MEDICAL NEGLIGENCE AND MEDICAL

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

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

- a branch of medicine which deals with the application of medical

knowledge to the purposes of law and in the administration of justice.
 HISTORY OF LEGAL MEDICINE

Paulus Zacchias (1584 – 1659) is the “Father of

Forensic Medicine”; an Italian practical
physician, teacher of medical science, medio-
legal jurist, philosopher, and poet. His most
well known book is Quaestiones medico-
legales (written in 1557).

He was the first to describe the importance and application

of medicine to the proper administration of justice.

-He is said to have occupied the position as

personal physician for Pope Innocentius X.
Zacchias was also an adviser for the Rota
Romana, the highest Papal court of appeals.
 HISTORY OF LEGAL MEDICINE

*I n t h e P h i l . , t h e f a t h e r o f L e g a l Medicine can be rightfully

bestowedto Dr. PedroP.Solis.

The late Dr. Pedro P. Solis completed his elementary education at Julugan Elementary School,
secondary education at the University of the Philippines (U.P.) High School and Associate in Arts in
U.P.. Dr. Pedro Solis finished Medicine at the U.P. College of Medicine and Law at the Manila Law
College.His graduatedegreein Criminologywas obtainedfromCambridge Universityin England.

For forty-four years Dr. Solis served the government initially as medico-legal officer, eventually
becomingthe NationalBureau of Investigation'sDeputyDirectorforTechnicalServices.

He taught in various institutions such as the Colleges of Law, Medicine and Public Health of the
University of the PHilippines, Manila Law College, Philippine College of Criminology, the medical
colleges of Far Eastern University (FEU), University of the East (U.E.), Manila Central University
(M.C.U.)and thecollegesof Lawof Lyceumand San Sebastian.

Dr. Solis wrote textbooks in Legal Medicine, Medical Jurisprudence and Criminal Investigation,
which are still widely used at present. He represented the country in various international
organizationsand committees in the fieldsoflaw, medicine and criminology.
 APPLICATION OF LEGAL
MEDICINE TO LAW
Legal Medicine is applied to Law

1. CIVIL LAW- the determination and termination of civil personality

- the limitation or restriction of a natural person’s capacity to act
- marriage and legal separation
- testamentary capacity of a person making a will
- paternity and filiation
- the right to hereditary succession

2. CRIMINAL LAW-Felonies and circumstances which affect criminal liability

-Civil liability ex delictu
-Crimes relative to opium and prohibited drugs
-Crimes against civil status of persons -Crimes against chastity
-Crimes against persons -Quasi – offenses

3. REMEDIAL LAW-Physical and Mental Examination of a person

-Hospitalization of insane persons
-Rules of Evidence
 APPLICATION OF LEGAL
MEDICINE TO LAW

4. SPECIAL LAWS- Dangerous Drug Act

- Youth and Child Welfare Code
- Insurance law
- Sanitation Code
- Employees Compensation Law
- Labor Code

5. CORPUS DELICTI
- is the body or substance of the crime and is defined as the fact that a
crime actually has been committed. In all criminal prosecutions, the
burden is on the prosecution to prove the corpus delicti.
WHAT IS FORENSIC MEDICINE?
FORENSIC MEDICINE is the practice of medicine as it pertains to the Law. It involves areas
like determining the nature and cause of death, medical negligence and identification of human
remains. It can include medical examination of suspects and victims in support of the investigation
of crime such as medical examination of the victims of rape, for the purpose of determining the
nature and extent of any injuries and the taking of samples, fitness of suspects to be interviewed
where it may be in doubt for medical reasons, and determining whether a person is acting under the
influence of drugs.

There are various branches within the field of forensic medicine including Forensic pathology that
is concerned primarily with establishing the nature and cause of suspicious death.

Forensic Odontology is the application of dentistry to legal matters. Amongst other tasks the
Forensic Odontologists can identify individuals using their dentition and through bite marks.

Forensic Radiography is the application of science of diagnostic imaging to questions of law.

Forensic Radiography can be used to identify the individual, identify the cause of the injury or death
and to identify evidential material.a
WHAT IS MEDICAL JURISPRUDENCE?

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

applicable Jurisprudence that governs, regulates and defines
the practice of medicine.

-It includes the rights, duties, obligations and liabilities of both

physician and patient to each other in a physician patient
professional contract.

In the Philippines, Legal Medicine is the appropriate name for

Forensic Medicine.
 WHAT ARE THE “ACTS” WHICH
CONSTITUTE MEDICAL PRACTICE?

The following acts constitute the Practice of

Medicine:

1. To physically examine and diagnose a patient.

2. To physically examine and treat a patient
3. To physically examine and perform surgery in a
patient
4. To physically examine and prescribe any remedy
to a patient.
 WHAT ARE THE “RIGHTS” INHERENT
IN THE PRACTICE OF MEDICINE?

Rights inherent in the Practice of Medicine:

1. The right to choose his patients

2. The right to limit the practice of his profession
3. The right to determine appropriate treatment procedures
in the discretion and judgment of the physician.
4. The right to avail of hospital privileges after being
qualified.
5. The right to receive just and fair compensation from his
patients.
 WHAT IS THE DIFFERENCE BETWEEN
MEDICAL NEGLIGENCE AND MEDICAL
MALPRACTICE?
• MEDICAL MALPRACTICE – general
term used when a medical practitioner
(Doctor) or an allied medical practitioner
(Dentist, Nurse, Medical Technologist)
KNOWINGLY DEVIATES from the
standard practice of medicine
Common complaints about doctors
who commit MALPRACTICE include:
Error in anesthesia
Mistake during childbirth
Surgical errors
Unnecessary surgery
Wrongful death
Wrong diagnosis or misdiagnosis
• MEDICAL NEGLIGENCE – specific
term used when a medical practioner
does not exercise due diligence and
standard care required of him thus
resulting to injury to the patient.
Usually connotes accidental or
unintentional injury.
Examples of MEDICAL NEGLIGENCE include:
Failure to revise a diagnosis
Failure to warn patients of the risks of treatment
Failure to remove surgical instruments from the
patient during surgery
Failure to attend to or treat a patient
Incompetence
Failure to refer a patient to a specialist relevant
to their disease or injury
Wrongful diagnosis
DOCTRINE OF PROXIMATE CAUSE

•“That cause, which, in natural and continuous sequence,

unbroken by any efficient intervening cause, produces the
injury, and without which the result would not have
occurred.”
•a legal concept of "cause-and-effect" relationships
•determines whether an injury would have resulted from a
particular cause.
•In Malpractice - An element required to prove
negligence; i.e., the plaintiff–Patient or Patient's estate
must prove that the Patient's injury is reasonably
connected to the physician's action.
 WHAT IS THE DEGREE OF CARE
NEEDED TO BE APPLIED BY
PHYSICIANS?

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

Source: Solis MEDICAL JURISPRUDENCE 1988

 DOCTRINE OF RES IPSA
LOQUITUR

-Literally means: “the thing speaks for itself”.

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

-Literally means: “the thing speaks for itself”.

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

Medical malpractice can be established by the

doctrine of res ipsa liquitur. It is applicable to cases
where the court, from its fund of knowledge, can
determine the standard of care or where an ordinary
layman can conclude that there was negligence on the
part of the doctor.
 CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007
Facts: Petitioner Dr. Milagros L.
Cantre is a specialist in Obstetrics
and Gynecology at the Dr. Jesus
Delgado Memorial Hospital. She
was the attending physician of
respondent Nora S. Go, who was
admitted at the said hospital on
April 19, 1992.

Nora Go delivered a baby boy by

normal vaginal delivery, with Dr.
Cantre in attendance. After the
delivery, Nora had massive
vaginal bleeding.
Because of profuse bleeding, patient went into hypovolemic shock.
 CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007

The BP dropped to 0/0.

Dr. Cantre was able to stabilize the patient. She

ordered a drop light to be placed near the patient
and her blood pressure monitored.

However, a gaping wound was caused by the

blood pressure cuff that was used to monitor the
patient’s blood pressure.
CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007
ISSUES:

Is petitioner liable for the injury suffered by respondent Nora

Go?

Injury – gaping wound in the arm where the BP cuff was placed.

Cause - either the BP cuff or the drop light which was placed
too near the arm of the patient
CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007

RULING:

The Hippocratic Oath mandates physicians to give primordial

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

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

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

absence of someone's negligence;

2. It is caused by an instrumentality within the exclusive control of the

defendant or defendants; and

3. The possibility of contributing conduct which would make the plaintiff

responsible is eliminated.
 CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007

• As to the first requirement, the gaping wound on Nora's arm is certainly not an
ordinary occurrence in the act of delivering a baby, far removed as the arm is from
the organs involved in the process of giving birth. Such injury could not have
happened unless negligence had set in somewhere.

• Second, whether the injury was caused by the droplight or by the blood pressure cuff
is of no moment. Both instruments are deemed within the exclusive control of the
physician in charge under the “CAPTAIN OF THE SHIP" doctrine. -This doctrine
holds the surgeon in charge of an operation liable for the negligence of his assistants
during the time when those assistants are under the surgeon's control.

• In this particular case, it can be logically inferred that petitioner, the senior
consultant in charge during the delivery of Nora's baby, exercised control over the
assistants assigned to both the use of the droplight and the taking of Nora's blood
pressure. Hence, the use of the droplight and the blood pressure cuff is also within
petitioner's exclusive control.
CASE STUDY: CANTRE VS SPS GO,
G.R. NO. 160889, APRIL 27, 2007
• Third, the gaping wound on Nora's left arm, by its very nature and
considering her condition, could only be caused by something external to
her and outside her control as she was unconscious while in hypovolemic
shock. Hence, Nora could not, by any stretch of the imagination, have
contributed to her own injury.

• NO CONTRIBUTORY NEGLIGENCE ON THE PART OF THE

PATIENT
DOCTRINE OF CONTRIBUTORY
NEGLIGENCE

• Doctrine of Common Fault.

• It is the conduct on the part of the plaintiff, contributing as a legal cause
to the harm he has suffered, which falls below the standard to which he
is required to conform for his own protection.

Legal Basis
Article 2179, Civil Code:

When the plaintiff’s own negligence was the immediate and proximate cause
of his injury, he cannot recover damages. But if his negligence was only
contributory, the immediate and proximate cause of the injury being the
defendant’s lack of due care, the plaintiff may recover damages, but the
court shall mitigate the damages to be awarded.
Article 2214, Civil Code

In quasi-delicts, the contributory negligence of the plaintiff shall reduce the

damages that he may recover.
 LIABILITIES OF HOSPITALS

The hospital’s liability is also anchored upon the following

doctrines:

• agency PRINCIPLE OF APPARENT AUTHORITY or

agency by estoppel
• DOCTRINE OF CORPORATE
NEGLIGENCE/CORPORATE RESPONSIBILITY

which have gained acceptance in the determination of a

hospital’s liability for negligent acts of professionals because of
the actions for a principal or an employer .
 DOCTRINE OF APPARENT
AUTHORITY

“Where it is shown that a hospital, by its actions, has held out a

particular physician as its agent and/or employee and that a
patient has accepted treatment from that physician in the
reasonable belief that it is being rendered in behalf of the
hospital, the hospital will be liable for physician’s negligence.”

(Professional Services, Inc. v Agana, G.R. No. 126297, January

31, 2006)
DOCTRINE OF CORPORATE
RESPONSIBILITY

• A hospital has the duty to see that it meets the standards of

responsibilities for the care of patients. Such duty includes the
proper supervison of the members of its medical staff.

• If a hospital breached its duties to oversee or supervise all persons

practicing medicine within its walls and also failed to take an
active step in fixing the negligence committed, it will be
vicariously liable for the negligence of the doctor under Art. 2180,
and directly liable for its own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January 31,

2006)
 DOCTRINE OF RESPONDENT
SUPERIOR

• A hospital has the duty to see that it meets the standards of

responsibilities for the care of patients. Such duty includes the
proper supervison of the members of its medical staff.

• If a hospital breached its duties to oversee or supervise all

persons practicing medicine within its walls and also failed to
take an active step in fixing the negligence committed, it will be
vicariously liable for the negligence of the doctor under Art.
2180, and directly liable for its own negligence under Art. 2176.

(Professional Services, Inc. v Agana, G.R. No. 126297, January

31, 2006)
 LIABILITIES OF A PHYSICIAN WHICH MAY
ARISE FROM HIS NEGLIGENT OR WRONGFUL
ACTS OR OMISSIONS

Liabilities of a Physician Which May Arise from His Negligent or

Wrongful Acts or Omissions:

1. ADMINISTRATIVE LIABILITY- A complaint under oath can be filed

before the Professional RegulationCommission Board of Medicine, for
reprimand, of the license to practice medicine.

2. CRIMINAL LIABILITY- When an act or omission constitutes a crime,

the physician can be imprisoned or fined or both, as any other profession.

3. CIVIL LIABILITY- The aggrieved party can be awarded

monetary damages for any wrongful or
negligent act or omission, when the professional is found guilty.
Questions/Tips/Trivia?