy” operation.
 Anesthesiologist: Dr. Gutierrez; had
difficulty intubating the patient.
 Dr. Calderon, another anesthesiologist
was called to assist.
 Patient was released after 4 months
but in comatose state.
 Doctrine of Res Ipsa Loquitor applies
 Captain of the ship also applies
VI
 DR. VICTORIA L. BATIQUIN v. CA, GR
No. 118231, 1996-07-05
“PIECE OF RUBBER GLOVE”
 FACTS: Mrs. Villegas submitted to Dr.
Batiquin for prenatal care as the latter's
private patient.
 After 45 minutes Mrs. Villegas
delivered her first child.
 Suffer abdominal pains and complained
of being feverish.
 Another physician discovered piece of
rubber material which Dr. Kho
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 described as a "foreign body" looked
like a piece of a "rubber glove"... this
foreign body was the cause of the
infection of the ovaries.
 Res ipsa loquitor applies.

VII

 Cruz vs Court of Appeals, GR No.

122445 November 18, 1997

 FACTS: Petitioner who found a

“Myoma” in her uterus, and scheduled
her for a hysterectomy operation.
 Patient died of shock.
 HELD: Petitioner committed an
“inexcusable lack of precaution” in the
treatment of his patient.