This document summarizes a medical malpractice case involving Fe Cayao-Lasam (petitioner), a physician, and Spouses Claro and Editha Ramolete (respondents). Editha underwent a procedure performed by the petitioner and later required a hysterectomy. The respondents alleged the procedure and petitioner's negligence caused Editha's injuries. The PRC revoked the petitioner's medical license, but the petitioner argued expert testimony was needed to support causation. The court found for the petitioner, as the respondents did not provide expert testimony, while the petitioner's expert witness testified the procedure did not cause the injuries.
This document summarizes a medical malpractice case involving Fe Cayao-Lasam (petitioner), a physician, and Spouses Claro and Editha Ramolete (respondents). Editha underwent a procedure performed by the petitioner and later required a hysterectomy. The respondents alleged the procedure and petitioner's negligence caused Editha's injuries. The PRC revoked the petitioner's medical license, but the petitioner argued expert testimony was needed to support causation. The court found for the petitioner, as the respondents did not provide expert testimony, while the petitioner's expert witness testified the procedure did not cause the injuries.
This document summarizes a medical malpractice case involving Fe Cayao-Lasam (petitioner), a physician, and Spouses Claro and Editha Ramolete (respondents). Editha underwent a procedure performed by the petitioner and later required a hysterectomy. The respondents alleged the procedure and petitioner's negligence caused Editha's injuries. The PRC revoked the petitioner's medical license, but the petitioner argued expert testimony was needed to support causation. The court found for the petitioner, as the respondents did not provide expert testimony, while the petitioner's expert witness testified the procedure did not cause the injuries.
G.R. No. 159132 | December 18, 2008 Respondents alleged
Austria-Martinez, J. | Group 2 Gueco that Editha’s hysterectomy was caused by petitioner’s unmitigated negligence and Topic: Res ipsa loquitur versus expert testimony professional incompetence in conducting the in medical negligence cases D&C procedure and the petitioners failure to remove the fetus inside Edithas womb. Petitioner: Fe Cayao-Lasam Among the alleged acts of negligence were: Respondents: Spouses Claro and Editha o petitioners failure to check up, visit or Ramolete administer medication on Editha during her first day of Facts confinement at the LMC o petitioner recommended that a D&C July 28, 1994 Editha Ramolete (3 procedure be performed months pregnant) was brought to the on Editha without conducting any Lorma Medical Center (LMC) in San internal examination prior to the Fernando, La Union due to vaginal procedure bleeding. Upon advice of Dr. Cayao- o petitioner immediately suggested a Lasam relayed via telephone, Editha was D&C procedure instead of closely admitted to LMC on the same day. monitoring the state of pregnancy A pelvic sonogram was conducted, of Editha. revealing the fetus’ weak cardiac pulsation. The next day, Editha’s repeat In her Answer, petitioner denied the pelvic sonogram also showed that no allegations of negligence and incompetence fetal movement was appreciated. and contended that it was Editha’s gross o Due to persistent and profuse negligence and/or omission in insisting to vaginal bleeding, petitioner be discharged on July 31, 1994 against advised Editha to undergo a doctor’s advice and her unjustified failure Dilatation and Currettage to return for check-up as directed by Procedure (D&C) or raspa petitioner that contributed to her life- July 30, 1994 petitioner performed the threatening condition on September 16, D&C procedure. Editha was discharged 1994; that Edithas hysterectomy was brought from the hospital the following day. about by her very abnormal pregnancy known September 16, 1994 Editha was as placenta increta, which was an extremely brought to LMC again, as she was rare and very unusual case of abdominal suffering from vomiting and severe placental implantation. Petitioner argued that abdominal pains. whether or not a D&C procedure was done by o She was attended by Dr. Beatriz her or any other doctor, there would be no de la Cruz, Dr. Victor B. Mayo, difference at all because at any stage of and Dr. Juan V. Komiya gestation before term, the uterus would o Dr. Mayo allegedly informed rupture just the same. Editha that there was a dead fetus in her womb. March 4, 1999 the Board of Medicine (the Editha underwent laparotomy, where she Board) of the PRC rendered a Decision, was found to have a massive intra- exonerating petitioner from the charges filed abdominal hemorrhage and a ruptured against her. uterus. Respondents went to the PRC on appeal. o Had to undergo a procedure for November 22, 2000 the PRC rendered a hysterectomy – as a result, she Decision reversing the findings of the Board can no longer bear a child and revoking petitioners authority or license to November 7, 1994 Editha and her practice her profession as a physician. husband Claro filed a Complaint for Petitioner brought the matter to the CA in a Gross Negligence and Malpractice Petition for Review under Rule 43 of the Rules against petitioner before the Professional of Court and for certiorari under Rule 65 Regulations Commission (PRC). o CA held that these were improper determinable only in the light of scientific remedies knowledge, it has been recognized that expert o Citing Section 26 of RA 2382 testimony is usually necessary to support the (Medical Act of 1959), the CA held conclusion as to causation. that the plain, speedy and adequate remedy under the ordinary course of law which petitioner should have In the present case, respondents did not availed herself of was to appeal to present any expert testimony to support their the Office of the President. claim that petitioner failed to do something which a reasonably prudent physician or Relevant issue: surgeon would have done. Petitioner, on the W/N PRC committed grave abuse of other hand, presented the testimony of discretion in revoking petitioner’s license Dr. Augusto M. Manalo, who was clearly an to practice medicine without an expert expert on the subject. testimony to supports its conclusion as to Generally, to qualify as an expert witness, one the cause of respondent’s injury NO. must have acquired special knowledge of the subject matter about which he or she is to Held: testify, either by the study of recognized Petitioner avers that in cases of medical authorities on the subject or by practical malpractice, expert testimony is necessary to experience. support the conclusion as to the cause of the Dr. Manalo specializes in gynecology and injury. obstetrics, authored and co-authored various Medical malpractice is a particular form of publications on the subject, and is a professor negligence which consists in the failure of a at UP. According to him, his diagnosis physician or surgeon to apply to his practice of of Edithas case was Ectopic Pregnancy medicine that degree of care and skill which is Interstitial (also referred to as Cornual), ordinarily employed by the profession Ruptured. generally, under similar conditions, and in like o Dr. Manalo testified that he did not surrounding circumstances. think the D&C was the proximate In order to successfully pursue such a claim, a cause of the rupture of the uterus patient must prove that the physician or because (1) the instrument cannot surgeon either failed to do something which a reach the site of the pregnancy, 92) if reasonably prudent physician or surgeon it is because of D&C the rupture would not have done, and that the failure or could have occurred much earlier action caused injury to the patient. From the testimony of the expert witness and There are four elements involved in medical the reasons given by him, it is evident that the negligence cases: duty, breach, injury and D&C procedure was not the proximate cause proximate causation. of the rupture of Edithas uterus. A physician-patient relationship was created During his cross-examination, when Editha employed the services of the Dr. Manalo testified on how he would have petitioner. As Editha’s physician, petitioner addressed Edithas condition should he be was duty-bound to use at least the same level placed in a similar circumstance as the of care that any reasonably competent doctor petitioner. It was made clear that the D&C would use to treat a condition under the same procedure was conducted in accordance with circumstances. the standard practice, with the same level of The breach of these professional duties of skill care that any reasonably competent doctor and care, or their improper performance by a would use to treat a condition under the same physician surgeon, whereby the patient is circumstances; injured in body or in health, constitutes Medical malpractice, in our jurisdiction, is often actionable malpractice. brought as a civil action for damages under As to this aspect of medical malpractice, the Article 2176 of the Civil Code. The defenses in determination of the reasonable level of care an action for damages, provided for under and the breach thereof, expert testimony is Article 2179 of the Civil Code are: essential. Further, inasmuch as the causes of the injuries involved in malpractice actions are Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause Had Editha returned, petitioner could have of his injury, he cannot recover conducted the proper medical tests and damages. But if his negligence was procedure necessary to only contributory, the immediate and determine Edithas health condition and proximate cause of the injury being applied the corresponding treatment which the defendants lack of due care, the could have prevented the rupture plaintiff may recover damages, but of Edithas uterus. The D&C procedure having the courts shall mitigate the been conducted in accordance with the damages to be awarded. standard medical practice, it is clear that Edithas omission was the proximate Proximate cause has been defined as that cause of her own injury and not merely a which, in natural and continuous sequence, contributory negligence on her part. unbroken by any efficient intervening cause, produces injury, and without which the result Contributory negligence is the act or omission would not have occurred. An injury or damage amounting to want of ordinary care on the part is proximately caused by an act or a failure to of the person injured, which, concurring with act, whenever it appears from the evidence in the defendants negligence, is the proximate the case that the act or omission played a cause of the injury. Difficulty seems to be substantial part in bringing about or actually apprehended in deciding which acts of the causing the injury or damage; and that the injured party shall be considered immediate injury or damage was either a direct result or a causes of the accident. reasonably probable consequence of the act or omission. Where the immediate cause of an accident In the present case, the Court notes the resulting in an injury is the plaintiffs own act, findings of the Board of Medicine: which contributed to the principal occurrence as one of its determining factors, he cannot When complainant was discharged recover damages for the injury. on July 31, 1994, herein respondent advised her to ]Based on the evidence presented in the return on August 4, 1994 or four present case under review, in which no (4) days after the D&C. This negligence can be attributed to the advise was clear in complainants petitioner, the immediate cause of the Discharge accident resulting in Edithas injury was Sheet. However, complainant her own omission when she did not return failed to do so. This being the case, for a follow-up check up, in defiance of the chain of continuity as required in petitioners orders. The immediate cause order that the doctrine of proximate of Edithas injury was her own act; thus, cause can be validly invoked was she cannot recover damages from the interrupted. Had she returned, the injury. respondent could have examined her thoroughly. x x x All told, doctors are protected by a special rule of law. Also, in the testimony of Dr. Manalo, he stated They are not guarantors of care. They are not insurers further that assuming that there was in fact a against mishaps or unusual consequences specially so misdiagnosis, the same would have been if the patient herself did not exercise the proper diligence rectified if Editha followed the petitioners order required to avoid the injury. to return for a check-up on August 4, 1994. It is undisputed that Editha did not return for a follow-up evaluation, in defiance of the petitioners advise. Editha omitted the diligence required by the circumstances which could have avoided the injury. The omission in not returning for a follow-up evaluation played a substantial part in bringing about Edithas own injury.