Published 18 December 2023, The Daily Tribune

Medical negligence or medical malpractice is a complex issue with serious consequences for the patient and the physician. It involves understanding technical and medical matters that cover procedures and proper treatment to prove negligence. Since these cases involve the element of negligence, they are classified as claims based on torts.

Article 1173 of the New Civil Code of the Philippines defines negligence as the “omission of that degree of diligence which is required by the nature of the obligation and corresponds to the circumstance of the persons, time, and place.”

In the often-cited case of Picart v. Smith (G.R. No. L-12219, 15 March 1918), the Supreme Court laid down the test to determine the existence of negligence: Did the defendant, in doing the alleged negligent act, use that reasonable care and caution which an ordinarily prudent person would have used in the same situation? If not, then he is guilty of negligence. In proving medical negligence, four essential elements need to be established: (1) duty; (2) breach; (3) injury; and (4) proximate causation.

First and Second Elements. Duty or legal obligation immediately comes as a natural consequence of having a doctor-client relationship. This relationship is created when the patient engages the services of a doctor, and the doctor agrees to provide such services (Lucas V. Tuaño, G.R. No. 178763, 21 April 2009). Physicians have the duty to exercise that degree of care and skill that is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. (De Jesus v. Uyloan et al., G.R. No. 234851, 15 February 2022).

The non-observance of this duty leads to a breach. In the case of Borromeo v. Family Care Hospital Inc. (G.R. No. 191018, 25 January 2016), the Supreme Court ruled that there was no breach in this case since the cause of the uncontrollable bleeding of the patient leading to his ultimate demise was due to a medical disorder called Disseminated Intravascular Coagulation and not because of the doctor’s negligence.

Under the doctrine of res ipsa loquitor (“the thing speaks for itself”), these two elements are presumed and need not be proven anymore. The court is then permitted to find a physician negligent upon proper proof of injury to his patient where common knowledge, without need of expert testimony, determines the proper standard of care. (Solidum v. People of the Philippines, G.R. No. 192123, 10 March 2014).

Third and Fourth Elements. Injury pertains to the direct result of the breach of a physician’s duty. It must be proven that the proximate cause of this injury is the doctor’s breach of his duty.

“The injury or damage is proximately caused by the physician’s negligence when it appears, based on the evidence and the expert testimony, that the negligence played an integral part in causing the injury or damage, and that the injury or damage was either a direct result, or a reasonably probable consequence of the physician’s negligence.” (Casumpang, citing the case of Jarcia Jr. v. People of the Philippines, G.R. No. 187926, 15 February 2012).

Given the complexity of medical procedures, there is admittedly difficulty in proving the elements of medical negligence. However, so long as physicians and other medical professionals observe the level of diligence necessary in the conduct of their profession, these cases may be avoided.

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