NILO B. ROSIT vs. DAVAO DOCTORS HOSPITAL AND DR. ROLANDO G.

GESTUVO
G.R. No. 210445, December 07, 2015
Facts:
On January 15, 1999, Rosit figured in a motorcycle accident. The X-ray soon taken the next day at the Davao Doctors Hospital
showed that he fractured his jaw. Rosit was then referred to Dr. Gestuvo, a specialist in mandibular whooperated on Rosit. During the operation,
Dr. Gestuvo used a metal plate fastened to the jaw with metal screws to immobilize the mandible. As the operation required the smallest screws
available, Dr. Gestuvo cut the screws on hand to make them smaller. Dr. Gestuvo knew that there were smaller titanium screws available in
Manila, but did not so inform Rosit supposing that the latter would not be able to afford the same.

Following the procedure, Rosit could not properly open and close his mouth and was in pain. X-rays done on Rosit two (2) days after
the operation showed that the fracture in his jaw was aligned but the screws used on him touched his molar. Given the X-ray results, Dr. Gestuvo
referred Rosit to a dentist. The dentist who checked Rosit, Dr. Pangan, opined that another operation is necessary and that it is to be performed in
Cebu. In Cebu, Dr. Pangan removed the plate and screws thus installed by Dr. Gestuvo and replaced them with smaller titanium plate and screws.
Dr. Pangan also extracted Rosit's molar that was hit with a screw and some bone fragments. Three days after the operation, Rosit was able to eat
and speak well and could open and close his mouth normally. On his return to Davao, Rosit demanded that Dr. Gestuvo reimburse him for the
cost of the operation and the expenses he incurred in Cebu but Dr. Gestuvo refused. Thus, Rosit filed a civil case for damages and attorney's fees
with the RTC against Dr. Gestuvo and DDH, the suit docketed as Civil Case No.

Issue:
Whether or not Dr. Gestuvo is guilty of medical malpractice?

Held:
Yes. 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. Duty refers to the standard of behavior which imposes restrictions on one's conduct. The standard in turn refers to the amount of
competence associated with the proper discharge of the profession. A physician is expected to use at least the same level of care that any other
reasonably competent doctor would use under the same circumstances. Breach of duty occurs when the physician fails to comply with these
professional standards. If injury results to the patient as a result of this breach, the physician is answerable for negligence.

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. This is so considering that
the requisite degree of skill and care in the treatment of a patient is usually a matter of expert opinion. However, when the doctrine of res ipsa
loquitur applies, the need for expert medical testimony is dispensed with because the injury itself provides the proof of negligence. And 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.12

Here, the essential requisites for the application of the doctrine of res ipsa loquitur are present. The first element was sufficiently
established when Rosit proved that one of the screws installed by Dr. Gestuvo struck his molar because the size and length was too long or
improperly placed, both facts are the product of Dr. Gestuvo's negligence. Anent the second element, 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 was
satisfied in this case because 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

The court also found that Dr. Gestuvo is guilty of negligence on the ground that he deprived Rosit of the opportunity to make an
informed consent. 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 gravamen in an informed consent case requires the plaintiff to point to significant undisclosed information
relating to the treatment which would have altered her decision to undergo it.

The four adverted essential elements above are present here. First, Dr. Gestuvo clearly had the duty of disclosing to Rosit the risks of
using the larger screws for the operation. Second, Dr. Gestuvo failed to disclose these risks to Rosit. 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. 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. This was evident from the fact that just three (3) days after Dr. Pangan repeated the operation conducted by Dr. Gestuvo, Rosit was
pain-free and could already speak. 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
 CARLOS BORROMEO vs. FAMILY CARE HOSPITAL, INC. and RAMON S. INSO, M.D
G.R. No. 191018 January 25, 2016
Facts:

On July 13, 1999, the Borromeo brought his wife, Lilian to the Family Care Hospital because she had been complaining of acute pain
at the lower stomach area and fever for two days. She was admitted at the hospital and was operated by Dr. Inso as she was suffering from acute
appendicitis. Six hours after, Lilian was brought back to her room, Dr. Inso was informed that her blood pressure was low. After assessing her
condition, she was given several treatments. Nevertheless, her condition continued to deteriorate. At this point, Dr. Inso suspected that Lilian had
Disseminated Intravascular Coagulation, a blood disorder characterized by bleeding in many parts of her body caused by the consumption or the
loss of the clotting factors in the blood.
Dr. Inso also informed her family that there may be a need to re-operate on her, but she would have to be put in an Intensive Care
Unit . Unfortunately, Family Care did not have an ICU. Dr. Inso then personally coordinated with the Muntinlupa Medical Center which had an
available bed. Unfortunately, Lilian passed away despite efforts to resuscitate her. According to the autopsy report, Dr. Reyes concluded that the
cause of Lilian’s death was haemorrhage due to bleeding petechial blood vessels: internal bleeding. He further concluded that the internal
bleeding was caused by the 0.5 x 0.5 cm opening in the repair site. Based on the autopsy, the petitioner filed a complaint for damages against
Family Care and against Dr. Inso for medical negligence.

Issue:
Whether or not respondents are guilty of medical negligence

Ruling:
No. The alleged medical malpractice was not established by an expert witness. Because medical malpractice cases are often highly
technical, expert testimony is usually essential to establish: (1) the standard of care that the defendant was bound to observe under the
circumstances; (2) that the defendant’s conduct fell below the acceptable standard; and (3) that the defendant’s failure to observe the industry
standard caused injury to his patient. Furthermore, the expert witness must be a similarly trained and experienced physician. Here, it was proven
during thr trial that Dr. Reyes is not an expert witness who could prove Dr. Inso’s alleged negligence. Dr. Reyes can be considered an expert in
traumatic autopsies or autopsies involving violent deaths. However, his expertise in traumatic autopsies does not necessarily make him an expert
in clinical and pathological autopsies or in surgery. Hence, his testimony cannot be relied upon to determine if Dr. Inso committed errors during
the operation, the severity of these errors, their impact on Lilian’s probability of survival, and the existence of other diseases/condition. On the
other hand, the respondents presented testimonies from Dr. Inso himself and from two expert witnesses, Dr. Hernandez and Dr. Ramos in
pathology and surgery. Both experts agreed that Lilian could not have died from bleeding of the appendical vessel. They identified Lilian’s cause
of death as massive blood loss resulting from DIC.

Furthermore, petitioner cannot invoke the doctrine of res ipsa loquitur in order to dispense with expert medical testimony and to shift
the burden of evidence onto the respondent as it is not applicable in this case. The Doctrine is not applicable because Dr Inso’s alleged failure to
observe due care is not immediately apparent to a layman. The instances in this cae require expert opinion to establish the culpability of the
defendant doctor. It is also not applicable to cases where the actual cause of the injury had been identified or established. Here, the respondents
established that the cause of Lilian’s uncontrollable bleeding and, ultimately, her death, was a medical disorder – Disseminated Intravascular
Coagulation.