CASUMPANG v.

CORTEJO
G.R. No. 171127 | March 11, 2015  At 12:00 midnight, Edmer, accompanied by his parents and by Dr.
Casumpang, was transferred to Makati Medical Center. Upon
FACTS: examination, the attending physician diagnosed Dengue Fever Stage IV
that was already in its irreversible stage. Edmer died at 4:00 in the
 On April 22, 1988, at about 11:30 in the morning, Mrs. Cortejo brought morning of April 24, 1988. His Death Certificate indicated the cause of
her 11-year old son, Edmer, to the Emergency Room of the San Juan de death as Hypovolemic Shock/hemorrhagic shock/Dengue Hemorrhagic
Dios Hospital (SJDH) because of difficulty in breathing, chest pain, Fever Stage IV.
stomach pain, and fever. Thereafter, she was referred and assigned to
Dr. Casumpang, a pediatrician. At 5:30 in the afternoon of the same day,  Believing that Edmer's death was caused by the negligent and erroneous
Dr. Casumpang, upon examination using only a stethoscope, confirmed diagnosis of his doctors, the respondent instituted an action for damages
the diagnosis of Bronchopneumonia. Mrs. Cortejo immediately advised against SJDH, and its attending physicians: Dr. Casumpang and Dr.
Dr. Casumpang that Edmer had a high fever, and had no colds or cough Miranda.
but Dr. Casumpang merely told her that her son's bloodpressure is just
being active and remarked that that's the usual bronchopneumonia, no  Dr. Casumpang contends that he gave his patient medical treatment and
colds, no phlegm. care to the best of his abilities, and within the proper standard of care
required from physicians under similar circumstances.
 Dr. Casumpang next visited the following day. Mrs. Cortejo again called
Dr. Casumpang's attention and stated that Edmer had a fever, throat  Dr. Miranda argued that the function of making the diagnosis and
irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted undertaking the medical treatment devolved upon Dr. Casumpang, the
Dr. Casumpang about the traces of blood in Edmer's sputum. Despite doctor assigned to Edmer. Dr. Miranda also alleged that she exercised
these pieces of information, however, Dr. Casumpang simply nodded prudence in performing her duties as a physician, underscoring that it
and reassured Mrs. Cortejo that Edmer's illness is bronchopneumonia. was her professional intervention that led to the correct diagnosis of
Dengue Hemorrhagic Fever.
 At around 11:30 in the morning of April 23, 1988, Edmer vomited phlegm
with blood streak prompting the Edmer's father to request for a doctor.  SJDH, on the other hand, disclaims liability by asserting that Dr.
Later, Miranda, one of the resident physicians of SJDH, arrived. She Casumpang and Dr. Miranda are mere independent contractors and
claimed that although aware that Edmer had vomited phlegm with blood consultants (not employees) of the hospital; hence, Article 2180 of the
streak she failed to examine the blood specimen. She then advised the Civil Code does not apply.
respondent to preserve the specimen for examination. Thereafter, Dr.
Miranda conducted a check-up on Edmer and found that Edmer had a ISSUES:
low-grade fever and rashes.
1. W/N Casumpang had committed inexcusable lack of precaution in
 At 3:00 in the afternoon, Edmer once again vomited blood. Dr. Miranda diagnosing and in treating the patient
then examined Edmer's sputum with blood and noted that he was
bleeding. Suspecting that he could be afflicted with dengue, Dr. Miranda 2. W/N Miranda had committed inexcusable lack of precaution in
conducted a tourniquet test, which turned out to be negative. Dr. Miranda diagnosing and in treating the patient
then called up Dr. Casumpang at his clinic and told him about Edmer's
condition. Upon being informed, Dr. Casumpang ordered several 3. W/N Whether or not the petitioner hospital is solidarity liable with the
procedures done. Dr. Miranda advised Edmer's parents that the blood petitioner doctors
test results showed that Edmer was suffering from Dengue Hemorrhagic
Fever. Dr. Casumpang recommended Edmer’s transfer to the ICU, but 4. W/N or not there is a causal connection between the petitioners'
since the ICU was then full, the respondent, insisted on transferring his negligent act/omission and the patient's resulting death
son to Makati Medical Center.
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HELD/RATIO: conducting the necessary tests, and promptly notified Dr. Casumpang
about the incident. Indubitably, her medical assistance led to the finding
1. YES, Casumpang was negligent. of dengue fever. Dr. Miranda's error was merely an honest mistake of
judgment; hence, she should not be held liable for medical negligence.
 Even assuming that Edmer's symptoms completely coincided with the
diagnosis of bronchopneumonia, we still find Dr. Casumpang guilty of 3. Yes, causal connection between the petitioners' negligence and the
negligence. Wrong diagnosis is not by itself medical malpractice. patient's resulting death was established
Physicians are generally not liable for damages resulting from a bona
fide error of judgment and from acting according to acceptable medical  Casumpang failed to timely diagnose Edmer with dengue fever despite
practice standards. Nonetheless, when the physician's erroneous the presence of its characteristic symptoms; and as a consequence of
diagnosis was the result of negligent conduct, it becomes an evidence of the delayed diagnosis, he also failed to promptly manage Edmer's
medical malpractice. illness. Had he immediately conducted confirmatory tests, and promptly
administered the proper care and management needed for dengue fever,
 In the present case, evidence on record established that in confirming the risk of complications or even death, could have been substantially
the diagnosis of bronchopneumonia, Dr. Casumpang selectively reduced. That Edmer later died of Dengue Hemorrhagic Fever Stage IV,
appreciated some and not all of the symptoms presented, and failed to a severe and fatal form of dengue fever, established the causal link
promptly conduct the appropriate tests to confirm his findings. In sum, between Dr. Casumpang's negligence and the injury. The element of
Dr. Casumpang failed to timely detect dengue fever, which failure, causation is successfully proven.
especially when reasonable prudence would have shown that indications
of dengue were evident and/or foreseeable, constitutes negligence. 4. YES, SJDH is solidarily liable.
Apart from failing to promptly detect dengue fever, Dr. Casumpang also
failed to promptly undertake the proper medical management needed for  As a rule, hospitals are not liable for the negligence of its independent
this disease. Dr. Casumpang failed to measure up to the acceptable contractors. However, it may be found liable if the physician or
medical standards in diagnosing and treating dengue fever. independent contractor acts as an ostensible agent of the hospital. This
exception is also known as the doctrine of apparent authority.
 Dr. Casumpang's claim that he exercised prudence and due diligence in
handling Edmer's case, sside from being self-serving, is not supported by  SJDH impliedly held out and clothed Dr. Casumpang with apparent
competent evidence. He failed, as a medical professional, to observe the authority leading the respondent to believe that he is an employee or
most prudent medical procedure under the circumstances in diagnosing agent of the hospital. Based on the records, the respondent relied on
and treating Edmer. SJDH rather than upon Dr. Casumpang, to care and treat his son Edmer.
His testimony during trial showed that he and his wife did not know any
2. No, Dr. Miranda is not liable for negligence. doctors at SJDH; they also did not know that Dr. Casumpang was an
independent contractor. They brought their son to SJDH for diagnosis
 We find that Dr. Miranda was not independently negligent. Although she because of their family doctor's referral. The referral did not specifically
was subject to the same standard of care applicable to attending point to Dr. Casumpang or even to Dr. Miranda, but to SJDH.
physicians, as a resident physician, she merely operates as a
subordinate who usually refer to the attending physician on the decision  Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable
to be made and on the action to be taken. We also believe that a finding belief that such were being provided by SJDH or its employees, agents,
of negligence should also depend on several competing factors. In this or servants. By referring Dr. Casumpang to care and treat for Edmer,
case, before Dr. Miranda attended to Edmer, Dr. Casumpang had SJDH impliedly held out Dr. Casumpang as a member of its medical
diagnosed Edmer with bronchopneumonia. There is also evidence staff. SJDH cannot now disclaim liability since there is no showing that
supporting Dr. Miranda's claim that she extended diligent care to Edmer. Mrs. Cortejo or the respondent knew, or should have known, that Dr.
In fact, when she suspected, during Edmer's second episode of bleeding, Casumpang is only an independent contractor of the hospital. In this
that Edmer could be suffering from dengue, she wasted no time in case, estoppel has already set in.
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