MEDICAL JURISPRUDENCE
2021 Medical Board Review
Atty. Antonio D. Rebosa, M.D., FCLM, DABLM
___________________________________________________________________________
LEGAL MEDICINE … application of medical knowledge to the purposes of law and in the
administration of justice
MEDICAL JURISPRUDENCE … knowledge of law in relation to the practice of medicine.
Branch of law that deals with the licensure and regulation for the practice of medicine.
It covers all laws, legal doctrines and principles, and decisions of the Supreme Court
regarding regulation of the practice of medicine.
It emphasizes the legal and ethical duties and obligations of the physician to his patients,
colleagues, community, paramedical professionals and pharmaceutical companies.
Liabilities of physicians for non-compliance with the law.
PHYSICIAN-PATIENT RELATIONSHIP
CONTRACT
• consensual and fiduciary
• subject matter
• cause or consideration
TThe practice of the medicine is not a right but only a privilege bestowed by the State. The
conferment of such privilege is by virtue of the police power of the state.
The basic medical law that regulates the practice of medicine is the Medical Act of 1959
(Republic Act No. 2382) enacted in 1959. The Medical Act of 1959, as amended, governs the
regulation of medical education, licensing and the practice of medicine by physicians in the
country.
Basic Sources of Law
1.
Constitution
2.
Laws enacted by the legislative body (House of Representatives, Senate)
3. Decrees, Orders, Proclamation, Letters, Commonwealth Acts, Batas Pambansa, Presidential
Decrees issued during the Marcos era, Executive Orders issued by President Aquino before the
1987 Constitution and Republic Acts
4. Administrative Acts, Orders, Rules and Regulations (PRC, DOH, PhilHealth)
5.
Generally accepted principles of International law
6.
Supreme Court Decisions (Legal Doctrines and Jurisprudence)
The Philippine Court
The Philippine Court is an adversarial trial system.
There is presentation of contrasting versions of facts and legal theories during trial.
Each party is given equal opportunity to investigate the case, gather and present all
evidence that his contention is correct
Professional Regulations Commission (PRC)
Three-man commission attached to the Office of the President.
Its main function is to provide general supervision and regulation of all professions requiring
licensure examinations, including the medical profession.
Just to note, lawyers are under the supervision and regulation of the Supreme Court and are
mandated to be members of the Integrated Bar of the Philippines (IBP)
BOARD OF MEDICINE
Composition:
Six members appointed by the President from a list submitted by the Philippine Medical
Association.
Qualifications:
1.Natural-born citizen
2.Duly-registered physician
3.In the practice of medicine for at least 10 years
4.Of good moral character and of recognized standing in the medical profession as certified
by PMA
5.Not a member of any faculty of any medical school (including any pecuniary interest in
any medical school).
Commission on Higher Education
(CHED)
 Attached to the Office of the President for administrative purposes, covers both public
and private higher educational institutions as well as degree-granting programs in all
post-secondary educational institutions in the country.
 Only schools, colleges and universities duly authorized by the CHED shall be allowed to
provide medical education programs.
ASSOCIATION OF PHILIPPINE
MEDICAL COLLEGES (APMC)
APMC is an organization of medical colleges whose purpose is to make certain that each
member offer quality medical education. It also administers the internship-matching program
in the Philippines.
 The NMAT is a prerequisite for admission to a medical college as a gauge intended to
limit the admission to medial schools only to those who have initially proved their
competence and preparation for a medical education.
 It is important to note the case of Teresita Tablarin, et al. vs. Angelina Gutierrez (G.R.
No. 78164, July 31, 1987), the Supreme Court upheld the constitutionality of the NMAT.
And subsequently, in the case of DECS vs. Roberto Rey San Diego (G.R. No. 89572,
December 21, 1989), the Supreme Court likewise upheld the Three-Flunk Rule in NMAT
as it is “intended to insulate the medical schools and ultimately the medical profession
from the intrusion of those not qualified to be doctors. The medical profession directly
affects the very lives of the people, unlike other careers which, for these reasons, do not
require more vigilant regulation.”
 Pursuant to Secs. 6 and 7 of the Medical Act of 1959, students seeking admission to the
medical course must have a bachelor’s degree in science or arts and that the medical
school may admit any student who has not been convicted by any court of competent
jurisdiction of any offense involving moral turpitude.
The basic requirements for admission to a medical school are:
1. A record showing completion of a bachelor’s degree in science and arts.
2. A certified true copy of National Medical Admission Test
(NMAT) score.
3. A certificate of good moral character.
 It must be noted that there is nothing in the Medical Act of 1959 that shall be construed
to deter any medical school from establishing, in addition to the preceding, other
entrance requirements it may deem necessary. Therefore, a medical school may require
a panel interview or other requirements before admission thereto.
Basic Requisites to Practice Medicine
Pursuant to Sec. 8 of the Medical Act of 1959, the following are the basic prerequisites to
practice medicine:
1.
Age requirement
at least twenty-one years old.
2.
Proper Educational Background
Holder of a bachelor’s degree
Not convicted of any crime involving moral turpitude
Of good moral character
3.
Examination Requirements
Two types of Physician Licensure Examination:
A. Preliminary Examination
Examinee must be at least 19 years of age
Of good moral character
Have completed the first two years of the medical course
To take the four basic subjects of Physiology, Biochemistry, Anatomy, Micro-
parasitology
B.
Final or Complete Examination
To take the 8 other subjects, or
To take all 12 subjects for the scheduled licensure examination
4. Holder of Certificate of Registration
No issuance to any candidate who has been the following:
Convicted by a court of competent jurisdiction of any crime involving moral
turpitude
Found guilty of immoral or dishonorable conduct after investigation by the Board
of Medicine
Declared to be of unsound mind
Reciprocity Rule
Citizen of the Philippines or of any country who has submitted competent and conclusive
documentary evidence confirmed by the DFA showing that his country’s existing laws permit
citizens of the Philippines to practice medicine under the same rules and regulations governing
citizens thereof.
ENDORSEMENT RULE
 Allows a non- Filipino citizen to practice in the country if there is an endorsement from
the Board of Medicine to practice for a limited or specific case only. These physicians
from other countries can engage in the practice of medicine and solely in specific and
definite case provided further that they shall secure a previous authorization from the
Board of Medicine.
PRACTICE OF MEDICINE
 It is a privilege or franchise granted by the State to any person to perform medical acts
upon
 Compliance with law, that is, the Medical Act of 1959 as amended which has been
promulgated by the State in the exercise of police power to protect its citizenry from
unqualified practitioners of medicine.
It is diagnosing and applying and the usage of medicine and drugs for curing, mitigating, or
relieving bodily disease or conditions
ACTS CONSTITUTING THE PRACTICE OF MEDICINE pursuant to Sec.10, Art. III of the Medical Act
of 1959, as amended
A) who shall for compensation, fee, reward in any form paid to him directly or through another,
or even without the same, physically examine any person, and diagnose, treat, operate or
prescribe any remedy for human disease, injury, deformity, physical, mental, psychical
condition or any ailment, real or imaginary, regardless of the nature of the remedy or
treatment administered, prescribed or recommended;
B) who shall by means of signs, cards, advertisement, written or printed matter, or through the
radio, television or any other means of communication, either offer or undertake by any means
or method to diagnose, treat, operate, or prescribe any remedy for human disease, injury,
deformity, physical, mental or psychical condition;
C) who shall falsely use the title of M.D. after his name, shall be considered as engaged in the
practice of medicine.
Exemptions
By PROVISIONS OF LAW are not considered to constitute practice of medicine (Sec.11, Art. III,
Medical Act of 1959 as amended):
a)
Any medical student duly enrolled in an approved medical
college
provided under supervision of a duly
registered physician;
b)
Dentist;
c)
Physiotherapist;
d)
Optometrist;
e) Any person who renders any service gratuitously in
cases of emergency or in
places where the services of a
physician, nurse or midwife are not available;
f)
Any person who administers or recommends any household remedy as per
classification of existing
Pharmacy Laws;
g)
Clinical psychologist with the prescription and direct
supervision of a
physician;
h)
Prosthetist.
Also not considered to constitute practice of medicine:
a)
One who takes BP reading b) Application of medicated massage
c) Hospital
d)
The act of investing in stocks in
hospitals
e) Nurse anesthetist
FAITH HEALING
 Related to constitutional guarantee to religious freedom (freedom to believe and
freedom to act in accordance with one’s belief)
 There is nothing in the Medical Act of 1959 exempting it from the definition of the acts
which constitute practice of medicine
Acted in pursuance of his religious belief and with the tenets of his church he professes, not
deemed to be a practice of medicine but part of his religious freedom
ILLEGAL PRACTICE OF MEDICINE
 Practice of medicine by any person not qualified and not duly-admitted to perform
medical acts in compliance with law.
Penalties
 Pursuant to Sec.28, Art. IV, Medical Act of 1959 as amended – Any person found guilty
of “illegal practice” shall be punished by a fine of not less than one thousand pesos or
more than ten thousand pesos with subsidiary imprisonment in case of insolvency or by
imprisonment of not less than one year no more than five years, or by both such fine
and imprisonment, in the discretion of the court.
Qualified to Practice
Medicine in the Philippines
1. Those who have complied with the prerequisites to the practice of medicine in accordance
with Sec. 8, Art. III, Medical Act of 1959 as amended;
2. Those who can have limited practice without any certificate of registration in accordance
with Sec.12, Art. III, Medical Act of 1959 as amended:
Exclusive consultation in specific and definite cases;
Attached to international bodies to perform certain definite work in the Phils;
Commissioned medical officers stationed in the Phils in their own territorial jurisdiction;
Exchange professors in special branches of medicine;
Medical students who have completed the first four years of medical course, graduates of
medicine and registered nurses who may be given limited and special authorization by the DOH
3. “Balikbayan” Physicians pursuant to PD 541, Allowing Former Filipino Professionals to
Practice Their Respective Professions in the Philippines
Proviso:
Of good standing prior to their departure and in their adopted country;
Have registered with PRC and paid their professional fee;
- Pay the corresponding income tax
4. Foreign physicians qualified to practice by Reciprocity Rule or by endorsement;
5. Medical Students pursuant to Sec.11(a) and
1959 as
amended;
Sec.12(d), Art. III, Medical Act of
6. Limited practitioners of medicine
Those that are governed by specific licensure laws
Rationale why artificial
persons cannot practice medicine
 Cannot be subjected to licensure examinations as required by law
 Practice of medicine may be employed and controlled by unqualified physicians
 Professional relationship between the patient and the physician will be impaired
 Deprivation of free choice of physicians
PHYSICIAN-PATIENT RELATIONSHIP
Contract - is the meeting of minds between two persons whereby one binds himself with
respect to the other, to give something or to render some service (Art.1305, NCC)
CONSENSUAL FIDUCIARY -
based on mutual consent of both parties
based on mutual trust and confidence
Requisites of a
contractual relationship
CONSENT – manifested by the meeting of the offer and the acceptance upon the thing and the
cause which are to constitute the contract (Art.1319NCC)
OBJECT – the subject matter of the contract which is the medical service which the patient
wants to be rendered to him by his physician
CAUSE – is the consideration or the factor that instigated the physician to render the medical
service to the patient, which could be remuneratory or an act of liberality
Forms of Physician-Patient Relationship
1. Expressed – explicitly stated orally or in writing
2. Implied – the existence can be inferred from the acts of the contracting parties.
Inferred by law as a matter of reason and justice for their acts or conduct
Some Instances where
there is no Physician-Patient Relationship
1. Pre-employment PE for purposes of determining
employment;
2. PE for eligibility for insurance;
3. Physician appointed by court to examine the
4. In performing an autopsy;
5. Casual consultation in an unordinary place such
conventions, parties and social gatherings and broadcast
6. Under duress or threat
whether an applicant is suitable for
accused;
as grand- rounds consultation,
interviews
DUTIES and OBLIGATIONS Imposed on the Physician in the Physician-Patient Relationship
1.
He should posses the knowledge and skill of which an average physician;
General practitioner vs Specialist
2.
He should use such knowledge and skill with ordinary care and diligence;
“locality rule” – the standard of care is
measured by the degree of care in
the locality
“similar locality rule” – diligence is determined when the other physicians in
the
locality or similar locality could have acted the
same way
“national standard of care” - the diligence is
determined on what is
applicable on a
national standard basis
3. He is obliged to exercise the best judgment;
4. He has the duty to observe utmost good faith
 Physician-Patient relationship does not imply guaranty or any promise that the
treatment will be successful
 It does not imply any promise or guaranty that the treatment will benefit the patient
 It does not imply any promise or guaranty that the treatment will produce certain result
 It does not promise or guaranty that the treatment will not harm the patient
 It does not promise that the physician will not commit errors in an honest way
DUTIES and OBLIGATIONS Imposed on the Patient in the Course of the Physician-Patient
Relationship
1. He must give an honest and comprehensive
medical history.
2. A patient must state whether he understands or not the intended medical care.
3. A patient must inform the physician of what transpired in the course of the treatment.
4. A patient must be compliant with instructions, prescriptions and medical advice of the
physician.
5. A patient must exercise the prudence to be expected of an ordinary patient including
payment of necessary hospital and professional fees.
STAGES OF PHYSICIAN-PATIENT RELATIONSHIP
 COMMENCEMENT
It is the very time the physician is obliged to comply with the legal duties and obligations
imposed upon him to his patient.
TERMINATION
It is the time when the duties and obligations by a physician to his patient ceases.
1.Recovery of the patient
2.When the physician considers that his medical services will no longer be beneficial to
the patient.
3.Withdrawal of the physician provided there was notice and ample time for the
patient to look for another physician
4. Discharge of the physician by the patient;
5. Death of either party;
6.. Incapacity of the physician
RIGHTS OF PHYSICIAN
A. INHERENT RIGHTS
to choose patients
to limit practice of medicine
to determine appropriate management procedures
to avail of hospital services
B. INCIDENTAL RIGHTS
Right of way while responding to emergency
Right of exemption from execution of instruments and library
Right to hold certain public/private offices
Right to perform certain services
Right to compensation
Right to membership in medical societies
Kinds of Medical Fees
1.
Simple Contractual Fee – specifically stating the value of such medical service, either
orally or in
writing.
2.
Retainer Fee – measured by the space of time
rendered by patient.
3.
Contingent Fee – depends upon the failure of the treatment instituted.
4.
Dichotomous Fee (Fee splitting) – the physician may require the services of a person
who may act as agent to solicit patients, and the agent will share in the medical fee.
5.
Straight Fee – for the amount tendered by the patient to the physician, the latter shall
be
responsible for the payment of hospital bill, lab fees, medicines, and other incidental
expenses.
Factors That Determine
Reasonableness of Professional Medical Fees
 Nature of the medical service rendered
 Labor and time involved
 Responsibility imposed
 Difficulty of the medical or surgical cases involved
 Skill and experience called for in the performance of the services
 Professional character and social standing of the physician
 Customary fees within the locality
Instances where the physician
cannot recover professional fees
 Agreement that the service is gratuitous
 In government charity hospitals, health centers and other similar health units
 Rendered in private charitable institutions
 Waiver on the part of the physician
 When the physician cannot charge the patient pursuant to the Code of Ethics Those
covered by PhilHealth unless there is express knowledge and consent on the part of the
patient that an additional medical fee will be charged
 Medical services rendered under a contract of employment unless expressly provided
otherwise
RIGHTS OF PATIENTS
1.
Right to give consent to diagnostic and treatment procedures
2.
Right to religious belief
3.
Right of privacy
4.
Right to disclosure of information
5.
Right to confidential information
6.
Right to choose his physician
7.
Right of treatment
8.
Right to refuse necessary treatments
Legal Requisites of a Valid Consent
1. Age of majority
2. Sound mind
3. Subject matter is legal
4. Consent given voluntarily
Instances When Consent
Is Not Necessary
1.
In cases of emergency, there is an “implied consent” or the physician is “privilege
because he is reasonably entitled to assume consent.
2. When the law made it compulsory for everyone to submit to the procedure
Emergency Operations Without Consent
 When the situation is such that an immediate action is necessary to save the life or
preserve the health of the patient.
 Theory of Implied Consent
NB:
The refusal of the patient who is of legal age and of sound mind to submit to medical
treatment shall prevail even if the danger to his life is eminent.
Right to Refuse Treatment
Forms of Consent
1. Expressed consent
2. Implied consent
Order of Securing Consent
1. Patient himself
2. Spouse (Legal)
3. Descendants (children)
4. Ascendants (parents, grandparents)
5. Collaterals (siblings)
6. Nearest of kin
7. Legally appointed guardian
8. State or government
 In cases of illegitimate child, the mother would have a better right than that of the
biological father in providing consent.
RIGHT OF CONFIDENTIAL INFORMATION
Statutory Privileged Communication
Pursuant to the Rules of Court, Rule 130, Sec. 24(c), a person authorized to practice
medicine, surgery or obstetrics cannot in a civil case, without the consent of the patient, be
examined as to any information which he may have acquired in attending such patient in a
professional capacity, which information was necessary to enable him to act in that capacity,
and which would blacken the character of the patient.
Ethical/Professional Confidential Information
Pursuant to Code of Medical Ethics, the medical practitioner should guard as a sacred
trust anything that is confidential or private in nature that he may discover or that may be
communicated to him in his professional relation with his patients, even after death. He should
never divulge this confidential information, or anything that may reflect upon the moral
character of the person involved, except when it is required in the interest of justice, public
health or public safety.
Some instances where
confidentiality is not applicable
1. When such disclosure is necessary to serve the best interest of justice.
2. When the disclosure will serve public health and safety.
3. When the patient waives its confidentiality.
Right to Disclosure of Information
 The patient has the right to know what transpired from his management and treatment
procedures.
 The patient has the right to obtain from his physician practically complete and all
existing information concerning his diagnosis, results of all ancillary and laboratory
procedures, treatment, management procedures including prognosis in terms the
patient can be reasonably expected to understand. It likewise includes all that
transpired during all medical management of the patient.
Right to Choose His Physician
 In the same manner that physicians can choose their patients except during emergency,
a patient have the right to choose their own physicians.
 Patients can terminate the physician-patient relationship at any time and the physician
is not even entitled to an explanation.
Instances where a patient cannot invoke his right to choose his physician:
1.
In a government hospital or government medical care institutions
2.
A patient has expressly waived this right through their HMO memberships
3.
In charitable medical missions
4.
Generally, in cases of emergency
5.
Prisoners and detainees
6.
When the Court appoints a physician pursuant to its Order
Right to Privacy
 One’s personal information is protected from public scrutiny.
 The right to privacy provides one’s ability to choose which others can access parts in his
domain, and to control the scope, manner and timing of the use of those parts one
chooses to disclose.
 R.A. 10173, otherwise known as the Data Privacy Act of 2012 to protect the individual
personal data
Right to Religious Belief
 Right to religious belief is a basic and fundamental right of any person anywhere in the
world.
 In case of conflict between the conscious, coherent patient invoking one’s right to
religious belief and the physician, the right to religious belief by the patient shall prevail.
Right to Treatment
 The patient has the right to have a reasonable continuity of medical care.
 The patient has the right to expect that the hospital will provide a mechanism whereby
his physician or a delegate of the physician, of the patient’s continuing health care
requirements following discharge.
RIGHT TO REFUSE TREATMENT
 In the legal sense, every man of adult age and of sound mind has the right to determine
what must be done in his own body. A man is the master of his own self and may
expressly prohibit a life-saving surgery or medical treatment.
 Doctrine of parens patria, the State has the right to assume guardianship when the
child is neglected by the parents to have the child treated, and parents have no right to
base it on religious beliefs or any other grounds.
 When the law provides for treatment, the patient has no right to refuse treatment
LIABILITIES OF PHYSICIAN
 CRIMINAL
 An act or omission which constitute a crime by the physician;
 Laws: Revised Penal Code and other special laws;
 Penalty: imprisonment and/or fine.
 CIVIL
 Awarded against a physician to compensate for theinjury he suffered on account
of the physician’s act or omission as a breach of the contractual relationship of
both parties;
 Laws. Civil Code of the Philippines and other related laws;
 Art. 100, RPC states that “Every person criminally liable is civilly liable.”Penalty:
damages
 ADMINISTRATIVE
 Right to practice is temporarily withdrawn from the physician;
 A valid exercise of the police power of the State;
 Laws: Medical Act of 1959 as amended including the Code of Ethics and Rules
and Regulations of the PRC;
 Penalty: reprimand, suspension, to revocation of license.
Medical Malpractice
Elements:
1. The physician has a duty to the patient.
2. The physician commits a breach of his duties to his
patient.
3. As a consequence of the failure, injury was sustained by the patient.
4. The failure of the physician is the proximate cause of the injury sustained by the patient.
GROUNDS FOR ADMINISTRATIVE LIABILITIES
Sec.24, Art. III, Medical Act of 1959, as amended
Personal Disqualifications
1. Immoral or dishonorable conduct;
2. Insanity;
3. Gross negligence, ignorance or incompetence resulting in an injury to or death of the
patient;
4. Addiction to alcoholic beverages or to any habit- forming drug rendering him incompetent to
practice medicine.
Criminal Acts
1. Conviction by a court of competent jurisdiction of any criminal offense involving moral
turpitude
2. Fraud in the acquisition of the certificate of registration;
3. Performance of or aiding in any criminal abortion
4. Knowingly issuing false medical certificate;
5. Aiding or acting as dummy of an unqualified or unregistered person to practice medicine.
Unprofessional Conduct
1. False or extravagant or unethical advertisements wherein other things than his name,
profession, limitation of practice, clinic hours, office and home address, are mentioned;
2. Issuing any statement or spreading any news or rumor which is derogatory to the character
and reputation of another physician without justification;
3. Violation of any of the Code of Ethics as approved by the PMA.
 DAMAGES are the pecuniary compensations that may be recovered for breach of some
duty or the violation of some rights recognized by law. If a suit is filed against a physician
for a professional liability claims, the objective of the plaintiff is to recover damages. If
the physician is found negligent in the performance of his professional services, he liable
for the payment of damages for all the direct, natural and logical consequences of his
act.
Art. 20, Civil Code
Every person who, contrary to law, willfully or negligently causes damage to another
shall indemnify the latter for the same.
Art. 2176, Civil Code
Whoever, by act or omission causes damage to another, there being fault or negligence,
is obliged to pay for the damages done.
TYPES OF DAMAGES
Actual or Compensatory
Moral
Exemplary
Nominal
Temperate
Liquidated
Compensatory Damages
Applied to Medical Malpractice
1. Death
Art. 2206, Civil Code
The amount of damages for the death caused by a crime or quasi-delict shall be at least
three thousand pesos(now Php 75,000.00), even though there may have been mitigating
circumstances.
2. Physical Disability
3. Loss of Earning Capacity
4. Medical, Surgical, Hospital, and Related Expenses
5. Loss of Service or Support
6. Funeral Expenses
MORAL DAMAGES
 Art. 2217, Civil Code
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 defendant’s act or omission.
EXEMPLARY OR CORRECTIVE DAMAGES
 Punitive or exemplary damages are monetary compensation over and above actual or
compensatory damages awarded as punishment or deterrence, because of the wanton,
reckless, malicious or oppressive nature of the wrong committed.
Punitive damages are recoverable from a physician in an action for malpractice where there is
evidence tending to show that he has acted with malice, or that he acted with recklessness,
oppression, or with utter disregard to the effects of his act, or that he is guilty of gross
negligence in the performance of his profession.
NOMINAL DAMAGES
Art. 2221, Civil Code
o Nominal damages are adjudicated in order that a right of the plaintiff, which has been
violated or invaded by the defendant, may be vindicated or recognized not for the
purpose of indemnifying the plaintiff for any loss suffered.
o It is a trifling sum awarded to the plaintiff in an action where there is no substantial loss
or injury to be compensated.
o It is awarded to plaintiff as a vindication of a right violated.
LIQUIDATED DAMAGES
 Art. 2226, Civil Code
Liquidated damages are those agreed upon by the parties to a contract, to be paid in
case of breach thereof
TEMPERATE DAMAGES
 Art. 2224, Civil Code
Temperate or moderate damages, which are more than nominal but less than
compensatory damages, may be recovered when the court finds that some pecuniary loss has
been suffered but its amount cannot, from the nature of the case, be proved with certainty.
LEGAL PRINCIPLES AND DOCTRINES AS
APPLIED IN MEDICAL MALPRACTICE CASES
1.Doctrine of Vicarious Liability
2. Doctrine of Ostensible Agent
3. Borrowed Servant Doctrine
4. Captain of the Ship Doctrine
5. Doctrine of Independent Contractor
6. Doctrine of Res Ipsa Loquitor
7. Doctrine of Contributory Negligence
8. Doctrine of Continuing Negligence
9. Doctrine of Assumption of Risk
10. Doctrine of Last Clear Chance
11. Doctrine of Foreseeability
12. Rescue or Good Samaritan Doctrine
13. Doctrine of Corporate Negligence
14. Doctrine of Apparent Authority
15. Sole vs Shared Responsibility
Doctrine of Vicarious Liability
 Doctrine of Respondeat Superior
 Doctrine of Imputed Negligence or Command Responsibility
 “let the master answer”
 the principal or employer is responsible for the wrongful acts of his agent or employee
in certain cases.
 The responsibility of the principal or employer ceases when the latter proves that he
observed all the diligence of a good father of a family to prevent damage.
Doctrine of Ostensible Agent
 The principal is bound by the acts of his agent with the apparent authority, which he
knowingly permits the agent to assume.
 There are physicians in a hospital set-up who are deemed ostensible agents of the
hospital and therefore, their liability may redound to be the liability of the hospital.
[Radiologist, Pathologist, Employed Resident Physicians (non-training program) or
“moonlighters” , Employed Emergency Medicine Consultants and House Specialist or
Hospitalist]
Borrowed Servant Doctrine
 Generally, nurses, medical technologist, therapist, pharmacist and other personnel of
the hospital are employees of the hospital. However, when they perform acts under the
supervision and control of another, these employees are deemed by fiction of law
borrowed from the hospital by someone.
Captain-of-the-Ship Doctrine
 It pronounces the liability of the surgeon or main attending physician not only for the
wrongful acts of those who are under his physical control and supervision but including
those wherein he has extension of control.
Doctrine of Independent Contractor
 In instances where there is no employer-employee relationship, the doctrine of
Independent Contractor is applicable.
 In most hospital set-up, physicians are not employees (other than those who are
deemed considered ostensible agents of the hospital) and thus, the physician is to be
held liable under this doctrine.
Doctrine of Res ipsa loquitur
(Common Knowledge Doctrine )
Requisites of Res ipsa loquitur
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 physician.
3. The possibility of contributing conduct, which would make the plaintiff or patient
responsible, is eliminated.
 It is generally limited 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.
 Res ipsa loquitur may not be applicable in honest mistakes in the diagnosis, under the
Bad Result Rule and Calculated Risk Rule of a procedure.
Doctrine of Contributory Negligence
 Doctrine of Common Fault
 It is the act or omission amounting to want of care on the part of the complaining party,
which concurring with the defendant’s negligence is the proximate cause of the injury
Doctrine of Continuing Negligence
 If the physician, after a prolonged treatment of a patient, which normally produces
improvement of the illness, fails to investigate non-response may be held liable if in the
exercise of the care and diligence he could have discovered the cause of non-response.
Doctrine of Assumption of Risk
 When a patient freely consents to a treatment procedure, the inherent risk attached
thereto are deemed assumed by the patient provided the physician acted in accordance
with sound medical standards.
 To note, the physician is not a guarantor of care and neither does he warrant a good
result and there will always be attendant risks and possible medical complications in
every medical procedure and treatment.
Doctrine of Last Clear Chance
 In a multidisciplinary approach of treatment, every physician providing care and
treatment to a patient must work in harmony for the best interest of the patient.
 Thus, a physician who has the last clear chance of avoiding damage or injury to his
patient but negligently fails to do so maybe held liable
Doctrine of Foreseeability
 If foreseeable complications arise from competent and diligent treatment and care and
the physician did not do anything, he can be made liable for such.
 Accordingly, a physician cannot be held liable for negligence if the injury sustained by
patient is on account of unforeseen conditions or complications that may arise from
treatment and care.
Rescue Doctrine or Good Samaritan Law
 Under this doctrine, if a physician came to help and was not able to save the life of the
patient, the physician cannot be held liable for it.
 Any person who, in good faith, renders emergency medical assistance to an injured
person at the scene of the accident or other emergency without the expectation of
receiving compensation from such injured person for such service, shall not be liable for
any commission or omission, not constituting gross negligence, in the course of such
medical assistance.
Doctrine of Corporate Negligence
 Physicians are deemed employees of the hospital, thus, the fault of the physician will
redound to be the fault of the hospital.
 Does this mean to say that hospital administrators supervise and control their doctors in
their actual treatment and management of patients?
Doctrine of Apparent Authority
 In the same manner as with the Doctrine of Corporate Negligence, recent decisions of
the Court have seriously extended hospital liability for its failure to make careful
selection, review, and supervision of independent physicians who are permitted to
practice in the hospital.
 Physicians being allowed to practice in their hospitals are considered to be under their
authority or supervision and considered in a sense, ostensible agents.
Sole vs. Shared Responsibility
 When a patient is confined, the physician who admitted the patient is termed as
attending physician. And accordingly based on the clinical condition of the patient, the
patient is referred to other filed of specialties. If a patient is referred to another
physician for consultation, the patient is still the sole responsibility of the attending
physician, as he will decide as to the management of the patient. However, if the
referral to other physicians is for co-management, then it becomes a shared
responsibility among all of them.
HOSPITALS
Sec.2(a), RA 4226, Hospital Licensure Act
HOSPITAL means a place devoted primarily to the maintenance and operation of
facilities for the diagnosis, treatment, and care of individuals suffering from illness, disease,
injury or deformity, or in need of obstetrical or other medical and nursing care.
The term ‘hospital’ shall also be construed as any institution, building or place where there are
installed beds, cribs, bassinets for twenty-four hour use or longer by patients in the treatment
of diseases, …..xxx.”
Basic Duties of a Hospital
1. To furnish a safe and well-maintained building and ground
2. To furnish adequate and safe equipment
3. To exercise reasonable care and diligence in the selection of its staff
4. The formulation, adoption and enforcement of adequate rules and policies that ensure
quality care for its patients
Types of Hospital According to Ownership
1. Public/Government – operated and maintained either partially or wholly by the national,
provincial, municipal, or city government or other political subdivision, or by any department,
division, board or other agency thereof. (Sec. 2(b) RA 4226)
2. Private – privately owned, especially established and operated with funds raised and
contributed through donations, or private capital or other means. (Sec. 2(C), RA 4226)
For purposes of determining
liability of private hospitals
1. Private charitable or eleemosynary – established for the public benefit and not conducted for
the pecuniary gain of the management.
2. Private pay – established for profit and gain.
Rationale Why Hospital
Cannot Practice Medicine
1. The privilege to practice medicine is personal.
2. The hospital cannot be subjected to government licensure examinations to determine
whether it is qualified to practice medicine.
3. A non-medical will be allowed to control a physician and circumvent the practice medicine.
4. Breach of the confidential relationship in a physician- patient relationship.
5 Hospital, being a juridical entity, cannot be subjected to criminal liability.
LIABILITIES OF HOSPITAL
1. CORPORATE Liabilities
Those arising from failure of the hospital to furnish accommodations and facilities
necessary to carry out its purpose or to follow in a given situation, the established standard of
conduct to which the corporation should conform.
Recent decisions of the court have extended hospital liability to patient for its failure to make
careful selection, review, and supervision of independent physicians who are permitted to
practice in the hospital.
2. VICARIOUS Liabilities for the Acts of Hospital Employees.
Vicarious Liability of Hospital
Government or Public Hospital
Under the Doctrine of State Immunity, a public or government hospital cannot be sued.
Art. XVI, Sec. 3 of the 1987 Philippine Constitution states that, “The State may not be sued
without its consent.” This is the Doctrine of State Immunity from Suit or Non-suability of State.
It is the government hospital that is immune from suit and not the doctors practicing
medicine in the government hospital.
Doctrines Applied to Charitable Hospital Immunity for the Acts of its Employees
A. TRUST FUND DOCTRINE
Charitable hospitals derived support from voluntary contributions or donations for the
reception, care and treatment of charity patients. The contributions are held only in trust by
the governing body of the hospital. Diverting the money for the payment of damage will be
utilizing the money not intended by the donor.
B. IMPLIED WAIVER THEORY
A patient who enters a private hospital, knowing fully well that it is merely supported by
contributions, waives his right to claim damages
C. PUBLIC POLICY THEORY
It renders medical service without remuneration. It is doing an undertaking of the obligation
of State for the preservation of life and maintenance of health.
D. INDEPENDENT CONTRACTOR THEORY
A patient who enters a private charitable hospital does not have a contract with the hospital
but with the attending physician.
Rules applied in determining the vicarious liability for the negligent acts of the resident
physicians, nurses and other employees.
Principle of administrative
as against medical duties
 The performance of routine duties which is the very reason why employed physicians
(non-training resident physicians), nurses and other employees is appointed or
employed in the ordinary sense constitutes administrative or ministerial duties and any
negligent acts committed in the course of their appointment or employment which
causes injury or death to the patient, may make the hospital vicariously liable.
 Medical duties are within the sole discretion and judgment of physicians. Thus,
negligence of such physicians and nurses and others employees in the discharge of their
professional duties, the hospital may not be held vicariously liable including those cases
where the “Borrowed Servant Doctrine” under the circumstances is applicable.
 A person has no absolute right to be admitted in a hospital or to avail of hospital
services. However, a government has no absolute privilege of choice of patients
inasmuch as it is established and maintained by public funds except for justifiable
grounds.
Republic Act No. 8344, August 25, 1997
AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER
APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS
CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE
KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS
FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL
CLINICS IN CERTAIN CASES"
 REPUBLIC ACT No. 10932
An Act Strengthening the Anti-Hospital Deposit Law by Increasing the Penalties for the
Refusal of Hospitals and Medical Clinics to Administer Appropriate Initial Medical Treatment
and Support in Emergency or Serious Cases, Amending for the Purpose Batas Pambansa
Bilang 702, Otherwise Known as "An Act Prohibiting the Demand of Deposits or Advance
Payments for the Confinement or Treatment of Patients in Hospitals and Medical Clinics in
Certain Cases", As Amended by Republic Act No. 8344, and for Other Purposes
Transfer of patients
 It must be premised that a valid consent of the patient was secured and when the
clinical condition of the patient would permit to do so.
Discharge of patients
 After a thorough assessment of the patient’s condition, considers that further
hospitalization is no longer necessary, a physician may order the discharge with or
without condition.
Premature discharge
 If a patient necessitates further hospitalization, the attending physician and the hospital
may be held liable to the patient if the latter is discharged from the hospital, unless the
patient was discharge against medical advice.
Anti-Hospital Detention Law
 Under Republic Act No. 9439, or the Anti-Hospital Detention Law, it shall be unlawful for
any hospital or medical clinic in the country to detain or ‘to otherwise cause, directly or
indirectly the detention of patients who have fully or partially recovered or have been
adequately attended to or who may have died, for reasons of nonpayment in part or in
full of hospital bills or medical expenses.
 A patient cannot be detained in a hospital for non- payment of the hospital bill. The law
provides a remedy for them to pursue by filling the necessary suit in court for the
recovery of such fee or bill.
Republic Act No. 9439
 SEC. 2. Patients who have fully or partially recovered and who already wish to leave the
hospital or medical clinic but are financially incapable to settle, in part or in full, their
hospitalization expenses, including professional fees and medicines, shall be allowed to
leave the hospital or medical clinic, with a right to demand the issuance of the
corresponding medical certificate and other pertinent papers required for the release of
the patient from the hospital or medical clinic upon the execution of a promissory note
covering the unpaid obligation. The promissory note shall be secured by either a
mortgage or by a guarantee of a co-maker, who will be jointly and severally liable with
the patient for the unpaid obligation. In the case of a deceased patient, the
corresponding death certificate and other documents required for interment and other
purposes shall be released to any of his surviving relatives requesting for the
same: Provided, however, That patients who stayed in private rooms shall not be
covered by this Act.
 A hospital can legally detain a patient against his will when he is detained or convicted
prisoner, or when the patient is suffering from a very contagious disease wherein his
release is prejudicial to public health, or when the patient is mentally ill, that his release
will endanger public safety.
 In fact, the death certificate cannot also be withheld due to non-payment of hospital
bills and should be release with 48 hours from the time of death.
LIABILITIES OF HOSPITAL
FOR ITS ANCILLARY SERVICES
 Whenever the hospital administration enters into contract with a partnership of
physicians to run the emergency room, the medical staff therein are not considered
employees of the hospital. Consequently, liability for negligence in the emergency room
is shifted to the medical partnership.
 Courts have held that even if contracts specify that physicians will be considered
independent contractors, the hospitals are responsible for their action if they can
exercise control over them.
 Patients are not bound by the secret limitations contained in a private contract between
the hospital and the physician.
Medical Records
It is compilation of the pertinent facts of the patient’s life history, illness, and treatment.
Generally, the guardian and owner of the medical records is the hospital for in-patients.
But ownership of the medical record is a limited one and absolute and considered primarily
custodial.
Types of Medical Records
1.
Hospital In-patient Medical Records
2.
Hospital Out-patient Medical
Records
3.
Physician’s Private Out-patient Medical
Records
VIOLATION OF THE
CONFIDENTIAL NATURE OF RECORD
Code of Medical Ethics
The medical practitioner should guard as a sacred trust anything that is confidential or
private in nature that he may discover of that may be communicated to him in his professional
relation with the patient, even after their death. He should never divulge this confidential
information, or anything that may reflect upon the moral character of the person involved,
except when it is required in the interest of justice, public health or safety.
R.A. 11332 - Mandatory Reporting of Notifiable Diseases and Health Events of
Public Health Concern Act
Section 9 of the law provides for the acts which are prohibited, namely:
(a) Unauthorized disclosure of private and confidential information pertaining to a patient’s
medical condition or treatment;
(b) Tampering of records or intentionally providing misinformation;
(c)
Non-operation of the disease surveillance and response systems;
(d)
Non-cooperation of persons and entities that should report and/or respond to
notifiable diseases or health events of public concern; and
(e)
Non-cooperation of the person or entities identified as having the notifiable disease,
or affected by the health event of public concern.
Disclosure of confidential information will not be considered violation of this Act if the
disclosure was made to comply with a legal order issued by a court of law with competent
jurisdiction.
Notable today amid the COVID-19 crisis is the issue on self-quarantine. When an individual
does not self-quarantine in case of infection, he or she may be liable under Sec. 9,
paragraph d of RA 11332, for non-cooperation of persons and entities that should report
and/or respond to notifiable diseases or health events of public concern.
Sec. 21 (c), Rule 130, Rules of Court (Privilege Communication)
A person authorized to practice medicine, surgery, obstetrics cannot in civil case,
without the consent of the patient, be examined as to any information, which he may have
acquired in attending such patient in a professional capacity, which information was necessary
to enable him to act in that capacity, and which would blacken the character of the patient.
Instances When the Contents
of the Medical Record May Be Disclosed
1. When demanded by the patient or by someone who could act in his behalf, which must be
made in writing with the proper identification
2. When the law compels such disclosure
3. Through a subpoena issued by the courts and other agencies of the government
N.B.
The attending doctor has no legal right to determine who shall and who shall not see
the record. At the most, his approval or permission is only a matter of courtesy.
Members of the resident staff, student and attending medical staff may freely consult
such records as pertain to their work.
Standard of Care in Emergencies
A physician cannot be held to the same conduct as one who had an opportunity to reflect, even
though it later appears that he made a wrong decision yet prudent at that time.
Philippine Medical Code of Ethics
General Principles
1. The physician belongs to a noble profession whose primary purpose is to provide competent
and compassionate medical care.
2. The physician’s primary objective is the best interest of the patient, respecting human
dignity regardless of stage of development, socioeconomic status, religion, gender, political
beliefs, racial background or other circumstances.
3. Primarily, the practice of medicine is service to mankind.
4. Physicians should cooperate with and safeguard the interest, reputation and dignity of
paramedical and other health.
5. The promotion and advancement of the health of patients should be prioritized over the
benefits of the physicians and the health products industries.
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Duties of Physicians to Their Patients
Duties of Physicians to the Community
Duties of Physicians to Their Colleagues and to the Profession
Duties of Physicians to Allied Professionals
Duties of Physicians to Health Product Industry
Duties of Physicians to their Patients
To attend to his patients faithfully and conscientiously.
Free to choose whom to serve.
Immediate action in cases of emergency.
Proper consultation and referral.
He must exercise good faith and strict honesty in expressing his opinion.
Sacred trust of information
Practice of medicine is not a business.
Duties of Physicians to the Community
Cooperation with proper authorities, sanitation and health.
- To assist in the administration of justice.
- To protect the public from charlatans.
- No solicitation and extravagant and false advertisements.
-Gratuitous services to the indigents.
Duties of Physicians to their
Colleagues and to the Profession
- Gratuitous services to a colleague.
- Proper consultation and referral.
- Uphold the honor and dignity of the profession.
- Observe utmost caution, tact and prudence as regards professional conduct
of
another physician.
- To refrain from making unfair and unwarranted criticisms of other physicians.
- To keep abreast to the advancements of medical science and contribute to its
progress.
- No advertising by means of untruthful or improbable statements in newspapers or
exaggerated announcements.
- Should expose without fear or favor, before the proper medical or legal tribunals
corrupt and dishonest conduct of members of the profession.
- Should aid in safeguarding against the admission of those who are unfit or unqualified
because of deficiency in moral character.
Duties of Physicians
to Allied Professionals
1. A physician should never pay nor receive commissions to or from any allied worker for
cases referred.
2. A physician should never commit payment of commissions to any person who refers
cases to help him acquire patients.
3. A physician should respect and cooperate with members of other health professions in
the delivery of health care.
Duties of Physicians
to Health Product Industry
A physician does not derive any form of material gain from product samples.
A physician doing research activities receives remuneration that is reasonable and does
not constitute an enticement.
A physician should be transparent in his relations with organizations and enterprises. He
should be especially careful to remain faithful to his primary duty to his patient.
Penal Provisions
 -Violation of the provisions of this Code constitute unethical and unprofessional conduct
and therefore a sufficient ground for the reprimand, suspension or revocation of the
certificate of registration of the offending physician in accordance with the provisions of
Sec. 24, par. 12 of the Medical Act of 1959.
Distinctions Between
an Ordinary and Expert Witness
1.
An ORDINARY witness can only testify as a general rule, on those things which he has
perceived with his own organs of perception, while an EXPERT witness may render his opinion,
inference, conclusion or deduction on what he and others perceived;
2.
An ORDINARY witness need not be skilled on the line he is testifying but an EXPERT
witness must be skilled on the art, science or trade he is testifying.
Disqualification by reason of
Privileged Communication
Sec. 24, Rule 130, Rules of Court – The following persons cannot testify as to matters learned
in confidence in the following cases:
1. The husband or the wife, during or after the marriage, cannot be examined without
the consent of the other as to any communication received in confidence by one
from the other during the marriage except in a civil case by one against the other, or
for a crime committed by one against the other or the latter’s direct descendants
and ascendants;
2. The attorney cannot, without the consent of his client, be examined as to any
communication made by the client to him or his advice given thereon in the course
of, or with a view to professional employment; nor can an attorney’s secretary,
stenographer or clerk be examined, without the consent of the client and his
employer, concerning any fact the knowledge of which has been acquired in such
capacity;
3. A person authorized to practice medicine, surgery or obstetrics cannot in a civil
case, without the consent of the patient, be examined as to any information which
he may have acquired in attending such patient in a professional capacity, which
information was necessary to enable him to act in that capacity, and which would
blacken the reputation of the patient;
4. A minister or a priest cannot, without the consent of the person making the
confession, be examined as to any confession made to or any advice given him in his
professional character in the course of discipline enjoined by the church to which he
belongs;
5. A public officer cannot be examined during his term of office or afterwards as to
communications made to him in official confidence, when the court finds that the public
interest would suffer by the disclosure.
ATTENDANCE OF A MEDICAL WITNESS IN COURT
Sec. 1, Rule 21, Rules of Court
“Subpoena is a process directed to a person requiring him to attend and to testify at the
hearing or the trial of an action, or at any investigation conducted by competent authority, or
for the taking of his deposition. It may also require him to bring with him books, documents, or
other things under his control, in which case it is called subpoena duces tecum.”
Kinds of Subpoena
1. Subpoena ad testificandum
A process requiring a person to appear before a trial or hearing of an action or
investigation conducted under our laws or for the taking of a deposition at a certain definite
date, time and place to testify on some material issues.
2. Subpoena duces tecum
A process which requires a person to produce at the trial some documents or papers
which are under his control or possession that are pertinent to the issues of his controversy, at
a certain date, time and place.
N.B.
Failure to comply with a subpoena without justifiable reason is a ground for
reprimand, suspension or revocation of the certificate of registration.
Code of Medical Ethics
It is the duty of every physician, when called upon by the judicial authorities, to
assist in the administration of justice on matters which are medico-legal in character.
CONTEMPT
 Direct Contempt – inside or anywhere the courtroom, proper court decorum ( penalty –
up to 200 pesos fine, prison term of 1-10 days, or both)
 Indirect contempt – open defiance of court orders, failure to appear in court despite
receipt of subpoena (penalty- fine of up to 30, 000.00 fine and prison term of up to 6
months, or both)
___________________________________XXX_______________________________________
CASES:
Dr. Ninevetch v. Cruz, G.R. No. 122445, November 18, 1997
Topic: Practice of medicine
The practice of medicine is “indispensable to humanity” and should not be fettered by rules and
responsibilities so strict as to exact a “perfect outcome” on the part of the physician. “If a
physician had to exercise his profession with the sword of Damocles in the shape of liability for
damages [or in this case, even incarceration], continually suspended over his head, his work might
be seriously hampered.” Much the same thought was expressed by the late Jr. Justice Mignault,
an English judge, when he said, “we would be doing a great disservice to the community at large
if we were to impose liabilities on … doctors for everything that goes wrong. Doctors would be led
to think more of their safety than the good of their patients. Initiative would be stifled and
confidence shaken.”
Lucas v. Dr. Tuaño, G.R. No. 178763, April 21, 2009
Topic: Practice of medicine
The mere fact that a bad result occurs does not of itself indicate failure to exercise due care. The
result is not determinative of the performance [of the physician] and he is not required to be
infallible
Garcia-Rueda v. Pascasio, et al. GR. No. 118141 September 5, 1997
Topic: Duties of a physician ; necessity of an expert witness.
In accepting a case, a doctor in effect represents that, having the needed training and skill
possessed by physicians and surgeons practicing in the same field, he will employ such training,
care and skill in the treatment of his patients. He therefore has a duty to use at least the same
level of care than any other reasonably competent doctor would use to treat a condition under
the same circumstances.
It is in this aspect of medical malpractice that expert testimony is essential to establish not only
the standard of care of the profession but also that the physician’s conduct in the treatment
and care falls below that standard. Further, inasmuch as the causes of the injuries involved in
malpractice actions are determinable only in the light of scientific knowledge, it has been
recognized that expert testimony is usually necessary to support the conclusion as to causation.
Sps. Flores v. Sps. Pineda, G.R. No. 158996, November 14, 2008
Topic: Medical Negligence
[T]he critical and clinching factor in a medical negligence case is proof of the causal connection
between the negligence which the evidence established and the plaintiff’s injuries; the plaintiff
must plead and prove not only that he had been injured and defendant has been at fault, but
also that the defendant’s fault caused the injury. …Causation must be proven within a
reasonable medical probability based upon competent expert testimony
Reyes v. Sisters of Mercy GR. No. 130547 October 3, 2000
Topic: Practice of medicine requiring the highest degree of diligence; application of Res Ipsa
Loquitur
Diligence
The practice of medicine is a profession engaged in only by qualified individuals. It is a right
earned through years of education, training, and by first obtaining a license from the state
through professional board examinations. Such license may, at any time and for cause, be
revoked by the government. In addition to state regulation, the conduct of doctors is also strictly
governed by the Hippocratic Oath, an ancient code of discipline and ethical rules which doctors
have imposed upon themselves in recognition and acceptance of their great responsibility to
society. Given these safeguards, there is no need to expressly require of doctors the observance
of “extraordinary” diligence.
As it is now, the practice of medicine is already conditioned upon the highest degree of diligence.
And, as we have already noted, the standard contemplated for doctors is simply the reasonable
average merit among ordinarily good physicians. That is reasonable diligence for doctors or, as
the Court of Appeals called it, the reasonable “skill and competence . . . that a physician in the
same or similar locality . . . should apply.”
Res Ipsa Loquitur
Though expert testimony is usually needed to prove malpractice, where common knowledge
and experience teach that the injury would not have occurred if due care had been exercised,
the doctrine of res ipsa loquitur can be invoked to establish negligence.
Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician
negligent upon proper proof of injury to the patient, without the aid of expert testimony, where
the court from its fund of common knowledge can determine the proper standard of care. Where
common knowledge and experience teach that a resulting injury would not have occurred to the
patient if due care had been exercised, an inference of negligence may be drawn giving rise to an
application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily
required to show not only what occurred but how and why it occurred.
When the doctrine is appropriate, all that the patient must do is prove a nexus between the
particular act or omission complained of and the injury sustained while under the custody and
management of the defendant without need to produce expert medical testimony to establish
the standard of care.
It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit
against a physician or a surgeon which involves the merits of a diagnosis or of a scientific
treatment. The physician or surgeon is not required at his peril to explain why any particular
diagnosis was not correct, or why any particular scientific treatment did not produce the desired
result.
Ramos v. Court of Appeals G.R. No. 124354 December 29, 1999
Topic: Captain of the Ship Doctrine (Respondeat Superior); Vicarious Liability of Hospitals
Captain of the Ship
As the head of the surgical team and as the so-called captain of the ship, it is the surgeons
responsibility to see to it that those under him perform their task in the proper manner.
Respondent Dr. Hosakas negligence can be found in his failure to exercise the proper authority
(as the captain of the operative team) in not determining if his anesthesiologist observed
proper anesthesia protocols. In fact, no evidence on record exists to show that respondent Dr.
Hosaka verified if respondent Dra. Gutierrez properly intubated the patient. Furthermore, it does
not escape the court that respondent Dr. Hosaka had scheduled another procedure in a different
hospital at the same time as Erlinda's operation, and was in fact over three hours late for the
latter's operation. Because of this, he had little or no time to confer with his anesthesiologist
regarding the anesthesia delivery. This indicates that he was remiss in his professional duties
towards his patient.
Thus, he shares equal responsibility for the events which resulted in Erlindas condition.
Vicarious Liability
As for the hospital (employer) itself, the Court ruled 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.
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 Erlindas condition.
Professional Services Inc. (PSI) v. Agana GR. No. 126297 January 31, 2007
Topic: Res Ipsa Loquitur ; Vicarious liability of Hospitals / respondeat superior.
Leaving foreign substances in the wound after incision has been closed is at least prima facie
negligence by the operating surgeon. Even if it has been shown that a surgeon was required to
leave a sponge in his patient’s abdomen because of the dangers attendant upon delay, still, it is
his legal duty to inform his patient within a reasonable time by advising her of what he had been
compelled to do, so she can seek relief from the effects of the foreign object left in her body as
her condition might permit. What’s worse in this case is that he misled her by saying that the
pain was an ordinary consequence of her operation.
Previously, employers cannot be held liable for the fault or negligence of its professionals.
However, this doctrine has weakened since courts came to realize that modern hospitals are
taking a more active role in supplying and regulating medical care to its patients, by employing
staff of physicians, among others. Hence, there is no reason to exempt hospitals from the
universal rule of respondeat superior.
Tablarin v. Gutierrez
Topic: Propriety of the NMAT
Prescribing the NMAT and requiring certain minimum scores therein as a condition for admission
to medical schools in the Philippines, do not constitute an unconstitutional imposition. An
important component of that public order is the health and physical safety and well being of
the population, the securing of which no one can deny is a legitimate objective of governmental
effort and regulation. The regulation of the practice of medicine in all its branches has long been
recognized as a reasonable method of protecting the health and safety of the public.
Interesting cases related to medicine and law (sex change)
Silverio v. Republic GR. No. 174689 October 22, 2007
Facts: On November 26, 2002, Silverio field a petition for the change of his first name “Rommel
Jacinto” to “Mely” and his sex from male to female in his birth certificate in the RTC of Manila,
Branch 8, for reason of his sex reassignment. He alleged that he is a male transsexual, he is
anatomically male but thinks and acts like a female. The Regional Trial Court ruled in favor of him,
explaining that it is consonance with the principle of justice and equality.
The Republic, through the OSG, filed a petition for certiorari in the Court of Appeals alleging that
there is no law allowing change of name by reason of sex alteration. Petitioner filed a
reconsideration but was denied. Hence, this petition.
Ruling: A change of name is a privilege and not a right. It may be allowed in cases where the name
is ridiculous, tainted with dishonor, or difficult to pronounce or write; a nickname is habitually
used; or if the change will avoid confusion. The petitioner’s basis of the change of his name is
that he intends his first name compatible with the sex he thought he transformed himself into
thru surgery. The Court says that his true name does not prejudice him at all, and no law allows
the change of entry in the birth certificate as to sex on the ground of sex reassignment. The Court
denied the petition.
Republic vs. Cagandahan GR No. 166676, September 12, 2008
Facts: Jennifer Cagandahan filed before the Regional Trial Court Branch 33 of Siniloan, Laguna a
Petition for Correction of Entries in Birth Certificate of her name from Jennifer B. Cagandahan to
Jeff Cagandahan and her gender from female to male. It appearing that Jennifer Cagandahan is
suffering from Congenital Adrenal Hyperplasia which is a rare medical condition where afflicted
persons possess both male and female characteristics. Jennifer Cagandahan grew up with
secondary male characteristics. To further her petition, Cagandahan presented in court the
medical certificate evidencing that she is suffering from Congenital Adrenal Hyperplasia which
certificate is issued by Dr. Michael Sionzon of the Department of Psychiatry, University of the
Philippines-Philippine General Hospital, who, in addition, explained that “Cagandahan genetically
is female but because her body secretes male hormones, her female organs did not develop
normally, thus has organs of both male and female.” The lower court decided in her favor but
the Office of the Solicitor General appealed before the Supreme Court invoking that the same
was a violation of Rules 103 and 108 of the Rules of Court because the said petition did not
implead the local civil registrar.
Ruling: In deciding the case, the Supreme Court considered “the compassionate calls for
recognition of the various degrees of intersex as variations which should not be subject to
outright denial.” The Supreme Court made use of the available evidence presented in court
including the fact that private respondent thinks of himself as a male and as to the statement
made by the doctor that Cagandahan’s body produces high levels of male hormones (androgen),
which is preponderant biological support for considering him as being male.”
The Supreme Court further held that they give respect to (1) the diversity of nature; and (2) how
an individual deal with what nature has handed out. That is, the Supreme Court respects the
respondent’s congenital condition and his mature decision to be a male. Life is already difficult
for the ordinary person. The Court added that a change of name is not a matter of right but of
judicial discretion, to be exercised in the light of the reasons and the consequences that will
follow.