NEGLIGENCE

&
MEDICAL MALPRACTICE

ATTY. MALAYA M. CAPULONG, MD

 NEGLIGENCE

Negligence – want of care

required by the circumstances.
 NEGLIGENCE

Negligence is the failure to

observe that degree of care,
precaution and vigilance
which the circumstances
justly demand resulting in
injury to another person.
 NEGLIGENCE

The existence of negligence

is determined by the
behavior of the person in the
situation.
 NEGLIGENCE

How do we determine if a
person acted in a negligent
manner?

What is the standard of care?

 NEGLIGENCE

That which an ordinary

prudent man would exercise
under the same
circumstances.
MEDICAL MALPRACTICE
• Any act or failure to act by a
member of the medical
profession that results to harm,
injury, distress, prolonged
physical or mental suffering or
the termination of life to a
patient while that patient is
under the care of that medical
professional
MEDICAL MALPRACTICE

• Doctors
• Nurses
• Midwives
• Pharmacists
• Dentists
• Physical Therapists
 MEDICAL
MALPRACTICE

DUTY

BREACH

INJURY

PROXIMATE CAUSATION
 MEDICAL
MALPRACTICE

DUTY
MEDICAL MALPRACTICE

Duty to -
 Possess medical knowledge
 Possess the necessary skills
 Exercise care
 Use sound medical judgment
 MEDICAL
MALPRACTICE
It is the responsibility of every
doctor to practice medicine
according to the ethical
standards of his profession
MEDICAL MALPRACTICE

Every member of the

healthcare team should
follow the ethical codes
of their profession
 MEDICAL
MALPRACTICE
Ordinary prudent man

Reasonably competent
practitioner in the same
class, acting in similar
circumstances.
MEDICAL MALPRACTICE

• DUTY
• BREACH
 MEDICAL MALPRACTICE
• Bad or unskillful practice by a
physician or other professional in
which the health or welfare of the
patient is injured.
• Failure of a professional to follow the
accepted standards of practice of his
profession.
 MEDICAL MALPRACTICE
• Failure to diagnose or
misdiagnosis.
• Failure to provide appropriate
treatment.
• Unreasonable delay in treatment
MEDICAL MALPRACTICE

• DUTY
• BREACH
• INJURY
MEDICAL MALPRACTICE

• DUTY
• BREACH
• INJURY
• PROXIMATE
CAUSATION
MEDICAL MALPRACTICE
Proximate Causation

That cause, which, in natural and

continuous sequence unbroken
by any efficient intervening
cause, produces the injury and
without which the result would
not have occurred.
MEDICAL MALPRACTICE

Failure to adhere to the

standard of care

INJURY
MEDICAL MALPRACTICE

“But for” the

physician’s conduct
the patient would not
have been injured.
 MEDICAL MALPRACTICE

Doctrine of Res Ipsa Loquitor -

 “The thing speaks for itself”

 The fact of occurrence of

injury raises the presumption
of negligence.
 MEDICAL MALPRACTICE

Doctrine of Res Ipsa Loquitor -

•The patient was injured in a
manner that would not normally
occur but for a breach of the
applicable standard of care;
 MEDICAL MALPRACTICE

Doctrine of Res Ipsa Loquitor -

• He was injured by an agency or
instrumentality within the
exclusive control of the
defendant;
 MEDICAL MALPRACTICE

Doctrine of Res Ipsa Loquitor -

 Other possible causes are
sufficiently eliminated by the
evidence such that the jury could
reasonably conclude that the
negligence was, more probably
than not, that of the defendant.
 MEDICAL MALPRACTICE

Doctrine of Vicarious Liability -

 Liability for the tort of another

 Secondary or indirect liability

 MEDICAL MALPRACTICE

Doctrine of Vicarious Liability -

 Employer becomes liable for the

acts of an employee

 Employee must be acting within

the scope of their responsibilities
 MEDICAL MALPRACTICE

Doctrine of Vicarious Liability

Employer – Employee
relationship must exist and
proven.
 MEDICAL MALPRACTICE

“Captain of the Ship” Doctrine

Assumes that the doctor is in

complete control of everything
and everyone in the OR.
 MEDICAL MALPRACTICE

“Captain of the Ship” Doctrine

Largely abandoned in other

jurisdictions.
 MEDICAL MALPRACTICE

“Borrowed Servant” Doctrine

The physician “borrows” the

nurses, med tech, residents etc.
employed by the hospital to help
him provide medical care to his
patients.
 MEDICAL MALPRACTICE

Doctrine of Apparent Authority

Or Ostensible Agent
- Fixes liability when there is no
Employer-Employee
relationship
 MEDICAL MALPRACTICE

Doctrine of Apparent Authority

Or Ostensible Agent

1. The principal holds itself out to

the public as a provider of medical
services through advertising or by
an express representation.
 MEDICAL MALPRACTICE

Doctrine of Apparent Authority

Or Ostensible Agent

2. The patient “looked” to the

hospital to provide competent
medical care.
MEDICAL MALPRACTICE

Is a Hospital Liable for

Medical Malpractice?

NO
MEDICAL MALPRACTICE

RAMOS vs. COURT OF

APPEALS, DE LOS SANTOS
MEDICAL CENTER, ET. AL
April 11, 2002
MEDICAL MALPRACTICE

No Employee-Employer
relationship between Drs.
Hosaka and Gutierrez and
De Los Santos Medical
Center
MEDICAL MALPRACTICE

Drs. Hosaka and Gutierrez

are solely liable for their
own negligent acts
MEDICAL MALPRACTICE

Is a Hospital Liable for

Medical Malpractice?

YES
MEDICAL MALPRACTICE

Rogelio P. Nogales, et. al.

vs.
Capitol Medical Center, et.
al.

December 19 2006
MEDICAL MALPRACTICE

Doctrine of Apparent Authority

2. Plaintiff was led to believe that
the negligent person was an
employee or agent of the
hospital – Appearance of
authority
MEDICAL MALPRACTICE
Doctrine of Apparent Authority

3. The hospital knew that the

person was claiming to be an
agent/employee of the
hospital
4. The person relied upon the
conduct of the hospital
MEDICAL MALPRACTICE

• CMC granted hospital

privileges to Dr. Estrada
• On admission, consent forms
were printed on CMC
letterhead
• The spouses Nogales were
not informed that Dr. Estrada
was an independent
contractor
MEDICAL MALPRACTICE

• Mr. & Mrs. Nogales chose Dr.

Estrada because of his
affiliation/employment with
CMC which they
characterized as a reputable
hospital
MEDICAL MALPRACTICE

PROFESSIONAL SERVICES, INC.

vs. AGANA
AGANA vs. JUAN FUENTES
AMPIL vs. AGANA
JANUARY 31, 2007
MEDICAL MALPRACTICE

PSI’s (Medical City Hospital)

liability is based on:

Doctrine of Apparent
Authority
Doctrine of Corporate
Negligence
MEDICAL MALPRACTICE

Doctrine of Apparent Authority

By accrediting Dr. Ampil & Dr.

Fuentes and publicly advertising
their qualifications the hospital
created the impression that they
were its agents.
MEDICAL MALPRACTICE

Doctrine of Corporate Negligence

The hospital is liable if it fails to

uphold the proper standard of
care owed the patient, which is
to ensure the patient’s safety
and well-being while at the
hospital.
MEDICAL MALPRACTICE

Doctrine of Corporate Negligence

The duty of providing quality medical service is
no longer the sole prerogative and
responsibility of the physician. Hospitals now
tend to organize a highly professional medical
staff whose competence and performance need
to be monitored by the hospitals
commensurate with their inherent
responsibility to provide quality medical care.
MEDICAL MALPRACTICE

Duty of a hospital
2) the use of reasonable care in the
maintenance of safe and adequate
facilities and equipment;
3) the selection and retention of
competent physicians;
MEDICAL MALPRACTICE

Duty of a hospital
2) the overseeing or supervision of all
persons who practice medicine
within its walls; and
3) the formulation, adoption and
enforcement of adequate rules and
policies that ensure quality care for
its patients
MEDICAL MALPRACTICE

QUESTIONABLE SPONGE
COUNT

SCRUB NURSE’ DUTY

HOSPITAL LIABILITY
MEDICAL MALPRACTICE

CHARITABLE, NON-PROFIT
INSTITUTION

CORPORATE ENTERPRISE
 MEDICAL
MALPRACTICE

• Criminal prosecution

• Civil suit

• Administrative complaint
MEDICAL MALPRACTICE
Criminal Prosecution under the
Revised Penal Code

Art. 365 – Reckless Imprudence/Gross

negligence resulting in
 Serious Physical Injuries
 Less Serious Physical Injuries
 Homicide
MEDICAL MALPRACTICE

Distinguish Art. 365 from

other provisions of the
Revised Penal Code and other
laws which makes certain
acts criminal.
 MEDICAL MALPRACTICE

Art. 173, RPC – False Medical Certificates

Art. 253, RPC – Giving assistance to

suicide

Art. 259,RPC – Abortion practiced by a

physician or midwife and
dispensing of abortives.
MEDICAL MALPRACTICE

Sec. 17, RA 9165 –

Maintenance and
keeping of original
records of transactions
Sec. 18, RA 9165 –
Unnecessary
Prescription of Dangerous
Drugs
MEDICAL MALPRACTICE
Civil Suit for Negligence

Civil Code –
Art. 2176 – Whoever by act or
omission causes damage to
another, there being fault or
negligence, is obliged to pay
for the damage done.
MEDICAL MALPRACTICE

Administrative Liability

Complaint for Negligence

before the Professional
Regulation Commission
THANK YOU
AND
HAVE A NICE
WEEKEND!