MEDICAL NEGLIGENCE AND MEDICAL

MALPRACTICE DIFFERENTIATED

TABLE OF CONTENTS
What is Legal Medicine?
History of Legal Medicine
Application of Legal Medicine to LAW
What is Forensic Medicine?
What is Medical Jurisprudence?
What are the Acts which constitute Medical Practice?
What are the Rights inherent in the practice of Medicine?
What is the difference between Medical Negligence and Medical Malpractice?
Doctrine of Proximate Cause
What is the Degree of Care needed to be applied by Physicians?
Doctrine of Res Ipsa Loquitur
- Case of Cantre V. Sps. Go
Doctrine of Contributory Negligence
Liabilities of Hospitals
-Doctrine of Apparent Authority
- Doctrine of Corporate Responsibility
- Doctrine of respondent Superior
What are the Liabilities of a Physician Which May Arise from His Negligent or
Wrongful Acts or Omissions

WHAT IS LEGAL MEDICINE?

LEGAL MEDICINE
-is the branch of medicine that applies medical and surgical concepts, scientific
knowledge, and skills to medico legal issues, in order to assist the trier of facts in the proper
dispensation of justice.

- a branch of medicine which deals with the application of medical knowledge to the
purposes of law and in the administration of justice.

HISTORY OF LEGAL MEDICINE

Paulus Zacchias (1584 1659) is the Father of
Forensic Medicine; an Italian practical
physician, teacher of medical science, mediolegal jurist, philosopher, and poet. His most
well known book is Quaestiones medicolegales (written in 1557).
He was the first to describe the importance and application
of medicine to the proper administration of justice.
-He is said to have occupied the position as
personal physician for Pope Innocentius X.
Zacchias was also an adviser for the
Rota Romana, the highest Papal court of appeals.

HISTORY OF LEGAL MEDICINE

*I n t h e P h i l . , t h e f a t h e r o f L e g a l
bestowed to Dr. Pedro P. Solis.

Medicine can be rightfully

The late Dr. Pedro P. Solis completed his elementary education at Julugan Elementary School,
secondary education at the University of the Philippines (U.P.) High School and Associate in Arts in
U.P.. Dr. Pedro Solis finished Medicine at the U.P. College of Medicine and Law at the Manila Law
College. His graduate degree in Criminology was obtained from Cambridge University in England.
For forty-four years Dr. Solis served the government initially as medico-legal officer, eventually
becoming the National Bureau of Investigation's Deputy Director for Technical Services.
He taught in various institutions such as the Colleges of Law, Medicine and Public Health of the
University of the PHilippines, Manila Law College, Philippine College of Criminology, the medical
colleges of Far Eastern University (FEU), University of the East (U.E.), Manila Central University
(M.C.U.) and the colleges of Law of Lyceum and San Sebastian.
Dr. Solis wrote textbooks in Legal Medicine, Medical Jurisprudence and Criminal Investigation,
which are still widely used at present. He represented the country in various international
organizations and committees in the fields of law, medicine and criminology.

APPLICATION OF LEGAL
MEDICINE TO LAW
Legal Medicine is applied to Law
1. CIVIL LAW- the determination and termination of civil personality
- the limitation or restriction of a natural persons capacity to act
- marriage and legal separation
- testamentary capacity of a person making a will
- paternity and filiation
- the right to hereditary succession
2. CRIMINAL LAW-Felonies and circumstances which affect criminal liability
-Civil liability ex delictu
-Crimes relative to opium and prohibited drugs
-Crimes against civil status of persons
-Crimes against chastity
-Crimes against persons
-Quasi offenses
3. REMEDIAL LAW-Physical and Mental Examination of a person
-Hospitalization of insane persons
-Rules of Evidence

APPLICATION OF LEGAL
MEDICINE TO LAW
4. SPECIAL LAWS- Dangerous Drug Act
- Youth and Child Welfare Code
- Insurance law
- Sanitation Code
- Employees Compensation Law
- Labor Code

5. CORPUS DELICTI
- is the body or substance of the crime and is defined
as the fact that a
crime actually has been committed.
In all criminal prosecutions, the
burden is on the
prosecution to prove the corpus delicti.

WHAT IS FORENSIC MEDICINE?

FORENSIC MEDICINE is the practice of medicine as it pertains to the Law. It involves areas
like determining the nature and cause of death, medical negligence and identification of human
remains. It can include medical examination of suspects and victims in support of the investigation
of crime such as medical examination of the victims of rape, for the purpose of determining the
nature and extent of any injuries and the taking of samples, fitness of suspects to be interviewed
where it may be in doubt for medical reasons, and determining whether a person is acting under the
influence of drugs.
There are various branches within the field of forensic medicine including Forensic pathology that
is concerned primarily with establishing the nature and cause of suspicious death.
Forensic Odontology is the application of dentistry to legal matters. Amongst other tasks the
Forensic Odontologists can identify individuals using their dentition and through bite marks.
Forensic Radiography is the application of science of diagnostic imaging to questions of law.
Forensic Radiography can be used to identify the individual, identify the cause of the injury or
death and to identify evidential material.a

WHAT IS MEDICAL JURISPRUDENCE?

Medical Jurisprudence-is the study of the Medical Law and its

applicable Jurisprudence that governs, regulates and defines
the practice of medicine.
-It includes the rights, duties, obligations and liabilities of both
physician and patient to each other in a physician patient
professional contract.
In the Philippines, Legal Medicine is the appropriate name for
Forensic Medicine.

WHAT ARE THE ACTS WHICH

CONSTITUTE MEDICAL PRACTICE?

The following acts constitute the Practice of

Medicine:
1. To physically examine and diagnose a patient.
2. To physically examine and treat a patient
3. To physically examine and perform surgery in a
patient
4. To physically examine and prescribe any remedy
to a patient.

WHAT ARE THE RIGHTS INHERENT

IN THE PRACTICE OF MEDICINE?

Rights inherent in the Practice of Medicine:

1. The right to choose his patients
2. The right to limit the practice of his profession
3. The right to determine appropriate treatment procedures
in the discretion and judgment of the physician.
4. The right to avail of hospital privileges after being
qualified.
5. The right to receive just and fair compensation from his
patients.

WHAT IS THE DIFFERENCE BETWEEN

MEDICAL NEGLIGENCE AND MEDICAL
MALPRACTICE?
MEDICAL MALPRACTICE general
term used when a medical
practitioner (Doctor) or an allied
medical practitioner (Dentist,
Nurse, Medical Technologist)
KNOWINGLY DEVIATES from the
standard practice of medicine

Common complaints about doctors

who commit MALPRACTICE include:
Error in anesthesia
Mistake during childbirth
Surgical errors
Unnecessary surgery
Wrongful death
Wrong diagnosis or misdiagnosis

MEDICAL NEGLIGENCE
specific term used when a
medical practioner does not
exercise due diligence and
standard care required of him
thus resulting to injury to the
patient. Usually connotes
accidental
or NEGLIGENCE
unintentional
Examples
of MEDICAL
include:
injury.
Failure to revise a diagnosis
Failure to warn patients of the risks of
treatment
Failure to remove surgical instruments from
the patient during surgery
Failure to attend to or treat a patient
Incompetence
Failure to refer a patient to a specialist
relevant to their disease or injury
Wrongful diagnosis

DOCTRINE OF PROXIMATE CAUSE

That cause, which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces the
injury, and without which the result would not have
occurred.
a legal concept of "cause-and-effect" relationships
determines whether an injury would have resulted from a
particular cause.
In Malpractice - An element required to prove
negligence; i.e., the plaintiffPatient or Patient's estate
must prove that the Patient's injury is reasonably
connected to the physician's action.

WHAT IS THE DEGREE OF CARE

NEEDED TO BE APPLIED BY
PHYSICIANS?

Standard of care required is more than just ordinary care and diligence
but a HIGHER degree of care expected from an average physician or
general practitioner.
Source: Solis MEDICAL JURISPRUDENCE 1988

DOCTRINE OF RES IPSA

LOQUITUR
-Literally means: the thing speaks for itself.
-Originated in the English Jurisprudence of Byrne V.
Boadle (1853 Case)
-If one eventuality happens unusually or not occasionally,
NEGLIGENCE is presumed if one has control over things.
-Its function is to aid the plaintiff in proving the elements
of negligence by circumstancial evidence.
-The doctrine can only be invoked when and only when,
under the circumstances, involved, direct evidence is
absent and not readily available.

DOCTRINE OF RES IPSA

LOQUITUR
-Literally means: the thing speaks for itself.
-Originated in the English Jurisprudence of Byrne V.
Boadle (1853 Case)
-If one eventuality happens unusually or not occasionally,
NEGLIGENCE is presumed if one has control over things.
-Its function is to aid the plaintiff in proving the elements
of negligence by circumstancial evidence.
-The doctrine can only be invoked when and only when,
under the circumstances, involved, direct evidence is
absent and not readily available.

DOCTRINE OF RES IPSA

LOQUITUR

Medical malpractice can be established

by the doctrine of res ipsa liquitur. It is
applicable to cases where the court,
from its fund of knowledge, can
determine the standard of care or where
an ordinary layman can conclude that
there was negligence on the part of the
doctor.

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
Facts: Petitioner Dr. Milagros
L. Cantre is a specialist in
Obstetrics and Gynecology
at the Dr. Jesus Delgado
Memorial Hospital. She was
the attending physician of
respondent Nora S. Go, who
was admitted at the said
hospital on April 19, 1992.
Nora Go delivered a baby
boy by normal vaginal
delivery, with Dr. Cantre in
attendance. After the
delivery, Nora had massive
Because
of profuse bleeding, patient went into hypovolemic
vaginal bleeding.
shock.

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
The BP dropped to 0/0.
Dr. Cantre was able to stabilize the patient.
She ordered a drop light to be placed near
the patient and her blood pressure
monitored.

However, a gaping wound was caused by

the blood pressure cuff that was used to
monitor the patients blood pressure.

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
ISSUES:

Is petitioner liable for the injury suffered by respondent

Nora Go?
Injury gaping wound in the arm where the BP cuff was
placed.
Cause - either the BP cuff or the drop light which was placed
too near the arm of the patient

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
RULING:
The Hippocratic Oath mandates physicians to give
primordial consideration to the well-being of their
patients. If a doctor fails to live up to this precept, he
is accountable for his acts. This notwithstanding,
courts face a unique restraint in adjudicating medical
negligence cases because physicians are not
guarantors of care and, they never set out to
intentionally cause injury to their patients. However,
intent is immaterial in negligence cases because
where negligence exists and is proven, it
automatically gives the injured a right to reparation
for the damage caused.

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007

In cases involving medical negligence, the doctrine ofres ipsa loquitur allows
the mere existence of an injury to justify a presumption of negligence on
the part of the person who controls the instrument causing the injury,
PROVIDED THAT THE FOLLOWING REQUISITES CONCUR:

1. The accident is of a kind which ordinarily does not

occur in the absence of someone's negligence;
2. It is caused by an instrumentality within the
exclusive control of the defendant or defendants; and
3. The possibility of contributing conduct which would
make the plaintiff responsible is eliminated.

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
As to the first requirement, the gaping wound on Nora's arm is
certainly not an ordinary occurrence in the act of delivering a
baby, far removed as the arm is from the organs involved in the
process of giving birth. Such injury could not have happened
unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by
the blood pressure cuff is of no moment. Both instruments are
deemed within the exclusive control of the physician in charge
under the CAPTAIN OF THE SHIP" doctrine. -This doctrine holds
the surgeon in charge of an operation liable for the negligence
of his assistants during the time when those assistants are
under the surgeon's control.
In this particular case, it can be logically inferred that
petitioner, the senior consultant in charge during the delivery
of Nora's baby, exercised control over the assistants assigned
to both the use of the droplight and the taking of Nora's blood

CASE STUDY: CANTRE VS SPS GO,

G.R. NO. 160889, APRIL 27, 2007
Third, the gaping wound on Nora's left arm, by its very
nature and considering her condition, could only be
caused by something external to her and outside her
control as she was unconscious while in hypovolemic
shock. Hence, Nora could not, by any stretch of the
imagination, have contributed to her own injury.
NO CONTRIBUTORY NEGLIGENCE ON THE PART OF THE
PATIENT

DOCTRINE OF CONTRIBUTORY
NEGLIGENCE
Doctrine of Common Fault.
It is the conduct on the part of the plaintiff,
contributing as a legal cause to the harm he has
suffered, which falls below the standard to which he is
required to conform for his own protection.

Legal Basis
Article 2179, Civil Code:

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 court shall mitigate the damages to be
awarded.
Article 2214, Civil Code

In quasi-delicts, the contributory negligence of the

plaintiff shall reduce the damages that he may recover.

LIABILITIES OF HOSPITALS
The hospitals liability is also anchored upon the following
doctrines:

agency PRINCIPLE OF APPARENT AUTHORITY or

agency by estoppel
DOCTRINE OF CORPORATE
NEGLIGENCE/CORPORATE RESPONSIBILITY
which have gained acceptance in the determination of a
hospitals liability for negligent acts of professionals because of
the actions for a principal or an employer .

DOCTRINE OF APPARENT
AUTHORITY
Where it is shown that a hospital, by its actions, has held out a
particular physician as its agent and/or employee and that a
patient has accepted treatment from that physician in the
reasonable belief that it is being rendered in behalf of the
hospital, the hospital will be liable for physicians negligence.
(Professional Services, Inc. v Agana, G.R. No. 126297, January
31, 2006)

DOCTRINE OF CORPORATE
RESPONSIBILITY
A hospital has the duty to see that it meets the
standards of responsibilities for the care of
patients. Such duty includes the proper
supervison of the members of its medical staff.
If a hospital breached its duties to oversee or
supervise all persons practicing medicine within
its walls and also failed to take an active step in
fixing the negligence committed, it will be
vicariously liable for the negligence of the doctor
under Art. 2180, and directly liable for its own
negligence under Art. 2176.
(Professional Services, Inc. v Agana, G.R. No.
126297, January 31, 2006)

DOCTRINE OF RESPONDENT
SUPERIOR
A hospital has the duty to see that it meets the
standards of responsibilities for the care of
patients.
Such duty includes the proper
supervison of the members of its medical staff.
If a hospital breached its duties to oversee or
supervise all persons practicing medicine
within its walls and also failed to take an active
step in fixing the negligence committed, it will
be vicariously liable for the negligence of the
doctor under Art. 2180, and directly liable for
its own negligence under Art. 2176.

LIABILITIES OF A PHYSICIAN WHICH MAY

ARISE FROM HIS NEGLIGENT OR WRONGFUL
ACTS OR OMISSIONS
Liabilities of a Physician Which May Arise from His Negligent or
Wrongful Acts or Omissions:
1. ADMINISTRATIVE LIABILITY- A complaint under oath can be filed
before the Professional RegulationCommission Board of Medicine, for
reprimand, of the license to practice medicine.
2. CRIMINAL LIABILITY- When an act or omission constitutes a crime,
the physician can be imprisoned or fined or both, as any other profession.
3. CIVIL LIABILITY- The aggrieved party can be awarded
monetary damages for any wrongful or
negligent act or omission, when the professional is found guilty.

Questions/Tips/Trivia?