LEGAL MEDICINE

- A branch of medicine , which deals with the application of medical knowledge for the
purposes of law or simply put , medicine applied to legal cases!
Negligence is the failure to observe that degree of care, precaution and vigilance which the
circumstances, justly demand resulting in injury to another person.
MEDICAL MALPRACTICE
- Any act or failure to act by a member of the medical profession that results to harm,
injury, distress, prolonged physical or mental suffering or the termination of life to a
patient while that patient is under the care of that medical professional
Dr. Rubi Li vs Soliman
Medical malpractice or, more appropriately, medical negligence
- is that type of claim which a victim has available to him or her to redress a wrong
committed by a medical professional which has caused bodily harm
- a patient must prove that a health care provider, in most cases a physician, either failed
to do something which a reasonably prudent health care provider would have done, or
that he or she did something that a reasonably prudent provider would not have done;
and that that failure or action caused injury to the patient.
There are four essential elements a plaintiff must prove in a malpractice action based upon the
doctrine of informed consent:
(1) the physician had a duty to disclose material risks;
(2) he failed to disclose or inadequately disclosed those risks;
(3) as a direct and proximate result of the failure to disclose, the patient consented to treatment
she otherwise would not have consented to; and
(4) plaintiff was injured by the proposed treatment. The gravamen in an informed consent case
requires the plaintiff to point to significant undisclosed information relating to the treatment
which would have altered her decision to undergo it
RTC: the trial court declared that petitioner has taken the necessary precaution against the
adverse effect of chemotherapy on the patient, adding that a wrong decision is not by itself
negligence. Respondents were ordered to pay their unpaid hospital bill in the amount of
P139,064.43.
CA: Reversed. Held Rubi Li liable
SC: Reversed CA, RTC upheld.
PSI Inc vs Agana
RTC: Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice
Dr Fuentes: Absolved
Dr Ampil & PSI: Liable
* 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
* Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patient.

Elements:
- duty
- breach
- injury and
- proximate causation
Dr, Ampil, as the lead surgeon, had the duty to remove all foreign objects, such as gauzes, from
Natividads body before closure of the incision.
When he failed to do so, it was his duty to inform Natividad about it
That Dr. Ampils negligence is the proximate cause of Natividads injury could be traced from his
act of closing the incision despite the information given by the attending nurses that two pieces
of gauze were still missing
res ipsa loquitur
- "the thing speaks for itself."
- It is the rule that the fact of the occurrence of an injury, taken with the surrounding
circumstances, may permit an inference or raise a presumption of negligence, or make
out a plaintiffs prima facie case, and present a question of fact for defendant to meet
with an explanation.
Requisites
(1) the occurrence of an injury;
(2) the thing which caused the injury was under the control and management of the
defendant;
(3) 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
(4) the absence of explanation by the defendant. Of the foregoing requisites, the most
instrumental is the "control and management of the thing which caused the injury."
*** the element of "control and management of the thing which caused the injury" to be
wanting. Hence, the doctrine of res ipsa loquitur will not lie. Thus Dr. Fuentes is absolved
"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. Their duty is to obey his orders
- Dr. Ampil was the lead surgeon. In other words, he was the "Captain of the Ship."
- the control and management of the thing which caused the injury was in the hands of Dr.
Ampil, not Dr. Fuentes.
Liability of PSI
Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no preexisting contractual relation between the parties, is called a quasi-delict and is governed by the
provisions of this Chapter.
Vicarious liability under the doctrine of respondeat superior
ART. 2180. The obligation imposed by Article 2176 is demandable not only for ones
own acts or omissions, but also for those of persons for whom one is responsible.
Vicarious liability

The owners and managers of an establishment or enterprise are likewise responsible for
damages caused by their employees in the service of the branches in which the latter
are employed or on the occasion of their functions. Employers shall be liable for the
damages caused by their employees and household helpers acting within the scope of
their assigned tasks even though the former are not engaged in any business or
industry.
The responsibility treated of in this article shall cease when the persons herein
mentioned prove that they observed all the diligence of a good father of a family to
prevent damage.

Hospitals exercise significant control in the hiring and firing of consultants and in the conduct
of their work within the hospital premises. Doctors who apply for consultant slots, visiting or
attending, are required to submit proof of completion of residency, their educational
qualifications, generally, evidence of accreditation by the appropriate board (diplomate),
evidence of fellowship in most cases, and references. These requirements are carefully
scrutinized by members of the hospital administration or by a review committee set up by
the hospital who either accept or reject the application
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting consultant staff. While consultants are not, technically employees, the control
exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment of wages. In
assessing whether such a relationship in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating
responsibility in medical negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting physicians.
Basis of PSIs Liability
- principle of apparent authority or agency by estoppel
- the doctrine of corporate negligence which have gained acceptance in the determination
of a hospitals liability for negligent acts of health professionals.
Apparent authority/ "holding out" theory/ doctrine of ostensible agency/ agency by estoppel
- "The principal is bound by the acts of his agent with the apparent authority which he
knowingly permits the agent to assume, or which he holds the agent out to the public as
possessing. The question in every case is whether the principal has by his voluntary act
placed the agent in such a situation that a person of ordinary prudence, conversant with
business usages and the nature of the particular business, is justified in presuming that
such agent has authority to perform the particular act in question.
In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and
specializations of the physicians associated or accredited by it, including those of Dr. Ampil and
Dr. Fuentes. We concur with the Court of Appeals conclusion that it "is now estopped from
passing all the blame to the physicians whose names it proudly paraded in the public directory
leading the public to believe that it vouched for their skill and competence." Indeed, PSIs act is
tantamount to holding out to the public that Medical City Hospital, through its accredited
physicians, offers quality health care services. By accrediting Dr. Ampil and Dr. Fuentes and

publicly advertising their qualifications, the hospital created the impression that they were its
agents, authorized to perform medical or surgical services for its patients. As expected, these
patients, Natividad being one of them, accepted the services on the reasonable belief that such
were being rendered by the hospital or its employees, agents, or servants.
Doctrine of corporate negligence or corporate responsibility
- for negligence and malpractice is that PSI as owner, operator and manager of Medical
City Hospital, "did not perform the necessary supervision nor exercise diligent efforts in
the supervision of Drs. Ampil and Fuentes and its nursing staff, resident doctors, and
medical interns who assisted Drs. Ampil and Fuentes in the performance of their duties
as surgeons."
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of
the Medical City Hospitals staff, composed of resident doctors, nurses, and interns. As such, it
is reasonable to conclude that PSI, as the operator of the hospital, has actual or constructive
knowledge of the procedures carried out, particularly the report of the attending nurses that the
two pieces of gauze were missing.
Dr. Nineveth Cruz vs Umali
Medical malpractice suit
- 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
MTC: Dr Cruz liable charged of crime reckless imprudence, Dr Encillo not liable
RTC: Affirmed MTC decision
"incompetency,negligence and lack of foresight and skill of appellant (herein petitioner) in
handling the subject patient before and after
the operation."
The elements of reckless imprudence are:
(1) that the offender does or fails to do an act;
(2) that the doing or the failure to do that act is voluntary;
(3) that it be without malice;
(4) that material damage results from the reckless imprudence
(5) that there is 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
SC: Cruz not guilty of reckless imprudence but civilly liable
- a conviction of a crime requires proof beyond reasonable doubt, only a preponderance
of evidence is required to establish civil liability
Spouses Flores v Spouses Pineda
RTC: Dr Flores liable for damages
CA: Affirmed RTC decision
SC: Affirmed CA decision

A medical negligence case is a type of claim to redress a wrong committed by a medical

professional, that has caused bodily harm to or the death of a patient.
There are four elements
1. duty - refers to the standard of behavior which imposes restrictions on one's conduct. A
physician is expected to use at least the same level of care that any other reasonably
competent doctor would use under the same circumstances.
2. Breach - the physician fails to comply with these professional standards. If injury results
to the patient as a result of this breach, the physician is answerable for negligence
3. injury and proximate causation.
One must prove;
1. the physician 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
2. the failure or action caused injury to the patient.
Solidum vs People
RTC & CA: Dr Solidum pronounced guilty of reckless imprudence resulting in serious physical
injuries.
- by failing to monitor and regulate properly the levels of anesthesia administered to said
GERALD ALBERT GERCAYO and using 100% halothane and other anesthetic medications,
causing as a consequence of his said carelessness and negligence, said GERALD ALBERT
GERCAYO suffered a cardiac arrest and consequently a defect called hypoxic encephalopathy
meaning insufficient oxygen supply in the brain, thereby rendering said GERALD ALBERT
GERCAYO incapable of moving his body, seeing, speaking or hearing, to his damage and
prejudice
SC: Reversed CAs decision and aquits Dr. Solidum
Applicability of the Doctrine of Res Ipsa Loquitur
- "where the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not happen
if those who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from want of
care."
- It is generally restricted to situations in malpractice cases where a layman is able to say,
as a matter of common knowledge and observation, that the consequences of
professional care were not as such as would ordinarily have followed if due care had
been exercised.
- The Court considers the application here of the doctrine of res ipsa loquitur
inappropriate
- Although it should be conceded without difficulty that the second and third elements
were present, considering that the anesthetic agent and the instruments were
exclusively within the control of Dr. Solidum, and that the patient, being then
unconscious during the operation, could not have been guilty of contributory negligence,
the first element was undeniably wanting.

Cayao-Lasam v Spouses Claro

RTC
CA
SC: The Decision of the Board of Medicine dated March 4, 1999 exonerating petitioner is
AFFIRMED
the principle of double jeopardy finds no application in administrative cases

Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause of his
injury, he cannot recover damages. But if his negligence was only contributory, the immediate
and proximate cause of the injury being the defendants lack of due care, the plaintiff may
recover damages, but the courts shall mitigate the damages to be awarded.
Contributory negligence
- is the act or omission amounting to want of ordinary care on the part of the person
injured, which,concurring with the defendants negligence, is the proximate cause of the
injury.
Again, based on the evidence presented in the present case under review, in which
no negligence can be attributed to the petitioner, the immediate cause of the accident resulting
in Edithas injury was her own omission when she did not return for a follow-up check up, in
defiance of petitioners orders. The immediate cause of Edithas injury was her own act; thus,
she cannot recover damages from the injury.

Nogales vs Capitol Med & Dr. Estrada

RTC: Dr Estrada liable for damages for death of respondent Nogales
CA: Affirmed RTC decision
SC: Held Estrada & Capitol Med as liable for damages
In general, a hospital is not liable for the negligence of an independent contractor-physician.
Exception:
The hospital may be liable if the physician is the "ostensible" agent of the hospital. Or also
known as the "doctrine of apparent authority."
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.
The elements of the action have been set out as follows:
(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to
conclude that the individual who was alleged to be negligent was an employee or agent
of the hospital;

(2) where the acts of the agent create the appearance of authority, the plaintiff must also
prove that the hospital had knowledge of and acquiesced in them; and
(3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence."
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical staff.
Through CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the
Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. CMC cannot
now repudiate such authority.

Dr. Cantre v Spouses Go, De Los Santos Med

RTC: Dr canter is liable for damages
CA: Affirm
SC: Affirm CA Decision
ART. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done.
ART. 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury.
Though incapable of pecuniary computation, moral damages may be recovered if they are the
proximate result of the defendants wrongful act or omission.
Ramos vs CA, Delos Santos
RTC: Respondents are liable for negligence
CA: Reversed decision of RTC
SC: Held both respondents liable and modify damages awarded
We find the doctrine of res ipsa loquitur appropriate in the case at bar. As will hereinafter be
explained, the damage sustained by Erlinda in her brain prior to a scheduled gall bladder
operation presents a case for the application of res ipsa loquitur.
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for his
own acts but also for those of others based on the former's responsibility under a relationship of
patria potestas. Such responsibility ceases when the persons or entity concerned prove that
they have observed the diligence of a good father of the family to prevent damage.
In the instant case, respondent hospital, apart from a general denial of its responsibility over
respondent physicians, failed to adduce evidence showing that it exercised the diligence of a
good father of a family in the hiring and supervision of the latter. It failed to adduce evidence
with regard to the degree of supervision which it exercised over its physicians. In neglecting to
offer such proof, or proof of a similar nature, respondent hospital thereby failed to discharge its
burden under the last paragraph of Article 2180. Having failed to do this, respondent hospital is
consequently solidarily responsible with its physicians for Erlinda's condition

Dr, Jarcia v People

RTC: Accused found guilty beyond reasonable doubt
CA: Affirmed
SC: Reversed CA and RTC decision
The Court believes that accused are negligent when both failed to exercise the necessary and
reasonable prudence in ascertaining the extent of injury of Alfonso Santiago
Simple imprudence consists in the lack of precaution displayed in those cases in which the
damage impending to be caused is not the immediate nor the danger clearly manifest. The
elements of simple imprudence are as follows.
1. that there is lack of precaution on the part of the offender; and
2. that the damage impending to be caused is not immediate of the danger is not clearly
manifest.
3.