EXCERPTS FROM

DISSECTING PHILIPPINE LAW AND JURISPRUDENCE ON MEDICAL

MALPRACTICE
1. In Carillo v. People,47 the duty of a physician has been said to include
the duty to se!e the inteest of his patient "ith the #eatest of
solicitude$ #i!in# the% al"ays his best talent and s&ill.'() This
doctine ho"e!e "as te%peed in succeedin# cases.
*. Reyes v. Sisters of Mercy Hospital lays do"n the cuent standad$
"hich is not "hat is actually the a!ea#e %eit a%on# all &no"n
pactitiones fo% the best to the "ost and fo% the %ost to the least
e+peienced$ but the easonable a!ea#e %eit a%on# the odinaily
#ood physicians.'(,
-. .nothe useful yadstic& to dete%ine "hethe o not a physician is
#uilty of actionable %alpactice is enunciated in Cruz v. Court of
Appeals in this "ise/ 0"1hethe o not a physician has co%%itted an
2ine+cusable lac& of pecaution3 in the teat%ent of his patient is to be
dete%ined accodin# to the standad of cae obse!ed by othe
%e%bes of the pofession in #ood standin# unde si%ila
cicu%stances beain# in %ind the ad!anced state of the pofession at
the ti%e of teat%ent o the pesent state of %edical science.'45
(. Thus$ the Supe%e Cout "ent on to ule that/ a physician is not an
insurer of the good result of treatent' and that the %ee fact that a
patient does not #et "ell o that a bad esult occus thou#h the couse
of teat%ent does not in itself indicate failue to e+ecise due cae
"hich #i!es ise to an actionable %alpactice.'41
4. The esult is not dete%inati!e of the pefo%ance of the physician
and he is not e6uied to be infallible.'4*
(( Floes !. Pineda$ 7.R. 8o. 14),,9 :heeinafte Floes';$ 4<1 SCR. )-$ ,1$ 8o!. 1($ *55)$ citing C.R... M.RTI8$
=.> RE=.TI87 TO ME?IC.= M.=PR.CTICE -91 :*nd ed.;.
(4 Cayao@=asa%$ 4<( SCR. (-,$ (4($ ?ec. 1)$ *55)$ citing Reyes$ -,9 Phil. )<$ ,9$ Oct. -$ *555. See also =oc&id#e
!. Oa&"ood Aosp.$ *)4 Mich. .pp. 9<)$ <<< 8.>.*d 411 :*55,;.
(9 =ucas$ 4)9 SCR. 1<-$ *55$ .p. *1$ *55,$ citing Snyde !. Pantaleo$ 1(- Conn *,5$ 1** .*d *1 :1,49;. See also
Reyes$ -,9 Phil. )<$ ,9$ Oct. -$ *555.
(< 7.R. 8o. )9),5$ **, SCR. -)9$ Ban. *1$ 1,,(. () !d. at -,9 citing CO?E OF ETAICS OF TAE ME?IC.=
PROFESSIO8$ at. 1$ C-. (, Reyes$ -,9 Phil. )<$ 15($ Oct. -$ *555.
50 Cruz, 346 Phil. 872, 883, Nov. 18, 1997.
51 Lucas, 586 SCRA 173, 204, Ar. 21, 2009.
52 Id., citing !o"i#a v. Pra$$, 13 A 2% 198 &$. '1940(.
9. In fact$ in Reyes v. Sisters of Mercy Hospital$ the Supe%e Cout
distin#uished the standad of cae and dili#ence de%anded fo%
%edical pactitiones fo% co%%on caies as the pactice of %edicine
is aleady conditioned upon the hi#hest de#ee of dili#ence and that
thee is no need to e6uie e+taodinay dili#ence fo% it.
<. Fo% the foe#oin#$ it can be concluded the standad o duty
incu%bent upon a %edical pactitione is elati!e and is dependent on
the %ean co%petency of #ood doctos in the paticula locality o Deld
of pactice. .s the %ee failue of a couse of teat%ent to poduce the
desied eEect does not of itself #i!e ise to a sho"in# of ne#li#ence on
the pat of the %edical pactitione$ it can be said that as lon# as the
%edical pactitione e+ecises that de#ee of cae$ s&ill and dili#ence
that odinaily chaacteiFes the easonable a!ea#e %eit a%on# the
odinaily #ood physicians in the sa%e #eneal nei#hbohood and in
the sa%e #eneal line of pactice "ith due consideation to the
ad!anced state of the pofession at the ti%e of teat%ent o the
pesent state of %edical science$ the %edical pactitione can be said
to ha!e fulDlled the duty of cae and dili#ence e6uied by la".
). Aence$ the Supe%e Cout has uled that the follo"in# acts constitute
beaches of duty of a physician/ inade6uacy of facilities$ lac& of
po!isions$ untidiness of the clinic and failue to conduct pe@opeation
tests on the patientG49 the act of seein# the patient fo the Dst ti%e
only an hou befoe the scheduled opeati!e pocedue4<G schedulin#
anothe pocedue in a diEeent hospital thity %inutes apat fo% the
patient3s scheduled opeation causin# the su#eon to be o!e thee
hous late fo the pocedue4)G lea!in# of spon#es o othe foei#n
obHects in the "ound afte the incision has been closed4,G and failue
to conside the patient3s hi#h blood su#a and subHectin# the patient
to an e!aluati!e pocedue "hich caused the patient3s death due to
co%plications fo% diabetes95.
55 )lor*s, 571 SCRA 83, 94+95, Nov. 14, 2008.
56 Cruz, 346 Phil. 872, 876, Nov. 18, 1997.
57 Id.
58 Id.
59 Pro,*ssio#al S*rvic*s, -#c. v. A.a#a, /.R. No. 126927 'h*r*i#a,$*r 0Pro,*ssio#al S*rvic*s, -#c.1(, 513 SCRA 478,
2a#. 31, 20073 4a$i5ui#, 327 Phil. 965, 968, 2ul. 5, 1996.
60 )lor*s, 571 SCRA 83, 91, Nov. 14, 2008.
61 See P*r*z *$ al., supra #o$* 7.
62 /.R. No. 172406, 535 SCRA 633, 6c$. 11, 2007.
63 See Lucas, 586 SCRA 173, 206+207, Ar. 21, 20093 Cruz, 346 Phil. 872, 876, Nov. 18, 1997. See also 61 A". 2ur.
2% 7309 a$ 417,
,. In "ucas v. #ua$o$ it "as held that in the absence of a po!en standad
of le!el of cae$ s&ill and dili#ence fo a paticula couse of cae o
teat%ent$ thee can be no Dndin# of ne#li#ence a#ainst the %edical
pactitione. The Cout "ent on futhe to say that "ithout a standad
of cae$ the Cout "ill ha!e no yadstic& upon "hich to e!aluate o
"ei#h the attendant facts of this case to be able to state "ith
conDdence that the acts co%plained of$ indeed$ constituted ne#li#ence
and$ thus$ should be the subHect of pecuniay epaation.9<
10. Causation
To hold a %edical pactitione liable$ causation of the act of the %edical
pactitione leadin# to the inHuy %ust be po!en "ithin a easonable
%edical pobability and based upon co%petent e+pet testi%ony.,- If the
%edical pactitione3s ne#li#ence is not the i%%ediate cause of the
inHuy$ he %ay still be held liable if it is po!en by a pepondeance of
e!idence that the act o o%ission co%plained of is the po+i%ate cause of
the inHuy suEeed by the plaintiE. Po+i%ate cause of an inHuy is that
cause$ "hich$ in the natual and continuous se6uence$ unbo&en by any
eIcient inte!enin# cause$ poduces the inHuy$ and "ithout "hich the
esult "ould not ha!e occued.,(
Thus$ it can be said that an inHuy o da%a#e is po+i%ately caused by an
act o a failue to act$ "hene!e it appeas fo% the e!idence in the case
that the act o o%ission played a substantial pat in bin#in# about o
actually causin# the inHuy o da%a#eG and that the inHuy o da%a#e "as
eithe a diect esult o a easonably pobable conse6uence of the act o
o%ission.,4 In posecutin# his case$ a plaintiE %ust plead and po!e$ not
only that he had been inHued and defendant has been at fault$ but also
that it is the defendant3s fault that po+i%ately caused the inHuy "hich
%ust be po!en "ithin a easonable %edical pobability and upon
co%petent e+pet testi%ony.,9 Cayao%"asa v. Raolete is paticulaly
instucti!e in illustatin# the ele%ent of po+i%ate cause as applied to
cases of %edical %alpactice. .s "ill be discussed late on$ if it "ould be
dete%ined fo% the e!idence that the plaintiE is #uilty of contibutoy
ne#li#ence and such ne#li#ence "as the po+i%ate cause of the inHuy$
the %edical %alpactice case$ a physician "ill be absol!ed of liability
e#adless if he "as li&e"ise #uilty of ne#li#ence hi%self.
11. Thus$ it has beco%e the no% that a patient en#a#es the
se!ices of %oe than one docto in attendin# to his needs as
de%anded by his condition$ "hich at ti%es ae at a nu%be suIcient
to constitute a pesonal etinue of se!ants. In fact$ so%e Filipinos ha!e
e#aded the nu%be of specialists and consultants one consults
e#ulaly as a status sy%bol.155 This ne" eality of the pactice of
%edicine poses a si#niDcant challen#e to %edical %alpactice la" as to
"ho% liability %ust attach "hen thee is inHuy suEeed by the patient
in the couse of teat%ent due to ne#li#ence.
This is %ost ele!ant in the Deld of su#ey "hee a patient is not only
teated by a su#eon$ but is$ in addition$ attended to by at least an
anaesthesiolo#ist to facilitate the ad%inistation of anaesthesia$ and if
applicable$ anothe docto "hose specialty in!ol!es the pat to be
subHected to su#ey. 7eneally$ a %e%be of a su#ical tea% is liable
only to the e+tent of hisJhe ole in the su#ey.151
,< =ucas$ 4)9 SCR. 1<-$ *55$ .p. *1$ *55,$ citing 7acia@Rueda$ -(( Phil. -*-$ Sep. 4$ 1,,<.
,) Rafael Castillo$ M.?.$ #he PCP and the &ilipino !nternist$ Phil. ?aily In6uie$ Feb. 1*$ *55,$ availa'le at
http/JJsho"biFandstyle.in6uie.netJlifestyleJlifestyleJ!ie"J*55,5*1-@1),**)JThe@PCP@and@the@Filipino@
intenist ,, Rafael Castillo$ M.?.$ #he PCP and the &ilipino !nternist$ Phil. ?aily In6uie$ Feb. 1*$ *55,$
availa'le at http/JJsho"biFandstyle.in6uie.netJlifestyleJlifestyleJ!ie"J*55,5*1-@1),**)JThe@PCP@and@the@
Filipino@intenist accessed on Mach *4$ *515.
155 !d.
151 See generally Ra%os !. Cout of .ppeals :?ecision;G Ra%os !. Cout of .ppeals :Resolution;G 8o#ales !.
Capitol Medical Cente$ 7.R. 8o. 1(*9*4 :heeinafte 8o#ales';$ 411 SCR. *5($ *-5$ ?ece%be 1,$ *559.
1*. Physicians ae said to be #eneally fee to e+ecise thei o"n s&ill
and Hud#%ent in endein# %edical se!ices sans intefeence1-<
o"in# to the hi#hly de!eloped and specialiFed natue of the pactice of
%edicine.1-) Aence$ "hen a docto pactices %edicine in a hospital
settin#$ the hospital and its e%ployees ae dee%ed to subse!e hi% in
his %inistations to the patient and his actions ae of his o"n
esponsibility.1-, Ao"e!e$ the taditional !ie" has #i!en "ay due to
the %odeniFation of the pactice of %edicine. Aospitals ha!e beco%e
inceasin#ly acti!e in the supplyin# of and e#ulatin# %edical cae to
patients and thei ole "as no lon#e li%ited to funishin# oo%$ food$
facilities fo teat%ent and opeation$ and attendants fo its
patients1(5 and instead ha!e beco%e centes fo healin# and
teat%ent due to the facilities a!ailable that "ould enable co%petent
%edical pactitiones to fully cae fo the needs of thei patients.
133 41 C.2.S. 78 a$ 332 citing 6la#%*r v. 2oh#so#, 258 -ll. A. 89.
134 40 A". 2ur. 2% 720 a$ 863 citing 8#iv*rsi$9 o, Louisvill* v. :*$cal,*, 216 ;9 339, 287 S< 945, 49 ALR 375.
135 & =6L>N=-N6 616.
136 Pro,*ssio#al S*rvic*s, -#c., 513 SCRA 478, 497, 2a#. 31, 2007, citing Ar?a#sas :.R. Co. v. P*arso#, 98 Ar?. 442,
153 S< 595 '1911(3 Ru#9a# v. /oo%ru", 147 Ar?. 281, 228 S< 397, 13 ALR 1403 '1921(3 Rosa#* v. S*#.*r, 112
Colo. 363, 149 P. 2% 372 'su*rs*%*% @9 s$a$u$* o# o$h*r .rou#%s(3 :oo# v. :*rc9 Aos., 150 Col. 430, 373 P. 2%
944 '1962(3 Aus$i# v. Li$va?, 682 P. 2% 41, 50 ALR 4$h 225 '1984(3 <*s$*r# -#s. Co. v. 4roch#*r, 682 P. 2% 1213
'1983(3 Ro%ri.u*z v. !*#v*r, 702 P. 2% 1349 '1984(.
137 Id. a$ 498 citing )ri%*#a v. >va#s, 127 Ariz. 516, 522 P. 2% 463 '1980(.
138 Id. 139 Id. Citing
13. DEFENSES AAILA!LE
A. P"#su$%tion o& Du# Di'i(#n)# P#"&o"$#*
?octos ae potected by a special ule of la". They ae not #uaantos of
cae. They ae not insues a#ainst %ishaps o unusual conse6uences.*(1
In addition$ a physician is pesu%ed to ha!e confo%ed to the standad of
cae and dili#ence e6uied of the cicu%stances.*(* Ae is also pesu%ed
to ha!e the necessay &no"led#e to pactice his pofession.*(- >hen the
6ualiDcations of a physician ae ad%itted$ thee is an ine!itable
pesu%ption that in pope cases$ he ta&es the necessay pecaution and
e%ploys the best of his &no"led#e and s&ill in attendin# to his
patients.*(( These pesu%ptions aise fo% the Hudicial eco#nition that
the pactice of %edicine is aleady conditioned upon the hi#hest de#ee
of dili#ence.'*(4 .ccodin# to the Supe%e Cout thee e+ist suIcient
safe#uads toensue that the %edical po!ision is #o!ened hi#h
standads of 6uality and dili#ence$ to "it/
The pactice of %edicine is a pofession en#a#ed in only by 6ualiDed
indi!iduals. It is a i#ht eaned thou#h yeas of education$ tainin#$ and
by Dst obtainin# a license fo% the state thou#h pofessional boad
e+a%inations. Such license %ay$ at any ti%e and fo cause$ be e!o&ed by
the #o!en%ent. In addition to state e#ulation$ the conduct of doctos is
also stictly #o!ened by the Aippocatic Oath$ an ancient code of
discipline and ethical ules "hich doctos ha!e i%posed upon the%sel!es
in eco#nition and acceptance of thei #eat esponsibility to society.*(9
238 Pr*s. !*cr** No. 223 '1973(, 75.
239 76.
240 /.R. No. L+25018, 28 SCRA 344, :a9 26, 1969.
241 Ca9ao+Lasa", 574 SCRA 439, 461, !*c. 18, 20083 Cruz, 346 Phil. 872, 875+876, Nov. 18, 1997.
242 See Lucas, 586 SCRA 173, 200, Ar. 21, 20093 Cruz, 346 Phil. 872, 876, Nov. 18, 19973 61 A". 2ur. 2% 7309,
citing A9*rs v. Parr9, 192 ).2% 181 '3% Cir. 1951(3 Rho%*s v. !* Aaa#, 184 ;a#. 473, 337 P.2% 1043 '1959(.
243 See 61 A". 2ur. 2% 7309 citing >c?l*@*rr9 v. ;ais*r )ou#%a$io# Nor$h*r# Aosi$als, 226 6r. 616, 359 P.2% 1090,
84 A.L.R.2% 1327 '1961(. 244 Cruz, 346 Phil. 872, 885, Nov. 18, 1997. 245 R*9*s, 396 Phil. 87, 107, 6c$. 3, 2000.
1(. >hat the ulin# in the "asa case teaches us is that "hile a
physician is unde a duty to po!ide cae and teat%ent "ith a de#ee
of cae$ s&ill and dili#ence "hich physicians in the sa%e #eneal
nei#hbohood and in the sa%e #eneal line of pactice$ thee is a
concuent duty o obli#ation on the pat of the patient to follo" the
pescibed couse of teat%ent po!ided by the physician