TOMY OF

ANA

LA&W PHYSIOLOGY OF

NURSING
LAW
 LAW
“
Science of moral rules, founded on the rational nature
of man, which governs his free activity for the
realization of individual and social ends, of a nature
both demandable and reciprocal.

[Arturo Tolentino, Commentaries and Jurisprudence on the Civil Code of the Philippines I, 1]

5
 ANATOMY OF LAW

DIVINE

NAtural
JURAL Non-JURAL
LAWS LAWS
PHYSICAL
 LAW
“
a rule of conduct, just and obligatory, formulated by
legitimate power for common observance and benefit.

[Lapitan v. Philippine Charity Sweepstakes Office, 60 O.G. 6841; 4 C.A.R. (2s) 704]

7
What makes a Law?

8
Branches of Law

9
 Branches of Law
Jural Law

Substantive Remedial

Public Special Rules on

Private Civil Criminal
(Political) Proceedings Evidence

Civil Criminal Mercantile

10
Heirarchy of Law

11
 Hierarchy of Laws
Cons
tituti
on

• Treaties/International Obligations
• Decision of the Supreme Court provisions of
Statutes/Legislations law

Implementing Rules and Regulations

Procedure and Codes of Conduct

12
Constitution

13
Constitutional Supremacy
"…if a law or contract violates any norm
of the constitution that law or contract
whether promulgated by the legislative or
by the executive branch or entered into by
private persons for private purposes is null Place your screenshot here

and void and without any force and effect.

Thus, since the Constitution is the
fundamental, paramount and supreme law
of the nation, it is deemed written in every
statute and contract.”

[Manila Prince Hotel v. Government Service Insurance System, 335

Phil. 82, 101 (1997)]

14
 Preamble
“We, the sovereign Filipino people,
imploring the aid of Almighty God, in order
to build a just and humane society and
establish a Government that shall embody
our ideals and aspirations, promote the
common good, conserve and develop our
patrimony, and secure to ourselves and
our posterity the blessings of
independence and democracy under the
rule of law and a regime of truth, justice,
freedom, love, equality, and peace, do
ordain and promulgate this Constitution.”

15
 Treaties
& International Obligations

16
 Doctrine of Incorporation
"The Philippines … adopts the generally
accepted principles of international law
as part of the law of the land and adheres Place your screenshot here

to the policy of peace, equality, justice,

freedom, cooperation, and amity with all
nations.”

[Article II, Sec. 2; Philippine Constitution]

17
Treaty
an international agreement concluded
between states in written form and
Place your screenshot here
governed by international law, whether
embodied in a single instrument or in
two or more related instruments and
whatever its particular designation

[Article 2, Vienna Convention on the Law of Treaty; Bayan Muna v.

Romulo, G.R. No. 159618, February 1, 2011]

18
Treaties in Nursing
 ILO Nursing Personnel
Convention No. 149 (1977)
ratified in1979
 ILO Nursing Personnel
Recommendation No. 157
(1977)

19
Statutes &
Legislations

20
Statute
An act of the legislature declaring,
commanding, or prohibiting something;
a par- ticular law enacted and established
Place your screenshot here
by the will of the legislative department
of government; the written will of the
legislature, solemnly expressed
according to the forms necessary to
constitute it the law of the state.

[Statute, Black's Law Dictionary (10th ed. 2014)]

21
PHILIPPINE NURSING ACT
OF 2002
RA No. 9173
SCOPE OF NURSING PRACTICE
 INDEPENDENT NURSING
Linkages for
DirectPRACTICE
Community
Nursing
of health Care
• Promotion
Health
and prevention of illness

COLLABORATIVE NURSING
Nursing and
PRACTICE
Teaching in Health
Nursing Human
• Curative, Preventive, rehabilitative aspects of health care.
• Alleviation of suffering
• Peaceful Death Resource
 The
BOARD OF NURSING
 Powers, Functions & Responsibilities

Quasi-
Executive Quasi-Judicial
Legislative
Powers Powers
Powers
EXECUTI QUASI- QUASI- INCIDEN
VE LEGISLATI JUDICIAL TAL
VE POWERS
implement or adopt rules and hear and decide on authority
carry out the regulations intended cases in the necessary to
policy set out in to better carry out the performance of effectively carry
the law or statute policy; the function duty and to out the above
of rule-making. enforce its express powers
decisions
according to the
law
QUASI-LEGISLATIVE

 Promulgate a Code of Ethics

 Prescribe, adopt, issue and

promulgate guidelines, regulations,
measures and decisions
INCIDENTAL POWERS

ENABLI DIRECT
NG ING
DISPEN SUMM
SING ARY
ENABLING/LICENSING

 Conduct licensure examination

 Recognize nursing specialty
organizations in coordination
with the accredited professional
organization
 DIRECTING

 Monitor and enforce quality standards of nursing

practice in the Philippines
 Examining the prescribed facilities of
universities or colleges of nursing or departments
of nursing education and those seeking
permission to open nursing courses to ensure that
standards of nursing education are properly
complied with and maintained at all times
 DISPENSING
Four (4) years

Equity and justice

RE-ISSUANCE OF
REVOKED Disappearance, Cure,
CERTIFICATES AND Correction of Cause
REPLACEMENT OF
Application
LOST CERTIFICATE
(SEC. 24)

Payment of fees
 EXAMINING

 Conduct hearings and

investigations
 Issue subpoena ad
testificandum / subpoena duces
tecum 
 Production of documents
 Contempt powers
SUMMARY

 suspend or revoke
certificates of registration
for the practice of nursing
 REMOVAL OF BOARD

CONTINUOUS UNPROFESSIONAL,
NEGLECT OF IMMORAL OR
DUTY/INCOMPETEN DISHONORABLE
CE CONDUCT

COMMISSION/TOLE
RATION OF
IRREGULARITIES IN
NLE
EXAMINATION &
REGISTRATION
 LICENSURE &
REGISTRAT
ION REGISTRATION REGISTRAT
BY ION
LICENSUR BY
E RECIPROCI
EXAMINAT TY
ION

PRACTICE THROUGH
SPECIAL TEMPORARY
PERMITS
 PRACTICE THROUGH SPECIAL
TEMPORARY
IMPLICATIONS PERMITS
TO PERIOPERATIVE NURSING PRACTICE
INTERNATION
ALLY WELL-
KNOWN MEDICAL EXCHANGE
EXPERTS MISSIONARIES PROFESSORS

Either for a fee Free medical mission in a Employed by

or for free particular hospital, center, schools/colleges of
clinic nursing
LICENSURE EXAMINATION

 pass a written examination

 given by BON
 places and dates as may be
designated by the PRC
 RA 8981 (PRC Modernization
Act of 2000)
 QUALIFICATIONS FOR ADMISSION TO
LICENSURE EXAMINATION

CITIZENSHI BSN
P GRADUATE
• Filipino • college or university
• Reciprocity that complies with the
standards of nursing
education duly
recognized by the
proper government
agency
GOOD MORAL
CHARCTER
REGISTRATI RECIPROCITY EXAMINATI
ON BY ON BY
RECIPROCIT RECIPROCIT
Y
1. Registered under the laws of a 1.
Y
Applicant’s country permits
foreign state or country; Filipino nurses to practice
within its territorial limits;
2. Requirements for registration or
licensing of nurses in said 2. Same basis as the subject or
country are substantially the citizen of such country;

05
same as RA 9173;
3. Requirements for the
3. Same privileges to PH RN on registration or licensing of
the same basis as the subjects or nurses in said country are
citizens of such foreign state or substantially the same as RA
country. 9173
NON-REGISTRATION
 NON-REGISTRATION AND NON-ISSUANCE OF CERTIFICATES OF
REGISTRATION/PROFESSIONAL LICENSE OR SPECIAL/TEMPORARY PERMIT
CONVICTION OF
CRIME
INVOLVING IMMORAL &
MORAL DISHONORABLE UNSOUND MIND
TURPITUDE CONDUCT

Final Judgment Guilt Declaration of

Competent Court
REVOCATION
 NON-REGISTRATION/
NON-ISSUANCE (S22) REVOCATION/SUSPENSI
ON(S23)

1. Conviction by final judgment of 7. Malpractice or negligence in

any criminal offense involving practice of nursing
moral turpitude
8. Fraud, deceit, or false
2. Guilty of immoral or statements in obtaining a
dishonorable conduct CR/PL/STP
3. Unsound Mind 9. Violation of RA 9173, IRR,
COE, CTS, policies of the
5. Unprofessional and board, conditions and
unethical conduct limitations of CR/PL/ST
6. Gross incompetence 10. Practicing profession
and ignorance
while under suspension
PENAL PROVISIONS
 100
1- 6 K
IMPRIS
y
NMENT FINE
50
K

47
 GROUNDS
1. No CR/PL/ID/SP
2. Using CR/PL/ID/SP another;
3. Using invalid/ expired or cancelled
CR/PL/ID/SP

APRACTICING 4.
5.
6.
False evidence to obtain CR/PL/ID/SP;
Falsely poses or advertises RN;
Falsely appends B.S.N./R.N.

NURSING 7. Abets or assists the illegal practice of a

person not lawfully qualified to practice
nursing.
 GROUNDS

Undertaking in- WITHOUT

B service permit/clearanc
educational
Conducting e from the
programs
review classes Board and the
for both local Commission
and foreign
 GROUNDS

C Minimum Base
Pay G

15
Incentives
 free hospital care for
nurses and their
dependents
 scholarship grants other
non-cash benefits
 GROUNDS

D Other provisions
of
RA 9173
JUDICIAL DECISIONS

52
 “
Judicial decisions applying or interpreting the laws or
the Constitution shall form a part of the legal system
of the Philippines.
[Sec. 8; Civil Code of the Philipines]

53
STARE DECISIS
"The principle of stare
decisis enjoins adherence
by lower courts to doctrinal Place your screenshot here
rules established by the
Supreme Court in its final
decisions.

54
Implementing Rules
& Regulations

55
Delegation of
Legislative Power
Given the volume and variety of
interactions involving the members of Place your screenshot here
today's society, it is doubtful if the
legislature can promulgate laws dealing
with the minutiae aspects of everyday life.
Hence, the need to delegate to
administrative bodies, as the principal
agencies tasked to execute laws with
respect to their specialized fields, the
authority to promulgate rules and
regulations to implement a given statute
and effectuate its policies.

[Beltran v. Secretary of Health, 512 Phil. 560 (2005)]

56
 Ordinance Power of the President
Executive Order No. 292 [BOOK III/Title I/Chapter 2-Ordinance Power]

Executive rules of a general or permanent character in implementation or

orders execution of constitutional or statutory powers
Administrative particular aspects of governmental operations in pursuance of
Order Px duties as administrative head
Proclamations fixing a date or declaring a status or condition of public moment
or interest, upon the existence of which the operation of a
specific law or regulation is made to depend
Memorandum administrative detail or of subordinate or temporary interest
Orders which only concern a particular officer or office of the
Government
Memorandum o internal administration, which the Px desires to bring to the
Circular attention of all or some of the departments, agencies, bureaus
or offices of the Government, for information or compliance,
shall be embodied in memorandum circulars.
General or Acts and commands of the President in his capacity as
Special Commander-in-Chief of the Armed Forces of the Philippines
Orders

57
Application

58
 Ang Nars Party List vs.
Place your screenshot here
Executive Secretary
G.R. No. 215746, October 8, 2019

59
 FACTS:

Sec. 32, Joint

EO 891 RA 9173 Resolution No.
Modified the salary Mandates the 4
Authorized President to
grade (SG) provision of Salary modify the
classification of Grade 15 for Compensation and
Nurse from SG 10 public health Position Classification
to SG 11 nurses System; expressly
repealed RA 9173.

60
 Issue
Whether JR No. 4 and EO 811 amended Section
32 of RA 9173?

61
Ruling

NO. JR No. 4 did not amend Section 32 of RA 9173; EO 811, a

mere presidential issuance, cannot amend or repeal a prior law. –
Under Section 26 (2), Article VI of the 1987 Constitution, only a bill
can be enacted into law after following certain requirements expressly
prescribed under the Constitution. A joint resolution is not a bill, and
its passage does not enact the joint resolution into a law even if it
follows the requirements expressly prescribed in the Constitution for
enacting a bill into a law…. Moreover, EO No. 811, not being a law,
cannot also amend or repeal Section 32 of RA 9173. There can be no
dispute whatsoever that EO No. 811, a mere presidential issuance,
cannot amend or repeal a prior law.

62
 Issue
Can the DOH and DBM be compelled to implement SG
15 as base pay for entry level nurses?

63
Ruling

▸ DOH and DBM cannot be compelled to implement SG 15. –

Despite the continued existence and validity of Section 32 of RA
No. 9173, the Supreme Court cannot grant petitioner’s prayer to
compel respondents to implement Section 32 of RA No. 9173, an
implementation that requires the appropriation of public funds
through a law. The power of the purse belongs exclusively to
Congress under Sections 24 and 25, Article VI of the 1987
Constitution.

64
 CODE OF ETHICS FOR
REGISTERED NURSES

Board of Nursing Resolution No. 220 Series of 2004

 CODE OF
ETHICS
People /
Environment/
Society Co-Workers

Practice FOR REGISTEREDProfession

NURSES
 ARTICLE I : PREAMBLE
Health as a fundamental
right
▸ duty to preserve health at all cost
▸ duty to promote health
▸ duty to assist peaceful death
Diversity Respect
▸ Cultural diversity, political and socio-
economic status as factor of effective
▸ Respect and confidence of clientele,
colleagues, co-workers, and
nursing care
members of the community
▸ Duty to gain knowledge and understand of
man’s cultural, social, spiritual,
physiological, psychological and ecological
aspects of illness using therapeutic process
67
ARTICLE II : REGISTERED NURSES & PEOPLE

Respect:
▸ Values, customs and spiritual beliefs
▸ Individual freedom to make rational and unconstrained
decisions
▸ Confidentiality of personal information
GUIDELINE:
▸ Consider individuality and totality of patient
▸ Consider culture and values
▸ Application to diet and treatment
▸ Uphold rights of individuals
▸ Welfare and safety first

68
Situation
▸ A law was passed requiring all nurses to promote the use
of contraceptives to their clients regardless of their
personal beliefs on the use of contraceptive. The law
provides that, if a nurse’s personal belief is against the use
and prescription of contraceptives, she should
immediately refer such client to another accessible
healthcare provider. Otherwise, the nurse shall incur
criminal liability for violating his duty to refer.
 Imbong v. Ochoa
G.R. No. 204819, April 8, 2014
CONSCIENTOUS
OBJECTOR
▸ The obligation to refer
imposed by the RH Law
violates the religious belief
and conviction of a
conscientious objector.
An individual who has claimed the
right to refuse to perform military
service" on the grounds of freedom of
thought, conscience, or religion.
 Imbong v. Ochoa
G.R. No. 204819, April 8, 2014

religious freedom
“Once the medical practitioner,
of health providers against his will, refers a patient
seeking information on modern
reproductive health products,
services, procedures and methods,
his conscience is immediately
interest of the State, on the other, to burdened as he has been
provide access and information on
reproductive health products, services, compelled to perform an act
procedures and methods to enable the
people to determine the timing, number against his beliefs.
and spacing of the birth of their children
 ARTICLE III : RNS & Practice

Inviolability of Human Quality & Excellence Documentation of

Life
▸ Optimum standard of safe nursing
practice
▸ Minimize occurrences of ineffective and
unlawful nursing practice
▸ Scope of nursing practice (RA 9173)
▸ Competence in knowledge, skill and
attitudes
▸ Favorable environment for growth and
development
▸ Nursing Specialty Certification Council
Actions and Outcomes
▸ patients’ records shall be available only
if they are to be issued to those who are
professionally and directly involved in
their care and when they are required by
law.

Best Interest of All

Patient Advocates ▸ Conformity with laws, rules and regulations, measures and generally
accepted principle of moral conduct and proper decorum
▸ Respect Patient’s Bill of Rights
▸ Advertisement
▸ Informed consent
▸ Referral fees
▸ Iphold the patients’ rights when conflict
arises ▸ Abuse of privilege relationship

72
St. Luke’s Medical
G.R. No. 212054, March 11, 2015
Center v. Sanchez
▸ At the end of the shift, a staff
nurse was subjected standard
inspection procedure by the
security personnel. The security
personnel was able to confiscate
some syringes, drugs, and
medicines inside the bag of the
staff nurse.
 Defenses
Inadvertence due to of Non-filing of Admission unassisted
toxicity of the day criminal charges by counsel

She stressed the fact that She was unassisted by

She had no intention of
SLMC did not file any counsel when she
bringing outside the SLMC's
criminal charges against executed the same and,
premises the questioned items
her. thus, was inadmissible for
since she merely
inadvertently left the pouch being unconstitutional.
containing them in her bag as
she got caught up in work
that day
▸ The nurse submitted an Incident Report:

To In-House Security,
I am very sorry for bringing things from [SLMC] inside my bag.
Pasensya na po. Taos-puso po akong humihingi ng tawad sa aking
pagkakasala, Alam ko po na ako ay nagkamali. Hindi ko po dapat dinala
yung mga gamit sa hospital. Hindi ko po alam kung [paano] ako
magsisimulang humingi ng patawad. Kahit alam kong bawal ay nagawa
kong makapag uwi ng gamit. Marami pang gamit dahil sa naipon po.
Paisa-isa nagagawa kong makakuha pag nakakalimutan kong isoli. Hindi
ko na po naiwan sa nurse station dahil naisip kong magagamit ko rin po
pag minsang nagkakaubusan ng stocks at talagang may kailangan.
▸ [continued]
[…]

Humihingi po ako ng tawad sa aking ginawa. Isinakripisyo ko ang hindi

pagiging "toxic" sa pagkuha ng gamit para sa bagay na alam kong mali.
Inaamin ko na ako'y naging madamot, pasuway at makasalanan. Inuna
ko ang comfort ko keysa gumawa ng tama. Manikluhod po akong
humihingi ng tawad.

Sorry po. Sorry po. Sorry po talaga.

▸ [continued]
▸ The nurse submitted Incident Report Addendum:
○ questioned items came from the medication drawers of
patients who had already been discharged;
○ This is similarly practiced by the other staff members;
○ use in immediate procedures in case replenishment of stocks
gets delayed.
▸ Whether the nurse should be dismissed from
service?

Yes. She was has duty to obey all reasonable rules,

orders, and instructions of the employer; and willful or
intentional disobedience thereto, as a general rule,
justifies termination of the contract of service and the
dismissal of the employee.
PATIENT MONITORING

MERC
URYSTEWARDSHIP
MARS
A staff nurse is tasked with the proper
stewardship of medical supplies

If you want to modify these graph, click on them, follow the link, change the data and replace it
▸ What was the ground for dismissal?

It is apt to clarify that SLMC cannot be faulted in construing

the taking of the questioned items as an act of dishonesty
(particularly, as theft, pilferage, or its attempt in any form or
manner) considering that the intent to gain may be
reasonably presumed from the furtive taking of useful
property appertaining to another.
 ARTICLE IV: RNS & CO-WORKERS

SOLIDARITY, Collegial & Collaborative Working

Relationship

▸ Maintain professional identity
▸ Conform with acceptable group activities
▸ Contribute to professional growth
▸ Active participation in professional
organizations
▸ Not act in any manner prejudicial to other
professions
▸ Respect right of co-worker
▸ Honor and safeguard the reputation and dignity
of the members of nursing and other professions
▸ Refrain from making unfair and unwarranted
comments or criticisms on their competence,
conduct, and procedures; or
▸ not do anything that will bring discredit to a
colleague and to any member of other
professions.

81
 ARTICLE V: RN, SOCIETY & ENVIRONMENT

Preservation of Life, Respect for Human Rights, Promotion

of Healthy Environment

▸ Civic consciousness, involvement in
community concerns
▸ Knowledge of health resources within the
community
▸ Primary health care
▸ Participation in programs, projects,
activities that respond to the problems of
society
▸ Lead lives in conformity with right conduct and
proper decorum
▸ Project an image uplifting the nursing
profession at all times
▸ establishment of linkages with the public in
promoting local, national, and international
efforts to meet health and social needs of the
people as a contributing member of society

82
 ARTICLE VI: RNs & the Profession

Loyalty to & Preserving the Integrity of the Profession;

Growth, Development, and Improvement of the Socio-economic
conditions and general Welfare

▸ Be a member of the PNA

▸ Participate actively in growth and development of the nursing
profession
▸ Strive to secure equitable socio-economic and work conditions in
nursing through appropriate legislations and other means
▸ Assert for the implementation of labor and work standards

83
JURISPRUDENCE ON
MEDICAL
MALPRACTICE
▸ Implications in Safe, Quality,
Legally Sound Nursing Care
MEDICAL MALPRACTICE
A 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.
Dr. Rubi Li v. Spouses Soliman,
G.R. No. 165279, June 07, 2011
THREE-FOLD LIABILITY OF A HEALTH CARE
WORKER FOR MEDICAL NEGLIGENCE
Place Your Picture Here Place Your Picture Here Place Your Picture Here

CRIMINAL CIVIL ADMINISTRATIVE

LIABILITY LIABILITY LIABILITY
 1 Offender does or fails to do an act
CRIMINAL LIABILITY

2 Voluntariness of act or omission

Article 365,
RPC
amended by as 3 No malice
amended by RA
1790, as further
amended by RA Material damage results from the
4
10951 reckless imprudence

5 Inexcusable lack of precaution on the

part of the offender, taking into
consideration his employment or
occupation, degree of intelligence,
physical condition, and other
circumstances regarding persons,
time and place
CIVIL LIABILITY

Every person
Article 100, criminally liable for a
RPC felony is also civilly
liable.
CIVIL LIABILITY

1 Duty

2 Breach
Article
2176, Civil
Code 3 Injury

4 Proximate
causation
ADMINISTRATIVE LIABILITY
Sec. 23, RA 9173

1 Unprofessional and unethical conduct

2 Gross incompetence or serious ignorance

3
Malpractice or negligence in the practice of
nursing

4 For violation of this Act, the rules and

regulations, Code of Ethics for nurses and
technical standards for nursing practice, policies
of the Board and the Commission
EVIDENTIARY REQUIREMENTS

EXPERT WITNESS
▸In order to successfully pursue such
a 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 RES IPSA LOQUITOR
something that a reasonably prudent
provider would not have done; and
that that failure or action caused
injury to the patient.
RES IPSA LOQUITOR

2
4
Injuries loss of an eye
1 3
sustained on while the
a healthy part patient
Leaving of a of the body removal of
foreign object plaintiff was
which was the wrong
in the body of under the
not under, or part of the
the patient influence of
in the area, of body
after an anesthetic
treatment
operation
 DR. NINEVETCH
CRUZ
v.
COURT OF APPEALS
G.R. No. 122445, November 18, 1997
 FACTS

Lydia was diagnosed with myoma by Dr.

Cruz. She was scheduled to have an
operation at Perpetual Help Clinic and
General Hospital, in Balagtas Street, San
Pablo City, Laguna on March 22, 1991.
 FACTS
Lydia was admitted to the hospital on 21 March 199, the
night before her scheduled surgery. Rowena, Lydia’s
daughter, had apprehensions about continuing her mother’s
surgery as she noticed that untidy state of the clinic. The
following day, before her mother was wheeled into the
operating room, Rowena asked the Dr. Cruz if the
operation could be postponed. Dr. Cruz called Lydia into
her office and the two had a conversation. Lydia then
informed Rowena that the Dr. Cruz told her that she must
be operated on as scheduled. The surgery proceeded as
scheduled.
 FACTS

Rowena and Lydia’s other relatives waited outside the

operating room while Lydia underwent operation. While
they were waiting, the anesthesiologist went out of the
operating room and instructed them to buy Tagamet
ampules which Rowena's sister immediately bought.
 FACTS

About one hour had passed when Dr. Ercillo, the

anesthesiologist, came out again this time to ask them to
buy blood for Lydia, which they immediate complied with.
After the lapse of a few hours, the petitioner informed them
that the operation was finished.
 FACTS
Some thirty minutes after, Lydia was brought out of the
operating room in a stretcher and the petitioner asked
Rowena and the other relatives to buy additional blood for
Lydia. Unfortunately, they were not able to comply with
petitioner's order as there was no more blood available in
the blood bank. Thereafter, a person arrived to donate
blood which was later transfused to Lydia.
 FACTS
Rowena then noticed her mother, who was attached to an
oxygen tank, gasping for breath. Apparently, the oxygen
supply had run out and Rowena's husband together with the
driver of the accused had to go to the San Pablo District
Hospital to get oxygen. Lydia was given the fresh supply of
oxygen as soon as it arrived. But at around 10:00 o'clock
P.M. she went into shock and her blood pressure dropped to
60/50.
 FACTS

Lydia's unstable condition necessitated her transfer to

the San Pablo District Hospital so she could be
connected to a respirator and further examined. Upon
Lydia's arrival at the San Pablo District Hospital, she
was wheeled into the operating room and Dr. Cruz re-
operated on her because there was blood oozing from
the abdominal incision.
 FACTS

The attending physicians summoned Dr. Bartolome

Angeles, head of the Obstetrics and Gynecology
Department of the San Pablo District Hospital.
However, when Dr. Angeles arrived, Lydia was already
in shock and possibly dead as her blood pressure was
already 0/0.
 FACTS
Dr. Angeles then informed petitioner and Dr. Ercillo
that there was nothing he could do to help save the
patient. While petitioner was closing the abdominal
wall, the patient died. Thus, on March 24, 1991, at 3:00
o'clock in the morning, Lydia Umali was pronounced
dead. Her death certificate states "shock" as the
immediate cause of death and "Disseminated
Intravascular Coagulation (DIC)" as the antecedent
cause.
 FACTS

Lydia’s heir filed a criminal complaint against Dr.

Cruz and Dr. Ercillo for criminal negligence under the
Article 365 of the Revised Penal Code.
 
 ISSUE
Whether or not Dr. Cruz’s
conviction of the crime of
reckless imprudence
resulting in homicide?
 RULING

NO. Immediately apparent from a review of

the records of this case is the absence of any
expert testimony on the matter of the
standard of care employed by other
physicians of good standing in the conduct
of similar operations.
 RULING
Even granting arguendo that the inadequacy of the facilities
and untidiness of the clinic; the lack of provisions; the failure
to conduct pre-operation tests on the patient; and the
subsequent transfer of Lydia to the San Pablo Hospital and
the reoperation performed on her by the petitioner do
indicate, even without expert testimony, that petitioner was
recklessly imprudent in the exercise of her duties as a
surgeon, no cogent proof exists that any of these
circumstances caused petitioner's death.
 RULING

This court has no recourse but to rely on the expert

testimonies rendered by both prosecution and defense
witnesses that substantiate rather than contradict
petitioner's allegation that the cause of Lydia's death
was DIC which, as attested to by an expert witness,
cannot be attributed to the petitioner's fault or
negligence.
 ISSUE

Whether or not Dr. Cruz is

liable to pay the damages
to the heirs of Lydia
Umali?
 RULING

YES. This Court finds the petitioner civilly

liable for the death of Lydia Umali, for while
a conviction of a crime requires proof
beyond reasonable doubt, only a
preponderance of evidence is required to
establish civil liability.
 RULING
A precious life has been lost and the circumstances leading thereto
exacerbated the grief of those left behind. The heirs of the deceased
continue to feel the loss of their mother up to the present time and
this Court is aware that no amount of compassion and
commiseration nor words of bereavement can suffice to assuage
the sorrow felt for the loss of a loved one. Certainly, the award of
moral and exemplary damages in favor of the heirs of Lydia Umali
are proper in the instant case.
 RULING
WHEREFORE, premises considered, petitioner DR. NINEVETCH CRUZ is
hereby ACQUITTED of the crime of reckless imprudence resulting in
homicide but is ordered to pay the heirs of the deceased Lydia Umali the
amount of FIFTY THOUSAND PESOS (P50,000.00) as civil liability, ONE
HUNDRED THOUSAND PESOS (P100,000.00) as moral damages, and
FIFTY THOUSAND PESOS (P50,000.00) as exemplary damages.

Let the copy of this decision be furnished to the Professional Regulation

Commission (PRC) for appropriate action.
 Maintain cleanliness of the hospital.
IMPLICATIONS TO Keep the operating room a sterile environment.
NURSING PRACTICE

Prior to operation, make sure that there is sufficient provision

for blood, oxygen, and certain medicines.

Ensure that patient underwent a cardio-pulmonary test prior

to the operation. Recorded accordingly in the patient’s chart.

Ensure blood typing is done before transfusion. Record

accordingly in the patients chart.

Watch out for signs and symptoms of DIC. Manage symptoms

of DIC. Record assessments and intervention done. Report
immediately to attending physician.
SPOUSES FLORES, ET.
AL.
v.
SPOUSES PINEDA, ET.
AL.
G.R. No. 158996, November 14, 2008
 FACTS

Teresita Pineda presented in the hospital

for follow-up check up. She persistently
experienced general body weakness, loss
of appetite, frequent urination and thirst,
and intermittent vaginal bleeding since
her last check up.
 FACTS

Dr. Fredilicto Flores ordered laboratory exams in

preparation for D&C operation. At that time, only the
partial results for the blood sugar (BS), uric acid
determination, cholesterol determination, and complete
blood count (CBC) were available. Notably, Sweet's BS
count was high.
 
 FACTS

Notwithstanding high BS count, Dr. Flores still

proceeded with the D&C. The surgery was completed
in 10 to 15 minutes.
 
 FACTS
A day after the operation, Teresita's complete laboratory
examination results came out. Teresita's urinalysis showed
a three plus sign (+++) indicating that the sugar in her
urine was very high. By the second day of admission,
Teresita's condition worsened. She experienced difficulty
in breathing and was rushed to the intensive care unit.
Further tests confirmed that she was suffering from
Diabetes Mellitus Type II.
 FACTS

Insulin was administered on the patient, but the medication

might have arrived too late. Due to complications induced
by diabetes, Sweet died six (6) days later.
 FACTS

Believing that Teresita's death resulted from the negligent

handling of her medical needs, her family instituted an
action for damages against Dr. Strange.
 ISSUE

Whether Dr. Fredelicto Flores

and Dr. Felicisima Flores were
negligent in the performance of
their duties as medical
professionals?
 RULING

YES. Dr. Fredelicto Flores’ failure from the very start to

identify and confirm, despite the patient's complaints and
his own suspicions, that diabetes was a risk factor that
should be guarded against, and his participation in the
imprudent decision to proceed with the D&C operation
despite his early suspicion and the confirmatory early
laboratory results that was the proximate cause of the
patient’s death.
 RULING

The decision to proceed with the D&C operation,

notwithstanding Teresita's hyperglycemia and without
adequately preparing her for the procedure, was contrary to
the standards observed by the medical profession.
Deviation from this standard amounted to a breach of duty
which resulted in the patient's death. Due to this negligent
conduct, liability must attach to the petitioner spouses.
 IMPLICATIONS TO
PERIOPERATIVE
NURSING PRACTICE
Know your client

Listen to the signs

Complete pre-operative evaluation

Monitor and manage labs pre-op and

post-op
CARILLO v. PEOPLE
G.R. No. 86890, January 21, 1994
 FACTS

Catherine Acosta, a 13-year-old girl, was

diagnosed with appendicitis and was
scheduled for appendectomy. Dr. Emilio
Madrid, with the assistance of
anesthesiologist Dr. Leandro Carillo,
operated on Catherine.
 FACTS

When brought inside the operating room, the child was

feeling very well and they did not subject the child to
ECG) and X-ray. The surgical team did not also obtain
the child’s weight and/or body mass prior to the start of
the surgery.
 FACTS
The operation was finished at 7:00 o'clock in the evening.
Dr. Carillo ordered the administration of Nubain to the
patient only when warranted by the circumstances as post-
surgical analgesia. Shortly before Catherine was
transferred from the operating room to her room, Dr.
Carillo requested Catherine’s mother to go home and get a
blanket.
 
 FACTS

When the patient was wheeled out of the operating room

to her room after completion of surgery, she manifested
signs of medical instability i.e., shivering, paleness,
irregular breathing and weak heartbeat. Dr. Madrid and Dr.
Carillo stabilized the child’s heartbeat. Shortly thereafter,
Dr. Madrid and Dr. Carillo left the hospital.
 FACTS

Fifteen (15) to (30) thirty after Drs. Madrid and Carillo left
the hospital, Catherine suffered convulsions and cardiac
arrest. Responding to the situation, Dr. Madrid went back
to the hospital and called a cardiologist to contain
Catherine’s post-surgical complications.
 FACTS
 
The cardiologist informed Catherine’s parents that she
suffered severe infection which went up to her head.
Thereafter, Dr. Madrid and the cardiologist called in the Dr.
Carillo who was not readily found. When he finally
appeared at 10:30 in the evening, he was evidently in a bad
temper, commenting critically on the dextrose bottles
before ordering their removal.
 FACTS

 
When Catherine remained unconscious until noontime the
next day, a neurologist examined her and she was
diagnosed as comatose. Three (3) days later, Catherine died
without regaining consciousness.
 FACTS

 
Catherine’s parents filed a criminal case for simple
negligence resulting to homicide against Drs. Madrid and
Carillo.
 ISSUE
Whether the Dr. Carillo is
guilty of simple
negligence resulting in
homicide?
 RULING

YES. The Supreme Court affirmed the Decision of

the Court of Appeals find the guilt of the accused,
but modified the indemnity for the death of Catherine
Acosta is hereby increased to P50,000.00.
 RULING

In so ruling, the Supreme Court considered that the chain

of circumstances above noted, namely:

(1) the failure of petitioner and Dr. Madrid to appreciate

the serious post-surgery condition of their patient and to
monitor her condition and provide close patient care to
her;
 RULING

(2) the summons of petitioner by Dr. Madrid and the

cardiologist after the patient's heart attack on the very
evening that the surgery was completed;
 RULING

(3) the low level of care and diligence exhibited by

petitioner in failing to correct prescription of Nubain
for post-operative pain;
 RULING

(4) the extraordinary failure or refusal of petitioner

and Dr. Madrid to inform the parents of Catherine
Acosta of her true condition after surgery, in
disregard of the requirements of the Code of Medical
Ethics
 RULING

(5) the failure of petitioner and Dr. Madrid to prove

that they had in fact exercised the necessary and
appropriate degree of care and diligence to prevent
the sudden decline in the condition of Catherine
Acosta and her death three (3) days later.
 RULING

Nubain was an experimental drug for anaesthesia and

post-operative pain and the medical literature required
that a patient be weighed first before it is administered
and warned that there was no (or inadequate) experience
relating to the administration thereof to a patient less than
eighteen (18) years of age.
 RULING

Yet, the doctor's order sheet xxx did not contain this
precaution but instead directed a reader to apply the drug
only when warranted by the circumstances. xxx It must
be observed that the instruction was open-ended in that
some other individual still had to determine if
circumstances existed warranting administration of the
drug to the patient.
 IMPLICATIONS TO
PERIOPERATIVE
NURSING PRACTICE
Review medical literature

Clarify doctor’s order prior to

administration
Closely monitor patient and vital signs

Watch out for adversee effects of

medication
 DR. VICTORIA
BATIQUEN
v.
CA & SPOUSES
ACOGIDO &
FLOTILDE VILLEGAS
G.R. No. 118231 July 5, 1996
 FACTS

Flotilde Villegas, married woman to Quedo

Acogido, was scheduled for caesarian
section. Dr. Victoria Batiquin, with the
assistance of Dr. Doris Teresita Sy who was
also a Resident Physician at the same
Hospital, C.I. and O.R. Nurse Arlene Diones
and some student nurses performed a simple
caesarean section on Mrs. Villegas at the
Negros Oriental Provincial Hospital.
 FACTS

Thereafter, Plaintiff remained confined at the Hospital until

September 27, 1988 during which period of confinement
she was regularly visited by Dr. Batiquin. On September
28, 1988 Mrs. Villegas checked out of the Hospital.
 FACTS

Soon after leaving the Hospital Mrs. Villegas began to

suffer abdominal pains and complained of being feverish.
She also gradually lost her appetite, so she consulted Dr.
Batiquin at the latter's polyclinic who prescribed for her
certain medicines which she had been taking up to
December, 1988. 
 FACTS

The abdominal pains and fever kept on recurring and

bothered Mrs. Villegas no end despite the medications
administered by Dr. Batiquin. When the pains became
unbearable and she was rapidly losing weight she
consulted Dr. Ma. Salud Kho at the Holy Child's Hospital
in Dumaguete City on January 20, 1989.
 FACTS

After thorough examination, Dr. Kho concluded that Mrs.

Villegas had abdominal cavity infection. The results of all
those examinations impelled Dr. Kho to suggest that Mrs.
Villegas submit to another surgery to which the latter
agreed.
 FACTS

When Dr. Kho opened the abdomen of Mrs. Villegas she

found whitish-yellow discharge inside, an ovarian cyst on
each of the left and right ovaries which gave out pus, dirt
and pus behind the uterus, and a piece of rubber material
on the right side of the uterus embedded on the ovarian
cyst, 2 inches by 3/4 inch in size.
 FACTS

After discovering that a rubber was stuck inside Mrs.

Villegas after her C-Section, Spouses Villegas sued Dr.
Batiquin for medical malpractice.
 FACTS

 
Catherine’s parents filed a criminal case for simple
negligence resulting to homicide against Drs. Madrid and
Carillo.
 ISSUE

Whether Dr. Batiquen

committed medical
negligence?
 RULING

YES. Considering that we have assessed Dr. Kho to

be a credible witness, her positive testimony [that a
piece of rubber was indeed found in private
respondent Villega's abdomen] prevails over the
negative testimony in favor of the petitioner. As such,
the rule of res ipsa loquitur comes to fore.
 RULING

First, the entire proceedings of the caesarean section

were under the exclusive control of Dr. Batiquin. In this
light, the private respondents were bereft of direct
evidence as to the actual culprit or the exact cause of the
foreign object finding its way into private respondent
Villegas's body, which, needless to say, does not occur
unless through the intersection of negligence.
 RULING

Second, since aside from the caesarean section, private

respondent Villegas underwent no other operation which
could have caused the offending piece of rubber to
appear in her uterus, it stands to reason that such could
only have been a by-product of the caesarean section
performed by Dr. Batiquin.
 RULING

The petitioners, in this regard, failed to overcome the

presumption of negligence arising from resort to the
doctrine of res ipsa loquitur. Dr. Batiquin is therefore
liable for negligently leaving behind a piece of rubber in
private respondent Villegas's abdomen and for all the
adverse effects thereof.
 IMPLICATIONS TO PERIOPERATIVE NURSING PRACTICE
OTHER
AORN JCI GUIDELINES

Guideline for  Sentinel Alert: World Health

Prevention of Preventing Organization,
Retained Surgical unintended retained American College of
Items foreign objects Surgeons, No Thing
Left Behind, and
other organizations
and publications
 ROSIT
v.
DAVAO DOCTORS
HOSPITAL, ET. AL.
G.R. No. 210445, December 07, 2015
 FACTS

Nilo Rosit figured in a motorcycle accident

on January 15, 1999, The X-ray soon taken
the next day at the Davao Doctors Hospital
(DDH) showed that he fractured his jaw.
Rosit was then referred to Dr. Gestuvo, a
specialist in mandibular injuries, who, on
January 19, 1999, operated on Rosit.
 FACTS
During the operation, Dr. Gestuvo used a metal plate
fastened to the jaw with metal screws to immobilize the
mandible. As the operation required the smallest screws
available, Dr. Gestuvo cut the screws on hand to make
them smaller. Dr. Gestuvo knew that there were smaller
titanium screws available in Manila, but did not so inform
Rosit supposing that the latter would not be able to afford
the same.
 FACTS
Following the procedure, Rosit could not properly open
and close his mouth and was in pain. X-rays done on Rosit
two (2) days after the operation showed that the fracture in
his jaw was aligned but the screws used on him touched his
molar. Given the X-ray results, Dr. Gestuvo referred Rosit
to a dentist. The dentist who checked Rosit, Dr. Pangan,
opined that another operation is necessary and that it is to
be performed in Cebu.
 FACTS

Alleging that the dentist told him that the operation

conducted on his mandible was improperly done, Rosit
went back to Dr. Gestuvo to demand a loan to defray the
cost of the additional operation as well as the expenses of
the trip to Cebu.
 FACTS

Rosit went to Cebu on February 19, 1999, still suffering

from pain and could hardly open his mouth.
 FACTS

In Cebu, Dr. Pangan removed the plate and screws thus

installed by Dr. Gestuvo and replaced them with smaller
titanium plate and screws. Dr. Pangan also extracted Rosit's
molar that was hit with a screw and some bone fragments.
Three days after the operation, Rosit was able to eat and
speak well and could open and close his mouth normally.
 FACTS

On his return to Davao, Rosit demanded that Dr. Gestuvo

reimburse him for the cost of the operation and the
expenses he incurred in Cebu amounting to P140,000, as
well as for the P50,000 that Rosit would have to spend for
the removal of the plate and screws that Dr. Pangan
installed. Dr. Gestuvo refused to pay. Thus, Rosit filed a
civil case for damages and attorney's fees with the RTC
against Dr. Gestuvo and DDH.
 ISSUE

Whether or not Dr.

Gestuvo committed
medical negligence?
 RULING

YES. The Supreme Court found Dr. Gestuvo civilly

liable for medical malpractice. Clearly, had Dr.
Gestuvo used the proper size and length of screws
and placed the same in the proper locations, these
would not have struck Rosit's teeth causing him pain
and requiring him to undergo a corrective surgery.
 RULING

What is more damning for Dr. Gestuvo is his failure

to inform Rosit that such smaller screws were
available in Manila, albeit at a higher price.
 RULING

First, Dr. Gestuvo clearly had the duty of disclosing

to Rosit the risks of using the larger screws for the
operation. This was his obligation as the physician
undertaking the operation.
 RULING

Second, Dr. Gestuvo failed to disclose these risks to

Rosit, deciding by himself that Rosit could not afford
to get the more expensive titanium screws.
 RULING

Third, had Rosit been informed that there was a risk

that the larger screws are not appropriate for the
operation and that an additional operation replacing
the screws might be required to replace the same, as
what happened in this case, Rosit would not have
agreed to the operation.
 RULING

Without a doubt, Dr. Gestuvo is guilty of

withholding material information which would have
been vital in the decision of Rosit in going through
with the operation with the materials at hand. Thus,
Dr. Gestuvo is also guilty of negligence on this
ground.
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