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BLOCK C 2017 – Forensic Medicine | Atty.

Ivy Patdu
1. The Philippine Regulations Commission regulates the following Health Related shall produce a cause of action for damages, prevention and other
Professions: relief:
(1) Prying into the privacy of another's residence:
A.RA 9484: The Practice of Dentistry, Dental Hygiene, and Dental (2) Meddling with or disturbing the private life or family relations of
Technology another;
B.RA 5527: Medical Technology (3) Intriguing to cause another to be alienated from his friends;
C.RA 2383, as amended: Medicine (4) Vexing or humiliating another on account of his religious beliefs,
D.RA 7392: Midwifery lowly station in life, place of birth, physical defect, or other personal
E.RA 9173: Nursing condition.
F.PD No. 1286: Nutrition and Dietetics
G.RA No. 8050: Optometry Article 32: Any public officer or employee, or any private individual,
H.RA No. 5921: Pharmacy who directly or indirectly obstructs, defeats, violates or in any
I.RA No. 5680: Physical Therapists and Occupational Therapists manner impedes or impairs any of the following rights and liberties
J.RA No. 7431: Radiologic Technology of another person shall be liable to the latter for damages:
K.RA No. 1364: Board of Sanitary Engineering xxx
L.RA No. 4373: Social Work (11) The privacy of communication and correspondence
M.RA No. 9268: Veterinary Medicine xxx
N.RA No. 10029: Psychology
4. E-Commerce Act. Relevance to Medical Privacy.
2. Provisions in the Bill of Rights provide for the Right to Privacy
Electronic Commerce Act of 2000
Section 2. The right of the people to be secure in their persons, houses, papers, and PART II ELECTRONIC COMMERCE IN GENERAL
effects against unreasonable searches and seizures of whatever nature and for any CHAPTER I GENERAL PROVISIONS
purpose shall be inviolable, and no search warrant or warrant of arrest shall issue
except upon probable cause to be determined personally by the judge after Section 5. Definition of Terms - For the purposes of this Act, the following terms are
examination under oath or affirmation of the complainant and the witnesses he may defined, as follows:
produce, and particularly describing the place to be searched and the persons or (a)"Addressee" refers to a person who is intended by the originator to
things to be seized. receive the electronic data message or electronic document. The term does
Section 3. (1) The privacy of communication and correspondence shall be inviolable not include a person acting as an intermediary with respect to that
except upon lawful order of the court, or when public safety or order requires electronic data message or electronic data document.
otherwise, as prescribed by law. (b)"Computer" refers to any device or apparatus which, by electronic,
(2) Any evidence obtained in violation of this or the preceding section shall be electro-mechanical, or magnetic impulse, or by other means, is capable of
inadmissible for any purpose in any proceeding. receiving, recording, transmitting, storing, processing, retrieving, or
producing information, data, figures, symbols or other modes of written
3. Provisions of the Civil Code that provide that every person shall respect the expression according to mathematical and logical rules or of performing
privacy of another person any one or more of these functions.
(c)"Electronic Data Message" refers to information generated, sent,
Article 26 and Article 32, paragraph 11 of the New Civil Code provide for the privacy received or stored by electronic, optical or similar means.
rights of every person. (d)"Information and Communications System" refers to a system intended
Article 26: Every person shall respect the dignity, personality, privacy for and capable of generating, sending, receiving, storing, or otherwise
and peace of mind of his neighbors and other persons. The following processing electronic data messages or electronic documents and includes
and similar acts, though they may not constitute a criminal offense, the computer system or other similar device by or in which data is recorded
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
or stored and any procedures related to the recording or storage of CHAPTER II LEGAL RECOGNITION OF ELECTRONIC WRITING OR DOCUMENT AND
electronic data message or electronic document. DATA MESSAGES
(e)"Electronic Signature" refers to any distinctive mark, characteristic
and/or sound in electronic form, representing the identity of a person and Section 7. Legal Recognition of Electronic Documents - Electronic documents shall
attached to or logically associated with the electronic data message or have the legal effect, validity or enforceability as any other document or legal
electronic document or any methodology or procedures employed or writing, and - (a) Where the law requires a document to be in writing, that
adopted by a person and executed or adopted by such person with the requirement is met by an electronic document if the said electronic document
intention of authenticating or approving an electronic data message or maintains its integrity and reliability and can be authenticated so as to be usable for
electronic document. subsequent reference, in that - i. The electronic document has remained complete
(f)"Electronic Document" refers to information or the representation of and unaltered, apart from the addition of any endorsement and any authorized
information, data, figures, symbols or other modes of written expression, change, or any change which arises in the normal course of communication, storage
described or however represented, by which a right is established or an and display; and ii. The electronic document is reliable in the light of the purpose for
obligation extinguished, or by which a fact may be prove and affirmed, which it was generated and in the light of all relevant circumstances.
which is receive, recorded, transmitted, stored, processed, retrieved or
produced electronically. PART V FINAL PROVISIONS
(g)"Electronic Key" refers to a secret code which secures and defends
sensitive information that cross over public channels into a form Section 31. Lawful Access. - Access to an electronic file, or an electronic signature of
decipherable only with a matching electronic key. an electronic data message or electronic document shall only be authorized and
(h)"Intermediary" refers to a person who in behalf of another person and enforced in favor of the individual or entity having a legal right to the possession or
with respect to a particular electronic document sends, receives and/or the use of plaintext, electronic signature or file or solely for the authorized
stores provides other services in respect of that electronic data message or purposes. The electronic key for identity or integrity shall not be made available to
electronic document. any person or party without the consent of the individual or entity in lawful
(i)"Originator" refers to a person by whom, or on whose behalf, the possession of that electronic key;
electronic document purports to have been created, generated and/or
sent. The term does not include a person acting as an intermediary with Section 32. Obligation of Confidentiality. - Except for the purposes authorized under
respect to that electronic document. this Act, any person who obtained access to any electronic key, electronic data
(j)"Service provider" refers to a provider of - i. On-line services or network message or electronic document, book, register, correspondence, information, or
access or the operator of facilities therefor, including entities offering the other material pursuant to any powers conferred under this Act, shall not convey to
transmission, routing, or providing of connections for online or share the same with any other person.
communications, digital or otherwise, between or among points specified
by a user, of electronic documents of the user's choosing; or ii. The Section 33. Penalties. - The following Acts, shall be penalized by fine and/or
necessary technical means by which electronic documents of an originator imprisonment, as follows: (a) Hacking or crackling with refers to unauthorized access
may be stored and made accessible to designated or undesignated third into or interference in a computer system/server or information and communication
party. system; or any access in order to corrupt, alter, steal, or destroy using a computer or
other similar information and communication devices, without the knowledge and
Such service providers shall have no authority to modify or alter the content of the consent of the owner of the computer or information and communications system,
electronic data message or electronic document received or to make any entry including the introduction of computer viruses and the like, resulting in the
therein on behalf of the originator, addressee or any third party unless specifically corruption, destruction, alteration, theft or loss of electronic data messages or
authorized to do so, and who shall retain the electronic document in accordance electronic documents shall be punished by a minimum fine of One Hundred
with the specific request or as necessary for the purpose of performing the services Thousand pesos (P 100,000.00) and a maximum commensurate to the damage
it was engaged to perform. incurred and a mandatory imprisonment of six (6) months to three (3) years; (b)
Piracy or the unauthorized copying, reproduction, dissemination, or distribution,
importation, use, removal, alteration, substitution, modification, storage, uploading,
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
downloading, communication, making available to the public, or broadcasting of If test results for STDs or HIV are emailed, for example, they will always bear the
protected material, electronic signature or copyrighted works including legally signature of the medical professional handling the same. These are deeply sensitive
protected sound recordings or phonograms or information material on protected and personal information that should be kept private. Any untoward usage of the
works, through the use of telecommunication networks, such as, but not limited to, same can be identified and promptly penalized.
the internet, in a manner that infringes intellectual property rights shall be punished
by a minimum fine of one hundred thousand pesos (P 100,000.00) and a maximum Many organizations and individuals not subject to medical ethics codes use medical
commensurate to the damage incurred and a mandatory imprisonment of six (6) information. These including employers, insurers, government program
months to three (3) years; (c) Violations of the Consumer Act of Republic Act No. administrators, attorneys, and others. Regulatory protection for this highly sensitive
7394 and other relevant to pertinent laws through transaction covered by or using and deeply personal information become more necessary with the abundance of
electronic data messages or electronic documents, shall be penalized with the same users. Regulatory mechanisms, such as the Electronic Commerce Act, then, should
penalties as provided in those laws; (d) Other violations of the provisions of this Act, continue to be developed in response to the changing landscape of information
shall be penalized with a maximum penalty of one million pesos (P 1,000,000.00) or systems. Patients should be insulated from the distress and trauma of having private
six (6) years imprisonment. information about them fall into the right hands by establishing legal authorities and
regulated legal access over their medical information.
Contributions of the Electronic Commerce Act to Ensuring Medical Privacy
5. Anti-Wiretapping Law. Relevance to Medical Privacy
The right of patients to have their privacy protected is not only based on ethical
considerations owing to the physicians' code of conduct, but it also guaranteed by REPUBLIC ACT No. 4200
constitutional rights to privacy and a series of statutes aimed at regulating and AN ACT TO PROHIBIT AND PENALIZE WIRE TAPPING AND OTHER RELATED
protecting specific forms of information. One of these statutes is The Electronic VIOLATIONS OF THE PRIVACY OF COMMUNICATION, AND FOR OTHER PURPOSES.
Commerce Act of 2000, a law that institutionalizes the legal status of electronic
documents and electronic data messages and intends to protect the fidelity and Section 1. It shall be unlawful for any person, not being authorized by all the parties
confidentiality of electronic documents and electronic data messages. to any private communication or spoken word, to tap any wire or cable, or by using
any other device or arrangement, to secretly overhear, intercept, or record such
Health information is transmitted and stored increasingly through electronic communication or spoken word by using a device commonly known as a dictaphone
documents and electronic data messages nowadays. The prevalence of technology or dictagraph or dictaphone or walkie-talkie or tape recorder, or however otherwise
in the medical profession inevitably resulted to the digitalization of medical data and described:
patient information, making them easier to store, access, and reproduce. The caveat
to this is that sensitive and confidential information are easily multiplied and It shall also be unlawful for any person, be he a participant or not in the act or acts
vulnerable to unwanted and unwarranted disclosure. The Electronic Commerce Act penalized in the next preceding sentence, to knowingly possess any tape record,
of 2000 seeks to address this vulnerability by delineating the requisites for proper wire record, disc record, or any other such record, or copies thereof, of any
use of these data, obligating confidentiality in using the same and imposing punitive communication or spoken word secured either before or after the effective date of
measures to punish and deter malicious usage. this Act in the manner prohibited by this law; or to replay the same for any other
person or persons; or to communicate the contents thereof, either verbally or in
The law contributes to ensuring medical privacy through several ways. For example, writing, or to furnish transcriptions thereof, whether complete or partial, to any
when a video of a surgery is recorded for documentary or academic purposes, the other person: Provided, That the use of such record or any copies thereof as
same is encrypted with an electronic key for identity, which bars access to anyone evidence in any civil, criminal investigation or trial of offenses mentioned in section
not authorized to access the document. The electronic key is lawfully possessed by 3 hereof, shall not be covered by this prohibition.
authorized persons and can only be shared with express their express consent. If the
video is leaked by one of the authorized people or if it's hacked, these offenders will Section 2. Any person who willfully or knowingly does or who shall aid, permit, or
be punished accordingly by the same law for breaking their obligation of cause to be done any of the acts declared to be unlawful in the preceding section or
confidentiality. These offenders can be traced because transmission of electronic who violates the provisions of the following section or of any order issued
documents also bear electronic signatures that identify from where they originated. thereunder, or aids, permits, or causes such violation shall, upon conviction thereof,
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
be punished by imprisonment for not less than six months or more than six years government and in the private sector are secured and protected. This Act applies to
and with the accessory penalty of perpetual absolute disqualification from public the processing of all types of personal information and to any natural and juridical
office if the offender be a public official at the time of the commission of the person involved in personal information processing including those personal
offense, and, if the offender is an alien he shall be subject to deportation information controllers and processors.
proceedings.
RA 10173 specifies that the processing of personal information shall be permitted
Contributions of the Anti-Wire Tapping Law to Ensuring Medical Privacy only if not otherwise prohibited by law, and when at least one of the conditions
provided under Section 12 of the said Act exists, i.e. the data subject has given his or
The purpose of The Anti-Wire Tapping Law is for the protection of everyone’s right her consent, the processing of personal information is necessary and is related to
to privacy. It prohibits overhearing, intercepting, or recording private the fulfillment of a contract with the data subject or in order to take steps at the
communications. The law also provides that any evidence obtained in violation of request of the data subject prior to entering into a contract, the processing is
this law shall be deemed inadmissible in any civil, criminal, administrative and necessary for compliance with a legal obligation to which the personal information
legislative hearings or investigations. controller is subject, etc. Moreover, the processing of sensitive personal information
and privileged information shall be prohibited, except in cases enumerated under
Medical practitioners have the duty to keep information relating to a patient. Section 13 of said Act.
Everyone grants their medical practitioners high degree of trust of confidence with
regard to confidential information involving their medical information. Medical Paragraph (e) of Section 13 explicitly provides that the processing of sensitive
practitioners obtain information about a patient through communication. Through personal information and privileged information will be allowed when the
this communication channel, medical practitioners also relay and transmit processing is necessary for purposes of medical treatment, is carried out by a
information regarding medical conditions and advise to his/her patients. These medical practitioner or a medical treatment institution, and an adequate level of
communications can be classified as private communication in the ambits of the protection of personal information is ensured.
Anti-Wire Tapping Law. The law afforded such private communication protection
from any unlawful recording. The doctors and their patients can expect that the As a rule, therefore, sensitive personal information such as information about a
privacy of their conversation in all times. The law punishes those who secretly patient must be kept confidential. However, Section 13 (e) of R.A. 10173 provides for
record or intercept with private conversations and communications. the exception, provided the following requisites are satisfied:
(a)The processing of the patient’s information is necessary for the purposes
The law protects everyone’s right to privacy including medical privacy. An example of of medical treatment,
which is the recording of a confession made by a party in his official psychologist or (b)The medical treatment is carried out by a medical practitioner or a
psychiatrist about a crime he previously committed. The person who suffers from medical treatment institution, and
mental trauma and breakdown may opt to consult a psychiatrist. He may have given (c)An adequate level of protection of personal information is ensured.
pertinent information about an offense he committed. Unknown to both of them,
an NBI agent has been spying and following the party accused. He successfully 7. What is Medical or Health Privacy
obtained a recording of conversation between the psychiatrist and the patient
including the confession made by the patient of the crime he committed. Such There is currently no standard definition of privacy or confidentiality. Even
recording is inadmissible as evidence in the court in the prosecution of the party the Data Privacy Act of 2012 and the Rules of Court do not provide a
accused because of express prohibition mandated by the Anti- Wire Tapping Law. definition of both privacy and confidentiality. Instead, that law merely
provides the examples of information that are covered by existing rules on
6. How the Data Privacy Act of 2012 (R.A. 10173) is relevant to medical privacy. privacy and confidentiality.

Republic Act No. 10173 (“R.A. No. 10173”) or the Data Privacy Act of 2012 stems For purposes of this report, the Authors will use the definition adopted by
from the policy of the State to recognize the vital role of information and the United States (U.S.) National Library of Medicine. They define privacy as
communications technology in nation-building and the State’s inherent obligation to “the state of being free from intrusion or disturbance in one’s private life
ensure that personal information in information and communications systems in the
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
or affairs.” They define confidentiality as the “privacy of information and (1) the processing is necessary to protect the life and health of
its protection against unauthorized disclosure.” the person and the person is not legally or physically able to
express his or her consent prior to the processing,
In the Philippines, the Philippine Medical Association convened to write the (2) the processing is necessary for medical treatment, is carried
Philippine Medical Association Declaration on the Rights and Obligations of out by a medical practitioner or a medical treatment
the Patient. The Ninth (9th) Right declares the Right to Privacy and institution, and an adequate level of protection of personal
Confidentiality which provides the patient the right to privacy and information is ensured,
protection from unwarranted publicity. This right is for the patient to be (3) the person consents,
safeguarded from exposure, private or public, either by photography, (4) the processing is necessary to achieve lawful and
publications, video-taping, discussion, medical teaching or by any other noncommercial objectives of public organizations and their
means that would otherwise reveal his person and identity and the associations provided certain conditions are met,
treatment he has been, is being, or will be given. It further provides in (5) the processing will protect lawful rights and interests of
subsection (a) that the patient’s health status, diagnosis, prognosis, natural or legal persons in court proceedings, or the
treatment, and all other personal information be kept secret even after establishment, defense or exercise of legal claims or when
death except in cases where descendants would acquire knowledge that provided to government or public authority.
would inform them of their health risks. It also provides that the storage of
the data must be appropriate to protect the identity of the patient The Act also prohibits the processing of these kinds of data which are
including Human substance under subsection (b). There are exceptions to collected by, used, and stored with government agencies by the
patient confidentiality such as: when the controversy of his mental or government itself, third parties, or by their contractors without following
physical condition must be resolved in court litigation, when public health the proper commission guidelines and complying with the pertinent
and safety requires it, when the patient consents or his legal representative requirements.
gives consent if he is incapacitate, when his condition is important to a
medical or scientific forum for the advancement of science and medicine, 8. Differences between Privacy from Confidentiality.
and when it is otherwise required by law.
Ivy D. Patdu, et al., explains that
In strict legal statute we have Republic Act No. 10173 or the “Data Privacy
Act of 2012.” Its policy is the policy of the state which is to protect the In brief, privacy pertains to an individual’s right to be
fundamental human right of privacy, of communication while ensuring the free from unwanted external scrutiny; whereas
free flow of information to promote innovation and growth. The state confidentiality points to the duty that rests on those to
recognizes its inherent obligation to ensure that personal information and whom private information has been entrusted, that is,
information and communications systems in the government and in the that they will not unnecessarily disclose such privileged
private sector are secured and protected. In relation to medical or health communication.
privacy, Sensitive personal information as used in the Act, includes the
personal information of an individual regarding his health, genetics, or Therefore, what seems to be the more poignant issue for discussion is how
sexual life and also his/her current health records. the intrusion by a medical practitioner into the private life of a patient is
balanced by a medical practitioner’s responsibility of keeping of the
The Act prohibits the processing of sensitive personal information and information elicited as confidential.
privileged information. Processing here is defined but not limited to the
collection, recording, storage, modification, retrieval, consultation, use, A patient who comes before a doctor for treatment establishes a doctor-
erasure, and destruction of data. However, there are exceptions, Sensitive patient relationship that is highly fiduciary in nature. Necessarily, the
personal information and Privileged information can be processed when: patient will have to shed off his constitutional guarantee of privacy so that
the doctor will obtain relevant information essential for the patient’s
treatment. But the disclosure of such private information puts a
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
responsibility on the part of the medical practitioner to “secure [the Section 6. The physician should hold as sacred and highly
information] from unauthorized access, and that ultimately [,] the data confidential whatever may be discovered or learned
gathered will be used to deliver safe [and] quality care that will benefit the pertinent to the patient even after death, except when
patient.” required in the promotion of justice, safety and public
health.
The Authors reproduce the representation (Figure 1) by Patdu, et al. that
portrays the dynamics between confidentiality and privacy This is further reiterated by the CoE-BOM, which provides —

Section 6. 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 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 public safety.

Interestingly though, despite the nurses being a front-line service provider,


the CoE-RN does not provide for a specific provision that governs medical
privacy or confidentiality. The closest provision that the CoE-RN has that
relates to medical privacy are —

ARTICLE II
REGISTERED NURSES AND THE PEOPLE

SECTION 4.

Ethical Principles

Figure 1. A model for privacy, confidentiality, and security 1. Values, customs, and spiritual beliefs held by
within the context of health information by Patdu, et al. individuals shall be respected.
2. Individual freedom to make rational and
The concepts of medical privacy and medical confidentiality are also unconstrained decisions shall be respected.
covered by specific rules relating different medical professions and different 3. Personal information acquired in the process of
medical conditions. giving nursing care shall be held in strict
confidence.
Take for example the Code of Ethics of the Philippine Medical Association ...
(CoE-PMA), the Code of Ethics of the Board of Medicine (CoE-BOM), and
the Code of Ethics for Filipino Nurses (CoE-RN). ARTICLE V
REGISTERED NURSES, SOCIETY, AND ENVIRONMENT
The CoE-PMA provides —
SECTION 13.
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disclosed to the public.
Ethical Principles Juvenile Justice and Every child in conflict with The results of the child’s
Welfare Act of 2006 the law shall have the right physical and mental
1. The preservation of life, respect for human to privacy. examination shall be kept
rights, and promotion of healthy environment confidential unless
shall be a commitment of a Registered Nurse. The public shall be otherwise ordered by the
excluded during the Family Court.
Issues of privacy and confidentiality of specific conditions are covered by proceedings concerning a
different rules, e.g., cases involving sexual abuse, cases involving juvenile child in conflict with the The records and
delinquents, cases involving those afflicted with the Human law. proceedings of the trial
Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome shall be kept confidential.
(AIDS), cases involving dangerous drugs, and cases involving abuse of
women and children. The summary of the rules that pertain to privacy and The records shall not be
confidentiality in these conditions are found in Table 2. disclosed directly or
indirectly to anyone by
Specific Legislation Privacy Confidentiality any of the parties or the
Rape Victim Assistance The Rape Crisis Center It shall be the duty of the participants in the
and Protection Act of shall ensure the privacy of police officer or the proceedings for any
1998 rape victims. examining physician, who purpose whatsoever,
must be of the same except to determine if the
The police officer, the gender as the offended child in conflict with the
prosecutor, the Court and party, to ensure that only law may have his/hes
its officers, as well as the persons expressly sentence suspended or if
parties to the complaint authorized by the he/she may be granted
shall recognize the right to offended party shall be probation under the
privacy of the offended allowed inside the room Probation Law, or to
party and the accused. where the investigation or enforce the civil liability
medical or physical imposed in the criminal
The Court may order a examination is being action.
closed-door investigation, conducted.
prosecution or trial and Component authorities
that the name and The Court may order a shall at all times keep the
personal circumstances of closed-door investigation, records confidential and
the offended party and/or prosecution or trial and shall prevent the
the accused, or any other that the name and disclosure of information
information tending to personal circumstances of to the media and shall
establish their identities, the offended party and/or maintain a separate police
and such circumstances or the accused, or any other blotter for cases involving
information on the information tending to children in conflict with
complaint shall not be establish their identities, the law.
disclosed to the public. and such circumstances or
information on the Records shall not be used
complaint shall not be in subsequent proceedings
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unless when beneficial to order of the
the offender and with his Court.
consent.
Philippine AIDS The State shall extend to All health professionals, The results of an HIV test
Prevention and Control every person suspected or medical instructors, shall only be to persons
Act of 1998 known to be infected with workers, employers, designated by the law,
HIV/AIDS full protection of recruitment agencies, such as the patient
his/her human rights and insurance companies, data himself, his parents, his
civil liberties. Towards this encoders, and other guardian, an authorized
end, the right of privacy of custodians of any medical representative of the
individuals with HIV shall record, file, data, or test monitoring agencies, and
be guaranteed. results are directed to a Justice of the Court of
strictly observe Appeals or the Supreme
The privacy of a person confidentiality in the Court.
with HIV is guaranteed, handling of all medical Comprehensive Judicial and medical
most especially in the information, particularly Dangerous Drugs Act of records of drug
following locations and the identity and status of 2002 dependents shall be
conditions: persons with HIV. confidential and shall not
(a) In the workplace; be used against him for
(b) In schools; The only exceptions to the any purpose, except to
(c) In accommodation foregoing rule are: determine the frequency
and travel carriers; (a) When complying of his voluntary
(d) In public services; with the submission.
(e) In credit and reportorial
insurance requirements of The records of a drug
services; the law; dependent who was
(f) In hospitals and (b) When informing rehabilitated and
health other health discharged from the
institutions; and workers of the Center under the
(g) In funeral services. HIV status of the compulsory submission
patient, provided, program shall be
that care involves confidential.
the risk of
transmission, and Upon the dismissal of the
provided further, proceedings against the
that the other accused, the court shall
health workers enter an order to expunge
shall keep the all official records, other
confidential than the confidential
nature of the record to be retained by
information; and the DOJ relating to the
(c) When complying case. Such an order, which
with the lawful shall be kept confidential,
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shall restore the accused act in capacity, and which would blacken the
to his/her status prior to reputation of the patient.
the case.
This provision underwent several changes and can be traced from the 1940
The DOJ shall keep a Rules of Court. In Lim v. Court of Appeals , the Supreme Court traced the
confidential record of the roots of this provision; to wit:
proceedings on
suspension of sentence This is a reproduction of paragraph (c), Section 21, Rule
and shall not be used for 130 of the 1964 Revised Rules of Court with two (2)
any purpose other than to modifications, namely: (a) the inclusion of the phrase
determine whether or not ‘advice or treatment given by him,’ and (b) substitution of
a person accused under the word reputation for the word character. Said Section
this Act is a first-time 21 in turn is a reproduction of paragraph (f), Section 26,
minor offender. Rule 123 of the 1940 Rules of Court with a modification
Anti-Violence Against All records pertaining to All records pertaining to consisting in the change of the phrase ‘which would tend
Women and Their cases of violence against cases of violence against to blacken’ in the latter to ‘would blacken.’ Verily, these
Children Act of 2004 women and their children women and their children changes affected the meaning of the provision. Under the
including those in the including those in the 1940 Rules of Court, it was sufficient if the information
barangay shall be barangay shall be would tend to blacken the character of the patient. In
confidential and all public confidential and all public the 1964 Rules of Court, a stricter requirement was
officers and employees and officers and employees imposed; it was imperative that the information would
public or private clinics to and public or private blacken such character. With the advent of the Revised
hospitals shall respect the clinics to hospitals shall Rules on Evidence on 1 July 1989, the rule was relaxed
right to privacy of the respect the right to once more by the substitution of the word character
victim. privacy of the victim. with the word reputation. There is a distinction between
Table 1. Summary of privacy confidentiality rules as these two concepts.’ ‘Character’ is what a man is, and
provided by different legislations. ‘reputation’ is what he is supposed to be in what people
say he is. ‘Character’ depends on attributes possessed,
9. What is covered by Doctor-Patient Confidentiality and the Rules of Court and ‘reputation’ on attributes which others believe one
to possess. The former signifies reality and the latter
The doctor-patient confidentiality finds its relevance in law under the Rules merely what is accepted to be reality at present.
of Court. This section provides —
Doctor-patient privilege is also found in the international setting. However,
The following persons cannot testify as to matters several differences can be noted. In comparison with the U.S., the
learned in confidence in the following cases: physician-patient privilege of the Philippines under the Rules of Court is
... narrower. In the U.S., (1) the privilege extends to mental health providers
(c) A person authorized to practice medicine, surgery who act in the capacity of psychotherapists (2) the phrase “blacken the
or obstetrics cannot in a civil case, without the reputation of the patient” does not exist (3) the privilege can be waived by
consent of the patient, be examined as to any putting the condition in issue.
advice or treatment given by him or any
information which he may have acquired in The pertinent rule on evidence has been expounded by the Supreme
attending such patient in a professional capacity, Court by posing the following questions:
which information was necessary to enable him to
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(1) Can the patient-doctor privilege be invoked against a third
person? The Supreme Court held in Krohn that the wife cannot invoke such privilege
(2) What are the requisites for the proper invocation of this because it is not claimed by a duly authorized person who practices
privilege? medicine, surgery or obstetrics but only the patient’s husband. Neither can
(3) At what stage of the trial can privilege be invoked? his testimony be considered an exception because his testimony cannot
(4) Does privilege cover only testimonial evidence or does it also have the force and effect of the testimony of the physician.
extend to hospital records?
(5) What is the purpose of privilege? In Blue Cross Health Care, Inc. v. Olivares , Olivares applied for a health care
program with the petitioner, a health maintenance firm. 38 days after the
Can the patient-doctor privilege be invoked against a third person? What effectivity of her health insurance, respondent suffered a stroke and was
are the requisites for the proper invocation of this privilege? admitted at a hospital accredited by petitioner. Several laboratory tests
were performed. When respondent was about to be discharged, she
In Krohn v. Court of Appeals , the wife in an annulment proceeding sought requested the petitioner to settle her medical bills to which the latter
to enjoin her husband from disclosing the contents of a psychiatric refused because the stroke she suffered is not covered by her insurance.
evaluation report being presented in evidence before the trial court. The
wife argued that under Section 24 (c), Rule 130 of the Rules of Court, if The physician of the respondent refused to divulge any information
physician is prohibited from testifying on matters he acquired in attending because the respondent invoked the patient-physician confidentiality
to a patient in a professional capacity, with more reason should a third prompting petitioner to file the present case. Ultimately, the Supreme
person (the husband in this case) be prohibited from testifying the same Court held that respondent is correct in raising the privilege and the
matters. She argued that allowing her husband to testify on the contents burden of proving that the stroke is not covered by the insurance rests
of the report will set a very bad and dangerous precedent because it abets upon the petitioner.
circumvention of the rule’s intent.
At what stage of the trial can privilege be invoked? Does privilege cover
The Supreme Court held, in elaborating the privileged communication only testimonial evidence or does it also extend to hospital records?
between a doctor and a patient, that the rule intends to prevent the
doctor from making public information that will result in humiliation, In Chan v. Chan , petitioner filed for declaration of nullity of her marriage,
embarrassment, or disgrace to the patient. The privilege creates a zone of dissolution of their conjugal partnership of gains and the award of custody
privacy intended to preclude the humiliation of the patient that may of their children to her. The grounds were incessant drinking and excessive
follow the disclosure of his ailments. use of prohibited drugs despite undergoing hospital confinement for
detoxification and rehabilitation.
To properly invoke the privilege, the Supreme Court held in Lim that the
following requisites must concur: To support her action for annulment, petitioner filed a request for the
issuance of a subpoena ducestecum to the hospital where he was confined
1. The privilege is claimed in a civil case; regarding respondent’s medical records. This request was accompanied by
2. The person against whom the privilege is claimed is a motion to be allowed to submit in evidence the subpoenaed records.
one duly authorized to practice medicine, surgery or
obstetrics; Respondents opposed invoking the physician-patient privilege. The
3. Such person acquired the information in his Supreme Court held that the purpose of the privilege is to encourage the
personal capacity; patient to open up to the physician, relate to him the history of his ailment,
4. The information was necessary to enable him to act and give him access to his body, enabling the physician to make a correct
in the capacity; and diagnosis of that ailment and provide appropriate cure. Any fear that a
5. The information was confidential and, if disclosed, physician could be compelled in the future to come to court and narrate all
would blacken the reputation of the patient.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
that had transpired between him and the patient might prompt the latter “before, during and after the marriage and until the present.” Juan’s
to clam up, thus putting his own health at great risk. counsel announced that he would present as his witness the Chief of the
Female Services of the National Mental Hospital, Dr. Lydia Acampado, a
In the instant case, the Supreme Court held that the petitioner’s request for Doctor of Medicine who specializes in psychiatry. Counsel orally applied for
subpoena ducestecum is premature since the offer of evidence was made at a subpoena ad testificandum requiring Dr. Acampado to testify. Petitioner’s
the trial. Therefore, she will have to wait for trial to begin before making counsel opposed the motion on the ground that the testimony is
the same request. It is when those records are produced for examination at privileged since the latter had examined the petitioner in a professional
the trial, that respondent may opt to object, not just to their admission in capacity and had diagnosed her to be suffering from schizophrenia.
evidence, but more so to their disclosure. Subpoena was issued. Nelly’s counsel filed an urgent motion to quash the
subpoena and suspend the proceedings pending resolution of the motion.
Petitioner argued that the hospital records she requested is not privileged
since only testimonial evidence may be regarded as privileged. According to Petitioner’s arguments: Dr. Acampado is barred from testifying under the
the petitioner, only the examination of the physician at the trial is rule on confidentiality of a physician-patient relationship.
privileged.
Private respondents’ arguments: Dr. Acampado would be presented as an
The Supreme Court held that if the results of tests that the physician expert witness and would not testify on any information acquired while
ordered, the diagnosis of the patient’s illness and the advice or treatment attending to the petitioner in a professional capacity.
given to the patient are disclosed, it would allow access to evidence that is
inadmissible without the patient’s consent. Physician memorializes all these The Motion to quash the subpoena was denied.
information in the patient’s records. In effect, disclosing them would be the
equivalent of compelling the physician to testify on privileged matters he Dr. Acampado took the witness stand as an expert witness. She was asked
gained while dealing with the patient without the latter’s prior consent. hypothetical questions related to her field of expertise. She neither
revealed the illness she examined and treated the petitioner for nor
What is the purpose of privilege? disclosed the results of her examination and the medicines she had
prescribed.
Ultimately speaking, the doctor-patient privilege is for the sole benefit of
the patient. Firstly, it secures the patient of his right to privacy. As a patient, Petitioner filed with the Court of Appeals a petition for certiorari and
full disclosure is essential for proper diagnosis and treatment. Therefore, prohibition to annul the order of the RTC judge on the ground of grave
privacy can easily be compromised. If the patient chooses privacy, then the abuse of discretion amounting to lack of jurisdiction, and to prohibit him
right to life is sacrificed. To ensure both rights are protected, the law from proceeding with the reception of Dr. Acampado’s testimony.
prevented the further divulging of very personal information even if
essential in resolving civil cases. Secondly, it prevents public degradation The Court of Appeals denied the petition on the ground that the petitioner
resulting from persons passing upon judgments after disclosure of sickness. failed in establishing the confidential nature of the testimony given by or
With this privilege inscribed in our laws, the State is able to perform its obtained from Acampado. Petitioner then appealed to the Supreme Court.
duty in protecting the basic rights of its citizens.
ISSUE:
10. Lim v. Court of Appeals
Whether or not Dr. Acampado’s testimony is privileged on the ground of
FACTS: doctor-patient confidentiality

Nelly Lim and Juan Sim are lawfully married. Private respondent Juan filed a RULING:
petition for annulment of such marriage on the ground that petitioner
Nelly has allegedly been suffering from mental illness called schizophrenia
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
FIRST, it does not qualify as privileged communication. The Revised Rules 2. This element of confidentiality must be essential to the full
on Evidence provide — and satisfactorily maintenance of the relation between the
parties.
Disqualification by reason of privileged communication. - 3. The relation must be one which in the opinion of the
The following persons cannot testify as to matters community ought to be sedulously fostered.
learned in confidence in the following cases: 4. The injury that would inure to the relation by the disclosure of
... the communications must be greater than the benefit thereby
(c) A person authorized to practice medicine, surgery or gained for the correct disposal of litigation.
obstetrics cannot in a civil case, without the consent of
the patient, be examined as to any evidence or treatment Only disclosures which would have been efficaciously to treat his patient
given by him or any information which he may have are covered by the privilege. Also, it is only the tenor of the communication
acquired in attending such patient in a professional that is privileged. The mere fact of making a communication as well as the
capacity, which information was necessary to enable him date of consultation and the number of consultations, are therefore not
to act in that capacity, and which would blacken the privileged from disclosure, so long as the subject communicated it not
reputation of the patient. stated.

This rule on the physician-patient privilege is intended to facilitate and One who claims the privilege must prove the existence of the
make safe full and confidential disclosure by the patient to the physician of aforementioned requisites. As applied to the case, Dr. Acampado was
all facts, circumstances and symptoms, unrestricted by enforced disclosure presented and qualified as an expert witness. She did not disclose anything
on the witness stand. It rests on public policy and is for the general interest obtained in the course of her examination, interview and treatment of the
of the community. petitioner. The facts and conditions alleged in the hypothetical problem did
not refer to and had no bearing on whatever information or findings the
The rule may be waived if no timely objection to the physician’s testimony. doctor obtained while attending to the patient. There was no showing that
The following requisites must concur in order for the privilege to be Dr. Acampado’s answers to the questions propounded to her relating to the
successfully claimed: hypothetical problem were influenced by the information obtained from
the petitioner. As an expert witness, her testimony before the trial court
1. The privilege is claimed in a civil case; cannot be excluded.
2. The person against whom the privilege is claimed is one duly
authorized to practice medicine, surgery or obstetrics; Second, information elicited during consultation with a physician in the
3. Such person acquired the information while he was attending presence of a third parties removes such information from the mantle of
to the patient in his professional capacity; privilege. It is clear from Dr. Acampado’s testimony that interviews with the
4. The information was necessary to enable him to act in that petitioner were always conducted in the presence of a third party.
capacity; and
5. The information was confidential, and if disclosed, would Third, nothing specific or concrete was offered to show that indeed, the
blacken the reputation of the patient. information obtained from Dr. Acampado would blacken the former’s
“character” (or “reputation”).
These requisites conform to the 4 fundamental conditions necessary for
the establishment of a privilege against the disclosure of certain Finally, while counsel for petitioner opposed the oral request for the
communication: issuance of a subpoena ad testificandum to Dr. Acampado and filed a
formal motion for the quashal of said subpoena, the petitioner makes no
1. The communication must originate in a confidence that they claim in any of her pleadings that her counsel had objected to any
will not be disclosed. question asked of the witness on the ground that it elicited an answer
that would violate the privilege.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
Without denying any liability, the hospital and relatives of
11. Cebu Canister Scandal medical personnel involved were quick to point out that
the public should focus on the successful outcome of the
To provide context, the Authors reproduce, with gratitude, the following operation; that those involved were, in fact, first rate
scenario as authored by Patdu, et al. — health professionals and calling for a revocation of their
licenses was an excessive punishment; and that the
In mid-2008, a three-minute footage went viral on the incident was an isolated case of mischief.
video-sharing website YouTube showing what appears to
be an operation involving the extraction of a metal spray While some nurses and doctors were initially placed on a
bottle canister from the rectum of an unidentified three-month preventive suspension, the case filed with
patient. The operating room was crowded with giggling the Professional Regulation Commission was eventually
medical staff, all of them shown on the video with their dismissed on the basis of a technicality. The identity of
cellular phones on hand to document the procedure. the person who first uploaded the video on YouTube was
While the canister was being extracted, somebody never discovered, and the incident, which died a natural
shouted “Baby out!” after which the room broke into death, became a mere footnote in the annals of
laughter and applause. One medical staff even opened Philippine medical history.
the canister and sprayed its contents inside the room,
resulting to further laughter from those in attendance. The person who uploaded the video in the internet, knowing that it can be
seen by the general public, can be held liable under Republic Act 10175
The circumstances related to the incident only became known as the Cybercrime Prevention Act of 2012 which defines the crime
clear a few weeks after the video has circulated in emails of cyber libel —
and mobile phones and has been lengthily discussed in ...
various Internet forums. A 39-year-old homosexual florist (4) Libel. — The unlawful or prohibited acts of libel as
from Cebu City underwent minor operation on January 3, defined in Article 355 of the Revised Penal Code, as
2008 at the Vicente Sotto Memorial Medical Center amended, committed through a computer system or
(VSMMC) for extraction of a foreign body lodged in his any other similar means which may be devised in the
rectum. He was allegedly asleep at the time of the future.
operation, and was not made aware that the procedure
was going to be filmed, nor was he informed post facto Consequently, the Revised Penal Code defined libel as:
that the medical staff took a footage of his operation. He
claimed that he only learned of the existence of the Art. 353. Definition of libel. — A libel is public and
YouTube video when it was brought to his attention by malicious imputation of a crime, or of a vice or defect,
their barangay captain, who saw the video on YouTube. real or imaginary, or any act, omission, condition, status,
or circumstance tending to cause the dishonor, discredit,
As a response to the public outrage generated by the or contempt of a natural or juridical person, or to blacken
incident, various investigating bodies were formed – the the memory of one who is dead.
hospital, Department of Health (DOH), National Bureau of
Investigation (NBI), House of Representatives – to There is no question that the act of uploading a very intimate and personal
determine the culpability of those involved in the video caused humiliation and dishonor on the part of the patient. It can be
operation, as well as to identify the person who first gleaned from the facts that what the patient consented to is the act of
uploaded the video. taking the video of his unusual case and not to the uploading of video.
Certainly, the patient could not have consented to the upload because the
patient is well aware of the audience in the internet.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
2. However, in 1971, Ma. Paz underwent psychological testing purportedly in
Under the New Civil Code of the Philippines: an effort to ease the martial strain.
3. The effort proved futile which led to their separation in fact in 1973.
Article 2217. Moral damages include physical suffering, 4. Thereafter in 1975, Edgar secured a copy of the confidential psychiatric
mental anguish, fright, serious anxiety, besmirched report on Ma. Paz signed by Drs. Banaag and Reyes.
reputation, wounded feelings, moral shock, social 5. In 1978, with the report among others, Edgar obtained a decree from the
humiliation, and similar injury. Though incapable of Tirbunal Metropolitanum Matrimonilae in Manila nullifying his marriage
pecuniary computation, moral damages may be with Ma. Paz on the ground of “incapacitas assumendi onera conjugalia”
recovered if they are the proximate result of the due to lack of discretion existent at the time of the wedding and thereafter
defendant's wrongful act for omission. was pronounced “Final and Definite” in 1979.
6. Subsequently, in 1982, the CFI issued an order granting the voluntary
Therefore, as an additional remedy, the patient could actually recover dissolution of the conjugal partnership.
moral damages he suffered as a consequence of the upload and 7. In 1990, Edgar filed a petition for the annulment of his marriage with Ma.
unprofessional conduct of the medical staff. Paz before the trial court, citing the Confidential Psychiatric Evaluation
report which Ma. Paz opposed as “either unfounded or irrelevant.”
This is without prejudice to administrative sanctions that the Professional 8. At the hearing in 1991, Edgar took the witness stand and tried to testify on
Regulation Commission may provide. the contents of the confidential Psychiatric Evaluation Report. However,
this was objected to on the ground that it violated the rule on privileged
There is no better way to describe the opinion of the Authors than by communication between physician and patient.
quoting Patdu, et al. — 9. The contention of the parties are as follows:
a. Ma. Paz:
Regardless of the intent—whether for educational or i. filed a manifestation expressing her “continuing
entertainment purposes as in the first of these cases, or objection” to any evidence, oral or documentary that
out of curiosity or in return for a sum of money as in the would thwart the physician-patient privileged
second — these two cases demonstrate that even in the communication rule,”
presence of legal and ethical safeguards instances that ii. Submitted a Statement for the Record asserting among
result in violation of the patient’s right to privacy still others that “there is no factual or legal basis whatsoever
occur, though most are perhaps on a scale sufficient for Edgar to claim “psychological incapacity” to annul
warranting media attention. The pervasiveness of tsismis their marriage, such ground being completely false,
(gossip) in Filipino culture74–76 may lead a nurse fabricated and merely an afterthought.”
assigned to a well-known celebrity to talk about her b. Edgar
patient’s case with her family and friends. A group of i. Opposed Ma. Paz’ motion to disallow the introduction of
medical students, over the course of dinner at a public the confidential psychiatric report as evidence and
restaurant, may similarly discuss a novel case assigned to afterwards moved to strike out Ma. Paz’ Statement for
their care. the record.
10. The trial court issued an Order admitting the Confidential Psychiatric
12. Digest Krohn vs. Court of Appeals(G.R. No. 108854, June 12, 1994) Evaluation report ruling that the report is material in evidence on the
following grounds:
FACTS: a. The very issue in the case is whether or not the respondent had
1. Petitioner Ma. Paz Fernandez Krohn and Private respondent Edgar Krohn, been suffering from psychological incapacity
Jr. were married in 1964 and their union produced three children, Edgar b. When the psychiatric report was referred to in the complaint, the
Johannes, Karl Wilhelm and Alexandra. respondent did not object thereto on the ground of supposed
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
privileged communication between patient and physician but it (d)the information was necessary to enable him to act in that
being irrelevant. capacity; and
i. Due to the trial court’s denial of the Motion for (e) the information was confidential and, if disclosed, would
Reconsideration and the CA’s subsequent dismissal of the blacked the reputation of the patient.
case, petitioner now seeks to enjoin the presentation and A.In the instant case, the person against whom the privilege is
disclosure of the contents of the psychiatric report and claimed is not one duly authorized to practice medicine, surgery
prays for the admission of her Statement for the record to or obstetrics.
form part of the records of the case. B.Plainly and clearly, this does not fall within the claimed
11. Petitioner argues : prohibition. Neither can his testimony be considered a
a. Since Sec. 24, par.(c), rule 130, of the Rules of Court prohibits a circumvention of the prohibition because his testimony cannot
physician from testifying on matters which he may have acquired have the force of the prohibition because his testimony cannot
in attending to a patient in a professional capacity, “WITH MORE have the force and testimony of the physician who examined the
REASON should a third person (like respondent-husband in this patient and executed the report.
particular instance) be PROHIBITED from testifying on privileged C.It was a fatal mistake for petitioner to invoke the rule on
matters between a physician and patient or from submitting any privilege communications but never questioned the testimony as
medical report, findings or evaluation prepared by a physician hearsay, for counsel effectively waived his right to object and
which the latter has acquired as a result of his confidential and consequently, the evidence offered may be admitted.
privileged relation with a patient.”
b. To allow her husband to testify on the contents of the psychiatric 13. A psychiatrist who treated a woman is prevented from testifying in a civil case.
evaluation report “will set a very bad and dangerous precedent
because it abets circumvention of the rule’s intent in preserving A. If he will testify as an expert witness
the sanctity, security and confidence to the relation of physician B. If he will talk about matters he learned during a social gathering which will
and his patient.” blacken the reputation of his patient.
i. Private respondent contends that “the rules are very C. If he will talk only about advice he gave to woman while attending to her
explicit: the prohibition to testify is not applicable to the but
case at bar where the person sought to be barred from not her diagnosis.
testifying on the privileged communication is the D. If woman has waived her right to confidentiality.
husband and not the physician of the petitioner.”
Section 24 (C), Rule 30 of the Rules of Court provides:
ISSUE:
Whether or not the husband’s testimony regarding the contents of the “A person authorized to practice medicine, surgery or obstetrics cannot in a
Confidential Psychiatric Evaluation report is admissible civil case, without the consent of the patient, be examined as to any advice or
treatment given by him or any information which he may have acquired in
HELD: attending such patient in a professional capacity, which information was
THE HUSBAND’S TESTIMONY IS ADMISSIBLE. Petition dismissed. necessary to enable him to act in capacity, and which would blacken the
A.Lim v. CA lays down the requisites in order the privilege may be reputation of the patient”
successfully invoked:
(a)the privilege is claimed in a civil case; A. He cannot testify without the consent of the woman treated if such
(b)the person against whom the privilege is claimed is one testimony involves information which he may acquired in attending to the
duly authorized to practice medicine, surgery or obstetrics; woman in his capacity as a Psychiatrist. (Section 24 (C), Rule 30, Rules of Court)
(c)such person acquired the information while he was
attending to the patient in his professional capacity;
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
B. He can testify even without the consent of the woman since he has obtained The Philippine Aids Prevention and Control Act of 1998 protect this kind of
the information through a social gathering and not because of his capacity as a privacy and personal information through its provisions particularly with
Psychiatrist. regard to HIV testing. Since of the policies of the State is to accord the persons
inflicted with HIV full protection of their human rights and civil liberties, the
C. He cannot testify without the consent of the woman as long the information State shall strengthen the right of privacy of individuals with HIV.
involves any advice or treatment given by him in attending to the woman as his
Pschiatrist. According to the law, no compulsory HIV testing shall be allowed. Although
the State may encourage voluntary testing, this shall not be done without the
D. He can testify even without consent since the right of the woman is waived. consent of the volunteer. In addition, compulsory HIV testing as a precondition
to employment, admission to educational institutions, etc., shall be deemed
14. In relation to right to privacy and confidentiality (See Republic Act 9165, unlawful.
Republic Act 9262, reublic Act 8595), what specific health related data must be
kept confidential? Pursuant to the right of privacy of HIV victims, the law also provides that all
health professionals, medical instructors, employers, workers, insurance and
1. Cases of Battered Woman Syndrome (Section 26, RA 9262) recruitment agencies and other custodian of medical records and tests must
2. Victim’s records of physical, emotional or psychological injuries (Section 31, strictly observe confidentiality in the handling of all medical information
ibid) specifically the identity and status of these people. This confidentiality
3. Victims’ records regarding rehabilitative, counselling and treatment (Section however, also has exceptions such as when there is a need to comply with
41, id.) reportorial requirements; to inform other health workers about to be involved
4. Judicial and medical records of drug dependents (Section 60, RA 9165) in the treatment or care of a person with HIV and such care poses a risk of HIV
5. Records of drug dependents who were rehabilitated and discharged (Sec. 64, transmission; or when there is a need to respond to a subpoena, the main
ibid) issue of which is the HIV status of the person, provided that such judicial
proceeding such be conducted in an executive session. The law also provides
an exclusive list of persons who shall receive the results of the HIV testing.
15. Discuss the provisions of Republic Act No. 8504 “Philippine AIDS Prevention
and Control Act of 1998”(Section 15-17, 30-42) that are related to medical privacy. To strengthen the law about HIV confidentiality, this Act also provide for
penalties for any violation of medical confidentiality as may be determined by
Privacy in general is defined as the right of an individual to limit access to the courts.
others to with regard to some aspect of their person. On the other hand,
Medical privacy is defined as the practice of keeping information about a This confidentiality is not without limits. The law provides that any person
patient confidential. This includes conversational discretion of health care with HIV is obliged to disclose his or her HIV status to his or her spouse at the
providers; the security of medical records; as well as the physical privacy of earliest opportune time. Since the State aims to protect the human rights of
patients from other patients and providers while in a medical facility. HIV victims, discrimination, in all its forms and subtleties, against individuals
with HIV or persons perceived or suspected of having HIV shall be considered
Once a patient and health care provider relationship is established, the inimical to individual and national interest. Towards this end, discrimination in
health worker is provided for access to the private and personal information of the workplace, school, restriction on the right to travel and inhibition from
the patient which will serve as a guide for such health care provider to arrive at public services, exclusion from credit services, discrimination in hospitals and
a conclusion regarding the sickness or query of the patient. This interaction denial of burial services are highly discouraged.
between the health care provider and the patient obtains an implied
agreement whereby the personal information shared by the patient must not 16. Can a person be compelled to take an HIV test?
be shared and must be held by the health care provider in full confidence.
No. Compulsory HIV testing is considered unlawful under Republic Act 8504 or the
Philippine AIDS Prevention and Control Act.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
In the Declaration of Policy of the said, Sec. 2, par. b(1), it provided that record of the patient. Under paragraph 12 of the said declaration, a patient has
“compulsory HIV testing shall be considered unlawful unless otherwise provided in the right to his/her medical record only upon request. From this, it may be
this Act”. --- The only exception to the prohibition on compulsory HIV testing is inferred that the medical records are kept by the health care institution with
under Section 17 of the law which allows for compulsory HIV testing under the the patient having only the prerogative/right to access it. The textual reference
following circumstances: of the said declaration provides:
(a)When a person is charged with any of the crimes punishable under
Articles 264 and 266 as amended by Republic Act No. 8353, 335 and 338 of 12. Right to Medical Records. The health care institution and the
Republic Act No. 3815, otherwise known as the "Revised Penal Code" or physician shall ensure and safeguard the integrity and authenticity of
under Republic Act No. 7659; the medical records.
(b)When the determination of the HIV status is necessary to resolve the aUpon the request of patient, the physician shall issue a
relevant issues under Executive Order No. 309, otherwise known as the medical certificate, a clinical abstract to the patient
"Family Code of the Philippines"; and upon discharge from the institution. Any relevant
(c)When complying with the provisions of Republic Act No. 7170, otherwise document that the patient may require for insurance
known as the "Organ Donation Act" and Republic Act No. 7719, otherwise claims shall also be made available to him within a
known as the "National Blood Services Act" reasonable period of time.
(a)In Section 15, the law provided that consent is a requisite for HIV
Testing: “No compulsory HIV testing shall be allowed.” bHe has the right to view the contents of his medical
(b)In Section 16, the law further provided that compulsory HIV testing records with the attending physician explaining contents
as a precondition to employment, admission to educational institutions, thereof and at his expense.
exercise of freedom of abode, entry or continued stay in the country, or
the right to travel, the provision of medical service, or any other kind of cThe patient may obtain from the health care institution
service is deemed unlawful. a reproduction of his medical record at his expense.

18. What is the practice of medicine?


The State, however, is mandated to encourage voluntary testing for
individuals with a high risk for contracting HIV. Under this voluntary testing,
Section 10 of Republic Act No. 2382, known as The Medical Act of 1959, provides
the written informed consent of the person must first be obtained either
the following acts as constituting practice of medicine:
from the person concerned or from the parents or legal guardian in the case
of a minor or a mentally incapacitated individual. (Sec. 15, RA 8504).
Section 10. Acts constituting practice of medicine. A person shall be considered as
Lawful consent to HIV testing of a donated human body, organ, tissue, or blood shall engaged in the practice of medicine
be considered as having been given under the following circumstances:
(a)a person volunteers or freely agrees to donate his/her blood, organ, or (a) who shall, for compensation, fee, salary or reward in any form, paid to him
tissue for transfusion, transplantation, or research; directly or through another, or even without the same, physical examine any person,
(b)a person has executed a legacy in accordance with Sec. 3 of Republic Act and diagnose, treat, operate or prescribe any remedy for any human disease, injury,
No. 7170, also known as the"Organ Donation Act of 1991"; deformity, physical, mental or physical condition or any ailment, real or imaginary,
(c)a donation is executed in accordance with Sec. 4 of Republic Act No. regardless of the nature of the remedy or treatment administered, prescribed or
7170
recommended; or

(b) who shall, by means of signs, cards, advertisements, written or printed matter,
17) Who owns the medical record of a person admitted in a hospital?
or through the radio, television or any other means of communication, either offer
From the Philippine Medical Association Declaration on the Rights and or undertake by any means or method to diagnose, treat, operate or prescribe any
Obligations of the Patient, it would appear that the hospital owns the medical
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
remedy for any human disease, injury, deformity, physical, mental or physical Yes, according to Section 12 of Republic Act No. 2382, known as The Medical Act of
condition; or 1959, which states:

(c) who shall use the title M.D. after his name. Section 12. Limited practice without any certificate of registration. Certificates of
registration shall not be required of the following persons:

19. What is not considered practice of medicine? (See RA 2382) (a) Physicians and surgeons from other countries called in consultation only and
exclusively in specific and definite cases, or those attached to international bodies or
Section 11 of Republic Act No. 2382, known as The Medical Act of 1959, provides for organization assigned to perform certain definite work in the Philippines provided
the following acts as not considered as practice of medicine: they shall limit their practice to the specific work assigned to them and provided
further they shall secure a previous authorization from the Board of Medical
Section 11. Exemptions. The preceding section shall not be construed to affect
Examiners.
(a) any medical student duly enrolled in an approved medical college or school
(b) Commissioned medical officers of the United States armed forces stationed in
under training, serving without any professional fee in any government or private
the Philippines while rendering service as such only for the members of the said
hospital, provided that he renders such service under the direct supervision and
armed forces and within the limit of their own respective territorial jurisdiction.
control of a registered physician;
(c) Foreign physicians employed as exchange professors in special branches of
(b) any legally registered dentist engaged exclusively in the practice of dentistry;
medicine or surgery whose service may in the discretion of the Board of Medical
(c) any duly registered masseur or physiotherapist, provided that he applies Education, be necessary.
massage or other physical means upon written order or prescription of a duly
(d) Medical students who have completed the first four years of medical course,
registered physician, or provided that such application of massage or physical
graduates of medicine and registered nurses who may be given limited and special
means shall be limited to physical or muscular development;
authorization by the Secretary of Health to render medical services during epidemics
(d) any duly registered optometrist who mechanically fits or sells lenses, artificial or national emergencies whenever the services of duly registered physicians are not
eyes, limbs or other similar appliances or who is engaged in the mechanical available. Such authorization shall automatically cease when the epidemic or
examination of eyes for the purpose of constructing or adjusting eye glasses, national emergency is declared terminated by the Secretary of Health.
spectacles and lenses;
21. What is “illegal practice of medicine”? (See RA 2382)
(e) any person who renders any service gratuitously in cases of emergency, or in
Under Republic Act No. 2382, known as The Medical Act of 1959, there is an illegal
places where the services of a duly registered physician, nurse or midwife are not
practice of medicine when a person commits an act or acts under Section 10 of the
available;
said Act (mentioned above), not falling under the exemptions in Section 12
(f) any person who administers or recommends any household remedy as per (mentioned above) and not having the following qualifications:
classification of existing Pharmacy Laws; and (g) any psychologist or mental
Section 8. Prerequisite to the practice of medicine. No person shall engage in the
hygienist in the performance of his duties, provided such performance is done in
practice of medicine in the Philippines unless he is at least twenty-one years of age,
conjunction with a duly registered physician.
has satisfactorily passed the corresponding Board Examination, and is a holder of a
20. Can a person practice medicine without a duly issued medical license from valid Certificate of Registration duly issued to him by the Board of Medical
PRC? Examiners.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
The law further provides the following penalties: 23. Digest People vs. Vda. De Golez 108 Phil 855, 859 (1960)

Section 28. Penalties. Any person found guilty of "illegal practice of medicine" shall People v Vda. de Golez
be punished by a fine of not less than one thousand pesos nor more than ten GR No. L-14160
thousand pesos with subsidiary imprisonment in case of insolvency, or by June 30, 1960
imprisonment of not less than one year nor more than five years, or by both such
fine and imprisonment, in the discretion of the court. FACTS
• Dec. 1946, Negros Occidental: De Golez, a quack doctor, diagnosed and
22. Can a physician refuse to treat a patient? Explain. treated Tam for a certain bodily ailment that the latter was suffering from.
Yes, Article 2, Section 2 of the Code of Ethics of the Philippine Medical Association
• De Golez did this knowing fully well that she did not possess the necessary
technical or scientific knowledge or skill.
provides that, “A physician should be free to choose patients.” However, Republic
• As a result of De Golez’s negligence, carelessness and lack of medical skill,
Act No. 8344 (AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL Tam died.
CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT • An information was filed against De Golez.
IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS o Assistant fiscal made a manifestation that De Golez was also
PAMBANSA BILANG 702) provides that: charged with the crime of illegal practice of medicine before
another sala of the same court.
SECTION 1. In emergency or serious cases, it shall be unlawful for any proprietor,
o As such, the trial court dismissed the information for being fatally
president, director, manager or any other officer, and/or medical practitioner or defective on the basis that the facts do not constitute the offense
employee of a hospital or medical clinic to request, solicit, demand or accept any of homicide thru reckless imprudence,
deposit or any other form of advance payment as a prerequisite for confinement or ▪ Because illegal practice of medicine is malicious per se.
medical treatment of a patient in such hospital or medical clinic or to refuse to • By practicing medicine without academic
administer medical treatment and support as dictated by good practice of medicine preparation or a license, De Golez committed a
to prevent death or permanent disability: Provided, That by reason of inadequacy of criminal act for which criminal intent is
the medical capabilities of the hospital or medical clinic, the attending physician presumed.
may transfer the patient to a facility where the appropriate care can be given, after o Homicide cannot be imputed to a person who has no authority to
practice in the medical profession.
the patient or his next of kin consents to said transfer and after the receiving
hospital or medical clinic agrees to the transfer: Provided, however, That when the ▪ Homicide requires that the crime results from a lawful
act done without exercising care and diligence.
patient is unconscious, incapable of giving consent and/or unaccompanied, the
▪ The death in the case at bar resulted from illegal practice
physician can transfer the patient even without his consent: Provided, further, That
of medicine, which in itself is an unlawful act.
such transfer shall be done only after necessary emergency treatment and support
• Provincial fiscal, through Solicitor General urges that lower court erred in
have been administered to stabilize the patient and after it has been established dismissing the information for being fatally defective.
that such transfer entails less risks than the patient's continued confinement:
Provided, furthermore, That no hospital or clinic, after being informed of the ISSUE
medical indications for such transfer, shall refuse to receive the patient nor demand • W/N illegal practice of medicine requires an element of criminal intent
from the patient or his next of kin any deposit or advance payment: Provided,
finally, That strict compliance with the foregoing procedure on transfer shall not be HELD
construed as a refusal made punishable by this Act. NO.
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• The crime of illegal practice of medicine is a statutory offense wherein 24. Differentiate Administrative, Civil, and Criminal Liability of Physicians
criminal intent is taken for granted, so that a person may be convicted
thereof irrespective of his intention and in spite of his having acted in Administrative Civil Criminal
good faith and without malice
o Even if he was not motivated by an evil desire to injure or hurt Where is It is filed before the An original complaint Pursuant to the Rules
another, but by an honest desire to cure or alleviate the pain of a this filed? Board of Medicine; for civil actions are filed on Criminal
patient. and its decision in court, but the civil Procedure, the
• Also, the offense consists in the mere act of practicing medicine in violation becomes final after aspect of a criminal complaint or
of the Medical Law 30 days unless an complaint is deemed information should
appeal is filed before instituted with such be instituted and
o Even if no injury to another, much less death, results from
the Professional complaint subject to the tried in the court of
malpractice.
Regulations provisions of Rule 111 of the municipality or
• Where the patient dies, the illegal practitioner should be equally Commission and the Rules of Court. territory where the
responsible for the death of his patient, an offense independent and later to the Office of offense was
distinct from the illegal practice of medicine. the President committed or where
• The allegations in the information that De Golez, knowing that she did not any of its essential
possess technical knowledge or skill to treat Tam, thus causing the latter’s ingredients occurred,
death, are sufficient to charger her (the former) with homicide thru and the other items
reckless imprudence. enumerated under
Rule 110, Section 15
However, since the lower court dismissed an information that was valid in form and of the Rules of Court.
substance to sustain a conviction, and since De Golez pleaded not guilty, granting
this appeal would constitute double jeopardy. Further proceedings upon this case
are barred. Trial court should have been more careful. It should have allowed its
judgments to be influenced by preconceived notions or undue haste in dispatching
cases.
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Administrative Civil Criminal Administrative Civil Criminal

What is the The board may The Medical Act The criminal liability Proof Substantial evidence Preponderance of Proof beyond
consequenc reprimand, suspend imposed the penalty of of physicians vary Required or the amount of evidence reasonable doubt
e for the or revoke the imprisonment, fine, or depending on the relevant evidence
liability? physician's license. both for any person statute violated. The which a reasonable
However, after 2 found guilty of illegal nature of such mind might accept
years of exemplary medical practice. It does liabilities may either as adequate to
behavior, the not give penalty for be personal or justify a conclusion
revoked license may gross negligence, incidental devolving
be reinstated at the ignorance or on the following acts: 25. Discuss. Several sex videos found their way in the internet showing a physician
Board's discretion. incompetence other having sex with various female partners. Videos were apparently taken without
than administrative Personal: the knowledge and consent of the women, some of whom were his patients.
liability. - Abortion Immorality complaints were filed against the physician before the Professional
- Issuance of false Regulations Commission. (Read about the Hayden Kho case).
However, they may be medical certificate
the basis for the award - The complaint filed against the physician will prosper. The act of taking
Failure to
of damages under the videos without the knowledge and consent of the women, whom some of which
report treatment of
Civil Code (Art. 19-21, were his patients, is an “immoral or dishonorable conduct” which is a ground for
physical injuries
2176 and 2180) which reprimanding a physician, or suspending or revoking a certificate of registration as
- Simulation of
makes every person physician under RA 2382 or The Medical Act of 1959.
who negligently causes births, substitution
damage to another of one child for
another, and This situation is very similar to the case of Hayden Kho vs Katrina Halili
liable to indemnify the which was decided in the Court of Appeals. In that case, Hayden Kho is a duly
latter. concealment or
abandonment of a licensed physician and worked as one of the doctors of the Belo Medical Group, Inc.
legitimate child Katrina Halili went to the said clinic for consultation and thereafter, Kho performed
- liposuction on Halili. Weeks after, they developed an amorous relationship.
Refusal to
Subsequently, existence of their sex videos was rumored to be circulating online.
render treatment in
This is without the consent and knowledge of Halili. Halili filed a complaint against
emergency cases
Kho before the Board of Medicine for immorality and dishonorable/unethical
conduct. The Board found Kho guilty as charged. PRC affirmed such decision.
Incidental:
- Criminal When it was brought to The Court of Appeals, it affirmed the decision of
negligence and the Board and PRC that Kho is indeed guilty of “immorality and
imprudence dishonorable/unethical conduct” under Section 24 of the Medical Act of 1959. It is
- Violation of the interesting to note that when Kho raised the defense that such act is not in relation
Dangerous Drugs to the practice of medicine the Court of appeals stated that:
Act
- Violation of “It may be well to state that nowhere is it required in the law that
the complained immorality and dishonorable conduct must bear
Pharmacy Law
connection with the practice of medicine. “Dishonorable conduct is
- Defamation more embrasive to include intellectual and moral incompetence to
(slander or libel)

Note that the above


mentioned acts
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
practice the profession and also acts of a nature to jeopardize the gambling;
interest of the public. Immoral or dishonorable conduct is a (7) False or extravagant or unethical advertisements wherein other things
legislative catch-all ground to include a broad spectrum of than his name, profession, limitation of practice, clinic hours, office and
reprehensible conduct of a physician connected with the practice of home address, are mentioned.
the profession or not, provided it is contrary to existing norms or the (8) Performance of or aiding in any criminal abortion;
conduct is disgraceful, unbecoming, unethical or repulsive to the (9) Knowingly issuing any false medical certificate;
moral standard in society. The Board of Medicine, in view of (10) Issuing any statement or spreading any news or rumor which is
maintaining the ethical, moral and professional standard of the derogatory to the character and reputation of another physician without
medical profession may exercise discretion in determining what must justifiable motive;
be considered immoral or dishonorable conduct of a physician.” (11) Aiding or acting as a dummy of an unqualified or unregistered person
to practice medicine;
It added: (12) Violation of any provision of the Code of Ethics as approved by the
Philippine Medical Association.
“Indeed, a relation between the complained act constituting
immorality or dishonorable conduct to the practice of medicine need Also in the said section, it provides that refusal of a physician to attend a patient in
not exist. It may pertain to life in general as there can be no danger of death is not a sufficient ground for revocation or suspension of his
dichotomy to separate a physician’s existence into his professional registration certificate if there is a risk to the physician's life.
and personal being. Truly, the standard of morality to which medical
practitioners ought to adhere to is quite high, and with good reason. Section 28, in relation to section 10, 11 and 12, pertains to a situation
The State has the primary interest that the public health should be where a person has done acts committing “illegal practice of medicine”. Section 10
preserved and life be made secure. Thus, “[T]he regulation of the of the Act enumerates acts which considers a person engages in the practice of
practice of medicine in all its branches has long been recognized as medicine which are 1) one who shall diagnose, treat or prescribe a remedy for any
a reasonable method of protecting the health and safety of the public” disease, ailment or injury of a person for a fee; or 2) one who shall by means of
advertisement, radio or television or other means of communication, either offer or
26. Discuss the Administrative liability of Physicians (Medical Act of 1959, Code of undertake by any means or method to diagnose, treat or prescribe any remedy for
medical Ethics, E.O. No. 212, “Amending Presidential Decree no. 169”) What are any human disease, ailment or injury; or 3) one who shall use the title M.D after his
the grounds to hold a physician administratively liable? name. Section 11 provides the exemption which should no be construed as engaged
in the practice of medicine and Section 12 provides that the individuals enumerated
therein does not need to have certificate of registration. Upon careful review of the
Medical Act of 1959 said provisions, physician cannot be administratively liable in this case because this
situation actually contemplates a person not a physician who actually engaged to
Section 24 of the Medical Act of 1959 provides the ground for reprimanding a such practice of medicine provided he does not fall within the exception provided in
physician, or for suspending or revoking a certificate of registration as physician. Section 11 and Section 12. Thus, Physician cannot be held administratively liable on
The grounds are: the said provisions.
(1) Conviction by a court of competent jurisdiction of any criminal offense
involving moral turpitude; Executive Order No. 212
(2) Immoral or dishonorable conduct; Amending Presidential Decree no. 169.
(3) Insanity;
(4) Fraud in the acquisition of the certificate of registration; Executive Order No. 212, Section 1, gives an obligation to an attending physician to
(5) Gross negligence, ignorance or incompetence in the practice of his or report to the nearest government health authority the fact that he treated a person
her profession resulting in an injury to or death of the patient; for serious or less serious physical injuries as these injuries are defined in Articles
(6) Addiction to alcoholic beverages or to any habit forming drug rendering 262, 263, 264 and 265 of the Revised Penal Code. Also in the same provision, the
him or her incompetent to practice his or her profession, or to any form of records of the reports kept by said health authorities shall, upon written request, be
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
made available to law enforcement agencies. may be imposed on a physician who violates the Code of Medical Ethics as provided
by the Philippine Medical Association. As explicitly stated it allows for the
Section 2 of the Executive Order provides that the report shall indicate, when reprimand, suspension or even the revocation of the certificate of registration of a
practicable the following: physician who violates any of his duties under the code of medical ethics.
a) The name, age and address of the patient;
b) The name and address of the nearest of kin of the patient; 28. Which of the grounds to hold a physician administratively liable also constitute
c) The name and address of the person who brought the patient for criminal acts that may be punished under the Revised Penal Code?
medical treatment;
d) The nature and probable cause of the patient's injury;
e) The approximate time and date when the injury was sustained; It is submitted that the following grounds for a physician’s administrative liability
f) The place where the injury was sustained; also constitute criminal acts that may be punished under the Revised Penal Code:
g) The time, date and nature of the treatment; and …
h) The diagnosis, the prognosis and/or disposition of the patient. 5. Gross negligence, ignorance or incompetence in the practice of his or her
profession resulting in an injury to or death of the patient.

The violation of the said act will make the physician administratively liable 8. Performance of or aiding in any criminal abortion.
as provided in Section 4 of the said law which provides: “Any violation of this Act or 9. Knowingly issuing any false medical certificate.
of the aforesaid rules and regulations issued by the Secretary of Health, in 10. Issuing any statement or spreading any news or rumor which is
consultations with the Philippine Constabulary, shall be punished administratively derogatory to the character & reputation of another physician without
with a fine that shall not be less than One Hundred Pesos (P100.00) nor more than justifiable motive.
Five Hundred Pesos (P500.00). In addition, the license or permit of the attending …
physician shall be cancelled upon the third violations of this Act or of its 12. Violation of any provision of the Code of Ethics as approved by the Philippine
implementing rules and regulations.” Medical Association. Refusal of a physician to attend a patient in danger of death is
not a sufficient ground for revocation for suspension of his registration certificate if
27. Can a physician be made administratively liable for violating the Code of there is a risk to the physician’s life.
Medical Ethics. Why (If yes, what is your legal basis) or why not?
Respectively they correspond to the crimes of reckless imprudence (365), abortion
Yes a physician can be held administratively liable for violating the Code of Medical practiced by a physician or midwife (Article 259), false medical certificates (Article
Ethics. 174), libel (Article 353-355) and abandonment of a person in danger (Article 275).

Section 24 of the Medical Act of 1959 provides for the grounds for the reprimand, Gross negligence, ignorance or incompetence in the practice of his or her profession
suspension or revocation or registration certificate. To quote it states that: resulting in an injury to or death of the patient constitutes reckless imprudence
when a physician does or fails to do an act voluntarily and without malice resulting
Any of the following shall be sufficient ground for reprimanding a physician, or for to material damage on his patient.
suspending or revoking a certificate of registration as physician:
… Performance of or aiding in any criminal abortion is at square with Article 259 of the
12. Violation of any provision of the Code of Ethics as approved by the Revised Penal Code which punishes a physician or midwife who practices an
Philippine Medical Association. Refusal of a physician to attend to a patient in abortion. The elements of the crime are that there is a pregnant woman who has
danger of death is not a sufficient ground for revocation for suspension of his suffered an abortion that is intended and that a physician or midwife causes or
registration certificate if there is a risk to the physician’s life. assists in the abortion while taking advantage of his or her scientific knowledge or
skill.

This section provides for the legal basis for any administrative liability that Knowingly issuing and false medical certificates is also punished under the Revised
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
Penal Code under Article 174 which punishes a physician or surgeon who in
connection with the practice of his profession shall issue a false certificate. II. Four-fold Duty of a Physician
a. Duties of Physicians to their Patients
Issuing any statement or spreading any news or rumor which is derogatory to the i. Duty of Competence
character & reputation of another physician without justifiable motive will 1. Duty to provide medical care in accordance with the
constitute libel under when a physician makes a malicious imputation of any crime current standard of care compassion,
or vice or defect, real or imaginary, or any act, omission, condition, status or independence and respect for human dignity
circumstance tending to cause the dishonor, discredit or contempt of any other 2. Duty to accept only patients to whom he can provide
physician. medical services in accordance with the current
standards of care compassion, independence and
Under the Code of Ethics of Medical Professionals Section 3 provides: respect for human dignity
ii. Duty to Ensure the Safety and Health of a Patient
In cases of emergency, wherein immediate action is necessary, a physician 1. Duty to give first-aid in cases of emergency
should administer at least first aid treatment and then refer the patient to a more 2. Duty to seek assistance from a specialist in
qualified and competent physician if the case does not fall within his particular line. serious/difficult cases
iii. Duty of Honesty
A physician who fails to do this can be held administratively liable for violating the iv. Duty of Confidentiality
Code of Ethics of Medical Professionals. Furthermore he can also be held criminally v. Duty to Charge Fair and Equitable Medical Fees
liable for Article 275 of the Revised Penal code for abandoning a person in danger b. Duties of Physicians to the Community
when a physician shall fail to render assistance to any person whom he shall find in i. Duty to Cooperate with Authorities to Promote Health
an uninhabited place wounded or in danger of dying, when he can render such ii. Duty to Assist in the Administration of Justice
assistance without detriment to himself, unless such omission shall constitute a iii. Duty to Report Unlicensed Medical Practices
more serious offense. iv. Duty of Modest Advertising of Medical Services
v. Duty of Diligence in Multimedia
29. Briefly Outline the Code of Medical Ethics 1. Diligence in giving diagnosis in broadcast media
2. Diligence in writing articles
I. General Principles c. Duties of Physicians to Colleagues and to the Profession
a. Conduct of a Physician i. Duties to Colleagues
i. To serve mankind without discrimination 1. Duty to waive professional fees
ii. To act in accordance with the Code of Medical Ethics and 2. Duty to consult a specialist when necessary
generally accepted principles of the International Code of 3. Duty to observe protocol in making referrals
Medical Ethics 4. Duty of diligence of substitute physicians
iii. To fulfil civic duties of a good citizen, conform to laws and 5. Duty to respect the doctor-patient relationship of
cooperate with authorities colleagues
iv. To work together and in harmony with colleagues 6. Duty not to receive commission for referrals
v. To cooperate to safe-guard the interest, reputation and ii. Duties to the Profession
dignity of paramedical and other health professionals 1. Duty of competence of the editorial board of medical
vi. To be upright, diligent, sober modest and well-versed in both journals
the science and art of the medical profession 2. Duty to report corrupt and dishonest practices of
b. Considerations of a Physician colleagues
i. Primary - Service to mankind 3. Duty to keep abreast of medical developments
ii. Secondary - Financial gain and other benefits from health 4. Duty as to funds
product industries a. Duty to appropriate funds from commercial
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sources for the benefit of the association or IV. Amendments
society a. Procedure
b. Duty to only accept reasonable subsidies to i. Recommendation of the Commission on Ethics to amend or
support Continuing Medical Education repeal the code
(CME) events ii. Approval of the Board of Governors of the Philippine Medical
c. Duty of faculty/speaker/consultant to only Association of the amendment or repeal by a vote of 2/3
accept honoraria and reimbursement for Ratification of the General Assembly
reasonable transportation, lodging and meal
expenses from health industries. 30. There are advertisements showing doctors apparently endorsing commercial
d. Duty to grant scholarships only when the products. Discuss in relation to the Code of Medical Ethics.
selection of scholars is made by the
organizers of CME or an academic The revised Code of Medical Ethics, specifically Article III Section 5 of the same,
institution provides for the duties of a physician who is involved in multimedia, to wit:
5. Duty to not to commercialize the (CME)
a. Duty to use generic names during CME “Section 5. A physician involved in [multimedia] must be well informed of the
activities matter under discussion. Only the name of the physician and membership to a
b. Duty not to allow commercial exhibits society or institution may be mentioned or posted. A physician should only
interfere or influence CME activities make a general opinion and shall refrain from making a specific diagnosis,
d. Duty of Physicians to Allied Professionals therapy or projection to individual cases in his appearances in the broadcast
i. Duty Not to Pay or Receive Commission to or From Allied media. An article written by a physician must be evidenced-based and disclose
Health Workers connections with pharmaceutical or health product companies. A physician
III. Relationship of Physicians with the Health Product Industry shall not commercially endorse any medical or health product.” (Italics
a. Benefits Received from Health Products Industry supplied)
i. Physicians Shall Not Derive Any Material Gain From Product
Samples By carefully reading the above-mentioned provision, it is therefore clear that
ii. Physicians May Only Receive From Health Product Industries advertisements showing doctors endorsing commercial products is not per se
1. Gifts of reasonable value that primarily benefits contrary to the Code of Medical Ethics (Code). What is prohibited by the Code is the
patient care or related to the physicians’ work endorsement of a medical or health product. This is because when a physician
2. Donations requested by the physician for charitable endorses commercial products other than medical or health products, they endorse
purposes that does not redound to the physicians’ the same in their capacity as a private individual whose endorsement is just as good
benefit as any person. The same however cannot be said for a physician who advertises or
b. Research endorses a medical or health product. As a person who presents himself to the
i. Research activities must be ethically defensible, socially public to be learned in the field of health and medicine, a physician’s opinion and,
responsible and scientifically valid by extension, endorsement of a medical or health product carries much weight so
ii. Research trials conducted by a physician for a health product much so that it can induce persons into patronizing a medical or health product
industry should be in accordance with national or institutional based solely on such supposed learned opinion. In conclusion, advertisements
guidelines to protect human subjects showing doctors endorsing commercial products is not prohibited if such
iii. Remuneration should be reasonable and should not commercial products are not health-related or medical in nature.
constitute an enticement
c. Postmarketing Surveillance 31. Pharmaceutical company funds a medical research conducted by a physician.
i. Must be done with the informed consent of patients Is this allowed?
ii. Physicians are encouraged to report or share the result of the
activity with the authorities The Code provides for two kinds of research which may be conducted by a
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physician, that is, a research activity and a research trial. These two kinds of Article 174. False medical certificates, false certificates of merits or service, etc. The
research are governed by separate rules to determine whether such act is allowed. penalties of arresto mayor in its maximum period to prision correccional in its
Article VI Section 5 which deals with research activities provides: minimum period and a fine not to exceed P1,000 pesos shall be imposed upon:
1Any physician or surgeon who, in connection, with the practice of his profession,
“Section 5. Research activities shall be ethically defensible, socially responsible shall issue a false certificate …
and scientifically valid. Any remuneration should be reasonable and should not
constitute as an enticement.” Article 259. Abortion practiced by a physician or midwife and dispensing of
abortives. The penalties provided in Article 256 shall be imposed in its maximum
On the other hand, research trials are governed by Article VI Section 5, to wit: period, respectively, upon any physician … who, taking advantage of their scientific
knowledge or skill, shall cause an abortion or assist in causing the same.
“Section 6. Research trials conducted by physicians for an industry should be
done in accordance with the national or institutional guidelines for the Article 347. Simulation of births, substitution of one child for another and
protection of human rights.” concealment or abandonment of a legitimate child. — The simulation of births and
the substitution of one child for another shall be punished by prision mayor and a
The elements of a valid research activity and research trial can be gathered from fine of not exceeding 1,000 pesos.
these provisions. Under Section 5 of Article VI the elements of a lawful research
activity are: The same penalties shall be imposed upon any person who shall conceal or abandon
any legitimate child with intent to cause such child to lose its civil status.
1. It is ethically defensible
Any physician or surgeon … who, in violation of the duties of his profession or office,
2. It is socially responsible shall cooperate in the execution of any of the crimes mentioned in the two next
preceding paragraphs, shall suffer the penalties therein prescribed and also the
3. It is scientifically valid and, penalty of temporary special disqualification.

4. The remuneration should be reasonable and should not constitute and Article 365. Imprudence and negligence. — Any person who, by reckless
enticement imprudence, shall commit any act which, had it been intentional, would constitute a
grave felony, shall suffer the penalty of arresto mayor in its maximum period to
For a research trial to be lawful, the same should be in accordance with the national prision correccional in its medium period; if it would have constituted a less grave
or institutional guidelines for the protection of human life. In the instant case, it is felony, the penalty of arresto mayor in its minimum and medium periods shall be
not exactly stated what the nature of the research is. Nevertheless, the mere imposed; if it would have constituted a light felony, the penalty of arresto menor in
funding of a pharmaceutical company of a medical research is not in itself unlawful if its maximum period shall be imposed.
there is no absence in any of the requirements for a research activity or research
trial stated in the Code. Any person who, by simple imprudence or negligence, shall commit an act which
would otherwise constitute a grave felony, shall suffer the penalty of arresto mayor
in its medium and maximum periods; if it would have constituted a less serious
32. Enumerate the criminal liability of physicians under the Revised Penal Code – felony, the penalty of arresto mayor in its minimum period shall be imposed.
Articles 15, 174, 259, 347, 365
When the execution of the act covered by this article shall have only resulted in
Article 15. Alternative circumstances. Alternative circumstances are those which damage to the property of another, the offender shall be punished by a fine ranging
must be taken into consideration as aggravating or mitigating according to the from an amount equal to the value of said damages to three times such value, but
nature and effects of the crime and the other conditions attending its commission. which shall in no case be less than twenty-five pesos.
They are the … degree of instruction and education of the offender.
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A fine not exceeding two hundred pesos and censure shall be imposed upon any
person who, by simple imprudence or negligence, shall cause some wrong which, if
done maliciously, would have constituted a light felony.

Reckless imprudence consists in voluntary, but without malice, doing or falling to do


an act from which material damage results by reason of inexcusable lack of
precaution on the part of the person performing of failing to perform such act,
taking into consideration his employment or occupation, degree of intelligence,
physical condition and other circumstances regarding persons, time and place.

Simple imprudence consists in the lack of precaution displayed in those cases in


which the damage impending to be caused is not immediate nor the danger clearly
manifest.

The penalty next higher in degree to those provided for in this article shall be
imposed upon the offender who fails to lend on the spot to the injured parties such
help as may be in this hand to give.
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33. Cruz vs Court of Appeals, 282 SCRA 188 (1997)  The CA also affirmed the MTCC's decision, and on petition for review on
certiorari, modified her sentence to include indeminifcation of Php 50,000
FACTS for the death of Lydia
 Petitioner Dr Ninevetch Cruz found a myoma in the uterus of patient Lydia
Umali ISSUE
 Dr Cruz scheduled Lydia for a hysterectomy on March 23  W/N Dr Cruz's conviction of the crime of reckless imprudence resulting in
 Lydia was checked in the clinic by her daughter Rowena, who noticed the homicide, arising from an alleged medical malpractice, is supported by the
clinic was untidy and that the floor and window were dusty evidence on record
 Rowena wanted to postpone the operation but Dr Cruz convinced Lydia to
proceed with the original schedule HELD/RATIO
 The surgery was not an emergency, but elective NO, the circumstances are insufficient to sustain a judgment of conviction against
 During the surgery, Dr Lina Ercillo, the attending anaesthesiologist, Dr Cruz for the crime of reckless imprudence resulting in homicide.
instructed Lydia's relatives to buy tagamet ampules; after one hour, type
“A” blood from St Gerald Blood Bank; after the operation, more blood Whether or not a physician has committed an “inexcusable lack of precaution” in
 Lydia was gasping for breath because the oxygen tank had run out of supply the treatment of his patient is to be determined according to the standard of care
 A few hours after the operation, Lydia went into shock and her blood observed by other members of the prfession in good standing under similar
pressure dropped to 60/50, necessitating her transfer to San Pablo District circumstances, bearing in mind the advanced state of the profession at the time of
Hospital (SPDH) treatment or the present state of medical science.
 This transfer was made without the consent of Rowena or any other  In the instant case, there is an absence of expert testimony as to the matter
relative of Lydia of the standard of care employed by other physicians of good standing in
 Dr Cruz and Dr Ercillo re-operated on Lydia upon her arrival at SPDH the conduct of similar operations.
because there was blood oozing from the abdominal incision  The prosecution's expert witnesses (doctors of the NBI) only testified as to
 Lydia died while Dr Cruz was closing the abdominal wall; she was the possible cause of death but did not provide a standard of care that Dr
pronounced dead at 3 AM and her death certificate states “shock” as the Cruz should have exercised.
immediate cause of death and “Disseminated Intravascular Coagulation  While all three lower courts (MTCC, RTC, and CA) point out the inadequacy
(DIC)” as the antecedent cause and untidiness of the facilities, the lack of provisions, the failure to subject
 Rowena filed a case against Dr Cruz and Dr Ercillo, charging them with Lydia to a cardio-pulmonary clearance prior to the hysterectomy, and even
reckless imprudence and negligence resulting in homicide which the subsequent transfer to SPDH, the conclusions of whether these
information states that the two doctors “[failed] to supply or store circumstances constitute reckless imprudence on the part of Dr Cruz is still
sufficient provisions and facilities necessary to meet any and all exigencies best arrived at not through educated surmises nor conjectures of laymen –
apt to arise before, during, and/or after a surgical operation... including including judges – but by the uneqstionable knowledge of expert witnesses
lack of preparation and foresight needed to avert a tragedy, the untimely  Whether a doctor has exercise the requisite degree of skill and care in the
death of said Lydia Umali on the day following said surgical operation” treatment of a patient is a matter of expert opinion
 The MTCC of San Pablo City found Dr Ercillo not guilty for insufficiency of  Courts defer to the expert opinion of qualified physicials since the latter
evidence while Dr Cruz was guilty and sentenced to imprisonment possess unusual technical skills which laymen are incapable of inteliggently
 Basis of MTCC's decision: clinic was untidy, there was a lack of provisions evaluating
like bloody and oxygen to prepare for any contingency during the  Thus, expert testimony shoud have been offered to prove that the
operation, there was no showing that Dr Cruz conducted a cardio- circumstances cited by the lower courts are constitutive of conduct falling
pulmonary clearance or any typing of Lydia's blood; the patient chart (a below the standard of care employed by other physicians in good standing
public document) was not presented in evidence when performing the same operation (i.e. hysterectomy).
 Dr Cruz appealed her conviction to the RTC which affirmed the decision of  Even assuming arguendo that the attendant circumstances constitued
the MTCC reckless imprudence in the exercise of Dr Cruz's duties as a surgeon, no
proof exists that any of the circumstances caused Lydia's death.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
 Elements of reckless imprudence are
1) Offender does or fails to do an act
2) Doing or failure to do the act is voluntary
3) It be without malice
4) Material damage results from the reckless imprudence
5) There is inexcusable lack of precaution on the part of the
offender, taking into consideration his employment/occupation,
degree of intelligence, physical condition, and other circumstances
regarding persons, time, and place
 In this case, the fourth (4th) element is absent ? that the injury to the
person or property (i.e. Lydia's death) was a consequence of the reckless
imprudence
 There must be a proof of breach of duty on the part of Dr Cruz as well as a
causal connection of such breach and the resulting death of the patient (i.e.
Lydia)
 The possible causes of a hemorrhage are 1) failure of surgeon to tie or
suture a cut blood vessel, 2) allowing a cut blood vessel to get out of
control ,3) the subequent loosening of the tie or suture applied to a cut
blood vessel, and 4) a clotting defect known as DIC
 Lydia's autopsy did not reveal any untied or unsutured cut blood vessel nor
was there any indicaiton that the tie or suture of a cut blood vessel had
become loose thereby causing the hemorrhage
 The finding of all three doctors do not preclude the probability that DIC
caused the hemorrhage and consequently Lydia's death
 It was testified to that hemorrhage due to DIC cannot be prevented, it will
happen to anyone, anytime
 Nevertheless, Dr Cruz is civilly liable for the death of Lydia Umali, for
while a conviction of a crime requires proof beyond reasonable doubt,
only a preponderance of evidence is required to establish civil liability.
 Thus, Dr Cruz is acquitted of the crime of reckless impreudence resulting in
homicide but is ordered to pay the heirs of the deceased Lydia Umali Php
50,000 as civil liability, Php 100,000 as moral damages, and Php 50,000 as
exemplary damages
 A copy of the decision will be furnished to the Professional Regulation
Commission for appropriate action
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
34. How do you determine if a physician has committed an inexcusable lack of
precaution in the treatment of his patient?

Whether or not a physician had committed an “inexcusable lack of precaution” in


the treatment of their patient/s is to be determined according to the standard of
care observed by other members of the profession of the medical practice.

This standard of care is relative to the acts and practices of other


physicians in good standing given the similar circumstances of an event,
bearing in mind the advanced state of the profession at the time of
treatment or the present state of medical science. (Cruz vs Court of
Appeals, G.R. 122445)

The Court stated that a physician in effect represents that, having the same needed
training and skill possessed by other physicians practicing in the same field he will
employ such same training, care and skill in the treatment of his patients.

The physician therefore has a duty to use at least the same level of care that any
other reasonably competent doctor would use to treat a condition under the
same circumstances. (Leonila Garcia-Rueda v. Wilfred L. Pascasio, G.R. 118141)
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
35. What are the elements of criminal medical negligence?

Duty

 They have a duty to use at least the same level of care that any other
reasonably competent doctor would use under the same
circumstances

Breach

 The breach of these professional duties of skill and care, or their


improper performance, by a physician surgeon whereby the patient is
injured in body or in health, constitutes actionable malpractice

Injury

 In the event that any injury results to the patient from want of due
care or skill during the operation, the surgeons may be held
answerable in damages for negligence

Proximate causation

 2 queries:

o whether the doctor’s actions in fact caused the harm to the


patient

o whether these were the proximate cause of the patient’s


injury

 It is virtually impossible to ascertain the merits of a medical negligence


case without extensive investigation, research, and consultations with
medical experts (Garcia-Rueda v. Pascasio, G.R. 118141)

Burden of establishing negligence: there must be proof of breach of duty on the


part of the surgeon as well as a casual connection of such breach and the resulting
death of his patient

In this jurisdiction, such claims are most often brought as a civil action for damages
under Article 2176 of the Civil Code, and in some instances, as a criminal case
under Article 365 of the Revised Penal Code with which the civil action for damages
is impliedly instituted (Cruz v. CA, G.R. 122445)
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
36. Digest Carillo vs People, G.R. No. 869890, January 21, 1994.  The CA held that Catherine suffered from an overdose of, or an adverse
reaction to, anaesthesia, particularly the arbitrary administration of Nubain
FACTS (a painkiller) without benefit of prior weighing of Catherine's body mass,
 At about 10:30 AM on May 31, 1981, Catherine Acosta complained of pains which determines the dosage which can be safely given
in the lower part of her abdomen so she was brought to Dr. Elva Peña  The CA held that this triggered a heart attack as post-operative
 Dra. Peña called for Dr. Emilio Madrid, who examined Catherine complication, depriving Catherin's brain of oxygen, leading to the brain's
 According to Dr. Madrid, her condition might be appendicitis hemorrhage
 Dr. Peña told Catherine's parents to bring the child to the hospital in  This cardiac arrest was held to be the immediate cause of death
Baclaran so that the child will be observed  The CA found criminal negligence on the part of both doctors, holding that
 At the Baclaran General Hospital, a nurse took a blood sample from both failed to observe the required standard of diligence in the
Catherine examination of Catherine prior to the actual administration of the
 The findings became known at around 3:00 PM and Catherine was anaesthesia and that it was an act of negligence when they failed to
scheduled for operation at 5:00 PM; however, the operation took place at monitor her heartbeat after the operation and when they left the hospital
5:45 p.m. because Dr. Madrid arrived only at that time immediately after reviving Catherine's heartbeat, depriving Catherine of
 When brought inside the operating room, Catherine was feeling very well immediate and expert medical assistance when she suffered a cardiac
and they did not subject the child to ECG (electrocardiogram) and X-ray arrest approximately 15-30 minutes later
 Dr. Emilio Madrid, a surgeon, was assisted by Dr. Leandro Carillo,
anesthesiologist, in operating on Catherine. ISSUE
 According to the child’s mother, she "noticed something very unfamiliar."  W/N the CA drastically misapprehended the relevant, operative facts in the
 The three nurses who assisted in the operation were going in and out of the case to compel the Supreme Court to examine and resolve questions of fact
operating room, they were not carrying anything, but in going out of the  W/N the findings of the CA adequately support the conclusion that Dr
operating room, they were already holding something. Carillo was, along with Dr Madrid, guilty of simple negligence which
 It has also been established that Catherine was not weighed before the resulted in homicide
administration of anesthesia on her.
 The operation was finished at 7:00 PM and when Catherine was brought HELD/RATIO
out from the operating room, she was observed to be shivering; her heart No. Dr Carillo has not shown misapprehension of facts on the part of the CA which
beat was not normal; she was asleep and did not wake up; she was pale; would require the Supreme Court to overturn the judgment reached by the CA.
and had difficulty in breathing
 Dr. Emilio Madrid suggested that she be placed under an oxygen tank Yes. Both doctors failed to appreciate the serious condition of their patient whose
 Catherine was transferred to her room. Afterwards, her mother noticed adverse physical signs were quite manifest right after surgery.
that her heartbeat was not normal. According to the Dr. Madrid, it was due  After reviving her heartbeat, both doctors failed to monitor their patient
to the lesion of the child. Few minutes after they revived the heartbeat of closely or extend further medical care to her; such conduct was especially
the child, Dr. Madrid and Dr. Carillo left necessary in view of the inadequate, post-operative facilities of the hospital
 15-30 minutes after, Catherine developed convulsion and stiffening of the  The inadequate nature of those facilities did impose higher standard of
body professional diligence upon the two doctors personally than would have
 The nurse called on Dr. dela Peña, who called Dr. Madrid and the been called for in a modern fully-equipped hospital
cardiologist. The cardiologist informed the mother that that she suffered  There is a strong implication that the patient's post-operative condition
from severe infection which went up to her head. must have been considered by the two doctors as in some way related to
 When Catherine remained unconscious until noontime the next day, a the anesthetic treatment she had received from the petitioner either
neurologist examined her and she was diagnosed as comatose. Three (3) during or after the surgical procedure.
days later, Catherine died without regaining consciousness.  Once summoned, petitioner anesthesiologist could not be readily found
 A case was filed against Dr. Madrid and Dr. Carillo  When he finally appeared at 10:30 PM, he was evidently in a bad temper,
commenting critically on the dextrose bottles before ordering their removal
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
 This circumstance indicated he was not disposed to attend to this  Hence, the above mentioned incident presupposes that Dr. Madrid failed to
unexpected call, in violation of the canons of his profession that as a exercise the appropriate and necessary degree off care and diligence to
physician, he should serve the interest of his patient "with the greatest of prevent the sudden decline in the condition of Catherine Acosta.
solicitude, giving them always his best talent and skill."
 The canons of medical ethics require a physician to "attend to his patients
faithfully and conscientiously."
 He should secure for them all possible benefits that may depend upon his
professional skill and care
 As the sole tribunal to adjudge the physician's failure to fulfill his obligation
to his patient is, in most cases, his own conscience, violation of this rule on
his part is "discreditable and inexcusable.
 Dr Carillo relied heavily in this proceeding on the testimony on cross-
examination of the expert witnesses for the prosecution to show that blood
poisoning resulting from a ruptured appendix could also be responsible for
the Catherine's death
 Also, no suggestion has been made that the rupture of the patient's
occurred prior to surgery. After her blood sample was examined, the
patient was merely diagnosed as a case of appendicitis, without further
elaboration. No intensive preoperative preparations, like the immediate
administration of antibiotics, were thereafter undertaken on the patient.
This is a standard procedure for patients who are, after being diagnosed,
suspected of suffering from a perforated appendix and consequent
peritonitis.
 The gravamen of the offense of simple negligence is the failure to exercise
the diligence necessitated or called for the situation which was not
immediately
life-destructive but which culminated, in the present case, in the death of a
human being three (3) days later. Such failure to exercise the necessary
degree of care and diligence is a negative ingredient of the offense charged.
The rule in such cases is that while the prosecution must prove the negative
ingredient of the offense, it needs only to present the best evidence
procurable under the circumstances, in order to shift the burden of
disproving or countering the proof of the negative ingredient to the
accused, provided that such initial evidence establishes at least on a prima
facie basis the guilt of the accused. This rule is particularly applicable where
the negative ingredient of the offense is of such a nature or character as,
under the circumstances, to be specially within the knowledge or control of
the accused.
 In the instant case, the Court is bound to observe that the events which
occurred during the surgical procedure (including whether or not Nubain
had in fact been administered as an anesthesia immediately before or
during the surgery) were peculiarly within the knowledge and control of Dr.
Carillo and Dr. Madrid.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
37. List down the following provisions of the Civil Code: Arts. 1172-1174, 2176- The father and, in case of his death or incapacity, the mother, are
2180 responsible for the damages caused by the minor children who live in their
company.
Art. 1172. Responsibility arising from negligence in the performance of every kind of Guardians are liable for damages caused by the minors or incapacitated
obligation is also demandable, but such liability may be regulated by the courts, persons who are under their authority and live in their company.
according to the circumstances. (1103) The owners and managers of an establishment or enterprise are likewise
responsible for damages caused by their employees in the service of the branches in
Art. 1173. The fault or negligence of the obligor consists in the omission of that which the latter are employed or on the occasion of their functions.
diligence which is required by the nature of the obligation and corresponds with the Employers shall be liable for the damages caused by their employees and
circumstances of the persons, of the time and of the place. When negligence shows household helpers acting within the scope of their assigned tasks, even though the
bad faith, the provisions of Articles 1171 and 2201, paragraph 2, shall apply. former are not engaged in any business or industry.
If the law or contract does not state the diligence which is to be observed in The State is responsible in like manner when it acts through a special agent;
the performance, that which is expected of a good father of a family shall be but not when the damage has been caused by the official to whom the task done
required. (1104a) properly pertains, in which case what is provided in Article 2176 shall be applicable.
Lastly, teachers or heads of establishments of arts and trades shall be liable
Art. 1174. Except in cases expressly specified by the law, or when it is otherwise for damages caused by their pupils and students or apprentices, so long as they
declared by stipulation, or when the nature of the obligation requires the remain in their custody.
assumption of risk, no person shall be responsible for those events which could not The responsibility treated of in this article shall cease when the persons
be foreseen, or which, though foreseen, were inevitable. (1105a) herein mentioned prove that they observed all the diligence of a good father of a
family to prevent damage. (1903a)
Art. 2176. Whoever by act or omission causes damage to another, there being fault
or negligence, is obliged to pay for the damage done. Such fault or negligence, if
there is no pre-existing contractual relation between the parties, is called a quasi-
delict and is governed by the provisions of this Chapter. (1902a)

Art. 2177. Responsibility for fault or negligence under the preceding article is
entirely separate and distinct from the civil liability arising from negligence under
the Penal Code. But the plaintiff cannot recover damages twice for the same act or
omission of the defendant. (n)

Art. 2178. The provisions of Articles 1172 to 1174 are also applicable to a quasi-
delict. (n)

Art. 2179. 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 courts shall
mitigate the damages to be awarded. (n)

Art. 2180. The obligation imposed by Article 2176 is demandable not only for one's
own acts or omissions, but also for those of persons for whom one is responsible.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
38. What are the elements of quasi-delict?
The elements of quasi-delict are:
(a)There is fault or negligence on the part of the defendant resulting in a
wrongful act or omission, whether voluntary or not, and whether criminal
or not;

(b)There is damage and injury suffered by another person;

(c)There is a direct causal relation between the fault or negligence and the
resulting damage and injury.

That is, the fault or negligence is the proximate cause of the damage or injury.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
39. What is Negligence?

Concept of negligence
Negligence consists in the omission of that diligence which is required by
the nature of the particular obligation and corresponds with the circumstances of
the persons, of the time and of the place. It is not an absolute term but a relative
one, its application depends upon the situation of the parties and the degree of
vigilance and care demanded by the prevailing circumstances of time and place.
Negligence is the omission to do something which a reasonable man,
guided by those considerations which ordinarily regulate the conduct of human
affairs, would do, or the doing of something which a prudent man and reasonable
man would not do.

Test of Negligence
The test of negligence can be determined by this standard: If the
defendant, in committing or causing the negligent act, had used reasonable care and
vigilance which a man of ordinary prudence would have employed under the same
situation, he is not guilty of negligence. Otherwise, he is guilty.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
40. What is Proximate Cause?
Proximate cause is that cause, which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces the injury which the result
would not have occurred.
A person committing a felony is criminally liable for all the natural and
logical consequences resulting therefrom although the wrongful act done be
different from that which he intended. “Natural” refers to an occurrence in the
ordinary course of human life or events, while “logical means that there is a rational
connection between the act of the accused and the resulting injury or damage.
The proximate legal cause is that acting first and producing the injury,
either immediately, or setting other events in motion, all constituting a natural and
continuous chain of events, each having a close causal connection with its
immediate predecessor. There must be a relation of “cause and effect”, the cause
being the felonious act of the offender, the effect being the resultant injuries and/or
death of the victim.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
41. What are the elements of medical negligence?
To obtain a judgment against a physician for negligence, the patient must
present the following evidence: (1) that the physician owed a duty to the patient, (2)
that a physician was derelict and breached that duty by failing to act as the ordinary,
competent physician in the same community would have acted under the same or
similar circumstances, (3) that such failure or breach was the direct cause of the
patient’s injuries and (4) that damages to the patient resulted therefrom.
A.Duty. Duty exists when the physician-patient relationship has been
established. That is, the patient has sought the assistance of the physician
and the physician has knowingly undertaken to provide the needed medical
service. Physicians have a duty to use at least the same level of care that
any other reasonably competent medical practitioner would use to treat a
condition under the same circumstances.

A.Derelict (neglectful of obligation). Proof of dereliction, or proof of


negligence of an obligation, must be shown in obtaining a judgment for
malpractice. The breach of professional duties of skill and care, or their
improper performance constitutes actionable malpractice.

A.Direct cause. Another element in medical negligence cases is causation


which is divided into 2 inquiries: whether the actions in fact caused the
harm and whether these were the proximate cause of injury.

A.Damages. In the event that any injury results from want of due care or
skill, the surgeons maybe held answerable in damages for negligence may
be claimed.

The burden of proving each of the four elements of negligence is on the


plaintiff. Failure on the part of the plaintiff to prove any one of these elements may
result in the dismissal of the case. Negligence cannot create a right of action unless
it is the proximate cause—that which, in the natural and continuous sequence,
unbroken by an efficient intervening cause, produces injury and without which the
result would not have occurred—of the injury.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
42. When do you say there is a breach of duty on the part of the physician?
A breached of duty is established where a physician’s practice has failed to
meet an appropriate standard. Essentially, it requires two-pronged evidence:
evidence as to the recognized standards of practice in the particular kind of case and
a showing that a physician in question negligently departed from this standard in his
treatment.

Standards of practice are the boundaries by which the


knowledge and skill levels of a physician are determined

The standard of “reasonable man” who is said to be an ordinary person


placed in the same circumstances is usually applied for most tort cases. This rule is
based on the assumption that a physician is expected to use a reasonable level of
skill, knowledge and care that is possessed by other physicians of similar education
and background. There have been many cases that have tried to identify specific
standards, but in reality, the best way to identify them is to look at the resources
most often used to prove whether the standards have been adhered or not. In one
US jurisprudence, there was a patient who sustained fractures during ECT treatment
and who alleged that care under anesthesia had been negligent in part because he
had not been given muscle relaxation for the procedure, and had not been
restrained or warned of the risks of fracture. It was concluded however that
negligence could not be established, as evidence was provided that at the time it
was not universal practice to administer muscle relaxation, as contrasting opinions
existed as to the benefits of muscle relaxation balanced against the increased risks of
the relaxant.

Sources of proof of standard of care


When the standard of care must be proved in a court of law, certain
resources are frequently used. The “Bolam standard”, by which the alleged negligent
practice is compared with that of a doctor’s peers, is untilized. An expert witness—
the written or verbal evidence is given by qualified expert in an area— should be a
member of the profession in question who is qualified to identify what a reasonable
member of the profession would do under similar circumstances. Another resource
is documentary evidence, i.e., medical textbooks, medical journal articles,
professional treatises, and standards published by national organizations such as
Philippine Medical Association, as well as agency policies and regulations, maybe
used.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
43. Discuss how a patient’s own negligence may be a defense in a medical defendant from any liability, the presence of contributory negligence merely
malpractice case. (Cayao- Lasam vs. Ramolete, 574 SCRA 439 (2008) as reference) mitigates the his liability.
In the case of Cayao- Lasam vs. Ramolete, the Court defined medical In the case of Cayao- Lasam vs. Ramolete, Dr. Fe Cayao-Lasam was charged
negligence as a particular form of negligence which consists in the failure of a with Gross Negligence and Malpractice for her alleged negligence and incompetence
physician or surgeon to apply his practice of medicine that degree of care and skill in conducting Dilatation and Curettage Procedure (“D&C”) or “raspa.” The D&C
which is ordinarily employed by the profession generally, under similar conditions, procedure allegedly led to the rupture of the complainant’s uterus which forced her
and in like surrounding circumstances. The Court further provided that the four to undergo a hysterectomy. As a result, she lost her chance to bear a child. In
elements of medical negligence are: duty, breach, injury, and proximate causation. dismissing the complaint, the Court found that the complainant’s failure to return to
Medical negligence is brought as a civil action for damages under Article 2176 of the the defendant for her follow-up evaluation broke the chain of continuity that is
Civil Code which provides: required in the doctrine of proximate cause. The complainant could have avoided
Article 2176. Whoever by act or omission causes the rupture of her uterus and the resulting injury had she followed the defendant’s
damage to another, there being fault or advice to return for check-up four (4) days after the D&C procedure. Instead,
negligence, is obliged to pay for the damage complainant returned to the hospital one and a half months after when she was
done. Such fault or negligence, if there is no pre- already in a life-threatening condition. Moreover, through the expert witness, it was
existing contractual relation between the proven that the defendant conducted the D&C procedure in accordance with the
parties, is called a quasi-delict and governed by standard medical practice. The complainant’s clear omission was the proximate
the provisions of this Chapter. cause of her own injury and not merely contributory negligence on her part, thus,
The defenses in the aforementioned action for damages are provided in she cannot recover damages from the injury.
Article 2179: In view of the foregoing, the patient’s own negligence (i.e. failure to heed
Article 2179. When the plaintiff’s own the doctor’s advice), can be raised as a defense in malpractice cases either:
negligence was the immediate and proximate 1.To avoid liability as when the complainant’s own negligence is the
cause of his injury, he cannot recover damages. immediate and proximate cause of his injury; or
But if his negligence was only contributory, the
immediate and proximate cause of the injury 2. To mitigate liability as when the complainant’s negligence is only
being the defendant’s lack of due care, the contributory and the immediate and proximate cause of the injury is the
plaintiff may recover damages but the courts defendant’s lack of due care.
shall mitigate the damages to be awarded.
Proximate cause is that which, in natural and continuous sequence, The abovementioned defenses are expressly provided in Article 2179 of the
unbroken by an efficient intervening cause, produces injury, and without which the Civil Code.
result would not have occurred. An act or omission is the proximate cause of an
injury or damage if the act or omission played a substantial part in bringing about or
actually causing the injury or damage. The injury or damage should be the direct
result or a reasonably probable consequence of the act or omission. Hence, if it can
be proven that the act or omission of the defendant is the proximate cause of the
injury of the complainant, the defendant will be held liable for damages.
Consequently, if the act or omission of the defendant is not the proximate cause of
complainant’s injury, the defendant will not be held liable.
Contributory negligence is the act or omission amounting to want of
ordinary care on the part of the person injured, which, concurring with the
defendant’s negligence is the proximate cause of the injury. The presence of
contributory negligence on the part of the complainant has the effect of mitigating
the defendant’s liability. Thus, while the absence of proximate cause absolves the
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
44. Digest Flores vs. Pineda, 571 SCRA 83, 91 (2008) actual, moral, and exemplary damages, plus attorney's fees and costs. The CA
SPOUSES FREDELICTO FLORES (deceased) and FELICISIMA FLORES, petitioners, modified the decision by deleting the attorney’s fees and costs of suit.
vs.
SPOUSES DOMINADOR PINEDA and VIRGINIA SACLOLO, and FLORENCIO, CANDIDA, ISSUE:
MARTA, GODOFREDO, BALTAZAR and LUCENA, all surnamed PINEDA, as heirs of the Whether or not the doctor-spouses are liable through negligence for the death of
deceased TERESITA S. PINEDA, and UNITED DOCTORS MEDICAL CENTER, INC., Teresita, and should thus be made to pay damages?
respondents.
Ponente: BRION, J. HELD:
Yes, the doctor-spouses are liable for negligence resulting to the death of Teresita.
FACTS: Teresita’s family argues that the doctor-spouses decision to proceed with
On April 17, 1987, Teresita Pineda (Teresita) consulted Dr. Fredelicto Flores the D&C operation, despite Teresita's condition and the laboratory test results,
(Dr. Fredelicto), regarding her medical condition where she complained of general amounted to negligence. Doctor-spouses however argue that a D&C operation is the
body weakness, loss of appetite, frequent urination and thirst, and on-and-off proper and accepted procedure to address vaginal bleeding, which was the medical
vaginal bleeding. Dr. Fredelicto conducted an initial interview and advised Teresita to problem presented to them.
go to the United Doctors Medical Center (UDMC) in Quezon City for a general check-
up. Elements of a Medical Negligence Case
Teresita failed to return the following week but when her condition A medical negligence case is a type of claim to redress a wrong committed
persisted, she went to further consult Dr. Flores at his UDMC clinic on April 28, 1987, by a medical professional, that has caused bodily harm to or the death of a patient.
along with her sister, Lucena Pineda (Lucena). Upon their arrival, Lucena testified It involves four elements which are: duty, breach, injury, and proximate causation.
that her sister became very weak and had to lie down. After a routine check-up, Dr. Duty refers to the standard of behavior which imposes restrictions on one's
Fredelicto ordered Teresita's admission to the hospital and for Teresita’s blood and conduct. The standard in turn refers to the amount of competence associated with
urine samples be taken for tests. In the admission slip, he directed the hospital staff the proper discharge of the profession. A physician is expected to use at least the
to prepare the patient for an "on call" D&C operation to be performed by his wife, same level of care that any other reasonably competent doctor would use under the
Dr. Felicisima Flores (Dr. Felicisima). same circumstances. Breach of duty occurs when the physician fails to comply with
As preparation for the operation, Dr. Felicisima, called up the laboratory for these professional standards. If injury results to the patient as a result of this breach,
the results of the tests. At that time, only the results for the blood sugar (BS), uric the physician is answerable for negligence.
acid determination, cholesterol determination, and complete blood count (CBC) Doctor-spouses content that at the time of the operation, there was
were available. Teresita's BS count was 10.67mmol/l7 and her CBC was 109g/l.8. Dr. nothing to indicate that Teresita was afflicted with diabetes: a blood sugar level of
Felicisima then proceeded with the D&C operation with Dr. Fredelicto administering 10.67mmol/l did not necessarily mean that she was a diabetic considering that this
the general anesthesia. was random blood sugar; there were other factors that might have caused Teresita's
It was shown through an ultrasound the following day that Teresita had an blood sugar to rise. However the Supreme Court stated that prior to the D&C
enlarged uterus and myoma uteri. Dr. Felicisima then advised Teresita that she could operation, Teresita was already suspected to have diabetes, particularly when Dr.
recover at home, however the latter opted for hospital confinement. On April 29, Fredelicto had initially examined Teresita on April 17, 1987 and right before the
1987, when the laboratory examination results came in, Teresita's urinalysis showed operation when test results showed that Teresita had an increased blood sugar level.
a three plus sign (+++) indicating that the sugar in her urine was very high. She was Also, it was made known to the doctor-spouses that Teresita was the experiencing
then placed under the care of Dr. Amado Jorge, an internist. general body weakness, loss of appetite, frequent urination, and thirst - all of which
Teresita’s condition worsened and she was put in the ICU. Further tests are classic symptoms of diabetes, which should have alerted them to the possibility
confirmed that she was suffering from Diabetes Mellitus Type II. Insulin was that Teresita was suffering from the said disease.
administered on the patient, however due to complications brought by the diabetes, Expert testimony for the plaintiffs (Teresita’s family) showed that tests
Teresita died on May 6, 1987. should have been ordered immediately on admission to the hospital in view of the
Teresita’s family brought the current suit against the doctor-spouses, symptoms presented, and that failure to recognize the existence of diabetes
alleging that Teresita’s death was caused by their negligence and asked for damages. constitutes negligence.
The RTC ruled in favor of Teresita’s family and ordered the doctor-spouses to pay
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
Injury and Causation 2. It is caused by an instrumentality within the exclusive
The most critical factor in a medical negligence case is proof of the causal control of the defendant or defendants; and
connection between the negligence which the evidence established and the 3.The possibility of contributing conduct which would make
plaintiff's injuries. the plaintiff responsible is eliminated.”
Where Dr. Mendoza, an expert witness of the plaintiffs, explained thus: These elements were successfully proved in the case cited. The bluish discoloration
Stress, whether physical or emotional, is a factor that can aggravate diabetes; a D&C of the skin and the enlargement of the patient’s stomach, among others, are not
operation is a form of physical stress...surgical stress can aggravate the patient's ordinary circumstances when anesthesia or an endotracheal tube is being
hyperglycemia: when stress occurs, the diabetic's body, especially the autonomic administered. The Supreme Court also held that the surgeon and anesthesiologist
system, reacts by secreting hormones which are counter-regulatory; she can have were in control of the instrumentalities used in the operation and that the patient
prolonged hyperglycemia which, if unchecked, could lead to death. Medical could not have possibly contributed to the situation as she was under surgery.
literature further explains that if the blood sugar has become very high, the patient
becomes comatose (diabetic coma). When this happens over several days, the body It is also important to note that res ipsa loquitur is not a rule of substantive
uses its own fat to produce energy, and the result is high levels of waste products law but it gives evidentiary value and places the burden of proof on the defendant
(called ketones) in the blood and urine (called diabetic ketoacidiosis, a medical to disprove that s/he is not guilty of such negligence. Generally, what the patient
emergency with a significant mortality). must do is to “prove a nexus between the particular act or omission complained of
The Supreme Court ruled that such scenario was what had occurred in this and the injury sustained while under the custody and management of the defendant
case and thus found that the causal connection between D&C operation and without need to produce expert medical testimony to establish the standard of
Teresita's death due to aggravated diabetic condition was sufficiently established. care.”
Such findings thus led to the Supreme Court concluding that the doctor-
spouses’ decision to proceed with the D&C operation, despite Teresita's 46. What is the “Captain of Ship” Doctrine?
hyperglycemia and failing to adequately preparing Teresita for the procedure, was
contrary to the standards observed by the medical profession. Failure to observe The Captain of Ship Doctrine provides that the operating surgeon is held to
this standard amounted to a breach of duty which resulted in the patient's death. be completely in charge and can be held liable for any negligent act done in the
Due to this negligent conduct, liability must attach to the doctor-spouses. surgery room given that the duty of the personnel present in the operating room is
to obey the attending surgeon’s orders. This doctrine was first introduced into
45. What is Res Ipsa Loquitur? Philippine jurisprudence in the case of Ramos et al. v. CA.

Res ipsa loquitur is a legal maxim and a Latin phrase which means "the This doctrine was also applied in the case of Mendoza v. Casumpang,
thing or the transaction speaks for itself." In simple terms, it is a procedural doctrine where the surgeon, Dr. Mendoza, was found liable by the Court to pay for damages
applied in cases to justify an inference based on common knowledge and ordinary to the family of Josephine Casumpang who died due to complications brought about
experience of the circumstances surrounding the act or harm caused. by a gauze left in her cervix after a hysterectomy (removal of uterus) and
myomectomy (removal of uterine fibroids) performed by Dr. Mendoza.
In the case of Ramos v. CA, this doctrine served as a basis in holding the
surgeon and anesthesiologist liable for damages due to their negligence, which The court held that as the “Captain of the Ship”, the surgeon is the person
resulted in the comatose and subsequent death of the patient. The main act of primarily responsible for ascertaining if all the instruments and materials used have
negligence referred to the wrong intubation of the patient during a surgery for the been accounted for after the surgery. The court further elaborated that leaving any
removal of gallstones. foreign substance after an operation was prima facie evidence of negligence and
was a clear breach of her duty as a physician.
It was explained in the case that in invoking res ipsa loquitur, the following
elements have to be established: 47. What is the Doctrine of Informed Consent?
“1. The accident is of a kind which ordinarily does not occur in
the absence of someone's negligence; It is a general principle of law which states:
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
“A physician has a duty to disclose what a reasonably prudent the physician not falsely assured them of its side effects. The Supreme Court held
physician in the medical community in the exercise of reasonable that there was no violation of the doctrine in this case. When the physician
care would disclose to his patient as to whatever grave risks of informed the parents of the side effects such as lowered counts of white and red
injury might be incurred from a proposed course of treatment, so blood cells, decrease in blood platelets, possible kidney or heart damage and skin
that a patient, exercising ordinary care for his own welfare, and darkening, the physician could assume that the parents understood that the death
faced with a choice of undergoing the proposed treatment, or of their child was still a risk that could not be ruled out given the general side effects
alternative treatment, or none at all, may intelligently exercise his of chemotherapy disclosed by the physician.
judgment by reasonably balancing the probable risks against the
probable benefits.” 48. Are waivers signed by patients valid? Explain.

Jurisprudence has established the four elements that a plaintiff must prove in an Waivers signed by patients which relieve hospitals and other
action to hold a physician liable for violating the doctrine of informed consent. establishments from “any and all claims," which includes claims due to bad faith or
These are: gross negligence, would be contrary to public policy and thus void.
“1. The physician had a duty to disclose material risks
2. He failed to disclose or inadequately disclosed those risks In the case of Nogales v. Capital Medical Center, Nogales’ wife died because
3. As a direct and proximate result of the failure to disclose, the of complications that occurred after giving birth. Nogales sued the hospital because
patient consented to treatment she otherwise would not have of the latter’s negligence in the selection and supervision of its physicians and
consented to hospital staff. The hospital interposed the defense that Nogales had signed two
4. The plaintiff was injured by the proposed treatment. forms (a Consent on Admission and Agreement form and a Consent to Operation
The gravamen in an informed consent case requires the plaintiff to form) both of which contained the provision that “(Nogales) would not hold liable or
point to significant undisclosed information relating to the responsible and hereby waive and forever discharge and hold free...the Capitol
treatment which would have altered her decision to undergo it.” Medical Center...from any and all claims of whatever kind of nature, arising from
(Emphasis supplied) directly or indirectly, or by reason of said cure, treatment, etc. (or by reason of said
operation for the Consent to Operation form).
The doctrine is premised on the “trust relationship” formed in a physician-
patient relationship. A physician has the “duty to warn of the dangers lurking in the The Supreme Court held that the documents do not expressly release the
proposed treatment and to impart information which the patient has every right to hospital from liability. Such forms, being in the nature of contracts of adhesion, are
expect.” The physician is not expected to give a technical description of such risks. construed strictly against hospitals, and that even simple negligence is not subject to
The doctrine only requires a reasonable explanation from the physician in non- blanket release in favor of hospitals but may only mitigate their liability depending
technical terms as to what is at stake, the alternatives available, the goals to be on the circumstances. The Court further stated that a person asking for urgent
achieved from the treatment, and the risks that may ensure if the treatment is medical attention is at the mercy of the hospital and would not have the same
pursued or not. bargaining power as that of the hospital.

The scope of the information that must be disclosed by the physician is 49. What is the difference between Ramos v. CA, 321 SCRA 585, 588-89 (1999) and
measured by the patient’s need, which is whatever information material to the Ramos v. CA, 380 SCRA 467 (2002)? Briefly digest the cases and explain the basis of
decision. The test is whether a potential peril must be divulged in its materiality to the decision in the Motion for Reconsideration in the 2002 case.
the patient’s decision.
The two cases, Ramos v. CA (1999) and Ramos v. CA (2002) , involve the
The doctrine was applied in the case of Li v. Soliman. Here, a suit for same set of facts. It involves a certain Erlinda Ramos (“Erlinda”), a woman who
damages was pursued against a physician for allegedly failing to inform the parents underwent surgery to remove a stone in her gallbladder. On the day of the
of a child who had osteosarcoma (cancer of the bone) of all the side effects of operation, Dr. Hosaka, the attending surgeon, arrived three hours late due to
chemotherapy. The child eventually died after a few days of the treatment. The another surgery scheduled in a different hospital. Dr. Gutierrez, on the other hand,
parents claimed that they would not have given their consent to chemotherapy had
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
was the anesthesiologist who was recommended by Dr. Hosaka to the patient. It was SHALL BE COMMENTS
only on the day of the operation that Dr. Gutierrez met Erlinda. PENALIZED
During the surgery, the sister-in-law of the patient who was the Dean of a RA 9439 1. Duty not to detain 1. Any officer or The Department of
College of Nursing witnessed the operation and testified to the misapplication of the An act or to otherwise employee of the Health shall
anesthesia by Dr. Gutierrez specifically of the faulty intubation which caused several prohibiting the cause, directly or hospital or promulgate the
complications in the surgery. detention of indirectly, the medical clinic necessary rules and
As a result, Erlinda Ramos became comatose due to brain damage from the patients in detention of patients responsible for regulations to carry
lack of oxygen in the brain and subsequently died (cited in the 2002 case). Erlinda’s hospitals and who have fully or releasing patients, out the provisions
husband then sued Dr. Hosaka, Dr. Gutierrez, and De Los Santos Medical Center, the medical clinics partially recovered or who violates the of this Act.
hospital, for damages. on grounds of have been provisions of this
The Supreme Court, in its 1999 ruling, held them liable for damages based nonpayment of adequately attended Act
on the application of res ipsa loquitur. It held that brain damage is an injury which hospital bills or to or who may have
does not ordinarily occur in the process of a gall bladder operation, giving rise to a medical died, for reasons of Penalty:
presumption of negligence on the part of the doctors and the hospital. Dr. Hosaka, expenses nonpayment in part - a fine of not less
being the head of the surgical team, has the responsibility to see to it that those or in full of hospital than Twenty
under him perform their task in the proper manner. Dr. Gutierrez is negligent for bills or medical thousand pesos
failing to perform the pre-operative evaluation before the surgery. She admitted expenses. (P20,000.00), but
herself that she saw Erlinda for the first time on the day of the operation itself. And not more than
De Los Santos Medical Hospital, as the employer of Dr. Hosaka and Dr. Gutierrez, is 2. Duty to allow Fifty thousand
responsible for the negligence of its employees patients who have pesos
However, upon defendant’s motion for reconsideration, the Supreme Court fully or partially (P50,000.00), or
modified its ruling in 2002. It was also in the 2002 ruling that Erlinda had already recovered and who imprisonment of
died after years of being comatose. In the 2002 ruling, the Court absolved the already wish to leave not less than one
hospital, De Los Santos Medical Center, of its liability since there was no employer- the hospital or month, but not
employee relationship established between the hospital and Dr. Hosaka and Dr. medical clinic but are more than six
Gutierrez, who are regarded as “consultants” of the hospital. It was held that the financially incapable months, or both
contract of the hospital with its consultants is separate and distinct from the to settle, in part or in such fine and
contract with its patients. full, their imprisonment, at
Meanwhile, Dr. Hosaka claimed that the Captain of Ship Doctrine has been hospitalization the discretion of
abandoned in the United States and that it does not apply to him since his expenses, including the proper court.
specialization on surgery and Dr. Gutierrez’s specialization on anesthesiology are professional fees and
distinct fields and such cannot be considered under his control. He relied on medicines, to leave
American jurisprudence but the Supreme Court held that based on the the hospital or
circumstances of the case, it is evident that Dr. Hosaka had control in the operation medical clinic.
and thus, affirmed to be liable.
The Supreme Court, however, modified damages to delete the award of 3. Duty to respect the
temperate damages due to the supervening event of the death of Erlinda. right of the
abovementioned
50. WHAT ARE THE LEGAL DUTIES OF HOSPITALS? patients to demand
the issuance of the
The legal duties of hospitals are as follows: corresponding
medical certificate
LAW LEGAL DUTIES PENALTY/WHO OTHER
and other pertinent
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
papers required for act prohibiting treatment and thousand pesos refers to a
the release of the the demand of support as dictated (P20,000.00), but condition of a
patient from the deposits or by good practice of not more than patient
hospital or medical advance medicine to prevent One hundred characterized by
clinic upon the payments for death or permanent thousand pesos gravity or danger
execution of a the disability (P100,000.00) or wherein based on
promissory note confinement or provided: both, at the the objective
covering the unpaid treatment of discretion of the findings of a
obligation. patients in Provided: court. prudent medical
hospitals and a) that by reason of officer on duty for
4. Duty to release the medical clinics inadequacy of the 2. The director or the day when left
corresponding death in certain medical capabilities officer of such unattended to,
certificate and other cases" of the hospital or hospital or clinic may cause loss of
documents required medical clinic, the responsible for the life or cause
for interment and attending physician formulation and permanent
other purposes to may transfer the implementation of disability to the
any of his surviving patient to a facility the policy, if such patient.
relatives requesting where the violation was
for the same, in the appropriate care can committed "(c) 'Confinement'
case of a deceased be given, after the pursuant to their - a state of being
patient. patient or his next of established policy admitted in a
kin consents to said or upon hospital or medical
transfer and after the instruction of its clinic for medical
RA 8344 1. Duty of any 1. Any official, 1. DEFINITIONS; receiving hospital or management. observation,
An act proprietor, president, medical (a) 'Emergency' - a medical clinic agrees diagnosis, testing,
penalizing the director, manager or practitioner or condition or state to the transfer: Penalty: and treatment
refusal of any other officer, employee of the of a patient - imprisonment of consistent with the
hospitals and and/or medical hospital or wherein based on b) that when the four (4) to six (6) capability and
medical clinics practitioner or medical clinic who the objective patient is years, or a fine of available facilities
to administer employee of a violates the findings of a unconscious, not less than One of the hospital or
appropriate hospital or medical provisions of this prudent medical incapable of giving hundred thousand clinic
initial medical clinic not to request, Act officer on duty for consent and/or pesos
treatment and solicit, demand or the day there is unaccompanied, the (P100,000.00), but "(d) 'Hospital' - a
support in accept any deposit or Penalty: immediate danger physician can transfer not more than facility devoted
emergency or any other form of - imprisonment of and where delay in the patient even Five hundred primarily to the
serious cases, advance payment as not less than six initial support and without his consent thousand pesos diagnosis,
amending for a prerequisite for (6) months and treatment may (P500,000.00) or treatment and care
the purpose confinement or one (1) day but cause loss of life or c) that such transfer both, at the of individuals
batas medical treatment of not more than two cause permanent shall be done only discretion of the suffering from
pambansa a patient in such (2) years and four disability to the after necessary court. illness, disease,
bilang 702, hospital or medical (4) months, or a patient. emergency treatment injury or deformity,
otherwise clinic or to refuse to fine of not less and support have or in need of
known as "an administer medical than Twenty "(b) 'Serious case' - been administered to obstetrical or other
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
stabilize the patient medical and medical treatment Article 193-B and C
and after it has been nursing care. It and support. of Presidential
established that such shall also be Decree No 442; as
transfer entails less construed as any amended,
risks than the institution, building otherwise known
patient's continued or place where as the Labor Code
confinement there are facilities of the Philippines.
and personnel for
d) that no hospital or the continued and "(h) 'Stabilize' - the
clinic, after being prolonged care of provision of
informed of the patients. necessary care
medical indications until such time that
for such transfer, "(e) 'Emergency the patient may be
shall refuse to receive treatment and discharged or
the patient nor support' - any transferred to
demand from the medical or surgical another hospital or
patient or his next of measure within the clinic with a
kin any deposit or capability of the reasonable
advance payment hospital or medical probability that no
clinic that is physical
e) that strict administered by deterioration
compliance with the qualified health would result from
foregoing procedure care professionals or occur during
on transfer shall not to prevent the such discharge or
be construed as a death or transfer.
refusal made permanent
punishable by this Act disability of a
patient. 2. The Department
of Health shall
2. Duty of the "(f) 'Medical clinic' promulgate the
hospital or medical - a place in which necessary rules and
clinic, when proper, patients can avail regulations to carry
to cause the transfer of medical out the provisions
of the patient to an consultation or of this Act.
appropriate hospital treatment on an
consistent with the outpatient basis. 3. The transferring
needs of the patient, and receiving
preferably to a "(g) 'Permanent hospital: (a) shall
government hospital, disability' - a be as much as
specially in the case condition of practicable, be
of poor or indigent physical disability within ten (10)
patients, after they as defined under kilometer radius of
have administered Article 192-C and each other, and (b)
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
shall at all times be pharmacy, subsequent register of
properly dispensary or offense, not more approved
documented. out-patient than 1,000. And hospitals
department, each day that the  Grant licenses
4. Hospitals may delivery room, hospital shall for operation
require a deposit isolation rooms, operate after the and
or advance autopsy room or first conviction is a maintenance
payment when the morgue, subsequent of hospitals or
patient is no longer sufficient offense. revoke them
under the state of quarters for  Make periodic
emergency and residents, Licenses may be inspection of
he/she refuses to nurses, suspended or all hospitals to
be transferred. attendants and revoked for any of check
helpers and the following compliance
sufficient grounds: with rules and
number of toilet 1. Repeated regulations
RA 4226 1. Government or Any person,  Licenses are facilities and violation by the  Publish yearly
AN ACT private hospitals partnership, not wards shall be licensee of any a list of all
REQUIRING must obtain a association or transferrable constructed that provision of approved
THE LICENSURE construction corporation who  Licensed segregation of this act or of hospitals
OF ALL permit issued by establishes, agency – sexes if any other  Submit yearly
HOSPITALS IN licensing agency operates Bureau of observed. existing law reports to
THE before conducts, Medical 2. All hospitals must 2. Violation of Secretary of
PHILIPPINES construction. manages, Services be registered and rules and Health,
AND a. Permit will be maintains a It has the get a license for regulation Speaker of
AUTHORIZING issued if the hospital or following its operation from prescribed in House of
THE BUREAU following are hospital clinic powers: a licensing agency the Representative
OF MEDICAL provided for in within the  Conduct ocular before it operates implementatio , Senate
SERVICES TO the plan: meaning of this survey or opens to the n of this act President and
SERVE AS THE Sufficient bed act without first  Prescribe public. 3. Repeated chairmen and
LICENSING space for the obtaining a license standard plans failure to make members of
AGENCY hospital bed as provided for in for necessary Committees
capacity this Act or violates government corrections or on health of
proposed, any provision hospitals adjustments both houses,
laboratory  Approve plans required by the such reports to
room, operating Penalty: for hospital licensing include
room, work Shall be guilty of plants and agency in the approved
room for misdemeanor, and issue permits improvement hospital
sterilization, upon conviction or authority to of facilities and indicating the
anesthesia shall be liable for a construct services. name of the
preparation, X- fine: 1st offense = hospital hospital etc
ray or radiology not more than  Keep a
room, 500. Each permanent
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
RA 6615 All government and Any hospital The expenses and Twenty-three
AN ACT private hospitals or director, losses of earnings hundred eighty-
REQUIRING clinic duly licensed to administrator, incurred by a two in the case of
GOVERNMENT operate as such are officer-in-charge private hospital of physicians.
AND PRIVATE hereby required to or physician in the clinic for In the case of
HOSPITALS render immediate hospital, medical medicines, facilities Government
AND CLINICS emergency medical center or clinic, and services hospitals, the
TO EXTEND assistance and to who shall refuse beyond first aid imposition of the
MEDICAL provide facilities and or fail without extended to penalty upon the
ASSISTANCE IN medicine within its good cause to emergency cases as person or persons
EMERGENCY capabilities to render the required herein, guilty of the
CASES patients in appropriate and not to exceed violations shall be
emergency cases who assistance fifty thousand without prejudice
are in danger of dying pursuant to the pesos per year, to the
and/or who may have requirements of shall be deductible administrative
suffered serious section one after expenses and action that might
physical injuries. said case had been losses for income be proper.
brought to his tax purposes which In the case of
attention, or any may be carried private hospitals,
nurse, midwife or over for a period of aside from the
medical attendant five years, any imposition of
who shall refuse provision of law or penalty upon the
to extend the regulation to the person or persons
appropriate contrary guilty of the
assistance, subject notwithstanding. violations, the
to existing rules, license of the
or neglect to hospital to
notify or call a operate shall,
physician. whenever
justified, be
Penalty: suspended or
By imprisonment revoked.
of one month and
one day to one
year and one day,
and a fine of three
hundred pesos to 51. WHAT IS EMERGENCY?
one thousand
Emergency – is a condition or state of a patient wherein based on the objective
pesos, without
prejudice to the findings of a prudent medical officer on duty for the day there is immediate danger
provisions of and where delay in initial support and treatment may cause loss of life or cause
Republic Act permanent disability to the patient.
Numbered
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52. WHAT ARE THE DUTIES OF HOSPITALS UNDER THE HOSPITAL CODE OF ETHICS? 1. Hospital must recognize that the care of the sick is their first responsibility and a
sacred trust, striving, at all times, to provide the best possible care and treatment to
Objectives of the Hospital: all in need of hospitalization.

1. The Primary objective of the hospital are the following: 2. Hospitals, recognizing their unique role in safeguarding the nation's health,
should seek through compassionate and scientific care and health education, to
1.1 To provide the best possible facilities for the care of the sick and
extend life, alleviate suffering, and improve the general health of the communities
injured at all times;
they serve.
1.2 To constantly upgrade and improve methods for the care, the cure,
3. Hospitals should remain and promote harmonious relationships within the
amelioration and prevention of disease; and
organization, to insure the proper environment for effective, efficient and equitable
1.3 To promote the practice of medicine by Physicians within the care and treatment of patients.
institution consistent with the acceptable quality of patient care. These objectives
4. Hospitals should seek to inspire the confidence of the entire community and
require an efficient organization, a competent administrator, a qualified medical
should appreciate and respect the social and religious practices and customs of
staff, other well-trained personnel and adequate physical facilities with all of which
patients.
services are made available at all times consistent with community needs.
5. Hospitals, to the extent possible and within their limitations, should conduct
2. The hospital should have the following secondary objectives:
educational projects, stimulate research, and encourage preventive health practices
2.1 To encourage research and teaching and to assist in the advancement in the community.
of scientific knowledge.
6. Hospitals should cooperate with other hospitals, health and welfare agencies,
2.2 To set an example of ethical practice, cooperate with other hospitals government and non-government, and other recognized organizations engaged in
and take an active part in the promotion of health; activities related to the health of the country.

2.3 To provide kind and considerate care for all patients and must always 7. Hospitals, in reporting their work to the public, should give a factual and
provide needed emergency treatment. The hospital has a moral responsibility to objective interpretation of accomplishments and objectives without putting down
make every effort to ensure full and complete recovery of its patients because of directly or indirectly by implication, the work of other hospitals or related
which the hospitals' interest and activities require an extension beyond its walls. organizations.

1.1.1 To cooperate with recognized hospital associations and agencies and to 8. Hospital, cognizant of their social responsibilities, should actively support and
develop cooperative action with other hospitals within the country. encourage every effective means which will ease the financial burdens of illness.

9. Hospital should be fair, honest and impartial in all their business relationships
II. Hospital Ethics and utilize legal and legitimate means in promoting their public relations.
10. Hospitals should be progressive in policies, personnel policies, and effort to
maintain up-to-date equipment, methods and standards of performance.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
53. CASE DIGEST AQUINO V. HEIRS OF RAYMUNDA CALAYAG 678 SCRA 609 This notwithstanding, Dr. Unite cannot escape liability. Since she is the
surgeon in charge, she should not have allowed Dr. Aquino inside because
Facts: When Raymunda Calayag went into labor, her husband Rodrigo brought her
he is sick. As a last point, the trial court found out that there was no
to St. Michael’s Clinic. There, its owner, Dr. Unite after an examination told
notation in the records of Raymunda’s operation regarding the cardiac
the couple that Raymunda would have to undergo a caesarian operation
arrest. The absence of this notation spelled the difference because if the
but she has to be transferred to Sacred Heart Hospital. There, Dr. Aquino
surgeons had this notation, they have 6 to 8 minutes from the time of
applied a preliminary anesthesia and an anesthesia on her spine. After the
cardiac arrest to save Raymunda. The absence clearly marked the
operation, Raymunda had a stillborn eight-month-old baby. Suddenly, the
negligence of Dr. Unite and Dr. Aquino.
medical team noticed that Raymunda is turning blue and her vital signs
were gone, but they were able to restore these. However, the liability of Dr. Reyes was not proven since Dr. Unite and Dr.
Aquino were not under the hospital’s payroll and there were no evidence
Dr. Unite said to Rodrigo that Raymunda’s turning blue is just normal since
presented that Raymunda’s fate was caused by defective hospital facilities.
she had anesthesia and everything will return to normal after eight hours.
Not even the doctrine of ostensible agency or doctrine of apparent
However, this never happened. Upon referral to an internist, it was
authority would make Dr. Reyes liable since there was no evidence
discovered that Raymunda suffered a cardiac arrest during the operation.
adduced to this effect.
Thereafter, the internist ordered Raymunda’s move to a better hospital.

Raymunda was then admitted to Medical Center Manila where the 54. Digest Professional Services Inc vs Court of Appeals 611 SCRA 282 (2010).
attending neurologist declared Raymunda to be in “vegetative state”
because there was lack of oxygen coming to the brain caused by the Professional Services, Inc. v. Court of Appeals
cardiac arrest. She never recovered. She died eventually.
Facts:
Now, the heirs of Raymunda Calayag, namely Rodrigo and their seven
children sued Dr. Unite, Dr. Aquino and Dr. Reyes, owner of Sacred Heart Professional Services Inc. (PSI), the owner and operator of the Medical City,
Hospital for medical malpractice. They allege that Dr. Aquino and Dr. Unite together with Dr. Miguel Ampil and Dr. Juan Fuentes, was impleaded by Enrique
were grossly negligent while Dr. Reyes was remiss in his duty of Agana and Natividad Agana, in a complaint for damages filed in the RTC of Quezon
supervision. City for the injuries suffered by Natividad when Dr. Ampil and Dr. Fuentes neglected
to remove from her body two gauzes.
Issue: Whether or not the three doctors are negligent in their respective duties
resulting in the death of Raymunda Calayag. In the original case, the SC held that PSI is directly liable based on the following:

Held: In order to obtain a conviction for medical malpractice, the Heirs of 1. The relationship between PSI and Dr. Ampil is that of an employer-
Raymunda Calayag should establish these: (1) duty; (2) breach; (3) injury; employee relationship. Citing Ramos v. CA, "for purposes of allocating
and (4) proximate causation. The Heirs have successfully proven the breach responsibility in medical negligence cases, an employer-employee
of duty committed by Dr. Aquino and Dr. Unite since the former have relationship exists between hospitals and their consultants.” Although the
presented the attending neurologist where his expert testimony outlined ruling was reversed in Ramos, such cannot be applied here because the
before the trial court the cause of Raymunda being a “vegetable”.
defense raised by PSI consisted merely of a general denial of responsibility
Moreover, this witness clearly pointed the blame to the doctors present in
over the actions of Dr. Ampil.
Raymunda’s operation for failing to monitor the vital signs during the
2. Since PSI accredited Dr. Ampil and advertised his qualifications, PSI created
operation. Furthermore, the testimony of the neurologist outlined what
should usually happen and what happened here being an anesthetic the public impression that he was its agent, hence it is liable under the
accident since Dr. Aquino administered the anesthesia at the wrong site. doctrine of apparent authority.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
3. PSI, as owner and operation of Medical City General Hospital, PSI was Principle of Respondeat Superior
bound to provide comprehensive medical services to Agana and to exercise
 The application of the “Control Test” to determine the existence of an
reasonable care to protect her from harm. PSI committed a serious breach
employer-employee relationship between hospital and doctor.
of its corporate duty when it failed to conduct an immediate investigation
into the reported missing gauzes.  Under the "control test", an employment relationship exists between a
In this motion for reconsideration, PSI argues that: physician and a hospital if the hospital controls both the means and the
details of the process by which the physician is to accomplish his task.
1. Because of the reversal of the ruling in Ramos v. CA, stating that there is no  Although certain facts show that PSI exercised control over Dr. Ampil, since
employer-employee relationship between the hospital and the doctor, the the work of Dr. Ampil is being monitored, the decision of the lower courts
same ruling should be applied in this case as Aganas failed to prove the finding that there is no employer-employee relationship was not
employer-employee relationship between PSI and Dr. Ampil. questioned, hence, such finding became conclusive. Also, there was
2. Aganas engaged Dr. Ampil as their doctor in the latter’s personal capacity insufficient evidence to prove that PSI exercised to power of control over
and did not primarily and specifically engaged Medical City for its medical the means the details of the specific process by which Dr. Ampil applied his
services. skills. Hence, PSI cannot be liable under the principle of respondeat
3. It cannot be liable under the doctrine of corporate negligence since the superior.
proximate cause of the injury was the negligence of Dr. Ampil. Principle of Apparent Authority

 There is, however, ample evidence that PSI held out to the Aganas that Dr.
Issue: Ampil was its agent:
1. The hospital's implied manifestation to the patient which led the
W/N PSI should be liable?
latter to conclude that the doctor was the hospital's agent
Held/Ratio: Yes 2. The patient’s reliance upon the conduct of the hospital and the
doctor, consistent with ordinary care and prudence.
PSI is liable to the Aganas, not under the principle of respondeat superior for lack of
 In this case, one of the reasons why the Aganas chose Dr. Ampil was
evidence of an employment relationship with Dr. Ampil but under the principle of
because the latter was a staff of the Medical City, a prominent and known
ostensible agency for the negligence of Dr. Ampil and under the principle of
hospital.
corporate negligence for its failure to perform its duties as a hospital.
 Also, PSI required the Aganas to sign a “consent for hospital case” prior to
The hospital may be held liable in either of the following: Natividad’s surgery. By such statement, PSI virtually reinforced the public
impression that Dr. Ampil was a physician of its hospital, rather than one
1. The principle of respondeat superior – when there is an employment independently practicing in it; that the medications and treatments he
relationship prescribed were necessary and desirable; and that the hospital staff was
2. The principle of apparent authority – even when there is no employment prepared to carry them out.
relationship but the hospital holds out to the patient that the doctor is its  Hence, PSI is vicariously liable for the negligence of Dr. Ampil as its
agenct. ostensible agent.
3. The principle of corporate negligence - regardless of its relationship with
the doctor, the hospital may be held directly liable to the patient for its Principle of Corporate Negligence
own negligence or failure to follow established standard of conduct to
which it should conform as a corporation.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
 In this case, PSI admitted that although it had no power to control the hospital corporation gave rise to a direct liability to the Aganas distinct
means or method by which Dr. Ampil conducted its surgery, it had the from that of Dr. Ampil.
power to review or cause the review of what may have irregularly
transpired in the course of the operation strictly for the purpose of 55. What is the difference with Professional Services Inc vs Court of Appeals 544
determining whether some form of negligence may have attended any SCRA 170 (2008) and Professional Services Inc vs Court of Appeals 611 SCRA 282
procedure done inside its premises. (2010)?
 By such admission, PSI define the standards of its corporate conduct,
Basically, the 2008 case of Professional Services Inc. vs Court of Appeals
namely:
involved the resolution of the first motion for reconsideration filed by the petitioner
1. That it had a corporate duty to Natividad even after her operation
Professional Services, Inc. (PSI) with the Supreme Court. They assailed the decision
to ensure her safety as a patient
of the Court’s First Division which held the company solidarily liable with Dr. Ampil
2. That its corporate duty was not limited to having its nursing staff
for the latter’s medical negligence. On the other hand, the 2010 case of the same
note or record the two missing gauzes
name involves the second motion for reconsideration filed by the same party, this
3. That its corporate duty extended to determining Dr. Ampil's role
time urging referral to the Supreme Court en banc.
in it, bringing the matter to his attention, and correcting his
negligence. Additional parties intervened during the second motion of reconsideration
 PSI excuses itself from fulfilling its corporate duty on the ground that Dr. of the 2010 Decision to question the effects of the 2008 Decision on their business;
Ampil assumed personal responsibility already since the latter admitted particularly the finding of the Court in the first motion for reconsideration that
that he would personally notify Natividad of the 2 missing gauzes. Such is there existed an employer-employee relationship between the attending physician
unacceptable as PSI cannot simply waive its duty to review what transpired (Dr. Ampil) and the Medical City (PSI’s company).
during the operation. While Dr. Ampil may have had the primary
As for the resolution of the Court in both cases, though it arrived at the
responsibility of notifying Natividad about the missing gauzes, PSI imposed
same conclusion when it denied both motions for reconsideration of PSI, the 2010
upon itself the separate and independent responsibility of initiating the
en banc decision reversed the previous holding in the 2008 case insofar as in the
inquiry into the missing gauzes.
latter case, the Court affirmed that an employer-employee relationship existed
 PSI also had the duty to take notice of medical records prepared by its own
between Dr. Ampil and Medical City and therefore the latter was liable under the
staff and submitted to its custody. Thus, the record taken during the
principle of “respondeat superior” or vicarious liability as expressed in Art. 2180 of
operation of Natividad which reported a gauze count discrepancy should
the New Civil Code. The Court en banc specifically addressed this issue in the second
have given PSI sufficient reason to initiate a review. It should not have
motion for reconsideration to “allay the anxiety of the intervenors.” In so holding,
waited for Natividad to complain.
the Court held –
 As it happened, PSI took no heed of the record of operation and
consequently did not initiate a review of what transpired during Control as a determinative factor in testing the employer-
Natividad’s operation. By its inaction, therefore, PSI failed its own employee relationship between doctor and hospital under which
standard of hospital care. It committed corporate negligence. the hospital could be held vicariously liable to a patient in medical
 Note: The corporate negligence ascribed to PSI is different from the negligence cases is a requisite fact to be established by
medical negligence attributed to Dr. Ampil. The duties of the hospital are preponderance of evidence. Here, there was insufficient evidence
distinct from those of the doctor-consultant practicing within its premises that PSI exercised the power of control or wielded such power over
in relation to the patient; hence, the failure of PSI to fulfill its duties as a the means and the details of the specific process by which Dr.
Ampil applied his skills in the treatment of Natividad.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
Consequently, PSI cannot be held vicariously liable for the As earlier mentioned, the First Division, in its assailed Decision,
negligence of Dr. Ampil under the principle of respondeat superior. ruled that an employer-employee relationship “in effect” exists
between the Medical City and Dr. Ampil. Consequently, both are
56. Is the doctor an employee of the hospital?
jointly and severally liable to the Aganas. X x x.
No, it was eventually reconsidered by the Supreme Court that Dr. Ampil
X x x. The Court considered the peculiar relationship between a
had no employer-employee relationship with Medical City.
hospital and its consultants on the bases of certain factors. One
In the original decision sought to be reconsidered, the Court through its such factor is the “control test” wherein the hospital exercises
First Division declared that there was, in fact, an employer employee relationship control in the hiring and firing of consultants, like Dr. Ampil, and in
obtaining in the case, thus: the conduct of their work.

In our shores, the nature of the relationship between the hospital However, the Court en banc reversed this point of contention the second
and the physicians is rendered inconsequential in view of our motion for reconsideration wherein it was held that the question of whether or not
categorical pronouncement in Ramos v. Court of Appeals that for an employer-employee relationship existed was not raised as an issue by the parties
purposes of apportioning responsibility in medical negligence upon review; thus –
cases, an employer-employee relationship in effect exists between
X x x. it appears to have escaped the Court’s attention that both
hospitals and their attending and visiting physicians. This Court
the RTC and the CA found no employment relationship between
held:
PSI and Dr. Ampil, and that the Aganas did not question such
“x x x. In other words, private hospitals, hire, fire and exercise real finding. In its March 17, 1993 decision, the RTC found “that
control over their attending and visiting ‘consultant’ staff. While defendant doctors were not employees of PSI in its hospital, they
‘consultants’ are not, technically employees, x x x, the control being merely consultants without any employer-employee
exercised, the hiring, and the right to terminate consultants all relationship and in the capacity of independent contractors.” The
fulfill the important hallmarks of an employer-employee Aganas never questioned such finding.
relationship, with the exception of the payment of wages. In
PSI, Dr. Ampil and Dr. Fuentes appealed from the RTC decision but
assessing whether such a relationship in fact exists, the control
only on the issues of negligence, agency and corporate liability. X
test is determining. Accordingly, on the basis of the foregoing, we
x x.
rule that for the purpose of allocating responsibility in medical
negligence cases, an employer[-]employee relationship in effect In fine, as there was no dispute over the RTC finding that PSI and
exists between hospitals and their attending and visiting Dr. Ampil had no employer-employee relationship, such finding
physicians.” became final and conclusive even to this Court

This was affirmed in the first motion for reconsideration filed by X x x to allay the anxiety of the intervenors, the Court holds that,
Professional Services, Inc. wherein the Court addressed the issue of whether the in this particular instance, the concurrent finding of the RTC and
Court erred in considering that there was an employer-employee relationship in the the CA that PSI was not the employer of Dr. Ampil is correct.
following manner:
Therefore, it is clear that in the final resolution of this case, Dr. Ampil was
The motion lacks merit. not considered by the Final Arbiter as an employee of the hospital.

57. What is the doctrine of corporate negligence?


BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
The Doctrine of Corporate Negligence or Corporate Responsibility has been As can be culled from the decision of the Court in the Professional Services,
regarded as the solution by the Courts to the complex problem of distributing a Inc. v Court of Appeals set of cases, the Doctrine of Agency by Estoppel or Doctrine
hospital’s liability for the negligence of its health practitioners, when the of Apparent authority, as aptly explained by the Court –
respondeat superior or apparent authority is inapplicable.
X x x has its origin from the law of agency. It imposes
Said doctrine is grounded on realization of the Courts of the apparent fact
liability, not as the result of the reality of a contractual
that, at this present age, given the developments of modern-day hospitals, “the
relationship, but rather because of the actions of a principal or an
duty of providing quality medical service is no longer the sole prerogative and
employer in somehow misleading the public into believing that the
responsibility of the physician.” This is now a shared responsibility.
relationship or the authority exists. The concept is essentially one
The Doctrine of Corporate Negligence has its roots in the case of Darling v.
of estoppel and has been explained in this manner:
Charleston Community Hospital. According to the case, the hospital was found to
have been negligent on account of its failure to: “have a sufficient number of “The principal is bound by the acts of his agent with the apparent
trained nurses attending the patient, failing to require a consultation with or authority which he knowingly permits the agent to assume, or
examination by members of the hospital staff, and failing to review the treatment which he holds the agent out to the public as possessing. The
rendered to the patient.” question in every case is whether the principal has by his
The case of Darling has been the foundation of other jurisdictions for voluntary act placed the agent in such a situation that a person of
holding that a hospital’s corporate negligence extends to consciously letting a ordinary prudence, conversant with business usages and the
physician, known to be incompetent, to practice medicine at the hospital. nature of the particular business, is justified in presuming that
As several number of duties are now expected from hospitals given the such agent has authority to perform the particular act in question.
modernization of society:
“(1) The use of reasonable care in the maintenance of safe and adequate It can be readily seen that the doctrine is actually one based on the
facilities and equipment; concept of estoppel and therefore, the relationship of such doctrine with Art. 1431
(2) The selection and retention of competent physicians; of the New Civil Code is quite clear, which provides –
(3) The overseeing or supervision of all persons who practice medicine Article 1431. Through estoppel, an admission or representation
within its walls; and is rendered conclusive upon the person making it, and cannot be
(4) The formulation, adoption and enforcement of adequate rules and denied or disproved as against the person relying thereon.
policies that ensure quality care for its patients.”
Under this doctrine, a hospital has the responsibility to see to it that it An example of the interplay of the doctrine and the provision in question
meets the standards of responsibilities for the care of patients and must properly together with others of similar import was given in one of the cases when
the Court said that “[e]ven when no employment relationship exists but it
supervise the members of its medical staff.
is shown that the hospital holds out to the patient that the doctor is its
Lastly, it can be said that when a patient engages the services of a hospital,
agent, the hospital may still be vicariously liable under Article 2176 in
he has the right to reasonably expect that it will cure him. Because of this, the relation to Article 1431 and Article 1869 of the Civil Code or the principle of
hospital has the corresponding duty to “to make a reasonable effort to monitor and apparent authority.”
oversee the treatment prescribed and administered by the physicians practicing in
its premises.”

58. What is the doctrine of agency by estoppel or doctrine of apparent authority?


What is its relation with Art. 1431 of the Civil Code?
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
59. Difference between VICARIOUS LIABILITY and DIRECT LIABILITY 1.There must be an act or omission by the defendant;
Vicarious liability is where a person is held liable not only for torts
committed by himself, but also for those committed by third parties with whom he 2.There must be fault or negligence on the defendant;
has a certain relationship and for whom he is responsible. This is the doctrine of 3.There must be damage or injury caused to the plaintiff;
“imputed negligence” according to Anglo-American tort law.
4.There must be a direct relation or connection of cause and effect
As can be inferred from the above-stated definition of vicarious liability, it is between the act or omission and the damage;
a distinct concept from direct liability in the sense that in the latter, one is made to
answer for one’s own acts causing damage to another while vicarious liability 5.There is no pre-existing contractual relation between the parties.
presupposes that the person vicariously liable is not the one who directly committed
the act which is the basis of damages by a third person but by virtue of a Example:
relationship between said person and the tortfeasor, the former is held liable. In In a case, the holder of a first class ticket in a place who
both instances, liability is attached to the person which is not subsidiary but was ousted from his first class accommodation and compelled to
primary. To illustrate, when a father causes damage to another, he is directly liable. take a seat in the tourist class, was awarded damages because
And even if the damage was caused by his minor son who lives with him, negligence although the relation between the passenger and the carrier is
can be imputed to the father and therefore, the latter becomes vicariously liable. contractual both in origin and nature, the act that breaks the
The same is true as between guardians and their wards as well as between a teacher contract may also be a tort. The air carrier must answer for the
and his students. willful and malevolent act of its manager.

In the context of hospitals and other similar establishments, where an By the foregoing discussions, it can be concluded that a quasi-delict, as
employment relationship exists between the hospital and the negligent doctor or defined and established in Art. 2176 of the Civil Code, gives rise to a direct liability to
the doctor at fault, the hospital may be held vicariously liable under Art. 2176 in the person responsible thereof. The best proof of this is the first element of a quasi-
relation to Art. 2180 of the Civil Code or the principle of respondeat superior. delict which is “an act or omission by the defendant” which causes damage to
Moreover, even when there is no such relationship, but it is alleged and proven that another. As opposed to vicarious liability, the act or omission which is the basis for
the hospital holds out to the patient that the doctor is its agent, the hospital may damages in this case is that of the liable party himself.
still be vicariously liable under Art. 2176 in relation to Art. 1431 and Art. 1869 of the
Civil Code or the principle of apparent authority. 61. ART. 2180, CIVIL CODE

60. ART. 2176, CIVIL CODE Art. 2180 is an example of vicarious liability. Under this principle of
vicarious or imputed liability, a person is made liable not only for torts committed by
Based on Art. 2176, a quasi-delict is act or omission by a person usually himself, but also for torts committed by others with whom he has certain
called a tortfeasor which causes damage to another in his person, property or rights, relationships and for whom he is responsible, subject to certain conditions.
giving rise to an obligation to pay for the damage done, there being fault or Negligence is said to be imputed if the tortfeasor is different from the person who is
negligence even when no pre-existing contractual relation exists between the being held responsible.
parties. The direct and primary responsibility imposed by Art. 2180 is an application
of this principle. This is as opposed to the general rule that no person can be held
Except in certain cases expressly provided for by law, the basic principle in liable for the acts and omissions of another, and therefore, the enumeration under
our jurisdiction on quasi-delict is that a person cannot be held liable for damage this article is exclusive. As can be inferred from the first paragraph of Art. 2180, the
caused by him, unless he is at fault or is negligent and the damage is produced by liability imposed thereof is solidary. This conclusion is supported by Art. 2194 which
his wrongful act or omission. says that the responsibility of two or more persons who are liable for a quasi-delict
is solidary. Also, Art. 2180 does not distinguish whether the injured party or
De Leon has enumerated the essential requisites of Quasi-Delict as claimant is an employee or a third person.
follows:
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
The following are the persons enumerated in Art. 2180 to have obtaining liability insurance. In addition, by holding the employer responsible, the
vicarious liability: employer may be more careful in selection of employees and will take more precau-
A.Parents (father and in his absence, the mother) as to the tions to see that activities are conducted safely.
damages caused by their minor children who live in their
company; 62. Borrowed Servant Doctrine

B.Guardians as to the damages caused by the minors or Employees of the hospital are sometimes temporarily under the
incapacitated persons who are under their authority and live in supervision and control of another. The borrowed servant doctrine is a special
their company; application of the doctrine of respondeat superior and applies when a hospital
C.The owners and managers of an establishment or enterprise as employee is under the direct control of an independent doctor or agency. The
to the damages caused by their employees in the service of the person, who is actually controlling the employee’s actions, is responsible for them.
branches in which said employees are employed or on the In tort law, respondeat superior was used to hold the master liable for the acts of his
occasion of their functions; servant.

D.Employers as to the damages caused by their employees and “Sometimes an employer will lend his employee to another person
household helpers acting within the scope of their assigned tasks, without terminating the original employment contract. When the borrowing
even though the employers are not engaged in any business or person has the right to control the worker, and the employee has consented to the
industry. lending arrangement, a borrowed servant situation comes into existence. The
question then arises whether the general employer, special employer, or both will
E.The state as to its special agents, but not when the damage has be liable for workmen's compensation payments. Generally, the courts have held
been caused by the official to whom the task done properly only the special employer liable, employing the control test of the borrowed
pertains. servant cases to determine this liability”.
F.Teachers or heads of establishments of arts and trades as to the
damages caused by their pupils and students and apprentices, so In Saint Paul-Mercury Indemnity Co. v. St. Joseph's Hospital, the court held
long as they remain in their custody. that the hospital could not be jointly liable because the servant's negligence
occurred at a time when she was working under the exclusive direction and control
of the surgeon. “The rule is plain that when a general employer assigns his
It is clear from the foregoing that the parents, guardians, owner servant to duty for another and surrenders to the other direction and control in
and managers, etc. are the ones held liable for the acts and omissions done relation to the work to be done, the servant be- comes the servant of the other
by third persons. Thus, as opposed to direct liability, the liability attached insofar as his services relate to the work so controlled and directed. His general
to said persons is that of vicarious liability. employer is no longer liable for the servant's torts committed in the directed and
controlled work. In the operating room the surgeon must be the master. He can't
Doctrine of Vicarious Liability applied in Medical Malpractice tolerate any other voice in the control of his assistant.”

According to one of the leading authorities on the development of tort law, Another illustration of this doctrine is when the surgeon is supposed to
the idea of vicarious liability was common in primitive law where "owners" were teach and supervise the anesthesiologist who is a doctor in training/resident, and
liable for the negligence of servants, slaves, inanimate objects, and "wives" (Prosser, the resident becomes the surgeon’s borrowed servant during the surgery. However,
Law of Torts, page 470). the surgeon is only responsible for the act of Anesthesiology while under his
Losses caused by negligence of employees were carried by the employer as supervision. The hospital, which pays the resident’s salary, is responsible for what he
a required cost of doing business. The employer profits by the action of the does when the surgeon is not around. Likewise, the surgeon is expected to supervise
employee and should bear the damage. The employer is bet- ter able to absorb the the acts of a nurse anesthetist because s/he is neither a doctor nor a trainee. He or
cost and because negligence is a foreseeable aspect of business, vicarious liability she is the surgeon’s borrowed servant as long as he or she works on his patient, and
allows the cost of negligence to be distributed among users through setting prices or the surgeon is responsible for everything a nurse anesthetist does to his patient.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu

63. Captain of the Ship Doctrine The principal is bound by the acts of his agent with the apparent authority
which he knowingly permits the agent to assume, or which he holds the agent out
The surgeon is likened to a captain of the ship. The head surgeon is to the public as possessing. The question in every case is whether the principal has
responsible for anything that will go wrong in the four corners of the Operating by his voluntary act placed the agent in such a situation that a person of ordinary
Room. This is a legal doctrine, which holds that during an operation, the surgeon is prudence, conversant with business usages and the nature of the particular
liable for all actions conducted in the course of the operation The doctrine is a form business, is justified in presuming that such agent has authority to perform the
of the "borrowed servant doctrine", in which a party usually liable for the particular act in question.”
employee’s actions (like the hospital who pays the wages) is absolved of
responsibility when that "borrowed servant" is asked to do something that is The terms “ostensible agency,” “agency by estoppel,” “apparent authority,”
outside of the bounds of policy. and “holding out” tend to be used interchangeably by the courts to refer to this
theory of liability. Agency by estoppel is defined as “one created by operation of law
Captain of the Ship was first introduced into the law of negligence by the and established by proof of such acts of the principal as reasonably lead third
case of McConnell v Williams, the court said: “…in the course of an operation…and persons to the conclusion of its existence. Arises where principal by negligence in
until the surgeon leaves that room at the conclusion of the operation…he is in the failing to supervise agent’s affairs, allows agent to exercise powers not granted to
same complete charge of those who are present and assisting him as is the him, thus justifying others in believing the agent possesses requisite authority.
captain of a ship over all on board, and that such supreme control is indeed
essential in view of the high degree of protection to which an anaesthetized and An ostensible agency is “an implied or presumptive agency which exists
unconscious patient is entitled…” It can be gleaned that physicians who had the where one, either intentionally or from want of ordinary care, induces another to
right or responsibility to control the actions of the ‘agents’ or ‘employees’ assisting believe that a third person is his agent, though he never in fact, employed him. It is,
them becomes subject to liability for negligent acts committed by such agents. strictly speaking, no agency at all, but is in reality based entirely upon estoppel.”
Apparent authority refers to “the power to affect the legal relations of another
Hospitals have a non-delegable duty to patients and can be liable for the person by transactions with third persons, professedly as agent for the other, arising
breach of duties independent of the negligence of its employees or agents. Hospitals from and in accordance with the other’s manifestations to such third persons.
have: (1) a duty to use reasonable care in the maintenance of safe and adequate
facilities and equipment; (2) a duty to select and retain only competent physicians; Pathologist, radiologist and anesthesiologist occupy a peculiar stature they
(3) a duty to oversee all persons who practice medicine within its walls as to patient are usually employees and at the same time independent contractors. In practice,
care; and (4) a duty to formulate, adopt and enforce adequate rules and policies to they usually get a certain percentage of the fee paid to the hospital. Their PF are
ensure quality care for its patients. Thus a hospital is required to establish and collected by the hospital. Most courts consider them as ostensible agents therefore,
enforce policies that meet the duties incumbent upon it. For example, in Bilonoha v. the hospital must be held liable for their negligent act.
Zubritzky, the courts held that a hospital without a policy for counting instruments
at the end of a case could be negligent as an institution along with the surgeon Example: The radiologist performed a radiation therapy however the
when instruments were left in a patient’s wound. patient suffered severe burns on the skin. The hospital is liable also liable because
radiologists, although consultant doctors, are also employees of hospital.
64. Doctrine of Agency by Estoppel
65. DOCTRINE OF APPARENT AUTHORITY
In Ramos v. Court of Appeals, court said that:. “Apparent authority, or
what is sometimes referred to as the “holding out” theory, or doctrine of
ostensible agency or agency by estoppel, has its origin from the law of agency. It The Supreme Court discussed the doctrine of Apparent Authority in the
imposes liability, not as the result of the reality of a contractual relationship, but case of Nogales v Capitol Medical Center , citing Gilbert v Sycamore Municipal
rather because of the actions of a principal or an employer in somehow misleading Hospital:
the public into believing that the relationship or the authority exists. The concept
is essentially one of estoppel and has been explained in this manner:
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
[U]nder the doctrine of apparent authority a hospital can 66. DOCTRINE OF CORPORATE NEGLIGENCE
be held vicariously liable for the negligent acts of a
physician providing care at the hospital, regardless of The doctrine of corporate negligence holds hospitals to be liable for their
whether the physician is an independent contractor, unless patients while they are in the hospital. In Professional Services, Inc. v Agana , the
the patient knows, or should have known, that the Supreme Court stated that hospitals have the “duty to exercise reasonable care to
physician is an independent contractor. The elements of the protect from harm all patients admitted into its facility for medical treatment.”
action have been set out as follows:
These duties include:
For a hospital to be liable under the doctrine of apparent
authority, a plaintiff must show that: (a)the use of reasonable care in the maintenance of safe and adequate
facilities and equipment ;
(1) the hospital, or its agent, acted in a manner that would
lead a reasonable person to conclude that the individual (b)the selection and retention of competent physicians ;
who was alleged to be negligent was an employee or agent (c)the overseeing or supervision of all persons who practice medicine
of the hospital; within its walls;
(2) where the acts of the agent create the appearance of (d)the formulation, adoption and enforcement of adequate rules and
authority, the plaintiff must also prove that the hospital had policies that ensure quality care for its patients ;
knowledge of and acquiesced in them; and
(e)to make a reasonable effort to monitor and oversee the treatment
(3) the plaintiff acted in reliance upon the conduct of the prescribed and administered by the physicians practicing in its premises.
hospital or its agent, consistent with ordinary care and
prudence. 67. RES IPSA LOQUITUR

The element of “holding out” on the part of the hospital Res ipsa loquitur is a Latin phrase that means “the thing speaks for itself.”
does not require an express representation by the hospital In Ramos v. Court of Appeals , the Supreme Court had the opportunity to discuss
that the person alleged to be negligent is an employee. that res ipsa loquitur is a maxim that states the rule that the “fact of the
Rather, the element is satisfied if the hospital holds itself occurrence of an injury, taken with the surrounding circumstances, may permit an
out as a provider of emergency room care without inference or raise a presumption of negligence, or make out a plaintiff's prima
informing the patient that the care is provided by facie case, and present a question of fact for defendant to meet with an
independent contractors. explanation.”

The element of justifiable reliance on the part of the In other words, res ipsa loquitur means that the plaintiff can create a
plaintiff is satisfied if the plaintiff relies upon the hospital to rebuttable presumption of negligence committed by the defendant by proving
provide complete emergency room care, rather than upon a that:
specific physician.”
(a)the harm done would not have resulted if there is no negligence
The Court in this case stated that the doctrine of apparent authority is a
species of the doctrine of estoppel, citing Art. 1431 of the Civil Code, which state: (b)the instrument that caused the harm was under the defendant’s
control
[t]hrough estoppel, an admission or representation is
rendered conclusive upon the person making it, and cannot (c)there are no other plausible explanations
be denied or disproved as against the person relying
thereon.
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
However, res ipsa loquitur is not a substantive rule as it does not vest any • Upon instruction of Dr. Estrada 10 mg of valium was immediately
additional right. It is merely a procedural rule, and does not produce a separate administered by intramuscular injection and later syntocinon admixed with
ground for liability.
dextrose 5% in lactated Ringer’s solution was administered to Corazon.
Courts of other jurisdictions have found the maxim applicable in the following
cases: • Corazon was transferred to the delivery room and her bag of water
ruptured spontaneously and later, her cervix was fully dilated and then
leaving of a foreign object in the body of the patient after started to feel convulsions.
an operation, injuries sustained on a healthy part of the • Dr. Estrada ordered injection of 10 g of magnesium but only 2.5 g was
body which was not under, or in the area, of
administered. Assisted by Dr. Villaflor, Dr. Estrada applied low forceps to
treatment, removal of the wrong part of the body when
another part was intended, knocking out a tooth while a extract Corazon’s baby and in the process her cervical tissue was allegedly
patient's jaw was under anesthetic for the removal of his torn. The baby came out in an injured condition and had to be intubated
tonsils, and loss of an eye while the patient plaintiff was and resuscitated.
under the influence of anesthetic, during or following an • Corazon suffered profuse vaginal bleeding and later died. Her cause of
operation for appendicitis, among others.
death was “Hemorrhage Post Partum”.
It is not applicable in cases of malpractice suits when the only showing is • Nogales filed a complaint for damages with RTC of Manila against the
that the desired result of the treatment was not accomplished. doctors of CMC.
• TC: after 11 years, rendered judgment finding Dr. Estrada solely liable for
68. CASE DIGEST OF NOGALES VS. CAPITOL MEDICAL CENTER damages.

PETITIONER: ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER • CA affirmed TC.
ANTHONY, ANGELICA, NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES
RESPONDENT: CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, ISSUE:
DR. ROSA UY, DR. JOEL ENRIQUEZ, DR. PERPETUA LACSON, DR. NOE ESPINOLA, and • W/N CMC is liable for negligence of Dr. Estrada?
NURSE J. DUMLAO
HELD:
PONENTE: CARPIO, J.
YES. Although Dr. Estrada is solely liable for damages, CMC is liable by virtue of the
G.R. NO./DATE: GR. NO. 142625 and December 19,2006
doctrine of apparent authority.
• Dr. Estrada’s negligence in handling and management of Corazon’s condition
FACTS:
is final and is liable.
• Corazon Nogales was pregnant with her 4th child and is under the exclusive
• ON LIABILITY OF CMC
prenatal care or Dr. Estrada as early as her 4th month pregnancy or on
• In Ramos vs. CA, we held:
December 1975.
• While Corazon was on her last trimester of pregnancy, Dr. Estrada noted an “In other words, private hospitals, hire, fire and exercise real control over their
increase in her blood pressure and development of leg edema indicating attending and visiting "consultant" staff. While "consultants" are not,
preeclampsia; a dangerous complication in pregnancy. technically employees, the control exercised, the hiring, and the right to
• Around midnight, Corazon felt mild labor pains prompting her and her terminate consultants all fulfill the important hallmarks of an employer-
employee relationship, with the exception of the payment of wages. In assessing
husband Rogelio to go the home of Dr. Estrada.
whether such a relationship in fact exists, the control test is determining.
• After examination and upon advise of Dr. Estrada she was admitted to Accordingly, on the basis of the foregoing, we rule that for the purpose of
Capitol Medical Center. allocating responsibility in medical negligence cases, an employer-employee
BLOCK C 2017 – Forensic Medicine | Atty. Ivy Patdu
relationship in effect exists between hospitals and their attending and visiting because of Dr. Estrada's "connection with a reputable
physicians.” hospital, the [CMC]."
o CMC does not exercise control over Dr. Estrada’s treatment and ▪ In other words, Dr. Estrada's relationship with CMC played
management of Corazon’s condition. a significant role in the Spouses Nogales' decision in
o Corazon was under the exclusive prenatal care of Dr. Estrada and accepting Dr. Estrada's services.
at the time of her admission, there was no showing that CMC had ▪ Moreover, there is no showing that before and during
a part in diagnosing her condition. Corazon's confinement at CMC, the Spouses Nogales
o While Dr. Estrada enjoyed the privileges at CMC, such fact alone knew or should have known that Dr. Estrada was not an
does not make him an employee of CMC since the hospital merely employee of CMC.
allowed him to use facilities when Corazon was about to give birth. • ON LIABILTIY OF OTHER RESPONDENTS.
o Dr. Estrada was not an employee of CMC but an independent  These employees acted upon the order of Dr. Estrada and were in good
contractor. faith and had no evidence of any negligence with contributed to the death
• GENERAL RULE: A hospital is not liable for the negligence of an independent of Corazon.
contractor physician. • ON AWARD OF INTEREST ON DAMAGES
o EXCEPTION: when physician is the “OSTENSIBLE” AGENT of the • ARTICLE 211 OF THE CIVIL CODE states that in crimes and quasi-delicts,
hospital or the DOCTRINE ON APPARENT AUTHORITY. It’s elements interest as a part of the damages may, in a proper case, be adjudicated in
are: the discretion of the court.
▪ Hospital or agent acted in a manner that would lead a
reasonable person to conclude that the individual who DISPOSTION:
was alleged to be negligent was an employee or agent of WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds
the hospital respondent Capitol Medical Center vicariously liable for the negligence of Dr.
Oscar Estrada. The amounts of P105,000 as actual damages and P700,000 as
▪ acts of the agent create the appearance of authority, the
moral damages should each earn legal interest at the rate of six percent (6%)
plaintiff must also prove that the hospital had knowledge
per annum computed from the date of the judgment of the trial court. The
of and acquiesced in them Court affirms the rest of the Decision dated 6 February 1998 and Resolution
▪ the plaintiff acted in reliance upon the conduct of the dated 21 March 2000 of the Court of Appeals in CA-G.R. CV No. 45641.
hospital or its agent, consistent with ordinary care and SO ORDERED.
prudence.
o In the case, CMC impliedly held out Dr. Estrada as a member of it’s
medical staff. Through CMC's acts, it clothed Dr. Estrada with
apparent authority which leads the Spouses Nogales to believe
that Dr. Estrada was an employee or agent of CMC.
o The records show that the Spouses Nogales relied upon a
perceived employment relationship with CMC in accepting Dr.
Estrada's services.
▪ Rogelio testified that he and his wife specifically chose Dr.
Estrada to handle Corazon's delivery not only because of
their friend's recommendation, but more importantly

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