The most important goal of the medical profession is the preservation of life and health of the people. But what happens when a medical professional causes bodily harm or even death to his or her patient? What is the remedy available to the patient?
The remedy available is called a medical malpractice suit. In the Philippines, a medical malpractice suit is primarily governed by the Civil Law concept of damages. In order to successfully pursue a medical malpractice suit, the patient must prove the four (4) elements of medical negligence. The four (4) elements are (1) duty; (2) breach; (3) injury; and (4) proximate causation. Recent cases will illustrate how these 4 elements interact in order to pursue a successful medical malpractice suit.
Is there a Physician-Patient Relationship?
Duty means that there is a professional relationship between the doctor and the patient. This relationship is created when the patient engages the services of the doctor and the doctor agrees to provide care to the patient.
To illustrate, let us take the case of Jarcia v. People of the Philippines (G.R. No. 187926, February 15, 2012). In Jarcia, the patient was hit by a taxicab and was rushed to the hospital. The two doctors who attended the patient ordered an X-ray, which showed no fracture. The doctors informed the mother of the patient that since it was only the ankle of the patient that was hit by the taxicab, there is no need to examine the upper leg. Unfortunately, the patient subsequently developed fever, swelling of the right leg, and misalignment of the right foot. A new X-ray revealed a mid tibial fracture and a linear hairline fracture in the shaft of the patient’s bone.
The two doctors raised the argument that there is no physician-patient relationship in this case. They claim that they were merely passing by the emergency room for lunch when the nurse requested them to see the patient. The Supreme Court struck down the arguments of the doctors and said that when they examined the victim and gave assurances to the victim’s mother, a clear physician-patient relationship existed between the parties. Thus, the two doctors were under a duty to exercise the same degree of care, skill and diligence which physicians in the same line of practice ordinarily possess.
Standard of Breach
The breach referred to in medical malpractice cases is the breach of the standard of care expected of other similarly trained medical professionals acting under the same circumstances.
Let us take the example of Borromeo v. Family Care Hospital, Inc. (G.R. No. 191018, January 25, 2016). In Borromeo, the patient was complaining of acute pain and fever for two days. The doctor suspected that the patient might be suffering from acute appendicitis. After several inconclusive tests, the doctor decided to perform an exploratory laparotomy. After the surgery, the patient’s blood pressure suddenly dropped. Furthermore, the patient developed petechiae in various parts of her body. The doctor suspected that the patient has Disseminated Intravascular Coagulation, which is a blood disorder. Unfortunately, attempts to resuscitate the patient failed.
The Supreme Court held that there is no medical malpractice since the cause of the uncontrollable bleeding was a medical disorder, Disseminated Intravascular Coagulation. In this case there is no proof that the doctor fell short of the expected standard required under the circumstances.
Injury as a Result of Breach
The element of injury to the patient in medical malpractice cases is straightforward – it is the direct result of the doctor’s breach.
The case of Rosit v. Davao Doctors Hospital (G.R. No. 210445, December 7, 2015) perfectly illustrates how an injury to the patient can take place. In Rosit, the patient figured in a motorcycle accident, which fractured his jaw. During the operation, the doctor used a metal plate fastened to the jaw of the patient with metal screws to immobilize his mandible. However, despite the doctor’s knowledge that the operation requires the smallest screws available, the doctor simply cut the larger screws which were on hand. The doctor also knew that the smaller screws were available in Manila, but he simply assumed that the patient would not be able to afford the same.
Following the procedure, the patient could no longer properly open or close his mouth and was in constant pain. X-rays done on the patient revealed that the modified screws placed by the doctor reached the molar of the patient. The patient then had to seek the services of another doctor to undo the damage. In this case, the Supreme Court held that the doctor is liable for at least three types of damages, namely: actual, moral and exemplary damages. First, the patient was able to claim actual damages since he was able to prove the definite expenses that he incurred due to the negligence of the doctor. Second, the patient was likewise able to claim moral damages because of the unnecessary physical suffering he endured as a consequence of the doctor’ negligence. Third, the patient was entitled to exemplary damages because the doctor acted in bad faith or in a wanton, fraudulent, reckless, oppressive manner when he did not inform the patient of the risks of using large screws for the operation.
Proximate causation refers to the relation between the negligence or breach of the doctor and the resulting injury of the patient. The negligence or breach must have played an integral part in causing the injury or damage. In other words, the injury to the patient is either a direct result or a reasonably probable consequence of the negligence or breach of the doctor.
An illustration of proximate causation is provided for in the case of Casumpang v. Cortejo (G.R. No. 171127, March 11, 2015). In Casumpang, the patient is an 11-year old boy who initially complained of difficulty in breathing, chest pain, stomach pain and fever. The doctor who examined the patient diagnosed him with bronchopneumonia. However, the mother of the patient raised her doubts with the doctor’s diagnosis since her son had a high fever but did not have any colds or cough.
The following day, the mother of the patient informed the doctor that there were traces of blood in her son’s sputum. However, the doctor simply nodded and reassured them that it was due to bronchopneumonia. Later that morning, the patient vomited phlegm with blood streaks. He was attended to by one of the resident physicians. Several tests were ordered done on the patient. When the tests came out, the results showed that the patient was suffering from Dengue Hemorrhagic Fever.
The Supreme Court held that the doctor is liable for medical malpractice. In determining whether or not the negligence of the doctor is the proximate cause for the patient’s death, the court looked at the nature of Dengue. The court considered expert testimony stating that with correct and timely diagnosis and proper medical management, dengue fever is not a life threatening disease and could easily be cured. In fact, the mortality rate of dengue fever should fall to less than 2%. Thus, the proximate cause of patient’ death is the failure of the doctor to timely diagnose dengue, despite the presence of its characteristic symptoms.
Captain of the Ship Doctrine
Aside from the four (4) elements of Medical Malpractice cases, there are specific doctrines that should be taken into consideration in determining physician’s liability.
Under the Captain of the Ship Doctrine, the operating surgeon is the person in complete charge of the surgery room and all personnel connected with the operation. In Professional Services Inc. v. Agana (G.R. No. 126297, February 2, 2010), the patient was rushed to the hospital wherein a doctor diagnosed her to be suffering from cancer of the sigmoid. While performing anterior resection surgery on the patient, the doctor discovered that the malignancy in the patient’s sigmoid had already spread to her ovary. This prompted the doctor to obtain the consent of the patient’s husband, to permit another doctor to perform hysterectomy.
After completion of the hysterectomy, the first doctor took over and decided to close the incision despite the fact that the attending nurses informed him that there were missing gauzes. After her release from the hospital, the patient complained of excruciating pain in her anal region. Subsequently, the patient’s daughter found a piece of gauze protruding from her vagina. The doctor was able to remove the gauze but the pain did not subside. Upon consulting other doctors, another gauze was found inside the patient’s vagina, which was already causing infection.
The Supreme Court applied the Captain of the Ship Doctrine in upholding the liability of the doctor. The Court stressed that as the lead surgeon, the doctor had the duty to remove all foreign objects from the patient’s body before the closure of the incision. At the very least, the doctor should have informed the patient of his failure to do so. The act of ordering the closure of the incision notwithstanding that the pieces of gauze remained unaccounted for bolstered the application of the doctrine.
For victims of possible medical malpractice cases, we recommend that you immediately seek the advice of a legal counsel. A legal counsel should be able to provide advice on the proper course of action to take, from initial consultations to the possible filing of appropriate actions in court.
(Paolo Miguel C. Gonzales assists Founding Partner Sig Fortun in handling medical malpractice cases. Paolo is one of the newest members of the Firm, having joined this 2018. He may be reached at [email protected].)