770, RA 1885), A medical malpractice suit is an action available to victims to redress a wrong committed by medical professionals who caused bodily harm to, or the death of, a patient. 27 of Article V of Republic Act No. SJDH cannot now disclaim liability since there is no showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr. Casumpang is only an independent contractor of the hospital. L.J. (Evans v. Ohanesian). Ct. App. We resolve the three (3) consolidated petitions for review on Certiorari1 involving medical negligence, commonly assailing the October 29, 2004 decision2 and the January 12, 2006 resolution3 of the Court of Appeals (CA) in CA-G.R. CONCEPT: Petitioner’s action is for medical malpractice. Medical Malpractice in the Philippines 1. 2d 1298 (1986). A: He said, that is broncho pneumonia, It’s only being active now. I have known Phil for several years and he is an excellent attorney. Nor is it critical whether a medical expert is a general practitioner or a specialist so long as he exhibits knowledge of the subject. No. 160889, 522 SCRA 547, 556, Apr. One of the critical issues the petitioners raised in the proceedings before the lower court and before this Court was Dr. Jaudian’s competence and credibility as an expert witness. Medical Malpractice Defined - failure of a physician to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. It held that in diagnosing and treating an illness, the physician’s conduct should be judged not only by what he/she saw and knew, but also by what he/she could have reasonably seen and known. 27, 2007. By referring Dr. Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang, not only as an accredited member of Fortune Care, but also as a member of its medical staff. A: In the evening of April 23, 1988, I stayed in the hospital and I was informed by the pediatric resident on duty at around 11:15 in the evening that the blood pressure of the patient went down to .60 palpatory. 84 Tomasa vda. Based on these considerations, we rule that the respondent successfully proved the element of causation. It also claimed that Edmer had no hemorrhagic manifestations at the time of his admission and until the following day. Certification of Residency in Pediatrics; ii. We find that Dr. Sanga was not independently negligent. 181, 186 [1957]. 76 Mercil v. Mathers, No. As the term is used, the suit is brought whenever a medical practitioner or health care provider fails to meet the standards demanded by his profession, or deviates from this standard, and causes injury to the patient. WHEREFORE, premises considered, this Court PARTLY GRANTS the consolidated petitions. 171228, pp. Civil and Criminal Prosecution with Damages. SJDH is Solidarily Liable Based The test of qualification is necessarily a relative one, depending upon the subject matter of the investigation, and the fitness of the expert witness.84 In our jurisdiction, the criterion remains to be the expert witness’ special knowledge experience and practical training that qualify him/her to explain highly technical medical matters to the Court. Medical Malpractice. MEDICAL MALPRACTICE, which is a form of negligence, consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. The CA opined that the control which the hospital exercises over its consultants, the hospital’s power to hire and terminate their services, all fulfill the employer-employee relationship requirement under Article 2180. The dispositive portion of the decision reads: WHEREFORE, judgment is hereby rendered in favor of the plaintiff and against the defendants, ordering the latter to pay solidarily and severally plaintiff the following: (1) Moral damages in the amount of ₱500,000.00; (2) Costs of burial and funeral in the amount of ₱45,000.00; The petitioners appealed the decision to the CA. injuries filed against Dr. Jarcia, Dr. Bastan, and Dr. Pamittan. MEDICAL MALPRACTICE, which is a form of negligence, consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and … Finally, Brown v. Mladineo92 adhered to the principle that the witness’ familiarity, and not the classification by title or specialty, which should control issues regarding the expert witness’ qualifications: The general rule as to expert testimony in medical malpractice actions is that "a specialist in a particular branch within a profession will not be required." The Physician’s Progress Notes59 stated: "Blood streaks on phlegm can be due to bronchial irritation or congestion," which clearly showed that Dr. Casumpang merely assumed, without confirmatory physical examination, that bronchopneumonia caused the bleeding. In addition, considering the diagnosis previously made by two doctors, and the uncontroverted fact that the burden of final diagnosis pertains to the attending physician (in this case, Dr. Casumpang), we believe that Dr. Sanga’s error was merely an honest mistake of judgment influenced in no small measure by her status in the hospital hierarchy; hence, she should not be held liable for medical negligence. The trial court also found that aside from their self-serving testimonies, the petitioning doctors did not present other evidence to prove that they exercised the proper medical attention in diagnosing and treating the patient, leading it to conclude that they were guilty of negligence. A: We transfused platelet concentrate and at the same time, we monitor [sic] the patient. One hour later, Dr. Casumpang arrived at Edmer’s room and he recommended his transfer to the Intensive Care Unit (ICU), to which the respondent consented. He has tried more than 150 jury trials to conclusion, approximately 50 more which were commenced, then settled. On SJDH’s solidary liability, the CA ruled that the hospital’s liability is based on Article 2180 of the Civil Code. In the Philippines, a medical malpractice suit is primarily governed by the Civil Law concept of damages. Frank G. Feeley, Wendy K. Mariner, 4 February 2000, http://dcc2.bumc.bu.edu/RussianLegalHealthReform/ProjectDocuments/n740.IIG.Bkgd.pdf. Jane Clark, Medical malpractice Attorney on Dec 2, 2013 Relationship: Opposing Counsel on matter. It involves an inquiry on whether the hospital acted in a manner that would lead a reasonable person to conclude that the individual alleged to be negligent was an employee or agent of the hospital. Mrs. Cortejo did not know any doctor at SJDH. Frost v. Mayo Clinic89 also allowed an orthopedic surgeon to testify against a neurologist in a medical malpractice action. Furthermore, SJDH claims that the CA erroneously applied the control test when it treated the hospital’s practice of accrediting consultants as an exercise of control. A: We changed the IV fluid because lactated ringers was necessary to resume the volume and to bring back the blood pressure, to increase the blood pressure. The doctor (or the hospital or the clinic) I went to did not have a license. This is a dental medical malpractice suit brought against a practitioner of general dentistry. After taking Edmer’s medical history, Dr. Livelo took his vital signs, body temperature, and blood pressure.6 Based on these initial examinations and the chest x-ray test that followed, Dr. Livelo diagnosed Edmer with "bronchopneumonia.7 " Edmer’s blood was also taken for testing, typing, and for purposes of administering antibiotics. A layman’s testimony is enough if he “would be able to say, as a matter of common knowledge and observation, that the consequences of professional treatment were not as such as would ordinarily have followed if due care had been exercised.” (Ramos v. Court of Appeals, G.R. G.R. 42 Basic Elements of the Legal System of Physician Liability for Negligent Patient Injury in the United States With Comparisons to England and Canada. Additional punitive damages may also be available in some cases. In sum, Dr. Casumpang failed to timely detect dengue fever, which failure, especially when reasonable prudence would have shown that indications of dengue were evident and/or foreseeable, constitutes negligence. (1)Respondeat superior; (2) Res ipsa loquitor and (3) Good Samaritan Law/ Rescue Doctrine. He claims that SJDH fell short of its duty of providing its patients with the necessary facilities and equipment as shown by the following circumstances: (a) SJDH was not equipped with proper paging system; (b) the number of its doctors is not proportionate to the number of patients; (c) SJDH was not equipped with a bronchoscope; (d) when Edmer’s oxygen was removed, the medical staff did not immediately provide him with portable oxygen; (e) when Edmer was about to be transferred to another hospital, SJDH’s was not ready and had no driver; and. While he noted some of these symptoms in confirming bronchopneumonia, he did not seem to have considered the patient’s other manifestations in ruling out dengue fever or dengue hemorrhagic fever.58 To our mind, Dr. Casumpang selectively appreciated some, and not all of the symptoms; worse, he casually ignored the pieces of information that could have been material in detecting dengue fever. 693, 709 (1999). Most courts allow a doctor to testify if they are satisfied of his familiarity with the standards of a specialty, though he may not practice the specialty himself. No. 5-6. In this case, before Dr. Sanga attended to Edmer, both Dr. Livelo and Dr. Casumpang had diagnosed Edmer with bronchopneumonia. and not the liability of doctors or the hospital. In sum, a hospital can be held vicariously liable for the negligent acts of a physician (or an independent contractor) providing care at the hospital if the plaintiff can prove these two factors: first, the hospital’s manifestations; and second, the patient’s reliance. (f) despite Edmer’s critical condition, there was no doctor attending to him from 5:30 p.m. of April 22, to 9:00 a.m. of April 23, 1988. Sources of proof of standard of care/116 9.7. of Apparent Authority, Despite the absence of employer-employee relationship between SJDH and the petitioning doctors, SJDH is not free from liability.98, As a rule, hospitals are not liable for the negligence of its independent contractors. At around 11:30 in the morning of April 23, 1988, Edmer vomited "phlegm with blood streak"15 prompting the respondent (Edmer’s father) to request for a doctor at the nurses’ station.16 Forty-five minutes later, Dr. Ruby Miranda-Sanga (Dr. Sanga), one of the resident physicians of SJDH, arrived. Nonetheless, both the lower courts found his knowledge acquired through study and practical experience sufficient to advance an expert opinion on dengue-related cases. Similarly, in Cereno v. Court of Appeals,86 a 2012 case involving medical negligence, the Court excluded the testimony of an expert witness whose specialty was anesthesiology, and concluded that an anesthesiologist cannot be considered an expert in the field of surgery or even in surgical practices and diagnosis. Q: What was the blood pressure of the patient? We affirm the hospital’s liability not on the basis of Article 2180 of the Civil Code, but on the basis of the doctrine of apparent authority or agency by estoppel. He has litigated and tried more than 200 personal injury and wrongful death cases, including medical malpractice, and auto accidents. No. Health care in the Philippines, overall, can be considered to be of good standard. Rather, they regularly employ, on a salaried basis, a large staff of physicians, interns, nurses, administrative and manual workers. In Pamperin, the court held that the important consideration in determining the patient’s reliance is: whether the plaintiff is seeking care from the hospital itself or whether the plaintiff is looking to the hospital merely as a place for his/her personal physician to provide medical care.105 Thus, this requirement is deemed satisfied if the plaintiff can prove that he/she relied upon the hospital to provide care and treatment, rather than upon a specific physician. Use FindLaw to hire a local medical malpractice lawyer near you to represent you in your medical malpractice dispute. 171228, pp. RUBY SANGA-MIRANDA, Petitioner, The claim for damages is based on the petitioning doctors’ negligence in diagnosing and treating the deceased Edmer, the child of the respondent. We also stress that Mrs. Cortejo’s use of health care plan (Fortune Care) did not affect SJDH’s liability. Over the last three decades Phil has obtained multiple settlements and jury verdicts in the areas of medical malpractice, commercial vehicle (18 wheeler), automobile accidents, premises liability, products liability, and police civil rights cases. Medical malpractice; negligence - G.R. No. 90 McLean v. Hunter, 495 So. As the respondent had pointed out, dengue fever, if left untreated, could be a life threatening disease. The selection and retention of competent physicians; the overseeing or supervision of all persons who practice medicine within its walls;3. It is sometimes characterized as an inquiry on whether the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care and prudence. We will help you get your life back on track. [Emphasis supplied], Although Dr. Casumpang presented the testimonies of Dr. Rodolfo Jagonap and Dr. Ellewelyn Pasion (Dr. Pasion), Personnel Officer and Medical Director of SJDH, respectively as well as the testimonies of Dr. Livelo and Dr. Reyes (the radiologist who read Edmer’s chest x-ray result), these witnesses failed to dispute the standard of action that Dr. Jaudian established in his expert opinion. Furthermore, Dr. Casumpang based his diagnosis largely on the chest x-ray result that is generally inconclusive.61, Significantly, it was only at around 5:00 in the afternoon of April 23, 1988 (after Edmer’s third episode of bleeding) that Dr. Casumpang ordered the conduct of hematocrit, hemoglobin, blood typing, blood transfusion and tourniquet tests. Edmer died at 4:00 in the morning of April 24, 1988.24 His Death Certificate indicated the cause of death as "Hypovolemic Shock/hemorrhagic shock;" "Dengue Hemorrhagic Fever Stage IV.". Q: How long did Dr. Casumpang stay in your son’s room? After the respondent had signed the waiver, Dr. Casumpang, for the last time, checked Edmer’s condition, found that his blood pressure was stable, and noted that he was "comfortable." A medical malpractice suit is an extremely complicated type of lawsuit. After all, the sole function of a medical expert witness, regardless of his/her specialty, is to afford assistance to the courts on medical matters, and to explain the medical facts in issue. Furthermore, medical literature on dengue shows that early diagnosis and management of dengue is critical in reducing the risk of complications and avoiding further spread of the virus.96 That Edmer later died of "Hypovolemic Shock/hemorrhagic shock," "Dengue Hemorrhagic Fever Stage IV," a severe and fatal form of dengue fever, established the causal link between Dr. Casumpang’s negligence and the injury. Damages/115 9.6. SJDH likewise faults the CA for ruling that the petitioning doctors are its agents, claiming that this theory, aside from being inconsistent with the CA’s finding of employment relationship, is unfounded because: first, the petitioning doctors are independent contractors, not agents of SJDH; and second, as a medical institution, SJDH cannot practice medicine, much more, extend its personality to physicians to practice medicine on its behalf. Surgical injury/\18 4. 50 Solidum v. People, G.R. A decade later, Centman v. Cobb,78 affirmed the Jenkins ruling and held that interns and first-year residents are "practitioners of medicine required to exercise the same standard of care applicable to physicians with unlimited licenses to practice." 88 538 So. L-25018, 28 SCRA 344, May 26, 1969, the Supreme Court held that in an administrative hearing against a medical practitioner for alleged malpractice, the Board of Medical Examiners cannot, consistently with the self-incrimination clause, compel the person proceeded against to take the witness stand without his consent. This connection must be direct, natural, and should be unbroken by any intervening efficient causes. vs. Medical malpractice suits fall into the genre of claims based on tort, called quasi-delicts. A: No action. SJDH moreover contends that even if the petitioning doctors are considered employees and not merely consultants of the hospital, SJDH cannot still be held solidarily liable under Article 2180 of the Civil Code because it observed the diligence of a good father of a family in their selection and supervision as shown by the following: (1) the adequate measures that the hospital undertakes to ascertain the petitioning doctors’ qualifications and medical competence; and (2) the documentary evidence that the petitioning doctors presented to prove their competence in the field of pediatrics.27. One court explained that "it is the scope of the witness’ knowledge and not the artificial classification by title that should govern the threshold question of admissibility. 20 In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil Code, which reads: Art. Medical Malpractice Both the State of Florida and the Federal Government have dedicated task forces for Heath Care Fraud. 1201 (1987). In fact, when she suspected – during Edmer’s second episode of bleeding– that Edmer could be suffering from dengue fever, she wasted no time in conducting the necessary tests, and promptly notified Dr. Casumpang about the incident. As the term is used, the suit is brought whenever a medical practitioner or health care provider fails to meet the standards demanded by his profession, or deviates from this standard, and causes injury to the patient. The CA likewise found Dr. Rodolfo Jaudian’s (Dr. Jaudian) testimony admissible. It claimed that based on Edmer's signs and symptoms at the time of admission (i.e., one day fever,28 bacterial infection,29 and lack of hemorrhagic manifestations30), there was no reasonable indication yet that he was suffering from dengue fever, and accordingly, their failure to diagnose dengue fever, does not constitute negligence on their part. 103 144 Wis. 2d 188, 207, 423 N.W. See also Añonuevo v. Court of Appeals, G.R. In that case, the Illinois Supreme Court held that under the doctrine of apparent authority, hospitals could be found vicariously liable for the negligence of an independent contractor: Therefore, we hold that, under the doctrine of apparent authority, a hospital can be held vicariously liable for the negligent acts of a physician providing care at the hospital, regardless of whether the physician is an independent contractor, unless the patient knows, or should have known, that the physician is an independent contractor. Interestingly in this case, Dr. Jaudian, the expert witness was admittedly not a pediatrician but a practicing physician who specializes in pathology.87 He likewise does not possess any formal residency training in pediatrics. She then advised the respondent to preserve the specimen for examination. A: At that time I did not do anything to determine the cause of coughing of the blood because I presumed that it was a mucous (sic) produced by broncho pneumonia, And besides the patient did not even show any signs of any other illness at that time.83. Hence, the survival of the patient is directly related to early and proper management of the illness.95. 221.)3. certifying that he was considered to be the Most Outstanding Resident Physician in the Department of Pediatrics; and iii. Furthermore, there was no reasonable indication in Ramos and Cereno that the expert witnesses possess a sufficient familiarity with the standard of care applicable to the physicians’ specialties. 5-6. Q: Now, in the first meeting you had, when that was relayed to you by the father that Edmer Cortejo had coughed out blood, what medical action did you take? CV No. What is Medical Malpractice? 130547, Oct. 3, 2000. This doctrine provides that once the surgeon enters the operating room and takes charge of the proceedings, the acts or omissions of operating room personnel, and any negligence associated with such acts or omissions, are imputable to the surgeon. As pointed out in Nogales, the hospital need not make express representations to the patient that the physician or independent contractor is an employee of the hospital; representation may be general and implied.102. What are considered practices of medicine? (Batiquin v. Court of Appeals, G.R. (Darwin P. Angeles, “A Framework of Philippine Medical Malpractice Law”, 85 PHIL. As stated above, there was no issue as to the proper execution of the neurosurgery. The CA found the petitioning doctors’ failure to read even the most basic signs of "dengue fever" expected of an ordinary doctor as medical negligence. 124354, April 11, 2002. Medical malpractice law governs the liability of doctors and other treatment providers when they cause harm to a patient by rendering their services in a negligent manner. Editor in Chief, Journal of the Integrated Bar of the Philippines. As in any fatal diseases, it requires immediate medical attention.93 With the correct and timely diagnosis, coupled with the proper medical management, dengue fever is not a life threatening disease and could easily be cured.94, Furthermore, as Dr. Jaudian testified, with adequate intensive care, the mortality rate of dengue fever should fall to less than 2%. 2d 901 (Fla. Dist. Sample Cases of Medical Malpractice/117 1. 171127). A: I also told Dr. Casumpang about his chest pain and also stomach pain. 30 SJDH substantiated its claim that there were no indications of dengue fever yet at the time of Edmer’s admission by claiming that the latter was not hemoconcentrated and did not have. 45641, Feb. 6, 1998. Editor in Chief, Journal of the Integrated Bar of the Philippines. 49 Cruz v. Court of Appeals, 346 Phil. (Citations omitted), In the case and the facts before us, we find that Dr. Jaudian is competent to testify on the standard of care in dengue fever cases.1avvphi1. Merriam-Webster’s Medical Dictionary, p. 648. Based on her statements we find that Dr. Sanga was not entirely faultless. "12 Dr. Casumpang next visited and examined Edmer at 9:00 in the morning the following day.13 Still suspicious about his son’s illness, Mrs. Cortejo again called Dr. Casumpang’s attention and stated that Edmer had a fever, throat irritation, as well as chest and stomach pain. 2d. However, in Bing v. Thunig, the New York Court of Appeals deviated from the Schloendorff doctrine, noting that modern hospitals actually do far more than provide facilities for treatment. He also pointed out that out of the seven resident physicians in the hospital, only two resident physicians were doing rounds at the time of his son’s confinement. (Nogales v. Capitol Medical Center, 511 SCRA 204, 230, December 19, 2006. Since the ICU was then full, Dr. Casumpang suggested to the respondent that they hire a private nurse. In Spouses Flores v. Spouses Pineda,63 a case involving a medical malpractice suit, the Court ruled that the petitioner doctors were negligent because they failed to immediately order tests to confirm the patient’s illness. 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. 192123, March 10, 2014. She was thereafter referred to Dr. Casumpang, who is also accredited with Fortune Care. Had he immediately conducted confirmatory tests, (i.e., tourniquet tests and series of blood tests)and promptly administered the proper care and management needed for dengue fever, the risk of complications or even death, could have been substantially reduced. C3-93-140, 1994 WL 1114 (Minn Ct App Jan. 4, 1994). Although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or that he has deviated from the standard medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed with because the injury itself provides the proof of negligence. Frank G. Feeley, Wendy K. Mariner, 4 February 2000, http://dcc2.bumc.bu.edu/RussianLegalHealthReform/ProjectDocuments/n740.IIG.Bkgd.pdf. 2-3; TSN, Ramoncito Livelo, February 16, 1993, pp. In Jenkins v. Clark,77 the Ohio Court of Appeals held that the applicable standard of care in medical malpractice cases involving first-year residents was that of a reasonably prudent physician and not that of interns. The primary objective of the practice of medicine is service to mankind irrespective of race, age, disease, disability, gender, sexual orientation, social standing, creed or political affiliation. We now discuss the liability of the hospital. 237428 (Republic of the Philippines, represented by Solicitor General Jose Calida v. It clearly informed the jury that the medical care required is that of reasonably careful physicians or hospital emergency room operators, not of interns or residents. Whether or not the petitioner hospital is solidarily liable with the petitioning doctors; 3. No. 20. Q: So how long did Dr. Casumpang stay and attended your son on April 23? Error is possible as the exercise of judgment is called for in considering and reading the exhibited symptoms, the results of tests, and in arriving at definitive conclusions. In that case, expert testimony showed that tests should have been ordered immediately on admission to the hospital in view of the symptoms presented. In order for a victim to recover compensation for the injuries that he has suffered because of medical malpractice, the plaintiff has the burden of establishing certain legal elements. (Sidaway v. 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