SAN SEBASTIAN COLLEGE – RECOLETOS
MEDICAL MALPRACTICE / NEGLIGENCE
DR. JOEY MONTEMAYOR
Dema'ala$ Lo%elie Jamela&
*a+uilin+$ Nanette Ro)e
Branch of medicine that deals with the application of medical knowledge to
the purposes of law and in the administration of justice
Failure of a physician to properly perform the duty which devolves upon
him in his professional relation to his patient which results to injury.
It may be defined as bad or unskillful practice of medicine resulting to
injury of the patient or failure on the part of the physician to exercise the
degree of care, skill and diligence, as to treatment in a manner contrary to
accepted standards of medicine resulting to injury to the patient.
Occurs when a patient suffers complications, injury, or death because of a
health care professionals or health care facilitys medical negligence, and
provided there is proof of harm and loss.
!owever, not every instance of medical negligence is medical malpractice
because not every medical negligence case results in harming a patient,
and in some medical negligence cases, there is a lack of proof
". #he physician has a duty to the patient$
%. #he physician failed to perform such duty to his patient$
&. 's a conse(uence of the failure, injury was sustained by the patient$
). #he failure of the physician is the proximate cause of the injury sustained by
Is that cause, which, in natural continuous se(uence, unbroken by an
efficient intervening cause, produces the injury and without which the
result would not have occurred.
". #here must be a direct physical connection between the
wrongful act of the physician and the injury sustained by
%. #he cause or the wrongful act of the physician must be
efficient and must not be too remote from the development
of the injury suffered by the patient.
&. #he result must be the natural continuous and probable
'n act or omission by a health care provider which deviates from accepted
standards of practice in the medical community and which causes injury to
Occurs when a physician, hospital, pharmacist, or any other health care
professional fails to perform the expected duties of their respective jobs.
Once a medical professional or medical facility has agreed to treat a
patient, there is already the duty to treat such patient with reasonable skill,
prudence, and customary care based on a standard of medical care.
Occurs when a medical professional does not comply with the standard of
medical care, whether by performing flawed or irresponsible procedures or
by failing to take the necessary actions to prevent harm. *edical
negligence can result in injury or harm to the patient, but not in all cases.
It doesnt necessarily have to result in harm to the patient, which is a
necessary component in medical malpractice claims.
Medical ne+li+ence i) a -a%t o. medical mal-%actice.
Doct%ine o. E..icient Inte%/enin+ Cau)e
In the causal connection between the negligence of the physician and the
injury sustained by the patient, there may be an efficient intervening cause
which is the proximate cause of the injury.
E,am-le) o. Medical Ne+li+ence
failure to diagnose, treat or follow up in a timely manner,
or medication+prescription error.
' type of negligence, where a
licensed professional fails to provide
services as per standards set by the
Failure to exercise the care that a
reasonably prudent person would
exercise in like circumstances.
0an be intentional or
0ases filed in- 0ivil 0ourts 0ivil 0ourts
0riteria for proving
,uty, Breach, 0ausation and
,uty, Breach, 0ausation and
' doctor intentionally causing harm
to his patients due to not performing
his duties as per the medical
' driver causing harm to the
passengers due to his
T0O -%on+ed E1IDENCE o. Medical Ne+li+ence
". 1vidence, as to the recogni2ed standards of the medical community in
the particular kind of case, and
%. ' showing that the physician departed from this standard in his
It is a matter of expert opinion whether a physician or surgeon has
exercised the re(uisite degree of skill and care in the treatment of
RES I"SA LO2!IT!R justify 34156*3#IO7 OF 7189I81701
on the in the absence of ,I410# evidence.
LEGAL "RINCI"LES AND DOCTRINES A""LIED IN MEDICAL
,octrine of :icarious 9iability
,octrine of Ostensible 'gent
Borrowed 5ervant ,octrine
0aptain of the 5hip ,octrine
,octrine of 4es Ipsa 9o(uitor
,octrine of 0ommon ;nowledge
,octrine of 0ontributory 7egligence
,octrine of 'ssumption of 4isk
,octrine of 9ast 0lear 0hance
Fellow 5ervant ,octrine
DOCTRINE O3 1ICARIO!S LIABILITY
,octrine of Imputed 7egligence+0ommand 4esponsibility.
:icarious liability means the responsibility of a person, who is not
negligent, for the wrongful conduct or negligence of another.
A%t. 4#56$ Ci/il Code o. t&e "&ili--ine)
Obligation is demandable not only for ones own acts or omission
but also for those persons whom one is responsible.
<=.xxx the owners or managers of an establishment or enterprise
are likewise responsible for damages caused by their employees in
the service of the branches in which the latter are employed or on
the occasion of their functions=
1mployers shall be liable for the damages caused
by their employees and household helpers acting
within the scope of their assigned task, even
though the former are not engaged in any
business or industry=
#he responsibility treated of this article shall cease
when the person herein mentioned prove that they
observe all the diligence of a good father of a
family to prevent injury.>
DOCTRINE O3 OSTENSIBLE AGENT
In cases wherein the employees are at the same time are independent
contractors of the hospital$
Because of this peculiar situation, they are considered ostensible agents
and therefore, the hospital must be held liable for their negligent acts.
?pathologist, radiologist, [email protected]
BORRO0ED SER1ANT DOCTRINE
Ordinarily, resident physicians, nurses and other personnel of the hospital
are employees or servants of the hospital$
In some instances, they are under the temporary supervision and control
of another other than their employer while performing their duties$
By fiction of law, they are deemed borrowed from the hospital by someone
and for any wrongful act committed by them during the period, their
temporary employer must be held liable for the discharge of their acts and
In the determination whether one is a borrowed servant, it is necessary
that he is not only subjected to the control of another with regard to the
work done and the manner of performing it but also that the work to be
done is for the benefit of the temporary employer.
#his doctrine enunciates liability of the surgeon not only for the wrongful
acts of those who are under his physical control but also those wherein he
has extension of control.
#he operating surgeon is the person in complete charge of the surgery
room and all personnel connected with the operation. #heir ,uty is to obey
his orders. (Professional services, inc. v. Agana)
REASONS 3OR A""LICATION O3 T*E DOCTRINE O3 1ICARIO!S
". ,eep pocket theory$
%. #he employer has the power to select his employee and to control his acts$
&. since the employer benefits monetarily from the employee, the employer has
to bear the loss when neither the employer nor the employee is at fault$
). #o treat them as operating expense.
DOCTRINE O3 RES I"SA LO2!ITOR
“The thing speaks for itself”$ nature of the wrongful act or injury is
suggestive of negligence.
In cases involving medical negligence, the doctrine of res ipsa
loquitur allows the mere existence of an injury to justify a presumption of
negligence on the part of the person who controls the instrument causing
the injury= ?,r. *ilagros 9. 0antre vs 535. Aohn and 7ora 8o, G.R. No.
#76558$ A-%il 49$ 4669:
8eneral rule- expert testimony is necessary to prove that a physician has
done a negligent act or that has deviated from the standard of medical
Re;ui)ite) o. Re) I-)a Lo;uito% Doct%ine
". #he accident must be of a kind which ordinarily does not occur in the
absence of someones negligence$
%. It must be caused by an agency or instrumentality within the exclusive
control of the defendant$
&. It must not have been due to any voluntary action or contribution on the
part of the plaintiff.
It is a rebuttable presumption that defendant was negligent, which arises upon
proof that the instrumentality causing injury was in the defendants exclusive control,
and that the accident was one which ordinarily does not happen in the absence of
negligence ?0ollege 'ssurance 3lan, et. 'l v. Belfranet ,ev. Inc. 8.4.no "BBCD),
7ovember %E, %[email protected]
Some ca)e) <&e%ein t&e Doct%ine o. Re) I-)a Lo;uito% &a) been
". Objects left in the patients body at the time of caesarian section$
%. Injury to a healthy part of the body$
&. 4emoval of a wrong part of the body when another part wad intended$
). Infection resulting from unsterili2ed instruments$
B. Failure to take radiographs to diagnose a possible fracture$
In)tance) <&e%e t&e Doct%ine o. Re) I-)a Lo;uito% doe) not a--l=
". Fhere the ,octrine of 0alculated 4isk is applicable$
%. Fhen an accepted method of medical treatment involves ha2ards which
may produce injurious results regardless of the care exercised by the
&. Bad 4esult 4ule$
). !onest 1rrors of judgment as to 'ppropriate 3rocedure$
B. *istake in the ,iagnosis.
In most medical malpractice suits, there is a necessity for a physician to give his
expert medical opinion to prove whether acts or omissions constitute medical
negligence. #his doctrine has been regarded as rule of sympathy to counteract the
Gconspiracy of silence
DOCTRINE O3 CONTRIB!TORY NEGLIGENCE
,octrine of 0ommon Fault
It has been defined as conduct on the part of the plaintiff or injured party,
contributing as a legal cause to the harm he has suffered, which falls
below the standard which he is re(uired to conform to his own protection.
It is the act or omission amounting to want of care on the part of the
complaining party which, concurring with the defendants negligence is the
proximate cause of the injury.
4elated 0ivil 0ode 3rovisions
A%t. 4#98$ Ci/il Code
<Fhen the plaintiffs own negligence was the immediate and
proximate cause of his injury, he cannot recover damages.
But if his negligence was only contributory, the immediate
and proximate cause of injury being the defendants lack of
due care, the plaintiff may recover damages, but the court
may mitigate the damages to be awarded.>
'rt.%%"), 0ivil 0ode
In (uasiHdelicts, the contributory negligence of the plaintiff
shall reduce the damages that he may recover.>
Some In)tance) <&e%e t&e%e i) cont%ibuto%= ne+li+ence
". Failure to give the physician an accurate history$
%. Failure to follow the treatment recommended by the physician$
&. 9eaving the hospital against the advice of the physician$
). Failure to seek further medical assistance if symptoms persist.
Doct%ine o. Su-e%io% >no<led+e
In the physicianHpatient relationship, the physician has superior knowledge
over his patient. #he patient just follows the instructions and orders of the
physician and is usually inactive and virtually places himself in the
command and control of the physician.
#he defense of contributory negligence is available only when the patients
conduct is a truly flagrant disregard of his health and cannot apply where
the patient is mentally ill, semiconscious, heavily sedated or of advanced
DOCTRINE O3 CONTIN!ING NEGLIGENCE
If the physician, after a prolonged treatment of a patient which normally
produces alleviation of the condition, fails to investigate nonHresponse, he
may be held liable if in the exercise of care and diligence he could have
discovered the cause of nonHresponse.
DOCTRINE O3 ASS!M"TION O3 RIS>
3redicated upon knowledge and informed consent, anyone who voluntarily
assumes the risk of injury from a known danger, if injured, is barred from
/iolenti non .it inAu%ia>, which means that a person who assents and
was injured is not regarded in law to be injured.
DOCTRINE O3 LAST CLEAR C*ANCE
' physician who has the last clear chance of avoiding damage or injury
but negligently fails to do is liable.
It implies thought, appreciation, mental direction and lapse of sufficient
time to effectually act upon impulse to save the life or prevent injury to
DOCTRINE O3 3ORESEEABILITY
' physician cannot be held accountable for negligence if the injury
sustained by the patient is on account of unforeseen conditions but if a
physician fails to ascertain the condition of the patient for want of the
re(uisite skill and training is answerable for the injury sustained by the
patient if injury resulted thereto.
' physician owes duty of care to all persons who are foresee ably
endangered by his conduct, with respect to the risk which make the
conduct unreasonably dangerous.
3ELLO0 SER1ANT DOCTRINE
#his doctrine provides that if a servant [email protected]
was injured on account
of the negligence of his fellow servant [email protected]
, the employer cannot be
If a physician who went to rescue a victim of an accident was himself
injured, the original wrongdoer must be held liable for such injury.
SOLE RES"ONSIBILITY /). S*ARED RES"ONSIBILITY
Sole %e)-on)ibilit= H when the negligent act or omission which is the
proximate cause of the injury suffered by patient is attributed to the
wrongful act of person.
S&a%ed %e)-on)ibilit= H when the injury suffered by the patient is caused
by the negligent act of two or more persons, each of them acting
concurrently and successively in the production of injury.
S"ECI3IC ACTS OR OMISSIONS 0*IC* CONSTIT!TE MEDICAL
". Failure to take medical history$
%. Failure to examine or make a careful and ade(uate examination$
&. 7onHreferral of the patient to a specialist$
). Failure to consult prior physicians for previous management$
B. 7onHreferral of patient to a hospital with e(uipments and trained personnel$
C. Failure to use the appropriate diagnostic test$
E. Failure to diagnose infections$
I. #reatment resulting to addiction$
J. 'bandonment of patients$
"D. Failure to give proper instructions$
"". Failure to institute the proper prophylactic treatment$
"%. 1rrors in blood transfusion$
"&. 9iabilities in administration of drugs$
"). 3roduct liabilities of manufacturer$
"B. Frong baby cases.