Assignment #: 1 Date submitted: September , 2023

Name: Benitez, Gladys Jhaye P. Section: BSN 2-A Schedule: Monday 1:30-4:30
NCM 108 HEALTH CARE ETHICS

Topic: Example/s of Negligence/Malpractice CASE/S in Nursing Practice

CASE 1: NEGLIGENCE

Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI) against the
petitioners, Dr. Emmanuel Jarcia, Jr. and Dr. Marilou Bastan for their alleged neglect of professional
duty which caused her son, Roy Alfonso Santiago (Roy Jr.), to suffer serious physical injuries. Upon
investigation, the NBI found that Roy Jr. was hit by a taxicab; that he was rushed to the Manila Doctors
Hospital for an emergency medical treatment; that an X-ray of the victim’s ankle was ordered; that the
X-ray result showed no fracture as read by Dr. Jarcia; that Dr. Bastan entered the emergency room (ER)
and, after conducting her own examination of the victim, informed Mrs. Santiago that since it was only
the ankle that was hit, there was no need to examine the upper leg; that eleven days later, Roy Jr.
developed fever, swelling of the right leg and misalignment of the right foot; that Mrs. Santiago brought
him back to the hospital; and that the X-ray revealed a right mid-tibial fracture and a linear hairline
fracture in the shaft of the bone

The NBI indorsed the matter to the Office of the City Prosecutor of Manila for preliminary investigation.
Probable cause was found and a criminal case for reckless imprudence resulting to serious physical
injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr. Pamittan,5 before the RTC, docketed as
Criminal Case No. 01-196646.

On June 14, 2005, the RTC found the petitioners guilty beyond reasonable doubt of the crime of Simple
Imprudence Resulting to Serious Physical Injuries.

the CA affirmed the RTC decision.

In the case at bench, the accused-appellants questioned the imputation against them and argued that
there is no causal connection between their failure to diagnose the fracture and the injury sustained by
Roy.

The CA is correct in finding that there was negligence on the part of the petitioners. After a perusal of
the records, however, the Court is not convinced that the petitioners are guilty of criminal negligence
complained of. The Court is also of the view that the CA erred in applying the doctrine of res ipsa
loquitur in this particular case.

This doctrine of res ipsa loquitur means "Where the thing which causes injury is shown to be under the
management of the defendant, and the accident is such as in the ordinary course of things does not
happen if those who have the management use proper care, it affords reasonable evidence, in the
absence of an explanation by the defendant, that the accident arose from want of care.
The doctrine of res ipsa loquitur as a rule of evidence is unusual to the law of negligence which
recognizes that prima facie negligence may be established without direct proof and furnishes a substitute
for specific proof of negligence. The doctrine, however, is not a rule of substantive law, but merely a
mode of proof or a mere procedural convenience. The rule, when applicable to the facts and
circumstances of a given case, is not meant to and does not dispense with the requirement of proof of
culpable negligence on the party charged. It merely determines and regulates what shall be prima facie
evidence thereof and helps the plaintiff in proving a breach of the duty. The doctrine can be invoked
when and only when, under the circumstances involved, direct evidence is absent and not readily
available.

The requisites for the application of the doctrine of res ipsa loquitur are: (1) the accident was of a kind
which does not ordinarily occur unless someone is negligent; (2) the instrumentality or agency which
caused the injury was under the exclusive control of the person in charge; and (3) the injury suffered
must not have been due to any voluntary action or contribution of the person injured

In this case, the circumstances that caused patient Roy Jr.’s injury and the series of tests that were
supposed to be undergone by him to determine the extent of the injury suffered were not under the
exclusive control of Drs. Jarcia and Bastan. It was established that they are mere residents of the Manila
Doctors Hospital at that time who attended to the victim at the emergency room. While it may be true
that the circumstances pointed out by the courts below seem doubtless to constitute reckless imprudence
on the part of the petitioners, this conclusion is still best achieved, not through the scholarly assumptions
of a layman like the patient’s mother, but by the unquestionable knowledge of expert witness/es. As to
whether the petitioners have exercised the requisite degree of skill and care in treating patient Roy, Jr. is
generally a matter of expert opinion.

The totality of the evidence on record clearly points to the negligence of the petitioners. At the risk of
being repetitious, the Court, however, is not satisfied that Dr. Jarcia and Dr. Bastan are criminally
negligent in this case.

Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act from which
material damage results by reason of an inexcusable lack of precaution on the part of the person
performing or failing to perform such act.

The elements of simple negligence are: (1) that there is lack of precaution on the part of the offender,
and (2) that the damage impending to be caused is not immediate or the danger is not clearly manifest.

In this case, the Court is not convinced with moral certainty that the petitioners are guilty of reckless
imprudence or simple negligence. The elements thereof were not proved by the prosecution beyond
reasonable doubt.

It can be gleaned from the testimony of Dr. Tacata that a thorough examination was not performed on
Roy Jr. As residents on duty at the emergency room, Dr. Jarcia and Dr. Bastan were expected to know
the medical protocol in treating leg fractures and in attending to victims of car accidents. There was,
however, no precise evidence and scientific explanation pointing to the fact that the delay in the
application of the cast to the patient’s fractured leg because of failure to immediately diagnose the
specific injury of the patient, prolonged the pain of the child or aggravated his condition or even caused
further complications.

Although the Court sympathizes with the plight of the mother and the child in this case, the Court is
bound by the dictates of justice which hold inviolable the right of the accused to be presumed innocent
until proven guilty beyond reasonable doubt. The Court, nevertheless, finds the petitioners civilly liable
for their failure to sufficiently attend to Roy Jr.’s medical needs when the latter was rushed to the ER, for
while a criminal conviction requires proof beyond reasonable doubt, only a preponderance of evidence
is required to establish civil liability. Taken into account also was the fact that there was no bad faith on
their part.

WHEREFORE, the petition is PARTLY GRANTED. The Decision of the Court of Appeals dated August
29, 2008 is REVERSED and SET ASIDE. A new judgment is entered ACQUITTING Dr. Emmanuel
Jarcia, Jr. and Dr. Marilou Bastan of the crime of reckless imprudence resulting to serious physical
injuries but declaring them civilly liable in the amounts of: (1) ₱ 3,850.00 as actual damages; (2) ₱
100,000.00 as moral damages; (3) ₱ 50,000.00 as exemplary damages; and (4) Costs of the suit.

with interest at the rate of 6% per annum from the date of the filing of the Information. The rate shall be
12% interest per annum from the finality of judgment until fully paid.

SO, ORDERED.

CASE 2: MALPRACTICE

An 80 year-old male was transported by ambulance to the emergency department (ED) for evaluation
after experiencing an unwitnessed fall in a local nursing home. The patient resided at the nursing home
and had a medical history of severe dementia and osteoporosis. The patient arrived to the ED alone
without family or staff from the local nursing home.

Upon arrival to the ED, the patient was triaged by nursing staff. The triage documentation noted the
patient’s vital signs were stable, that he was a poor historian and complained of “hurting all over”. After
triage was completed, the patient was taken to a bed in the ED treatment area, which was located
approximately 20 feet from the nurses’ station, but not in direct view of the station.

The insured registered nurse assigned to the patient documented that the patient was confused,
uncooperative and incontinent. The nursing assessment was completed and noted the patient to be an
elderly male at risk for falls. Specific interventions were also documented to implement fall
interventions, to include side rails up, place call bell within reach of patient, maintain bed in low
position, and consider patient placement close to nursing station.

Two hours later, the patient was evaluated by the ED practitioner. The practitioner noted the patient was
restless and ordered a sedation medication in preparation for diagnostic tests which included a CT scan
of the head, and imaging studies of the knee, pelvis and ribs. The insured administered the ordered
sedative and the tests were completed in the diagnostic imaging department. The patient was returned to
his bed in the ED treatment area. The results of the diagnostic tests were reported as negative.
Following the patient’s return to the ED, the nurse assisted the patient to the bathroom, noting that he
was able to walk independently, but had an unsteady gait. The nurse left the room after returning the
patient to his bed, placing the side rails up and the call bell within reach of the patient.

Thirty minutes later, housekeeping staff found the patient yelling, laying on the floor on his right side,
next to the his bed. Staff immediately responded and the patient was assessed by the ED practitioner.
Following the department protocol, staff applied a cervical collar to the patient’s neck, placed him on a
backboard and then lifted him to a stretcher. The patient complained of pain in his right hip, and his right
leg was noted to be shortened and internally rotated. The patient underwent additional diagnostic tests,
and the hip x-rays results confirmed a fractured right hip. Following his return from the imaging, the
patient was moved to a bed closer to the nursing station.

The patient was later admitted to the hospital from the ED and evaluated by an orthopedic surgeon the
following morning. Surgical intervention for the hip fracture was recommended by the surgeon and the
patient’s son provided consent for the procedure. The patient underwent an open reduction and internal
fixation of his hip fracture.

Post-operatively, the patient developed pneumonia which required antibiotic therapy and lengthened his
hospitalization. He was subsequently discharge back to the nursing home. Despite having the diagnosis
of dementia, the patient was able to ambulate prior to this hospitalization, but his activity level is now
limited to a wheelchair.

After an investigation of the incident was completed, including an interview with the nurse and
obtaining a nurse expert review, negotiations pursued between the involved parties in the claim. A
settlement was reached prior to a lawsuit being filed, with payment on behalf of the nurse being 45
percent of the total settlement. As mandated by state law, the nurse was also reported to the National
Practitioner Data Bank (NPDA).

REFERENCES:

G.R. No. 187926. (n.d.). The Lawphil Project - Arellano Law Foundation, Inc.
https://lawphil.net/judjuris/juri2012/feb2012/gr_187926_2012.html

80 year-old male transported by ambulance to the emergency department. (n.d.). NSO.