MEDICAL MALPRACTICE REFERENCES 1 of 11

Proving medical malpractice in the Philippines one of treatment which according to my ability and judgment, I
the more difficult civil cases in the Philippines. Medical consider for the benefit of my patients, and abstain from
procedures involve, to a great degree, technical matters, which whatever is deleterious and mischievous. . . . While I continue to
must be clearly understood first, prior to pursuing a claim that a keep this oath unviolated may it be granted me to enjoy life and
treatment was attended with malpractice. Moreover, in order practice the art, respected by all men at all times but should I
to prove the existence of medical malpractice in any case, the trespass and violate this oath, may the reverse be my lot. At
legal requirements of the law must be completely satisfied. present, the primary objective of the medical profession is the
Medical malpractice suits fall into the genre of claims based on preservation of life and maintenance of the health of the
tort, called quasi-delicts. In general, negligence suits require people.
proof that a party failed to observe, for the protection of the Needless to say then, when a physician strays from his sacred
interest of another person, that degree of care, precaution, and duty and endangers instead the life of his patient, he must be
vigilance which the circumstances justly demand, whereby made to answer therefor. Although society today cannot and
such other person suffers injury. It is the omission to do something will not tolerate the punishment meted out by the ancients,
which a reasonable man, guided by those considerations which neither will it and this Court, as this case would show, let the act
ordinarily regulate the conduct of human affairs, would do, or go uncondemned.
the doing of something which a prudent and reasonable man xxx xxx
would not do. (Layugan vs. Intermediate Appellate Court, citing As a final word, this Court reiterates its recognition of the vital
Blacks Law Dictionary, Fifth Edition, 930). role the medical profession plays in the lives of the people, and
The Supreme Court, in a case, also had occasion to explain that the States compelling interest to enact measures to protect the
doctors, because of their training and the very nature of their public from the potentially deadly effects of incompetence
work, doctors or physicians are required to exercise utmost and ignorance in those who would undertake to treat our
diligence in the performance of their tasks, to wit: bodies and minds for disease or trauma. Indeed, a physician is
Throughout history, patients have consigned their fates and lives bound to serve the interest of his patients with the greatest of
to the skill of their doctors. For a breach of this trust, men have solicitude, giving them always his best talent and skill. Through
been quick to demand retribution. Some 4,000 years ago, the her tortious conduct, the petitioner endangered the life of
Code of Hammurabi then already provided: If a physician Flotilde Villegas, in violation of her professions rigid ethical code
make a deep incision upon a man with his bronze lancet and and in contravention of the legal standards set forth for
cause the mans death, or operate on the eye socket of a man professionals, in general, and members of the medical
with his bronze lancet and destroy the mans eyes, they shall cut profession, in particular. (Dr. Victoria L. Batiquin and Allan
off his hand. Subsequently, Hippocrates wrote what was to Batiquin vs. Court of Appeals, G.R. No. 118231, 05 July 1996.)
become part of the healers oath: I will follow that method of
 MEDICAL MALPRACTICE REFERENCES 2 of 11

If the application of the foregoing rulings of the Supreme Court When a doctor or hospital accepts a patient for treatment, a
to an incident will show the presence of negligence, i.e., when physician-patient relationship is created. The first element of
a doctor, hospital or medical professional failed to perform the duty arises at this stage. By accepting a case, the doctor or
necessary medical services on a patient according to the hospital commenced the duty to render medical service in
degree of skill required from an ordinary practitioner of their favor of the patient in accordance with the expected training
respective professions, then a cause of action arising from and skill of a medical practitioner. This is in line with the ruling of
negligence or quasi-delict exists. the Supreme Court in the case of Leonila Garcia-Rueda v.
However, being a distinct type of tort, the Supreme Court stated Wilfred L. Pacasio, et. al, to wit:
that, to prove medical malpractice or medical negligence, four Evidently, when the victim employed the services of Dr. Antonio
(4) elements have to be established, to wit: and Dr. Reyes, a physician-patient relationship was created. In
A word on medical malpractice or negligence cases. accepting the case, Dr. Antonio and Dr. Reyes in effect
In its simplest terms, the type of lawsuit which has been called represented that, having the needed training and skill
medical malpractice or, more appropriately, medical possessed by physicians and surgeons practicing in the same
negligence, is that type of claim which a victim has available to field, they will employ such training, care and skill in the
him or her to redress a wrong committed by a medical treatment of their patients. They have a duty to use at least the
professional which has caused bodily harm. In order to same level of care that any other reasonably competent doctor
successfully pursue such a claim, a patient must prove that a would use to treat a condition under the same circumstances.
health care provider, in most cases a physician, either failed to The breach of these professional duties of skill and care, or their
do something which a reasonably prudent health care provider improper performance, by a physician surgeon whereby the
would have done, or that he or she did something that a patient is injured in body or in health, constitutes actionable
reasonably prudent provider would not have done; and that malpractice. Consequently, in the event that any injury results
that failure or action caused injury to the patient. Hence, there to the patient from want of due care or skill during the
are four elements involved in medical negligence cases: duty, operation, the surgeons may be held answerable in damages
breach, injury and proximate causation. for negligence.
As with any civil case, substantial evidence must be presented The second element of breach is present when the hospital or
to establish the liability of the responsible party. If the elements doctor does treatment in breach of professional duties. An
of duty, breach, injury and proximate causation are established example of this would be a doctor that applies treatment
with substantial evidence, then a hospital, doctor, or other without consulting the patients history. It is a standard operating
medical professional will be held liable for malpractice. Civil procedure for all doctors to apprise themselves about the
liability, in the form of damages, may be awarded by the court medical history of a person before they decide on taking
in such instances. him/her as a patient. This process is necessary so that the doctor
 MEDICAL MALPRACTICE REFERENCES 3 of 11

can gauge whether he/she is capable of successfully helping is the proximate result or directly arose from the procedure
the patient and also for the doctor to make the proper conducted.
preparations and decisions with respect to how to treat said However, there are instances of medical malpractice or
patient. medical negligence that involve the application of the familiar
It is also worthy to note that under Section 2 Article II of the Code doctrine res ipsa loquitur. The doctrine of res ipsa loquitur, which
of Ethics promulgated by the Board of Medicine to govern the directly translates to the thing speaks for itself, governs cases
conduct of doctors practicing medicine in the Philippines, a where negligence is clear by a simple examination of the injury
physician has the obligation not to abandon a patient under or the circumstances surrounding the medical treatment given,
any circumstance, to wit: such as where a gauze or a pair of scissors are left inside the
Section 2. A physician is free to choose whom he will serve. He body cavity after it has been sutured, or blood of a different
may refuse calls, or other medical services for reasons type is infused to a patient.
satisfactory to his professional conscience. He should, however, In sum, the difficulty in successfully prosecuting medical
always respond to any request for his assistance in an negligence lies in the fact that medicine is not an exact science.
emergency. Once he undertakes a case, he should not There are numerous life-saving procedures that are
abandon nor neglect it. If for any reason he wants to be experimental, or even not experimental, but are fraught with
released from it, he should announce his desire previously, consequences, such that even the best doctors cannot predict
giving sufficient time or opportunity to the patient or his family to the outcome of the treatment. Also, countless environmental
secure another medical attendant. variable play a direct hand in the effectiveness of a treatment.
Thus, it can be said that when a doctor or hospital unjustifiably All that any medical professional or hospital has to do to avoid
refuses to proceed with treatment, or just suddenly abandons medical malpractice is to study the procedure well including
his or her patient, the act can be considered as breach of duty. the patients history, keep the patient well-informed of the
The presence of the third element arises where injury, liability or procedure which the doctor or hospital intends to perform,
even death arises as a consequence of a negligent medical conduct the treatment in good faith, and with the required
treatment or procedure. degree of competence, diligence and skill. This way, any claim
The last element to establish medical malpractice or medical of malpractice may be avoided.
negligence, is however, the most difficult one to prove. Medical
procedures are fraught with varying consequences, and
affected by innumerable factors such as the environment,
personal health, health of the other members of the family, food
intake, medicine, activities of the patient, such that it would be
difficult to establish, to a convincing degree, whether the injury
 MEDICAL MALPRACTICE REFERENCES 4 of 11

Medical Negligence, what do you need to prove for your action to

prosper? In the medical profession, specific norms or standards to protect the
Dr. Fernando P. Solidum vs. People, G.R. No. 192123, 10 March patient against unreasonable risk, commonly referred to as standards
2014, gives the requisites for an action based on medical negligence, of care, set the duty of the physician to act in respect of the patient.
whether civil, criminal, or administrative, to prosper. Unfortunately, no clear definition of the duty of a particular physician
in a particular case exists. Because most medical malpractice cases
Specifically, the Supreme Court explained that it is necessary to prove are highly technical, witnesses with special medical qualifications
by competent evidence the following elements: must provide guidance by giving the knowledge necessary to render
1. the duty owed by the physician to the patient, as a fair and just verdict. As a result, the standard of medical care of a
created by the physician-patient relationship, to act in prudent physician must be determined from expert testimony in most
accordance with the specific norms or standards established cases; and in the case of a specialist (like an anesthesiologist), the
by his profession (standards of care); standard of care by which the specialist is judged is the care and skill
2. the breach of duty by the physician's failing to act in commonly possessed and exercised by similar specialists under
accordance with the applicable standard of care; similar circumstances. The specialty standard of care may be higher
than that required of the general practitioner.
3. the causation (i.e., there must be a reasonably close
and casual connection between the negligent act or The standard of care is an objective standard by which the
omission and the resulting injury); and conduct of a physician sued for negligence or malpractice may
4. the damages suffered by the patient. be measured, and it does not depend, therefore, on any individual
physician's own knowledge either. In attempting to fix a standard
by which a court may determine whether the physician has
Standard of care, in the medical profession, refers to the specific properly performed the requisite duty toward the patient, expert
norms or standards to protect the patient against unreasonable risk. medical testimony from both plaintiff and defense experts is
As noted by the Supreme Court itself, no clear definition of the duty required. The judge, as the trier of fact, ultimately determines the
of a particular physician in a particular case exists and this standard standard of care, after listening to the testimony of all medical
must be determined in every case, with the judge weighing the experts.
testimonies of experts on both sides to ultimately determine the
standard, as the trier of fact. Here, the Prosecution presented no witnesses with special medical
qualifications in anesthesia to provide guidance to the trial court on
The discussion of the Supreme Court, which I find very clear, is what standard of care was applicable. It would consequently be truly
quoted below for reference, thus - difficult, if not impossible, to determine whether the first three elements
"An action upon medical negligence whether criminal, civil or of a negligence and malpractice action were attendant." (Emphasis
administrative calls for the plaintiff to prove by competent evidence and underscoring supplied)
each of the following four elements, namely: (a) the duty owed by the
physician to the patient, as created by the physician-patient As can be seen from above, in Dr. Fernando P. Solidum, the
relationship, to act in accordance with the specific norms or standards prosecution was not able to prove the foregoing requisites beyond
established by his profession; (b) the breach of the duty by the reasonable doubt, as it did not even establish the first three
physician's failing to act in accordance with the applicable standard of elements, namely, the duty on the part of Dr. Solidum to his patient;
care; (3) the causation, i.e., there must be a reasonably close and Dr. Solidum's breach thereof by failing to act in accordance with the
causal connection between the negligent act or omission and the standard of care appropriate for his particular profession in that
resulting injury; and (4) the damages suffered by the patient. particular situation; and the causation between Dr. Solidum's alleged
 MEDICAL MALPRACTICE REFERENCES 5 of 11

negligent act and the untimely demise of the patient. on the necessity of expert testimony applies only to such matters
clearly within the domain of medical science, and not to matters that
The Supreme Court thus reversed both the Court of Appeals and the are within the common knowledge of mankind which may be testified
trial court and acquitted Dr. Solidum of all charges. to by anyone familiar with the facts. Ordinarily, only physicians and
surgeons of skill and experience are competent to testify as to whether
xxxxxx a patient has been treated or operated upon with a reasonable degree
of skill and care. However, testimony as to the statements and acts of
Note that, as an exception to the foregoing, the Supreme Court physicians and surgeons, external appearances, and manifest
explained that in some cases of medical negligence, the doctrine conditions which are observable by any one may be given by non-
of res ipsa loquitur is applicable. expert witnesses. Hence, in cases where the res ipsa loquitur is
applicable, the court is permitted to find a physician negligent upon
The Supreme Court recognized that there are certain cases which are proper proof of injury to the patient, without the aid of expert testimony,
such of a character as to justify an inference of negligence as the where the court from its fund of common knowledge can determine
cause for that harm. In these case, expert testimony on the standard the proper standard of care. Where common knowledge and
of care applicable is not necessary, especially "when common experience teach that a resulting injury would not have occurred to the
knowledge and experience teach that a resulting injury would not have patient if due care had been exercised, an inference of negligence
occurred to the patient if due care has been exercised" (citing Ramos may be drawn giving rise to an application of the doctrine of res ipsa
vs. Court of Appeals, G.R. No. 124354, 29 December 1999) loquitur without medical evidence, which is ordinarily required to show
not only what occurred but how and why it occurred. When the
The doctrine of res ipsa loquitur, however, while recognized, should doctrine is appropriate, all that the patient must do is prove a nexus
be applied cautiously and depends upon the circumstances of each between the particular act or omission complained of and the injury
case. sustained while under the custody and management of the defendant
without need to produce expert medical testimony to establish the
I am quoting again the discussion of the Supreme Court on this standard of care. Resort to res ipsa loquitur is allowed because there
doctrine, as it presents an important caveat on the applicability of the is no other way, under usual and ordinary conditions, by which the
said doctrine to medical malpractice cases, to wit - patient can obtain redress for injury suffered by him.
"Medical malpractice cases do not escape the application of this Thus, courts of other jurisdictions have applied the doctrine in the
doctrine. Thus, res ipsa loquitur has been applied when the following situations: leaving of a foreign object in the body of the
circumstances attendant upon the harm are themselves of such a patient after an operation, injuries sustained on a healthy part of the
character as to justify an inference of negligence as the cause of that body which was not under, or in the area, of treatment, removal of the
harm. The application of res ipsa loquitur in medical negligence cases wrong part of the body when another part was intended, knocking out
presents a question of law since it is a judicial function to determine a tooth while a patient's jaw was under anesthetic for the removal of
whether a certain set of circumstances does, as a matter of law, permit his tonsils, and loss of an eye while the patient plaintiff was under the
a given inference. influence of anesthetic, during or following an operation for
Although generally, expert medical testimony is relied upon in appendicitis, among others.
malpractice suits to prove that a physician has done a negligent act or Nevertheless, despite the fact that the scope of res ipsa loquitur has
that he has deviated from the standard medical procedure, when the been measurably enlarged, it does not automatically apply to all cases
doctrine of res ipsa loquitur is availed by the plaintiff, the need for of medical negligence as to mechanically shift the burden of proof to
expert medical testimony is dispensed with because the injury itself the defendant to show that he is not guilty of the ascribed negligence.
provides the proof of negligence. The reason is that the general rule
 MEDICAL MALPRACTICE REFERENCES 6 of 11

Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily In the middle of the year, another health issue commanded
used but a rule to be cautiously applied, depending upon the wide media mileage the proposed medical malpractice law. If
circumstances of each case. It is generally restricted to situations in passed, it will punish not only doctors but other health
malpractice cases where a layman is able to say, as a matter of workers as well with six to 12 years imprisonment, cancellation
common knowledge and observation, that the consequences of of license and a fine ranging from half a million to one million
professional care were not as such as would ordinarily have followed pesos. News stories in early July told the public that doctors will
if due care had been exercised. A distinction must be made between lobby against the approval of the House bill sponsored by
the failure to secure results, and the occurrence of something more Pampanga Rep.
unusual and not ordinarily found if the service or treatment rendered
followed the usual procedure of those skilled in that particular practice. Oscar Rodriquez that seeks to criminalize medical
It must be conceded that the doctrine of res ipsa loquitur can have no malpractice in view of a reported increasing number of errors
application in a suit against a physician or surgeon which involves the committed by physicians on their patients. The Philippine
merits of a diagnosis or of a scientific treatment. The physician or College of Physicians (PCP) said that if the bill is approved, it
surgeon is not required at his peril to explain why any particular would shoot up medical expenses because doctors will become
diagnosis was not correct, or why any particular scientific treatment defensive in their practice of medicine that a simple case of
did not produce the desired result. Thus, res ipsa loquitur is not
sickness may require more than one laboratory test to prove the
available in a malpractice suit if the only showing is that the
veracity of the results. (Today, July 3)
desired result of an operation or treatment was not
accomplished. The real question, therefore, is whether or not in
The issue heated up more when Catanduanes Rep. Joseph
the process of the operation any extraordinary incident or
Santiago joined in the fray and echoed the need for a new
unusual event outside of the routine performance occurred
which is beyond the regular scope of customary professional legislation that would protect the rights of persons undergoing
activity in such operations, which, if unexplained would medical treatment. He said that compared to other countries,
themselves reasonably speak to the average man as the existing laws in the Philippines have been inadequate in
negligent cause or causes of the untoward consequence. If there protecting patients from medical malpractice and negligence.
was such extraneous intervention, the doctrine of res ipsa (Manila Times, July 14)
loquitur may be utilized and the defendant is called upon to
explain the matter, by evidence of exculpation, if he could." As if it were not enough, another lawmaker pushed for the
(citing Ramos vs. Court of Appeals, G.R. No. 124354, 29 December passage of the said bill in August, Leyte Rep. Ted Failon. Failon
1999; emphasis and underscoring supplied) said that with the enactment of the bill, victims would be able
to seek legal redress for medical malpractice. He added that
with its passage, the medical profession will be protected from
rogues and scalawags in lily-white uniforms who are turning the
profession into a quack industry. (Today, August 6)

At the wake of the said events, different health workers

organizations assailed the impending bill.

The Philippine General Hospital Physicians Association and

the Philippine Nurses Association said that they are not against
 MEDICAL MALPRACTICE REFERENCES 7 of 11

the rights of patients to file complaints against erring doctors Josephus Jimenez; Philippine Stars Domini Torrevillas; Daily
but they believe that the proposed bill would only create more Tribunes Armando Marfil; and Manila Standards Emil Jurado.
problems to the ailing health care system of the country. (Daily
Tribune, August 11)

The Philippine Medical Association, Philippine College of In the Philippines, there are adequate provisions in the Philippine
Hospital Administrators and Philippine Hospital Association Revised Penal Code for medical malpractice that would protect
also expressed opposition to the bill. One group, however, the patients against medical negligence and incompetence from erring or
Cebu-based Peoples Health Watch showed support to the criminal physicians. On top of this, the Republic Act #9173 or the
measure. The said group appealed for the passage of the bill Philippine Nursing Act of 2002 has also been passed by Congress to
that would stop members of the medical sector from guarantee the delivery of basic health services through adequate and
committing abuses. (Daily Tribune, August 22) competent nursing personnel in the country.

The Philippine Regulatory Commission believed that Significant awards have been awarded to victims of confirmed medical
existing laws are sufficient enough to address the problem of malpractice cases as well as fines meted out by the Department of
medical malpractice. Officials over at PRC said that they accept Health on erring physicians. However, according to the Philippine
and process malpractice cases. (PDI, August 22) Medical Association in a Medical Malpractice Workshop conducted in
2005, such medical malpractice incidence account only for a mere
The DOH rejected the anti-malpractice act, describing it as 0.00003% of the total number of affected patients.
essentially punitive. Dayrit warned that the proposed law would
not actually deter the crime of malpractice and will instead The Philippine Congress and the Senate continue to file bills related
to medical malpractice and healthcare liability, although the medical
wreak havoc in the system by resorting to defensive medicine.
sector continue to oppose passing of these resolutions, stating that
(Manila Times, August 23)
these are detrimental to the healthcare industry in the country.
The Philippine College of Physicians said that any
malpractice law could accelerate health care cost, undermine PROS
patient-doctor relationship, and encourage quack medicine in
the country. (Philippine Star, August 28)
Prices of medical procedures are very cost-effective.
The Philippine Heart Association argued that the proposed Medical staff are trained to international standards, and many
bill is a big setback to local healthcare and does not guarantee
the over-all safety and well being of the general population. doctors are trained in Western countries.
(Manila Times, September 7)
Hospitals catering to health tourism have state-of-the-art
The issue also became a favorite subject of many facilities.
columnists during the third quarter of the year. Among the
opinion writers who wrote their views, negative or otherwise, English is widely spoken among the medical staff, and by the
were PDIs Isagani Cruz, Conrado de Quiros, Neal Cruz, and general public.
 MEDICAL MALPRACTICE REFERENCES 8 of 11

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A medical malpractice case against a doctor is a generic
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Flight times from the US, Canada and Europe are long and How is medical malpractice proven? Conversely, how does a
doctor defend herself from such a charge?
may not be conducive for patients with certain medical
conditions The rulings of the Supreme Court on the liabilities of doctors
There are clear differences in the levels of quality and offered outline how to prove medical malpractice or negligence.
They lay down the standards of evidence for proving whether
healthcare services between private health institutions and a complaint for medical malpractice should be upheld or
public health providers. Good medical tourism packages are dismissed.
offered mostly in private institutions and are not available in
For one, the mere fact of an unfortunate or even tragic
public hospitals or clinics.
outcome is often insufficient proof of a doctors negligence.

In 1997, the Supreme Court affirmed that:

Doctors are protected by a special rule of law. They are not

guarantors of care. They do not even warrant a good result.
They are not insurers against mishaps or unusual
consequences. Furthermore they are not liable for honest
mistakes of judgment . . .

Dr. Ninevetch Cruz vs. Court of Appeals and Lydia Umali, G.R.
No. 122445, November 18, 1997
 MEDICAL MALPRACTICE REFERENCES 9 of 11

Other cases show how a medical malpractice case is proven. v. Wilfred L. Pascasio, et al., this Court stated that in accepting
We see from these cases that Courts tend to defer to a case, a doctor in effect represents that, having the needed
evidence presented by experts medical physcians or training and skill possessed by physicians and surgeons
surgeons about whether the actions of a doctor were in line practicing in the same field, he will employ such training, care
with professional standards and practices. and skill in the treatment of his patients. He 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
The type of lawsuit which has been called medical
under the same circumstances. It is in this aspect of medical
malpractice or, more appropriately, medical negligence, is
malpractice that expert testimony is essential to establish not
that type of claim which a victim has available to him or her to
only the standard of care of the profession but also that the
redress a wrong committed by a medical professional which
physicians conduct in the treatment and care falls below such
has caused bodily harm. In order to successfully pursue such a
standard. Further, inasmuch as the causes of the injuries
claim, a patient must prove that a health care provider, in
involved in malpractice actions are determinable only in the
most cases a physician, either failed to do something which a
light of scientific knowledge, it has been recognized that
reasonably prudent health care provider would have done, or
expert testimony is usually necessary to support the conclusion
that he or she did something that a reasonably prudent
as to causation.
provider would not have done; and that that failure or action
caused injury to the patient.
Dr. Ninevetch Cruz vs. Court of Appeals and Lydia Umali, G.R.
This Court has recognized that medical negligence cases are
No. 122445, November 18, 1997
best proved by opinions of expert witnesses belonging in the
As a rule, Courts do not favor mere allegations as proof of
same general neighborhood and in the same general line of
liability. More is required for proof.
practice as defendant physician or surgeon. The deference of
courts to the expert opinion of qualified physicians stems from
the formers realization that the latter possess unusual technical What this means in practice is that, in order to prove a case of
skills which laymen in most instances are incapable of medical malpractice against a doctor, evidence of these
intelligently evaluating, hence the indispensability of expert medical, professional standards need to be presented in
testimonies. Court. A laymans evidence is not enough. The evidence
required typically takes the form of testimony by other doctors
Dr. Rubli Li vs. Spouses Soliman, G.R. No. 165279, June 7, 2011 in the same or related fields of practice, and of medical
literature and regulations duly proven before the Court.
Evidence should also be presented to prove that the doctor
failed to abide by these standards. Absent these, a finding of
Whether or not a physician has committed an inexcusable
liability can be difficult to sustain.
lack of precaution in the treatment of his patient is to be
determined according to the standard of care observed by
other members of the profession in good standing under similar Conversely, a doctor defending herself from a complaint of
circumstances bearing in mind the advanced state of the medical malpractice or negligence would be well advised to
profession at the time of treatment or the present state of show proof of the standards and particular procedures
medical science. In the recent case of Leonila Garcia-Rueda
 MEDICAL MALPRACTICE REFERENCES 10 of 11

required by the situation. She should present proof that she giving rise to an application of the doctrine of res ipsa
followed these standards of care. loquitur without medical evidence, which is ordinarily required
to show not only what occurred but how and why it occurred.
When the doctrine is appropriate, all that the patient must do
is prove a nexus between the particular act or omission
complained of and the injury sustained while under the
Res ipsa loquitur? custody and management of the defendant without need to
There is, however, a strain of Supreme Court rulings which have produce expert medical testimony to establish the standard of
held a doctor liable for negligence even without medical care. Resort to res ipsa loquitur is allowed because there is no
experts or evidence presented against a defendant doctor. other way, under usual and ordinary conditions, by which the
patient can obtain redress for injury suffered by him.
In these cases, simply the fact of the injury was proven and
from this the Court inferred that the doctor is liable for Thus, courts of other jurisdictions have applied the doctrine in
the following situations: leaving of a foreign object in the body
negligence. To do this, the Supreme Court applied the rule of
of the patient after an operation, injuries sustained on a
evidence known as res ipsa loquitur, whereby the thing
speaks of itself. In such cases, healthy part of the body which was not under, or in the area,
the need for expert medical testimony is dispensed with of treatment, removal of the wrong part of the body when
because the injury itself provides the proof of negligence. The another part was intended, knocking out a tooth while a
reason is that the general rule on the necessity of expert patients jaw was under anesthetic for the removal of his
tonsils, and loss of an eye while the patient plaintiff was under
testimony applies only to such matters clearly within the
the influence of anesthetic, during or following an operation
domain of medical science, and not to matters that are within
the common knowledge of mankind which may be testified to for appendicitis, among others.
by anyone familiar with the facts. Ordinarily, only physicians
and surgeons of skill and experience are competent to testify Ramos vs. Court of Appeals, G.R. No. 124354, December 29,
as to whether a patient has been treated or operated upon 1999, 321 SCRA 584, 599, cited in DR. FERNANDO P. SOLIDUM
vs. PEOPLE OF THE PHILIPPINES, G.R. No. 192123, March 10, 2014.
with a reasonable degree of skill and care. However, testimony
But it must be borne in mind that the application of the res ipsa
as to the statements and acts of physicians and surgeons,
external appearances, and manifest conditions which are loquitur doctrine in medical malpractice cases is
observable by any one may be given by nonexpert witnesses. an exception to the general rule that evidence from medical
Hence, in cases where the res ipsa loquitur is applicable, the experts should be presented to prove a doctors liability.
court is permitted to find a physician negligent upon proper In the same case of Dr. Fernando P. Solidum vs. People of the
Philippines, the Supreme Court ruled that in order for res ipsa
proof of injury to the patient, without the aid of expert
testimony, where the court from its fund of common loquitur to apply, three essential requisites must be present:
knowledge can determine the proper standard of care. Where In order to allow resort to the doctrine, therefore, the following
common knowledge and experience teach that a resulting essential requisites must first be satisfied, to wit: (1) the accident
injury would not have occurred to the patient if due care had was of a kind that does not ordinarily occur unless someone is
negligent; (2) the instrumentality or agency that caused the
been exercised, an inference of negligence may be drawn
injury was under the exclusive control of the person charged;
 MEDICAL MALPRACTICE REFERENCES 11 of 11

and (3) the injury suffered must not have been due to any ultimately determines the standard of care, after listening to
voluntary action or contribution of the person injured. the testimony of all medical experts.
Because of the complexity inherent in many medical cases, a
Court would often be at sea in determining whether these Here, the Prosecution presented no witnesses with special
conditions all exist in a given case, thus requiring recourse to medical qualifications in anesthesia to provide guidance to
expert medical testimony. the trial court on what standard of care was applicable. It
would consequently be truly difficult, if not impossible, to
determine whether the first three elements of a negligence
Indeed, in Dr. Solidum, the Supreme Court ruled against relying
and malpractice action were attendant.
on res ipsa loquitur and, ultimately, acquitted Dr. Solidum of
both criminal and civil liability because the balance of
evidence was not against him.
In the medical profession, specific norms or standards to These are considerations to keep in mind when preparing for a
protect the patient against unreasonable risk, commonly medical malpractice case.
referred to as standards of care, set the duty of the physician
to act in respect of the patient. Unfortunately, no clear
The diligence with which the proper standards of care are
definition of the duty of a particular physician in a particular
presented to the tribunal, and the evidence showing how well
case exists. Because most medical malpractice cases are
these standards were followed, are usually determinative of
highly technical, witnesses with special medical qualifications
the case.
must provide guidance by giving the knowledge necessary to
render a fair and just verdict. As a result, the standard of
medical care of a prudent physician must be determined from
expert testimony in most cases; and in the case of a specialist
(like an anesthesiologist), the standard of care by which the
specialist is judged is the care and skill commonly possessed
and exercised by similar specialists under similar circumstances.
The specialty standard of care may be higher than that
required of the general practitioner.

The standard of care is an objective standard by which the

conduct of a physician sued for negligence or malpractice
may be measured, and it does not depend, therefore, on any
individual physicians own knowledge either. In attempting to
fix a standard by which a court may determine whether the
physician has properly performed the requisite duty toward the
patient, expert medical testimony from both plaintiff and
defense experts is required. The judge, as the trier of fact,