Philippine Medical Malpractice: Issues from Cases &

Proposed Legislations

Halos, Aeron B.
Kua, Kesterson
Sebastian, Bobby
Johnson

Barretto, Miguel
Angelo

Medical Malpractice: Definition and Recent Statistics

Philippine jurisprudence has defined medical malpractice as that type of claim
which a victim has available to him or her to redress a wrong committed by a
medical professional which has caused bodily harm. 1
As per the most recent Philippine Regulatory Commission (PRC) statistics on
docketed cases filed against physicians, there are a total of 1,201 cases that have
been filed against physicians. Of those cases, 665 involve medical malpractice or
gross negligence. Three hundred six of those cases are already decided, with 242
cases dismissed, 8 are archived, 16 cases resulting with a warning for the
respondent physician, 34 cases resulting in the suspension of the respondent
physician, and 8 cases resulting in the revocation of the respondent physicians
license. Three hundred fifty-nine cases remain pending. 2

Medical Malpractice Cases

Since there is still no law specifically concerning medical malpractice, cases that
have reached the Supreme Court are tried under the laws on torts. This sole reliance
on tort law is illustrated in the case of Spouses Flores v. Spouses Pineda 3 wherein
the Supreme Court relied on tort concepts to define the elements of a medical
negligence case such as breach of duty and proximal causation. The Supreme Court
ultimately ruled for the plaintiff through applying a tort concept as well, namely the
causal connection between the injury and the conduct complained of.
The implication of the lack of medical malpractice laws is that by solely relying on
tort law, tort principles will have to apply and therefore for the defendant physician
to be liable, plaintiffs will have to prove the standard by which the acts of the
physician can be deemed negligent. Proving such standard will often require the
expert testimony of other doctors since medical negligence, as the Court puts it in
the case of Lucas v. Truano, is best proved by opinions of expert witnesses
belonging in the same general neighborhood and in the same general line of
practice as defendant physician or surgeon 4. The case was ruled in favor of the
defendant physician mainly because of the lack of expert testimony of the plaintiff.
The Court, in the same case, conceded that the case would have been decided
differently had the plaintiffs were able to produce expert testimony.
For lack of a specific law geared towards the type of negligence committed by
members of the medical profession, the claim for damages in medical malpractice
cases is almost always anchored on the alleged violation of Article 2176 of the Civil
Code.5

Laws and Bills on Medical Malpractice

The law provides for the protection of patients from the negligence of their
physicians, as embodied in Article 2176 of the Civil Code 6 and Article 365 of the
Revised Penal Code.7 Article 2176 provides the principle of quasi-delict as the basis
of a plaintiffs civil claim against an erring physician while Article 365 provides the
basis of a criminal complaint on the basis of criminal negligence. Republic Act 2382,
otherwise known as The Medical Act of 1959 also provides for the possible
revocation of an erring physicians license in cases involving gross negligence. 8
Though said statutes are sufficient to vest a cause of action to a plaintiff who has
been a victim of medical malpractice and enable him to claim for damages and
criminally prosecute a grossly negligent physician, there have been attempts by
Congress to pass legislation that would specifically address the issue of gross
negligence by medical professionals.
Pending recent bills in the Senate include Senate Bill (SB) No. 121, which aims to
lessen deaths and injuries resulting from medical errors 9, SB No. 2371, which seeks
to delineate the rights and obligations of patients 10.
House bills pending that concern the same subject matter of medical malpractice
include House Bill (HB) No. 4955, the proposal of which caused a stir when it was
vigorously opposed by medical professionals and different health workers
organizations back in 200211. HB No. 495512, along with its Senate counterpart, SB
No. 743 proposes making medical malpractice and illegal surgery specific criminal
offenses, providing for fines and penalty of imprisonment by prision mayor 13.

Issues on Medical Malpractice Legislation

The prefatory notes of most bills involving medical malpratice indicated that the
proposed legislation aims to deter the needless deaths and injuries brought about
by gross negligence and to rid the medical profession of incompetent individuals.
This objective is to ensure that patients will always receive quality medical care.
The proposed legislations, particularly HB No. 4955 when it was first introduced in
2002, roused a debate on the effects of regulations meant to deter and criminalize
medical malpractice. Doctors and various health organizations, criticized the bill,
saying that the proposed law will only lead to higher medical costs for patients since
physicians will be forced to acquire malpractice insurance, the price of which will be
subsequently passed on to the patient. The necessity of malpractice insurance
should the bill become law also led to some to suspect that the bill is pushed by
those with vested interests. Others reasoned that the proposed law is unnecessary

since existing laws already provide for the protection of the patients and the PRC in
practice accepts malpractice complaints. The DOH also joined the fray saying that
the bill will not deter malpractice and will only force doctors to practice defensive
medicine for fear of litigation.14 In short, opposition to legislation against medical
malpractice boils down to three arguments: that it will only increase medical costs
due to the necessity of obtaining an insurance, that existing laws are already
adequate in protecting the rights of patients, and that it will only lead to
unnecessary behavior on the part of physicians such as defensive medicine for fear
of litigation.

Recommendations
Widespread advocacy campaign to inform people of their existing legal
rights vis a vis the standard of care required of medical practitioners.
The sad truth of the current state of affairs in the Philippines is that people,
especially those belonging to the lower income groups, have little if at all any
knowledge of their rights against medical negligence. Oftentimes the rural poor are
given inadequate and subpar medical services in rural hospitals. Although
unverified, horror stories of needles being re-used and beds sheets still stained with
blood being re-used abound in internet forums. 15 Campaign must thus be brought
into light to showcase to the entire country the correct procedures required in
diagnosing patients. When are X-rays mandatory? What about CT Scans?
Oftentimes, people blindly follow their doctors recommendation even if the doctor
did not perform a thorough diagnosis. People should be made aware of their rights
in order to make medical professionals more careful in the performance of their
profession.
An information drive regarding medical responsibility must also be conducted to
those in the medical profession as well. Lawyers are capable of recognizing then
requirements and nuances of medical negligence statutes and jurisprudence but
such may not be as apparent to those in the medical profession.

Make PMA membership a requirement for all doctors and medical

professionals.
As of the moment, PMA membership is not mandatory on all doctors in the
country.16 PMA membership should be made mandatory since it is the organization
in best position to adopt a standard for practice of medicine as well as to police its
own ranks. The PMAs peer review program must be strengthened and given more

tooth. It should be recognized an administrative proceeding with quasi-judicial

powers. It is also in the best position to thresh out the important and applicable
facts of the case as well as to lay out the standard technical procedures that should
have been performed in such a procedure. By mandating PMA as a administrative
agency, the standards of medical negligence will be made clearer to those in the
medical profession.

Enforce stricter administrative sanctions for erring medical professionals

after determination of wanton negligence by a review panel/court.
What is being pushed for by the proponents of this paper are stricter administrative
actions and not criminal actions against medical professionals in cases of gross
negligence in their work. Revocation of license must, as a penalty, be imposed more
often in order to heighten the attention given by medical practitioners to their line
of work. A specialized court composed of medical practitioners must be officially
formed and endowed with concrete judicial powers to try the case. Appeals from
such a decision may then be reviewed by the courts of proper jurisdiction. The idea
is to have a structure similar to that of tax cases where specialized tax courts are
organized to better tackle the highly specialized problem. The added benefit of such
a scenario is that the appellate court would have a more concrete understanding of
the technical details as this would have already been ruled upon by the special
court below. However, criminal actions must not be imposed by a national law as
this will be too harsh and might instead prove to be an incentive for medical
practitioners to not help at all even in times of emergency. For example, if a woman
is suddenly giving birth and the only medical professional available is a
dermatologist, imposing a criminal liability on negligence might result in the
dermatologist refraining to help due to fear of incarceration. Administrative
penalties should more than suffice.

1 Li v. Spouses Soliman, G.R. No. 165279, June 7, 2011

2 PRC Statistics
3 Spouses Flores v. Spouses Pineda, G.R. No. 158996, November 14, 2008
4 Lucas v. Truano, G. R. No. 178763, April 21, 2009
5 Same case as above
6 Article 2176 of the Civil Code
7 Article 365 of the Revised Penal Code
8 Republic Act No. 2382, June 20, 1959.
9 http://www.senate.gov.ph/lis/bill_res.aspx?congress=13&q=SBN-121
10 http://www.senate.gov.ph/lis/bill_res.aspx?congress=14&q=SBN-2371
11 http://www.doh.gov.ph/node/1343.html
12 http://www.geocities.ws/mmsi1902/malpractice.html
13 http://www.senate.gov.ph/lis/bill_res.aspx?congress=13&q=SBN-743
14 http://www.doh.gov.ph/node/1343.html
15 Wikimapia, Davao Regional Hospital. http://wikimapia.org/1258953/Davao-RegionalHospital
16 PMA Website https://www.philippinemedicalassociation.org/