1. G.R. No.

122445, November 18, 1997

DR. NINEVETCH CRUZ, vs. COURT OF APPEALS and LYDIA UMALI

FACTS
On March 22, 1991, the night before the scheduled hysterectomy operation of
respondent Umali, the respondent and her daughter stayed in the Perpetual Help Clinic and
General Hospital in San Pablo City, Laguna where the latter observed that the clinic was untidy.
On the day of the operation, the respondents daughter asked the herein petitioner if the
operation can be cancelled but, the respondent informed her that the operation must be
continued as scheduled after the petitioner and respondent had a conversation. During the
operation, the relatives of the respondent were asked by Dr. Ercillo to buy Tagamet ampules
and blood for the respondent. Additional blood was asked after the operation. Few hours after
the operation, the respondents daughter noticed that the respondents was gasping her breath
and found that the oxygen supply had run out. Thus, the husband of respondent's daughter and
petitioners drivers went to San Pablo District Hospital to get oxygen.
On the same day, the respondent was transferred to San Pablo District Hospital after
she went into shock and her blood pressure dropped without the consent of the respondents
relatives. The respondent was re-operated in the said hospital because there was blood oozing
from the abdominal incision. While the petitioner was closing the abdominal wall, the respondent
died and was pronounced dead on March 24, 1991 because of shock and Disseminated
Intravascular Coagulation (DIC). The petitioner and Dr. Ercillo were charged with reckless
imprudence and negligence resulting to homicide before the MTC in San Pablo City. MTC found
Dr. Ercillo not guilty while the petitioner was held responsible for the death of the respondent.
The petitioner appealed before the RTC which in turn, affirmed the MTCs decision. Then, the
petitioner filed a petition for review before the CA which also affirmed lower courts ruling.
Hence, this petition for review on certiorari was filed assailing the decision of CA.

ISSUE
Whether or not the circumstances of alleged medical malpractice is sufficient to sustain
the conviction of petitioner Cruz for reckless imprudence and negligence resulting to homicide.

RULING
The Court ruled in the NEGATIVE.
As provided by the Revised Penal Code, the elements of reckless imprudence are: (1)
that the offender does or fails to do an act; (2) that the doing or the failure to do that act is
voluntary; (3) that it be without malice; (4) that material damage results from the reckless
imprudence; and (5) that there is inexcusable lack of precaution on the part of the offender,
taking into consideration his employment or occupation, degree of intelligence, physical
condition, and other circumstances regarding persons, time and place. The lack of precaution
will be determined by the standard of care through expert testimony which must be observed
in these kinds of operation. It has been recognized that expert testimony is usually necessary to
support the conclusion as to causation. As applied in this case, the Court held that there was
no expert testimony on the matter of the standard of care employed by other physicians
of good standing in the conduct of similar operations. The prosecution's expert witnesses in
the persons of Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of
Investigation (NBI) only testified as to the possible cause of death but did not venture to
illuminate the court on the matter of the standard of care that petitioner should have exercised.
In cases involving medical negligence, the Court held that the plaintiff has the burden
of proof in establishing the negligence of the appellant and the breach of duty on the part of the
surgeon and the resulting death of his patient. In Chan Lugay v. St. Luke's Hospital, Inc., it was
said that the negligence must be the proximate cause of the injury. Further, based on the
expert testimonies rendered by both prosecution and defense witnesses, the Court held that the
cause of the death of respondent was DIC and not the fault or negligence of the
petitioner.
Hence, the petitioner is ACQUITTED of the crime of reckless imprudence resulting in
homicide but is ordered to pay the heirs of the deceased Lydia Umali the amount of FIFTY
THOUSAND PESOS (P50,000.00) as civil liability, ONE HUNDRED THOUSAND PESOS
(P100,000.00) as moral damages, and FIFTY THOUSAND PESOS (P50,000.00) as exemplary
damages.
2. G.R. No. 142625, December 19, 2006
ROGELIO P. NOGALES, Et. Al., vs. CAPITOL MEDICAL CENTER, ET. AL.

FACTS
On the month of December 1975, Corazon Nogales was 4 months pregnant with her fourth child
and under the exclusive prenatal care of Dr. Estrada, one of the herein respondents. During the last
trimester of her pregnancy, an increase in her blood pressure and development of leg edem indicating
preeclampsia were found by Dr. Estrada. On May 25, 1976 during midnight, mild labor pains were
experienced by Corazon, thus Dr. Estrada advised her admission to the Capitol Medical Center (CMC).
The next day at around 2:30am, she was admitted at CMC upon Dra. Estradas request and petitioner
Nogales signed the Consent on Admission and Agreement and Admission Agreement. Corazon was
transferred to the delivery room at 6:00am wherein Dr. Estrada was assisted by Dr. Villaflor and Nurse
Dumlao. The head of Gynecology Department of the CMC, Dr. Espinola ordered immediate hysterectomy
which the petitioner had consented. At 9:15am, Corazon died because of hemorrhage, post partum.
On May 14, 1980, a complaint for damages was filed by the petitioners before the RTC of Manila
against CMC, Dr. Estrada, Dr. Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a certain
Nurse J. Dumlao for the death of Corazon. Petitioners contended that defendant physicians and CMC
personnel were negligent in the treatment and management of Corazon's condition. The trial court
rendered a decision finding Dr. Estrada solely liable for damages. Petitioner appealed this decision
claiming that the other respondents shall be held liable for negligence but the CA affirmed the RTCs
decision. The motion for reconsideration filed was also denied by the CA. Hence, this petition.

ISSUE
Whether or not CMC is vicariously liable for the negligence of Dr. Estrada who was said to be an
independent-contractor physician.

RULING
The Court ruled in the POSITIVE.
As a general rule, the Court stated that a hospital is not liable for the negligence of an
independent contractor-physician. There is, however, an exception to this principle if the
physician is the ostensible agent of the hospital. This exception is also known as the doctrine of
apparent authority which involves two factors to determine the liability of an independent-contractor
physician. The first factor focuses on the hospitals manifestations and is sometimes described as an
inquiry whether the hospital acted in a manner which would lead a reasonable person to conclude that the
individual who was alleged to be negligent was an employee or agent of the hospital. In this regard, the
hospital need not make express representations to the patient that the treating physician is an employee
of the hospital; rather a representation may be general and implied. As for the second factor, it focuses on
the patients reliance which is characterized as an inquiry on whether the plaintiff acted in reliance upon
the conduct of the hospital or its agent, consistent with ordinary care and prudence.
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical staff.
Through CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the
Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. CMC cannot now
repudiate such authority. First, CMC granted staff privileges to Dr. Estrada. CMC extended its medical
staff and facilities to Dr. Estrada. Upon Dr. Estrada's request for Corazon's admission, CMC, through its
personnel, readily accommodated Corazon and updated Dr. Estrada of her condition. Second, CMC
made Rogelio sign consent forms printed on CMC letterhead. Prior to Corazon's admission and supposed
hysterectomy, CMC asked Rogelio to sign release forms, the contents of which reinforced Rogelio's belief
that Dr. Estrada was a member of CMC's medical staff. Without any indication in these consent forms
that Dr. Estrada was an independent contractor-physician, the Spouses Nogales could not have
known that Dr. Estrada was an independent contractor. Significantly, no one from CMC informed the
Spouses Nogales that Dr. Estrada was an independent contractor.
Further, the Court also held unconvincing is CMC's argument that petitioners are estopped from
claiming damages based on the Consent on Admission and Consent to Operation. The documents do
not expressly release CMC from liability for injury to Corazon due to negligence during her
treatment or operation. Neither do the consent forms expressly exempt CMC from liability for
Corazon's death due to negligence during such treatment or operation.
WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds respondent Capitol
Medical Center vicariously liable for the negligence of Dr. Oscar Estrada.
3. G.R. No. 158996, November 14, 2008
SPOUSES FLORES vs. SPOUSES PINEDA

FACTS
On April 17, 1987, herein respondent Teresita Pineda consulted with the petitioner Dr. Fredelicto
Flores and was advised to return the following week or go to the United Doctors Medical Center (UDMC)
in Quezon City for a general check-up. On April 28, 1987, when Pinedas conditions persisted, she went
to UDMC and consulted with Dr. Flores at UDMC. Upon the routine check-up conducted by petitioner Dr.
Fredelicto, he ordered Teresitas admission to the hospital, asked for laboratory examination on Teresita
and scheduled a D and C operation to be performed by his wife, herein respondent Dr. Felicisma Flores.
The latter conducted an internal vaginal examination of Teresita. The operation was conducted by the
petitioner Spouses Flores.
A day after the operation, Teresita underwent an ultrasound examination as a confirmatory
procedure, which showed that she had enlarged uterus and myoma uteri. Despite Dr. Felicismas advise
that Teresita can spend her recovery at home, the latter chose to stay at the hospital. Based on the other
laboratory results, it was found that Teresita was suffering from Diabetes Melitus Type II. Insulin was
administered on the patient. On May 26, 1987, Teresita died in the morning. Because of this, an action for
damages was filed by Teresitas family against Dr. Fredelicto and Dr. Felicisima Flores before the RTC of
Nueva Ecija believing that Teresitas death resulted from the negligent handling of her medical needs.
The trial court ruled in favor of Teresitas family. Then, the decision of RTC was affirmed by CA, but
modified the amount of damages, and deleted the award for attorneys fees and costs of suit. Hence, this
petition for review on certiorari was filed by petitioner spouses contending that the RTC and CA erred in
finding them liable through negligence for Teresitas death.

ISSUE
Whether or not petitioner spouses are liable through medical negligence for the death of
respondent Teresita.

RULING
The Court ruled in the POSITIVE.
A medical negligence case is a type of claim to redress a wrong committed by a medical
professional, that has caused bodily harm to or the death of a patient. There are four elements
involved in a medical negligence case, namely: duty, breach, injury, and proximate causation. As in any
civil action, the burden to prove the existence of the necessary elements rests with the plaintiff. To
successfully pursue a claim, the plaintiff must prove by preponderance of evidence that, one, the
physician either failed to do something which a reasonably prudent health care provider would
have done, or that he did something that a reasonably prudent provider would not have done; and
two, the failure or action caused injury to the patient.Expert testimony is therefore essential since the
factual issue of whether a physician or surgeon has exercised the requisite degree of skill and care in the
treatment of his patient is generally a matter of expert opinion.
The petitioner spouses' contentions, in our view, miss several points. First, as early as April 17,
1987, Teresita was already suspected to be suffering from diabetes. This suspicion again arose right
before the D&C operation on April 28, 1987 when the laboratory result revealed Teresita's increased
blood sugar level. Unfortunately, the petitioner spouses did not wait for the full medical laboratory
results before proceeding with the D&C. Second, the petitioner spouses were duly advised that the
patient was experiencing general body weakness, loss of appetite, frequent urination, and thirst - all of
which are classic symptoms of diabetes. When a patient exhibits symptoms typical of a particular
disease, these symptoms should, at the very least, alert the physician of the possibility that the
patient may be afflicted with the suspected disease. Third, the petitioner spouses cannot claim that
their principal concern was the vaginal bleeding and should not therefore be held accountable for
complications coming from other sources. This is a very narrow and self-serving view that even
reflects on their competence.
The above facts, point only to one conclusion - that the petitioner spouses failed, as medical
professionals, to comply with their duty to observe the standard of care to be given to
hyperglycemic/diabetic patients undergoing surgery. Whether this breach of duty was the proximate
cause of Teresita's death is a matter we shall next determine. Further, the findings lead us to the
conclusion that the decision to proceed with the D&C operation, notwithstanding Teresita's hyperglycemia
and without adequately preparing her for the procedure, was contrary to the standards observed by the
medical profession. Deviation from this standard amounted to a breach of duty which resulted in
the patient's death. Due to this negligent conduct, liability must attach to the petitioner spouses.
The decision of CA is AFFIRMED with the modifications on the amount of damages awarded.
4. G.R. No. 177407, February 9, 2011
RICO ROMMEL ATIENZA vs. BOARD OF MEDICINE and EDITHA SIOSON

FACTS
In 1999, respondent Sison was referred to Dr. Pedro Lantin III of Rizal Medical Center (RMC)
who found out that her left kidney was non-functioning and non-visualizing. She underwent kidney
operation in September of the same year. On February 18, 2000, a complaint for gross
negligence/incompetence against the doctors who participated in the kidney operation including petitioner
Atienza was filed by the respondents husband before the Board of Medicine (BOM). As provided in the
complaint, the respondents husband was contending that respondents right kidney was removed instead
of her left kidney which was said to be dysfunctional. The respondent presented documentary evidence
proving that her kidneys were both in their proper anatomical locations at the time she was operated. On
the other hand, the petitioner, through his comment, argued that the exhibits or documents presented by
the respondent are inadmissible in evidence because those are mere photocopies which were not
properly identified and authenticated. BOM set the hearing on July 19, 2004. Thereafter, the petitioner
moved for reconsideration, but it was denied by the BOM. Petitioner then filed a petition for certiorari
before CA, assailing the orders of BOM which admitted the respondents formal evidence. However, the
petition was dismissed. Hence, this petition for review on certiorari was filed.

ISSUE
Whether or not CA committed grave reversible error when it upheld the admission of incompetent
and inadmissible evidence by respondent board which can result in the deprivation of petitioners
professional license a property right of ones livelihood.

RULING
The Court ruled in the NEGATIVE.
It is well-settled that the rules of evidence are not strictly applied in proceedings before
administrative bodies such as the BOM. Although trial courts are enjoined to observe strict enforcement
of the rules of evidence, in connection with evidence which may appear to be of doubtful relevancy,
incompetency, or admissibility, the Court held that:
[I]t is the safest policy to be liberal, not rejecting them on doubtful or technical grounds,
but admitting them unless plainly irrelevant, immaterial or incompetent, for the reason that
their rejection places them beyond the consideration of the court, if they are thereafter found
relevant or competent; on the other hand, their admission, if they turn out later to be irrelevant or
incompetent, can easily be remedied by completely discarding them or ignoring them.
Second, petitioners insistence that the admission of Edithas exhibits violated his substantive
rights leading to the loss of his medical license is misplaced. Petitioner mistakenly relies on Section 20,
Article I of the Professional Regulation Commission Rules of Procedure. As pointed out by the appellate
court, the admission of the exhibits did not prejudice the substantive rights of petitioner because,
at any rate, the fact sought to be proved thereby, that the two kidneys of Editha were in their
proper anatomical locations at the time she was operated on, is presumed under Section 3, Rule 131
of the Rules of Court.
Third, the best evidence rule is inapplicable in this case. Section 3 of Rule 130 provides:
1. Best Evidence Rule
Sec. 3. Original document must be produced; exceptions. When the subject of inquiry is the
contents of a document, no evidence shall be admissible other than the original document itself,
except in the following cases:
(a) When the original has been lost or destroyed, or cannot be produced in court, without bad
faith on the part of the offeror;
(b) When the original is in the custody or under the control of the party against whom the
evidence is offered, and the latter fails to produce it after reasonable notice;
 (c) When the original consists of numerous accounts or other documents which cannot be
examined in court without great loss of time and the fact sought to be established from them is
only the general result of the whole; and
(d) When the original is a public record in the custody of a public officer or is recorded in a public
office.
As previously discussed, the proper anatomical locations of Edithas kidneys at the time of her
operation at the RMC may be established not only through the exhibits offered in evidence. Finally, these
exhibits do not constitute hearsay evidence of the anatomical locations of Edithas kidneys. To further
drive home the point, the anatomical positions, whether left or right, of Edithas kidneys, and the removal
of one or both, may still be established through a belated ultrasound or x-ray of her abdominal area. In
fact, the introduction of secondary evidence, such as copies of the exhibits, is allowed. Ultimately, since
the originals cannot be produced, the BOM properly admitted Edithas formal offer of evidence
and, thereafter, the BOM shall determine the probative value thereof when it decides the case.
Hence, the petition is DENIED.
5. G.R. No. 163879 July 30, 2014
DR. ANTONIO P. CABUGAO, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES and SPOUSES RODOLFO M. PALMA and ROSARIO F.
PALMA, Respondents.
x-----------------------x
G.R. No. 165805
DR. CLENIO YNZON, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES and SPOUSES RODOLFO M. PALMA AND ROSARIO F.
PALMA, Respondents.

FACTS
On June 14, 2000, the ten year-old Rodolfo Palma Jr. (JR) was brought to the clinic of petitioner
Dr. Cabugao because of stomach pain. The next day, respondents spouses Palma were advised by
petitioner Cabugao to bring JR to the Nazareth General Hospital in Dagupan City where the latter was
thereafter admitted. Blood samples were taken from JR for laboratory testing. Upon the rectal
examination done by petitioner Cabugao, he found that JR was suffering from Acute Apendicitis and
referred the case to his co-accused, herein petitioner Dr. Ynzon. Massive antibiotics and pain reliever
were ordered to be administered to JR. On June 16, 2000, JR experienced abdominal spasms and
diarrhea which were addressed by petitioner Ynzon through ordering the nurses to continue administer
medications to JR. The condition of JR had worsened the next day when he had a fever and became
unconscious. Thereafter, he died on the same day.
An information was filed against the herein petitioners for reckless imprudence resulting to
homicide on February 1, 2001. The trial court ruled in favor of the respondents, convicting the petitioners
for the crime charged which was affirmed by the Court of Appeals. Hence, this appeal before this Court
was filed.

ISSUE
Whether or not petitioners' conviction of the crime of reckless imprudence resulting in homicide,
arising from an alleged medical malpractice, is supported by the evidence on record.

RULING
As to petitioner Ynzons liability, the court ruled in the POSITIVE.
Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act
from which material damage results by reason of an inexcusable lack of precaution on the part of
the person performing or failing to perform such act. With respect to Dr. Ynzon, all the requisites of
the offense have been clearly established by the evidence on record. The court a quo and the
appellate court were one in concluding that Dr. Ynzon failed to observe the required standard of care
expected from doctors.
In the instant case, it was sufficiently established that to prevent certain death, it was
necessary to perform surgery on JR immediately. Even the prosecutions own expert witness, Dr.
Antonio Mateo, testified during cross-examination that he would perform surgery on JR. From the
testimonies of the expert witnesses presented, it was irrefutably proven that Dr. Ynzon failed to practice
that degree of skill and care required in the treatment of his patient. As correctly observed by the
appellate court, Dr. Ynzon revealed want of reasonable skill and care in attending to the needs of JR by
neglecting to monitor effectively the developments and changes on JR's condition during the observation
period, and to act upon the situation after the 24-hour period when his abdominal pain persisted and his
condition worsened. Among the elements constitutive of reckless imprudence, what perhaps is most
central to a finding of guilt is the conclusive determination that the accused has exhibited, by his voluntary
act without malice, an inexcusable lack of precaution. Further, In accepting a case, a doctor in effect
represents that, having the needed training and skill possessed by physicians and surgeons practicing in
the same field, he will employ such training, care 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 under the same circumstances. Sadly, Dr. Ynzon did not display
that degree of care and precaution demanded by the circumstances.

As to petitioner Cabugaos liability, the Court ruled in the NEGATIVE.

The Court is not convinced with moral certainty that Dr. Cabugao is guilty of reckless
imprudence as the elements thereof were not proven by the prosecution beyond a reasonable
doubt. Immediately apparent from a review of the records of this case is the fact that Dr. Cabugao is not
a surgeon, but a general practitioner specializing in family medicine; thus, even if he wanted to, he cannot
do an operation, much less an appendectomy on JR. It is precisely for this reason why he referred JR to
Dr. Ynzon after he suspected appendicitis.
Neither do we find evidence that Dr. Cabugao has been negligent or lacked the necessary
precaution in his performance of his duty as a family doctor. On the contrary, a perusal of the medical
records would show that during the 24-hour monitoring on JR, it was Dr. Cabugao who frequently made
orders on the administration of antibiotics and pain relievers.

Noteworthy, the evidence on record clearly points to the reckless imprudence of Dr. Ynzon;
however, the same cannot be said in Dr. Cabugao's case.

Hence, petitioner Cabugao is ACQUITTED. Due to the death of accused Dr. Clenio Ynzon prior
to the disposition of this case, his criminal liability is extinguished; however, his civil liability subsists.
11. G.R. No. 210445, December 7, 2015
NILO ROSIT vs, DAVAO DOCTORS HOSPITAL and DR. ROLANDO GESTUVO

FACTS
On January 19, 1999, petitioner Rosit was operated by the respondent Gestuvo at Davao Doctors
Hospital (DDH) because of a fracture in his jaw. During the operation, a metal plate was used by
respondent Gestuvo to the jaw using the screws which he cut. Although the operation required small
screws which were available in Manila, respondent Gestuvo did not inform the petitioner knowing that the
latter cannot afford to buy such screws. Thereafter, petitioner was in pain, so x-rays were conducted on
him. Based on the x-ray results, respondent Gestuvo referred the petitioner to Dr. Pangan, who was a
dentist in Cebu. After Dr. Pangan told the petitioner that the operation conducted on him was improperly
done, the latter demanded respondent Gestuvo to pay the additional operation and his transportation
expenses, so P4,500.00 was given to the petitioner.
After the petitioners operation conducted by Dr. Pangan, he can already eat ad speak well
without having difficulty in opening and closing his mouth. Further, the petitioner asked respondent
Gestuvo to reimburse him for the cost of operation and other expenses he incurred during his stay in
Cebu as well as the cost for the removal of the plate and screws installed by Dr. Pangan. However, the
respondent refused to the petitioner. A civil case was then filed by petitioner Rosit for damages and
attorneys fees against the respondent. The trial court ruled against the respondent Gestuvo ordering him
to pay the petitioner while the complaint against DDH was dismissed. Upon appeal before the CA, the
latter modified the trial courts decision by deleting the monetary awards in favor of petitioner Rosit.
Hence, this instant appeal was filed.

ISSUE
Whether or not the appellate court correctly absolved Dr.Gestuvo from liability.

RULING
The Court ruled in the NEGATIVE.
As the Court held in Flores v. Pineda, a medical negligence case is a type of claim to redress a
wrong committed by a medical professional, that has caused bodily harm to or the death of a patient. To
establish medical negligence, this Court has held that an expert testimony is generally required to
define the standard of behavior by which the court may determine whether the physician has
properly performed the requisite duty toward the patient. However, there is an exception which is the
doctrine of res ipsa loquitur which provides that the need for expert medical testimony may be
dispensed with because the injury itself provides the proof of negligence.
The doctrine of res ipsa loquitur may be availed of if the following essential requisites are
satisfied: ( 1) the accident was of a kind that does not ordinarily occur unless someone is
negligent; (2) the instrumentality or agency that caused the injury was under the exclusive control
of the person charged; and (3) the injury suffered must not have been due to any voluntary action
or contribution of the person injured. In the instant case, the first element was sufficiently established
when Rosit proved that one of the screws installed by Dr. Gestuvo struck his molar. Clearly, had Dr.
Gestuvo used the proper size and length of screws and placed the same in the proper locations, these
would not have struck Rosit's teeth causing him pain and requiring him to undergo a corrective surgery.
Anent the second element for the res ipsa loquitur doctrine application, it is sufficient that the operation
which resulted in the screw hitting Rosit's molar was, indeed, performed by Dr. Gestuvo. No other doctor
caused such fact. Lastly, the third element that the injury suffered must not have been due to any
voluntary action or contribution of the person injured was satisfied in this case. It was not shown that
Rosit's lung disease could have contributed to the pain. What is clear is that he suffered because one of
the screws that Dr. Gestuvo installed hit Rosit's molar.
 Clearly then, the res ipsa loquitur doctrine finds application in the instant case and no
expert testimony is required to establish the negligence of defendant Dr. Gestuvo.

Further, petitioner was deprived of the to make an informed consent. In Li v. Soliman, the
doctrine of informed consent provides that a physician has a duty to disclose what a reasonably
prudent physician in the medical community in the exercise of reasonable care would disclose to
his patient as to whatever grave risks of injury might he incurred from a proposed course of
treatment, so that a patient, exercising ordinary care for his own welfare, and faced with a choice of
undergoing the proposed treatment, or alternative treatment, or none at all, may intelligently exercise his
judgment by reasonably balancing the probable risks against the probable benefits. There are four
essential elements a plaintiff must prove in a malpractice action based upon the doctrine of
informed consent: "(1) the physician had a duty to disclose material risks; (2) he failed to disclose
or inadequately disclosed those risks; (3) as a direct and proximate result of the failure to
disclose, the patient consented to treatment she otherwise would not have consented to; and (4)
plaintiff was injured by the proposed treatment." The four adverted essential elements above are
present here.
In this case, as for the first element, Dr. Gestuvo clearly had the duty of disclosing to Rosit the
risks of using the larger screws for the operation. This was his obligation as the physician undertaking the
operation. Second, Dr. Gestuvo failed to disclose these risks to Rosit, deciding by himself that Rosit could
not afford to get the more expensive titanium screws. Third, had Rosit been informed that there was a risk
that the larger screws are not appropriate for the operation and that an additional operation replacing the
screws might be required to replace the same, as what happened in this case, Rosit would not have
agreed to the operation. Fourth, as a result of using the larger screws, Rosit experienced pain and could
not heal properly because one of the screws hit his molar.
Without a doubt, Dr. Gestuvo is guilty of withholding material information which would have been
vital in the decision of Rosit in going through with the operation with the materials at hand. Thus, Dr.
Gestuvo is also guilty of negligence on this ground.

WHEREFORE, the instant petition is GRANTED.