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September 27, 2016

Reyes vs. Sisters of Mercy

Facts:
  • Jorge Reyes has been suffering from recurring fever with chills for around days.
  • Home medication afforded him no relief so he went to Mercy Community Clinic. He was then attended by Dr. Marlyn Rico.
  • Since typhoid fever was common at that time, the Widal test was performed and he was found positive for typhoid.
  • Thereafter, Dr. Marlyn Rico indorse Jorge Reyes to Dr. Marvie Blanes. 
  • Suspecting that that Jorge had typhoid fever, Dr. Marvie Blanes ordered that Jorge be tested for compatibility with chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente.
  • As there was no adverse reaction, Dr. Blanes administered 500 mg of the antibiotic. Another dose was given 3 hours later.
  • Subsequently, Jorge Reyes developed high fever and experienced vomiting and convulsions. He then turned blue due to deficiency in oxygen – cyanosis – and died. The cause of death was stated to be “ventricular arrhythmia secondary to hyperpyrexia and typhoid fever.”
  • The heirs of Reyes filed with the RTC a complaint for damages against Sisters of Mercy, Sister Rose Palacio, Dr. Blanes, Dr. Rico and Mercy Community Clinic contending that the death of Jorge was due to the wrongful administration of chloromycetin. (NOTE: Petitioner’s action is for medical malpractice.)
  • RTC ruled in favor of the respondents. The CA affirmed in toto the RTC decision. Hence, this appeal.
  • Petitioners contend that:
    • Dr. Marlyn Rico hastily and erroneously relied upon the Widal test, diagnosed Jorge’s illness as typhoid fever, and immediately prescribed the administration of the antibiotic chloromycetin
    • Dr. Marvie Blanes erred in ordering the administration of the second dose of 500 milligrams of chloromycetin barely 3 hours after the first was given.
  • Testimony presented: That of Dr. Apolinar Vacalares, (Chief Pathologist of the Northern Mindanao Training Hospital) who performed an autopsy on the body – Dr. Vacalares testified that Reyes did not die of typhoid fever but of shock undetermined, which could be due to allergic reaction or chloromycetin overdose. 



Issue: WON there was medical malpractice. NO

Held: 

Dr. Apolinar Vacalares is not a specialist of typhoid fever and he is thus not qualified to prove that Dr. Marlyn Rico erred in her diagnosis.
While petitioners presented Dr. Apolinar Vacalares as an expert witness, we do not find him to be so as he is not a specialist on infectious diseases like typhoid fever. Furthermore, although he may have had extensive experience in performing autopsies, he admitted that he had yet to do one on the body of a typhoid victim at the time he conducted the postmortem on Jorge Reyes. It is also plain from his testimony that he has treated only about three cases of typhoid fever.

The two doctors presented by respondents clearly were experts on the subject
They vouched for the correctness of Dr. Marlyn Rico’s diagnosis. Dr. Peter Gotiong, a diplomate whose specialization is infectious diseases and microbiology and an associate professor at the Southwestern University College of Medicine and the Gullas College of Medicine, testified that he has already treated over a thousand cases of typhoid fever.

According to him, when a case of typhoid fever is suspected, the Widal test is normally used, and if the 1:320 results of the Widal test on Jorge Reyes had been presented to him along with the patient’s history, his impression would also be that the patient was suffering from typhoid fever. As to the treatment of the disease, he stated that chloromycetin was the drug of choice. He also explained that despite the measures taken by respondent doctors and the intravenous administration of two doses of chloromycetin, complications of the disease could not be discounted.

Respondents also presented the testimony of Dr. Ibarra T. Panopio who is a member of the Philippine and American Board of Pathology, an examiner of the Philippine Board of Pathology, and chief pathologist at the MetroCebu Community Hospital, Perpetual Succor Hospital, and the Andres Soriano Jr. Memorial Medical Center. 

He stated that, as a clinical pathologist, he recognized that the Widal test is used for typhoid patients, although he did not encourage its use because a single test would only give a presumption necessitating that the test be repeated, becoming more conclusive at the second and third weeks of the disease.

He corroborated Dr. Gotiong’s testimony that the danger with typhoid fever is really the possible complications which could develop like perforation, hemorrhage, as well as liver and cerebral complications.

Dr. Rico was not negligent in administering the 2 doses of 500 g of chloromycetin
The chloromycetin was likewise a proper prescription is best established by medical authority. Even if the deceased suffered from an anaphylactic shock, this, of itself, would not yet establish the negligence of the appellee-physicians for all that the law requires of them is that they perform the standard tests and perform standard procedures. The law cannot require them to predict every possible reaction to all drugs administered.

The practice of medicine requires the highest degree of diligence
The practice of medicine is a profession engaged in only by qualified individuals. It is a right earned through years of education, training, and by first obtaining a license from the state through professional board examinations. Such license may, at any time and for cause, be revoked by the government. In addition to state regulation, the conduct of doctors is also strictly governed by the Hippocratic Oath, an ancient code of discipline and ethical rules which doctors have imposed upon themselves in recognition and acceptance of their great responsibility to society. Given these safeguards, there is no need to expressly require of doctors the observance of “extraordinary” diligence. 

As it is now, the practice of medicine is already conditioned upon the highest degree of diligence. And, as we have already noted, the standard contemplated for doctors is simply the reasonable average merit among ordinarily good physicians. That is reasonable diligence for doctors or, as the Court of Appeals called it, the reasonable “skill and competence . . . that a physician in the same or similar locality . . . should apply.”

There are thus four elements involved in medical negligence cases, namely: duty, breach, injury, and proximate causation
Petitioner’s action is for medical malpractice. This is a particular form of negligence which consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances.

In order to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed to do something which a reasonably prudent physician or surgeon would have done, or that he or she did something that a reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient. 

The doctrine of Res Ipsa Loquitor is not applicable in this case.

Was there a physician-patient relationship between the respondent doctors and Jorge Reyes? Yes.
Respondents were thus duty-bound to use at least the same level of care that any reasonably competent doctor would use to treat a condition under the same circumstances. It is breach of this duty which constitutes actionable malpractice.

As to this aspect of medical malpractice, the determination of the reasonable level of care and the breach thereof, expert testimony is essential. Inasmuch as the causes of the injuries involved in malpractice actions are determinable only in the light of scientific knowledge, it has been recognized that expert testimony is usually necessary to support the conclusion as to causation.

The doctrine of res ipsa loquitor is not applicable in the case at bar
Though expert testimony is usually needed to prove malpractice, where common knowledge and experience teach that the injury would not have occurred if due care had been exercised, the doctrine of res ipsa loquitur can be invoked to establish negligence.  

Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common knowledge can determine the proper standard of care. Where common knowledge and experience teach that a resulting injury would not have occurred to the patient if due care had been exercised, an inference of negligence may be drawn giving rise to an application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily required to show not only what occurred but how and why it occurred. 

When the doctrine is appropriate, all that the patient must do is prove a nexus between the particular act or omission complained of and the injury sustained while under the custody and management of the defendant without need to produce expert medical testimony to establish the standard of care.

There is nothing unusual about the death of Jorge Reyes (absence of 1st requisite that the accident was of a kind which does not ordinarily occur unless someone is negligent)
In this case, while it is true that the patient died just a few hours after professional medical assistance was rendered, there is really nothing unusual or extraordinary about his death. 

Prior to his admission, the patient already had recurring fevers and chills for five days unrelieved by the analgesic, antipyretic, and antibiotics given him by his wife. This shows that he had been suffering from a serious illness and professional medical help came too late for him. 

It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit against a physician or a surgeon which involves the merits of a diagnosis or of a scientific treatment. The physician or surgeon is not required at his peril to explain why any particular diagnosis was not correct, or why any particular scientific treatment did not produce the desired result.

Citation:
  • G.R. No. 130547
  • October 3, 2000
  • LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES, represented by their mother, LEAH ALESNA REYES, petitioners, vs. SISTERS OF MERCY HOSPITAL, SISTER ROSE PALACIO, DR. MARVIE BLANES, and DR. MARLYN RICO, respondents.



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