1. DR.

RUBI LI v SPOUSES REYNALDO and LINA SOLIMAN as parents/heirs of

deceased Angelica Soliman

Facts:
Respondents’ 11-year old daughter, Angelica Soliman, underwent a biopsy of the mass
located in her lower extremity at the St. Luke’s Medical Center (SLMC). Results showed
that Angelica was suffering from osteosarcoma, osteoblastic type, a high-grade (highly
malignant) cancer of the bone which usually afflicts teenage children. Following this
diagnosis and as primary intervention, Angelicas right leg was amputated by Dr. Jaime
Tamayo in order to remove the tumor. As adjuvant treatment to eliminate any remaining
cancer cells, and hence minimize the chances of recurrence and prevent the disease from
spreading to other parts of the patients body (metastasis), chemotherapy was suggested
by Dr. Tamayo. Dr. Tamayo referred Angelica to another doctor at SLMC, herein
petitioner Dr. Rubi Li, a medical oncologist.

On August 18, 1993, Angelica was admitted to SLMC. However, she died on September
1, 1993, just eleven (11) days after the (intravenous) administration of the first cycle of
the chemotherapy regimen. Because SLMC refused to release a death certificate without
full payment of their hospital bill, respondents brought the cadaver of Angelica to the
Philippine National Police (PNP) Crime Laboratory at Camp Crame for post-mortem
examination. The Medico-Legal Report issued by said institution indicated the cause of
death as Hypovolemic shock secondary to multiple organ hemorrhages and
Disseminated Intravascular Coagulation. On the other hand, the Certificate of Death
issued by SLMC stated the cause of death as follows:

Immediate cause: a. Osteosarcoma, Status Post AKA Antecedent cause : b. (above knee
amputation) Underlying cause : c. Status Post Chemotherapy

On February 21, 1994, respondents filed a damage suit.

Issue:
Whether or not the Doctors were negligent in handling of their patient?

Held: No
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.

Examining the evidence on record, we hold that there was adequate disclosure of material
risks inherent in the chemotherapy procedure performed with the consent of Angelicas
parents. Respondents could not have been unaware in the course of initial treatment and
amputation of Angelicas lower extremity, that her immune system was already weak on
account of the malignant tumor in her knee. When petitioner informed the respondents
beforehand of the side effects of chemotherapy which includes lowered counts of white
and red blood cells, decrease in blood platelets, possible kidney or heart damage and
skin darkening, there is reasonable expectation on the part of the doctor that the
respondents understood very well that the severity of these side effects will not be the
same for all patients undergoing the procedure. In other words, by the nature of the
disease itself, each patient’s reaction to the chemical agents even with pre-treatment
laboratory tests cannot be precisely determined by the physician. That death can possibly
result from complications of the treatment or the underlying cancer itself, immediately or
sometime after the administration of chemotherapy drugs, is a risk that cannot be ruled
out, as with most other major medical procedures, but such conclusion can be reasonably
drawn from the general side effects of chemotherapy already disclosed.

As a physician, petitioner can reasonably expect the respondents to have considered the
variables in the recommended treatment for their daughter afflicted with a life- threatening
illness. On the other hand, it is difficult to give credence to respondents claim that
petitioner told them of 95% chance of recovery for their daughter, as it was unlikely for
doctors like petitioner who were dealing with grave conditions such as cancer to have
falsely assured patients of chemotherapy’s success rate. Besides, informed consent laws
in other countries generally require only a reasonable explanation of potential harms, so
specific disclosures such as statistical data, may not be legally necessary.

The element of ethical duty to disclose material risks in the proposed medical treatment
cannot thus be reduced to one simplistic formula applicable in all instances. Further, in a
medical malpractice action based on lack of informed consent, the plaintiff must prove
both the duty and the breach of that duty through expert testimony. Such expert testimony
must show the customary standard of care of physicians in the same practice as that of
the defendant doctor.

2. Alano v. Logmao

Facts:
Arnelito Logmao was brought to the East Avenue Medical Center (EAMC) by two sidewalk
vendors, who allegedly saw the former fall from the overpass near the Farmers’ Market
in Cubao, Quezon City. The patient’s data sheet identified the patient as Angelito
Lugmoso of Boni Avenue, Mandaluyong. However, the clinical abstract prepared by Dr.
Paterno F. Cabrera, the surgical resident on-duty at the Emergency Room of EAMC,
stated that the patient is Angelito [Logmao].

At the National Kidney Institute, the name Angelito [Logmao] was recorded as Angelito
Lugmoso. Lugmoso was immediately attended to and given the necessary medical
treatment. As Lugmoso had no relatives around, Jennifer B. Misa, Transplant
Coordinator, was asked to locate his family by enlisting police and media assistance. Dr.
Enrique T. Ona, Chairman of the Department of Surgery, observed that the severity of
the brain injury of Lugmoso manifested symptoms of brain death. He requested the
Laboratory Section to conduct a tissue typing and tissue cross-matching examination, so
that should Lugmoso expire he would be found to be a suitable organ donor and his family
would consent to organ donation, the organs thus donated could be detached and
transplanted promptly to any compatible beneficiary.

On March 3, 1988, at about 7:00 o’clock in the morning, Dr. Ona was informed that
Lugmoso had been pronounced brain dead. Two hours later, Dr. Ona was informed that
the electroencephalogram recording exhibited a flat tracing, thereby confirming that
Lugmoso was brain dead. The medical team then transplanted the kidneys and pancreas.
It appears that on the same day, Arlen Logmao, a brother of Arnelito, who was then a
resident of 17-C San Pedro Street, Mandaluyong, reported to Police Station No. 5,
Eastern Police District, Mandaluyong that the latter did not return home after seeing a
movie in Cubao, Quezon City, as evidenced by a Certification issued by said Station; and
that the relatives of Arnelito were likewise informed that the latter was missing. Upon
receiving the news from Aida, plaintiff and her other children went to La Funeraria Oro,
where they saw Arnelito inside a cheap casket. Plaintiff filed with the court a quo a
complaint for damages

Issue: Whether or not the respondent's sufferings were brought about by petitioner's
alleged negligence in granting authorization for the removal or retrieval of the internal
organs of respondent's son who had been declared brain dead.

Held: NO

The memorandum issued by petitioner showed the following statements:

“Please make certain that your Department has exerted all reasonable efforts to locate
the relatives or next-of-kin of the said deceased patient, such as appeal through the radios
and television, as well as through police and other government agencies and that the NBI
[Medico-Legal] Section has been notified and is aware of the case.”

“If all the above has been complied with, in accordance with the provisions of Republic
Act No. 349 as amended and P.D. 856, permission and/or authority is hereby given to the
Department of Surgery to retrieve and remove the kidneys, pancreas, liver and heart of
the said deceased patient and to transplant the said organs to any compatible patient
who maybe in need of said organs to live and survive.”

A careful reading of the above shows that petitioner instructed his subordinates to "make
certain" that "all reasonable efforts" are exerted to locate the patient's next of kin, even
enumerating ways in which to ensure that notices of the death of the patient would reach
said relatives. It also clearly stated that permission or authorization to retrieve and remove
the internal organs of the deceased was being given ONLY IF the provisions of the
applicable law had been complied with. Such instructions reveal that petitioner acted
prudently by directing his subordinates to exhaust all reasonable means of locating the
relatives of the deceased. He could not have made his directives any clearer. He even
specifically mentioned that permission is only being granted IF the Department of Surgery
has complied with all the requirements of the law.

The only question that remains pertains to the sufficiency of time allowed for notices to
reach the relatives of the deceased.

If respondent failed to immediately receive notice of her son's death because the notices
did not properly state the name or identity of the deceased, fault cannot be laid at
petitioner's door.

The NKI could not have obtained the information about his name from the patient,
because as found by the lower courts, the deceased was already unconscious by the time
he was brought to the NKI.

Lastly, respondents failed to present any expert witness to prove that given the medical
technology and knowledge at that time in the 1980's, the doctors could or should have
waited longer before harvesting the internal organs for transplantation.