Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
2.
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Superficial Laceration
Complete Hymenal Laceration
Complex Laceration
CASES:
Nogales v. Capitol Medical Center
Facts:
Corazon Nogales, 37, was under exclusive prenatal care of Dr.
Oscar Estrada with her fourth child. An increase in her blood
pressure and development of leg edema indicating preeclampsia
was noted during her last trimester of pregnancy; a dangerous
complication of her pregnancy. On 26 May 1976, Corazon was
admitted to CMC after the staff nurse noted the written admission
request for Dr. Estrada. Rogelio executed and signed the Consent
Admission and Agreement and Admission Agreement. During
the operation, Dr. Estrada was assisted by doctors of CMC. The
baby came out in an apnic, cyanotic, weak and injured condition
and had to be incubated and resuscitated by Drs. Enriquez and
Payumo. Corazons blood pressure dropped, she had continuous
vaginal bleeding, was administered hemacel and undergone
immediate hysterectomy. Eventually, she died at 9:15 a.m. with
hemorrhage, post partum.
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The element of "holding out" on the part of the hospital does not
require an express representation by the hospital that the person
alleged to be negligent is an employee. Rather, the element is
satisfied if the hospital holds itself out as a provider of emergency
room care without informing the patient that the care is provided
by independent contractors.
gauze (1.5 in) protruding from her vagina, so Dr. Ampil manually
Enrique
Agana
also
filed
an administrative
was heard since Dr. Ampil was abroad). Pending the outcome of the
cases, Natividad died (now substituted by her children). RTC
FACTS
found PSI and the two doctors liable for negligence and
1.
2.
3.
negligence. YES
RATIO
DR. AMPIL IS LIABLE FOR NEGLIGENCE AND MALPRACTICE
His arguments are without basis [did not prove that the American
doctors were the ones who put / left the gauzes; did not submit
evidence to rebut the correctness of the operation record (re:
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1.
Occurrence of injury
2.
Leaving
foreign
substances
in
the
wound
after
3.
4.
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
Under the Captain of the Ship rule, the operating surgeon is the
connected with the operation. That Dr. Ampil discharged such role
operation.
care provider would have done [or wouldn't have done], and that
2176]
Previously, employers cannot be held liable for the fault or
negligence of
its
professionals.
However,
this
doctrine has
patient
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PSI publicly displays in the Medical City lobby the names and
specializations of their physicians. Hence, PSI is now estopped from
passing all the blame to the physicians whose names it proudly
paraded in the public directory, leading the public to believe that it
vouched for their skill and competence.
Ramos v. CA
Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except for
her experiencing occasional pain due to the presence of stone in
her gall bladder. She was advised to undergo an operation for its
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the bedside. She herself admitted that she had seen petitioner only
in the operating room, and only on the actual date of the
cholecystectomy. She negligently failed to take advantage of this
important opportunity. As such, her attempt to exculpate herself
must fail.
Opinion of Expert Witness
An anesthetic accident caused by a rare drug-induced
bronchospasm properly falls within the fields of anesthesia, internal
medicine-allergy, and clinical pharmacology. The resulting anoxic
encephalopathy belongs to the field of neurology. While admittedly,
many bronchospastic-mediated pulmonary diseases are within the
expertise of pulmonary medicine, Dr. Jamora's field, the anesthetic
drug-induced, allergic mediated bronchospasm alleged in this case
is within the disciplines of anesthesiology, allergology and
pharmacology. On the basis of the foregoing transcript, in which
the pulmonologist himself admitted that he could not testify about
the drug with medical authority, it is clear that the appellate court
erred in giving weight to Dr. Jamora's testimony as an expert in the
administration of Thiopental Sodium. Generally, to qualify as an
expert witness, one must have acquired special knowledge of the
subject matter about which he or she is to testify, either by the
study of recognized authorities on the subject or by practical
experience. Clearly, Dr. Jamora does not qualify as an expert
witness based on the above standard since he lacks the necessary
knowledge, skill, and training in the field of anesthesiology. Oddly,
apart from submitting testimony from a specialist in the wrong
field, private respondents' intentionally avoided providing
testimony by competent and independent experts in the proper
areas.
Proximate Cause
Proximate cause has been defined as that which, in natural and
continuous sequence, unbroken by any efficient intervening cause,
produces injury, and without which the result would not have
occurred. An injury or damage is proximately caused by an act or a
failure to act, whenever it appears from the evidence in the case,
that the act or omission played a substantial part in bringing about
or actually causing the injury or damage; and that the injury or
damage was either a direct result or a reasonably probable
consequence of the act or omission. Instead of the intended
endotracheal intubation what actually took place was an
esophageal intubation. During intubation, such distention indicates
that air has entered the gastrointestinal tract through the
esophagus instead of the lungs through the trachea. Entry into the
esophagus would certainly cause some delay in oxygen delivery
into the lungs as the tube which carries oxygen is in the wrong
place. That abdominal distention had been observed during the
first intubation suggests that the length of time utilized in inserting
the endotracheal tube (up to the time the tube was withdrawn for
the second attempt) was fairly significant. Due to the delay in the
delivery of oxygen in her lungs Erlinda showed signs of cyanosis.
Responsibility of the Surgeon
As the so-called "captain of the ship," it is the surgeon's
responsibility to see to it that those under him perform their task in
the proper manner. Respondent Dr. Hosaka's negligence can be
found in his failure to exercise the proper authority 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 us
that respondent Dr. Hosaka had scheduled another procedure in a
different hospital at the same time as Erlinda's cholecystectomy,
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 Erlinda's condition.
Responsibility of the Hospital
Hospitals hire, fire and exercise real control over their attending
and visiting "consultant" staff. While "consultants" are not,
technically employees, a point which respondent hospital asserts in
denying all responsibility for the patient's condition, the control
exercised, the hiring, and the right to terminate consultants all
fulfill the important hallmarks of an employer-employee
relationship, with the exception of the payment of wages. In
assessing whether such a relationship in fact exists, the control
test is determining. Accordingly, on the basis of the foregoing, we
rule that for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting
physicians.
The basis for holding an employer solidarily responsible for the
negligence of its employee is found in Article 2180 of the Civil
Code which considers a person accountable not only for his own
acts but also for those of others based on the former's
responsibility under a relationship of patria potestas. Such
responsibility ceases when the persons or entity concerned prove
that they have observed the diligence of a good father of the
family to prevent damage. In the instant case, respondent hospital,
apart from a general denial of its responsibility over respondent
physicians, failed to adduce evidence showing that it exercised the
diligence of a good father of a family in the hiring and supervision
of the latter. It failed to adduce evidence with regard to the degree
of supervision which it exercised over its physicians. In neglecting
to offer such proof, or proof of a similar nature, respondent hospital
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The petitioners are not responsible for the alleged delay in blood
cross-matching. It is unreasonable if the petitioners were to be
sanctioned for lapses in procedure that does not fall within their
duties.
Dr. Zafe and Dr. Cereno examined Raymond and they found that
the latters blood pressure was normal.
At 12:15am, they started operating Raymond and they found
3,200cc of blood that was stocked in.
1:40am blood was transfused on Raymond, he suffered a cardiac
arrest.
1:50am the operation ended.
2:40am Raymond died.
The parents of Raymond filed this case against Dr. Zafe and Dr.
Cereno for damages.
Facts:
The Trial court dismissed the case against the Resident physician
and the nurse and rendered a decision making Dr. Zafe and Dr.
Cereno liable.
Dr. Bestan also conducted her own examination and told Mrs.
Santiago that there is no need to examine the upper leg of Roy.
11 days later, Roy developed a fever and there was a swelling on
his right foot. He was brought back to the hospital and a new x-ray
was conducted. They found out that there is a right mid-tibial
fracture and a linear hair line fracture on the shaft of the bone of
Roy.
Mrs. Santiago went to the NBI in which the latter endorsed the
matter to the Office of the prosecutor and found such probable
cause. The prosecutor filed a criminal case for reckless imprudence
resulting to serious physical injuries.
RTC found out that Dr. Jarcia and Dr. Bestan guilty of simple
imprudence resulting to SPI.
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Legal Facts:
Respondents 11-year old daughter, Angelica Soliman,
underwent a biopsy of the mass located in her lower extremity at
the St. Lukes Medical Center (SLMC) on July 7, 1993 and results
showed
that
Angelica
was
suffering
from
osteosarcoma,
Requisites:
1.
2.
3.
They are acquitted of the criminal charge but held civilly liable.
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Reasoning:
In Dr.
Rubi
Li
vs.
Spouses
Reynaldo
and
Lina
Policy Formation:
the physicians
duty
to
disclosematerial
risks;
(2)
future
medico-legal
suits
will
be
prevented.
Synthesis:
point
to
significant
undisclosed
information
relating
to
the
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FACTS:
very well that the severity of these side effects will not be the
Nora Go gave birth to her 4th child. Two hours later, she suffered
Nora's BP. While Dr. Cantre was massaging Nora's uterus for it to
a fresh gaping wound (2 1/2 x 3 1/2 in) in the inner portion of her
left arm near the armpit. When he asked the nurses about the
cause of the injury, he was informed that it was due to a burn. John
David filed a request for investigation. Dr. Cantre said that what
caused the injury was the blood pressure cuff. John David brought
Nora to the NBI for a physical examination. The medico-legal said
that the injury appeared to be a burn and that a droplight when
placed near the skin for about 10 minutes could cause such burn.
of
chemotherapy
pressure cuff since the scar was not around the arm, but just on
one side of the arm. Nora's injury was referred to a plastic surgeon
for skin grafting. However, her arm would never be the same--the
care
in
obtaining
consent
in
which were not testified to by any witness. RTC ruled in favor of the
spouses. CA affirmed RTC with modification (complaint dismissed
with respect to the medical director and the hospital; only moral
damages awarded).
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ISSUES AND HOLDING:
1.
2.
evidence. YES
2.
by
an instrumentality
exclusive control
Go. YES
RATIO
Preliminary discussion
Dr. Cantre's counsel admitted the existence of the additional
exhibits when they were formally offered for admission by the RTC.
3.
Cantre's
negligence
may
be
made
based
on
the res
ipsa
unique
restraint
in
cause
injury
is
negligence
to
immaterial in
exists
and
is
their
these
it
damage caused.
Res ipsa loquitur x Medical negligence cases
In medical
negligence
cases,
the
doctrine
of res
ipsa
saving grace
BP cuff defense does not afford her an escape. The
medical practice is to deflate the cuff immediately after use, or
else, it could cause an injury similar to what happened to Nora. If
the wound was caused by the constant taking of BP, it must have
been done so negligently as to inflict a gaping wound.
cases
proven,
notwithstanding, courts
within defendant's
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