CIVIL LAW > XI. QUASI-DELICTS > F. MEDICAL NEGLIGENCE AND MALPRACTICE

Medical negligence and malpractice fall under the broader category of quasi-delicts in Philippine civil law, governed primarily by Articles 2176 to 2194 of the Civil Code of the Philippines. These provisions outline the general principles of liability arising from acts or omissions that cause damage or injury to another person. Below is a detailed examination of the legal framework, elements, defenses, jurisprudence, and remedies surrounding medical negligence and malpractice in the Philippines.

I. DEFINITION AND NATURE OF MEDICAL NEGLIGENCE AND MALPRACTICE

Medical negligence and malpractice occur when a healthcare professional or institution fails to meet the standard of care required, resulting in harm or injury to a patient. The liability arises from the breach of duty in the practice of medicine, which is grounded in a professional obligation to exercise reasonable care, skill, and diligence.

Quasi-Delicts under Article 2176 of the Civil Code:
A person who, by act or omission, causes damage to another, there being fault or negligence, is obliged to pay for the damage done. This applies whether or not there is a pre-existing contractual relationship. Thus, a doctor may be held liable under quasi-delict principles even in the absence of a formal doctor-patient relationship.

II. ELEMENTS OF MEDICAL NEGLIGENCE AND MALPRACTICE

To establish liability, the following elements must be proven:

Existence of Duty
The healthcare provider has a duty to provide a standard of care that a reasonably competent professional in the same field would exercise under similar circumstances.
Breach of Duty
There is a deviation from the established standard of care, either through an act of commission (wrongful action) or omission (failure to act).
Causation
The breach of duty must be the proximate cause of the injury. This includes:
- Cause-in-Fact: The injury would not have occurred but for the healthcare provider's act or omission.
- Proximate Cause: The injury was a foreseeable consequence of the provider's negligence.
Damage or Injury
Actual harm, injury, or loss must be proven. These may include physical, emotional, or economic damages.

III. STANDARDS OF CARE

In the Philippines, the standard of care is determined based on:

Professional Expertise: The skill, knowledge, and care expected of a reasonably competent practitioner in the same field or specialization.
Circumstances: The resources available to the practitioner (e.g., rural or urban setting) and the urgency of the medical condition.
Medical Guidelines: Established protocols and evidence-based practices in the medical field.

IV. COMMON TYPES OF MEDICAL MALPRACTICE

Misdiagnosis or Delayed Diagnosis
Failure to correctly diagnose a condition in a timely manner, leading to inappropriate or delayed treatment.
Surgical Errors
Mistakes during surgery, such as wrong-site surgery, leaving instruments inside the patient, or causing avoidable complications.
Medication Errors
Incorrect prescribing, dosing, or administering of drugs.
Failure to Obtain Informed Consent
Proceeding with a medical intervention without adequately informing the patient of the risks, benefits, and alternatives.
Birth Injuries
Harm caused to a mother or child due to negligence during pregnancy, labor, or delivery.
Improper Treatment
Administering an inappropriate treatment or failing to provide the required treatment.

V. LEGAL BASES FOR LIABILITY

Civil Liability under Quasi-Delicts (Article 2176)
- A medical professional may be held liable if negligence results in injury, even absent a contractual relationship.
Contractual Liability
- If there is a doctor-patient relationship, liability may arise from a breach of the implicit contract to provide competent medical care.
Criminal Liability
- If the negligence amounts to reckless imprudence or gross negligence leading to death or serious physical injury, the healthcare provider may face criminal prosecution.
Administrative Liability
- The Philippine Medical Association (PMA) and Professional Regulation Commission (PRC) may impose sanctions, including suspension or revocation of licenses.

VI. DEFENSES AGAINST MEDICAL MALPRACTICE CLAIMS

No Breach of Duty
The healthcare provider exercised the standard of care expected under the circumstances.
Informed Consent
The patient was informed of the risks and voluntarily consented to the treatment.
Contributory Negligence
The patient’s own actions or inactions contributed to the injury.
Good Samaritan Doctrine
Emergency care rendered in good faith without expectation of compensation may exempt a healthcare provider from liability.
Assumption of Risk
The patient knowingly accepted the inherent risks of a medical procedure.

VII. BURDEN OF PROOF

Plaintiff’s Burden: The patient must establish the elements of negligence by preponderance of evidence.
Res Ipsa Loquitur: In certain cases, negligence is presumed when the injury would not ordinarily occur without negligence, shifting the burden to the defendant.

VIII. REMEDIES AND DAMAGES

Actual Damages
Compensation for medical expenses, lost income, and other quantifiable losses.
Moral Damages
Awarded for physical suffering, mental anguish, or emotional distress.
Exemplary Damages
Punitive damages to deter future misconduct, granted when the defendant acted with gross negligence or bad faith.
Nominal Damages
Awarded to vindicate a patient’s rights in cases where actual harm is minimal.
Attorney’s Fees and Costs
Recoverable in cases where the defendant’s negligence is evident.

IX. JURISPRUDENCE

Garcia-Rueda v. Pascasio (G.R. No. 118141, 1995)
- A physician is required to possess the necessary skill and knowledge commensurate with the medical field they practice.
Dr. Florenz C. Reyes v. CA (G.R. No. 116205, 1997)
- Established that negligence can occur not only through direct action but also by omission.
Professional Services, Inc. v. Agana (G.R. No. 126297, 2007)
- Highlighted the importance of hospital liability under the doctrine of respondeat superior.

X. CONCLUSION

Medical negligence and malpractice claims in the Philippines require careful evaluation of the duty, standard of care, and causation. While physicians and healthcare providers owe a high standard of care to their patients, the law also provides mechanisms to protect them from frivolous claims. Victims of malpractice must demonstrate clear evidence of negligence and resulting harm, while healthcare providers must exercise due diligence in their practice. Familiarity with the legal and procedural aspects is essential for both litigants and legal practitioners.