Medical malpractice, expert testimony & res ipsa loquitur
Medical malpractice occurs when a physician or surgeon fails to provide the expected level of care and skill that is typically practiced by professionals under similar circumstances. It is a specific type of negligence where the practitioner does not meet the standards of the medical field.
A claim for malpractice is proven when it is shown that the physician either failed to do something which a reasonably prudent physician or surgeon would have done, or that he or she did something that a reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient. (Reyes, et al. vs. Sisters of Mercy Hospital, et al., G.R. No. 130547, October 3, 2000)
The following elements for medical negligence must be established:
(a) There is a duty owed by the physician to the patient to act in accordance with the specific norms or standards
(b) There is a breach of the duty
(c) The cause which is reasonably close in connection between the negligent act or omission and the resulting injury
(d) Damage suffered by the patient
(Dr. Solidum vs. People of the Philippines, G.R. No. 192123, March 10, 2014)
The physician – patient relationship would be quite easy to establish. However, to prove that a physician was negligent or that it has deviated from the standard medical procedure would normally require expert testimony in the form of testimony by a specialist doctor.
Unfortunately, the reality is it could be difficult to obtain expert testimonies of doctors who may be hesitant to testify against fellow doctors.
The exception to expert testimony, however, is the application of the doctrine of res ipsa loquitur.
This exception was explained in the case of Ramos vs. Court of Appeals. (G.R. No. 124354 December 29, 1999)
In this case, Erlinda Ramos was considered having normal health, except that she had a stone in her gallbladder. She consulted with Dr. Hosaka, and a date for her operation — a “cholecystectomy” — was set.
During the operation, Erlinda was accompanied by her sister-in-law, Herminda, who was the dean of the College of Nursing at the Capitol Medical Center, for moral support.
Dr. Hosaka was hours late for the operation and the anesthesiologist had difficulty intubating Erlinda to the point that her nailbeds were already discolored and another anesthesiologist had to be called in. Erlinda also had to be repositioned so that her head would be lower than her legs, a sign that there was a decrease of blood supply to her brain.
After the operation, Dr. Hosaka informed Erlinda’s husband that something had gone wrong during intubation, and Erlinda was to be confined in the ICU for one month. After being discharged from the hospital, Erlinda remained in a comatose condition — unable to see, hear, and move any part of her body, as she had suffered brain damage as a result of absence of oxygen to her brain for four to five minutes, and she required constant medical attention.
Her husband filed a case for damages with the Regional Trial Court of Quezon City against the doctors and the hospital, claiming negligence in the management and care of Erlinda.
The Supreme Court ruled in favor of the Ramoses, and ordered the doctors and the hospital to pay actual, moral, and exemplary damages, as well as attorney’s fees and costs of suit. They were also ordered to make monthly payments until Erlinda expires or miraculously recovers.
In ruling for Erlinda, the Supreme Court reversed the decision of the Court of Appeals, which absolved the doctors and hospital. The Court of Appeals gave weight to the testimonies of respondent doctors and declared that they were able to show that the brain damage sustained by Erlinda was not caused by the alleged faulty intubation, but due to the allergic reaction of the patient to Pentothal.
The Court of Appeals also rejected the testimony of Herminda, who testified that the cause of Erlinda’s brain injury was traceable to the wrongful insertion of the tube, on the ground that being a nurse, she was not knowledgeable in the process of intubation.
The Supreme Court gave weight to the testimony of Herminda, and declared that the doctors and hospital were not able to disprove the presumption of negligence on their part in the care of Erlinda, and their negligence was the proximate cause of her condition.
Accordingly, even without an expert witness providing testimony and evidence for Erlinda, the Supreme Court found that there existed negligence and malpractice that caused damage and injury to Erlinda.
In reversing the Court of Appeals decision, the Supreme Court applied the principle of res ipsa loquitur. This is a Latin phrase which means “the thing or the transaction speaks for itself.” This maxim provides for the rule that for certain types of occurrences and injury, taken with the surrounding circumstances, there may raise a presumption of negligence, or make out a plaintiff’s prima facie case.
The elements of res ipsa loquitur is established when the accident is of a kind which does not ordinarily occur in the absence of negligence, it is caused by the defendant who has exclusive control, and there was no contributing negligence on the part of the claimant or victim.
The Supreme Court found that although Herminda is not an anesthesiologist, she can testify upon matters on which she is capable of observing such as, the statements and acts of the physician and surgeon, external appearances, and manifest conditions which are observable.
The Supreme Court took notice of the fact that anesthesia procedures have become so common, that even an ordinary person, without a medical degree, can tell if it was administered properly.
On the other hand, the Supreme Court found that the anesthesiologist was negligent as she only saw the patient, Erlinda, for the first time an hour before the scheduled operation. This was seen to be an act of exceptional negligence and professional irresponsibility considering that Erlinda was admitted a day before her operation.
There are other examples of the application of res ipsa loquitur in medical malpractice cases such as leaving of a foreign object in the body of the patient after an operation, injuries sustained on a healthy part of the body which was not under, or in the area, of treatment, removal of the wrong part of the body when another part was intended, knocking out a tooth while a patient’s jaw was under anesthetic for the removal of his tonsils, and loss of an eye while the patient was under the influence of anesthetic, during or following an operation for appendicitis.
The head of the surgical team, Dr. Hosaka, was also found to bear equal responsibility with the anesthesiologist under the “captain of the ship” doctrine. It was his responsibility to see to it that those under him perform their task in the proper manner. In this case, he did not verify if the anesthesiologist properly intubated the patient and he arrived over three hours late for the operation.
On a final note, the Supreme Court did recognize that while the scope of res ipsa loquitur has been measurably enlarged, it does not automatically apply to all cases of medical negligence as to mechanically shift the burden of proof to the defendant to show that it is not guilty of the ascribed negligence.
It does not apply to the failure to secure a particular result and can have no application in a suit against a physician or surgeon which involves the merits of a diagnosis or of a scientific treatment. A physician or surgeon is not required at his peril to explain why any particular diagnosis was not correct, or why any particular scientific treatment did not produce the desired result.
(The author, Atty. John Philip C. Siao, is a practicing lawyer and founding Partner of Tiongco Siao Bello & Associates Law Offices, teaches law at the MLQU School of Law, and an Arbitrator of the Construction Industry Arbitration Commission of the Philippines. He may be contacted at [email protected]. The views expressed in this article belong to the author alone.)
