Case Summary (G.R. No. 200555)
RTC Findings and Decision
The RTC found the petitioners negligent for misdiagnosing dengue as bronchopneumonia, failing to consider foreseeable indicators, and for inadequate examination and testing. It held San Juan de Dios Hospital solidarily liable under Article 2180 as an employer of its consultants and resident physicians. Damages awarded: P500,000 moral, P45,000 burial, P50,000 attorney’s fees, plus costs.
Court of Appeals Ruling
The CA affirmed the RTC, holding that the petitioners failed to exercise due medical care by ignoring classic dengue symptoms and overrelying on inconclusive X-rays. It admitted the expert testimony of Dr. Jaudian on dengue standards, ruled hospital liability under Article 2180 based on control over physicians’ accreditation, and found that the hospital failed to prove its diligence as a “good father of a family” in hiring and supervising its doctors.
Issues Raised by Petitioners
- Whether Dr. Casumpang and Dr. Miranda committed inexcusable negligence in diagnosing and treating Edmer.
- Whether San Juan de Dios Hospital is solidarily liable with its attending physicians.
- Whether causation exists between alleged negligence and Edmer’s death.
- Whether Dr. Jaudian was properly qualified and credible as an expert witness.
Medical Malpractice Standards Under Article 2176
Medical negligence requires proof of (1) duty arising from a physician-patient relationship; (2) breach of the standard of care; (3) injury; and (4) proximate causation. Physicians must exercise the care a reasonably competent practitioner would under similar circumstances.
Physician-Patient Relationship
Dr. Casumpang: relationship established by affirmative acceptance and treatment under the hospital’s accreditation.
Dr. Miranda: relationship arose when she examined, diagnosed, and treated Edmer as assigned resident physician under hospital supervision.
Standard of Care and Breach of Duty
Expert testimony is essential to define medical standards. Dr. Jaudian’s uncontroverted opinion identified classic dengue symptoms (fever, rapid breathing, abdominal/chest pain, blood-tinged sputum), recommended early confirmation via tourniquet and blood tests, and appropriate management (fluid replacement, oxygen, hemostatics, transfusion).
Liability of Dr. Casumpang
Dr. Casumpang ignored or failed to properly evaluate known dengue indicators, relied solely on a chest X-ray and stethoscope, delayed confirmatory tests until after two bleeding episodes, and did not follow standard dengue management protocols. His selective appreciation of symptoms and delayed intervention constituted breach of duty and medical negligence.
Liability of Dr. Miranda
As a resident under supervision, Dr. Miranda reported findings to Dr. Casumpang, timely ordered tests upon suspecting dengue, and did not independently assume final diagnostic responsibility. Her isolated failure to examine a washed-away blood specimen was an honest judgment error under institutional hierarchy and not gross negligence. Liability is therefore denied.
Expert Witness Qualification
Dr. Jaudian, a licensed pathologist with extensive exposure to pediatrics and over fifty dengue cases plus numerous seminars, demonstrated sufficient knowledge of dengue standards. His specialization mismatch does not bar testimony where the witness possesses requisite familiarity with the standard of care. His opinion was properly admitted and credited.
Causation Between Negligence and Death
Delayed diagnosis and management of dengue directly contributed to irreversible progression to Stage IV hemorrhagic fever and hypovolemic shock. Prompt testing and treatment would have substantially reduced mortality
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Facts
- On April 22, 1988 at 11:30 a.m., 11-year-old Edmer Cortejo was brought to San Juan de Dios Hospital (SJDH) with fever, chest pain, stomach pain and breathing difficulty.
- Dr. Livelo examined Edmer, took vitals and a chest X-ray, and diagnosed bronchopneumonia; antibiotics were started and blood was drawn.
- The patient’s Fortune Care referral assigned him to Dr. Noel Casumpang, who at 5:30 p.m. confirmed bronchopneumonia by stethoscope despite mother’s report of high fever without cough.
- At 9:00 a.m. on April 23, Dr. Casumpang again diagnosed bronchopneumonia though Edmer had throat irritation, chest/stomach pain and traces of blood in sputum.
- Edmer vomited blood-streaked phlegm at 11:30 a.m.; Dr. Ruby Sanga-Miranda arrived 45 minutes later, noted respiratory distress signs, low-grade fever and non-dengue-type rash, but lost the specimen.
- At 3:00 p.m., Edmer vomited fresh blood and complained of leg pain; Dr. Miranda drained stomach fluids, ran a negative tourniquet test, ordered blood pressure monitoring and labs.
- At 4:40 p.m., Dr. Miranda informed Dr. Casumpang, who ordered hematocrit, hemoglobin, typing, transfusion and tourniquet tests; results at 6:00 p.m. confirmed Dengue Hemorrhagic Fever.
- ICU was full; parents signed waiver and transferred Edmer by private ambulance at midnight to Makati Medical Center; diagnosed Dengue Fever Stage IV.
- Edmer died at 4:00 a.m. on April 24, 1988; death certificate cited hypovolemic/hemorrhagic shock from Stage IV dengue fever.
Procedural History
- Respondent sued SJDH, Dr. Casumpang and Dr. Miranda for wrongful death before RTC, Makati City, Branch 134.
- RTC Decision (May 30, 1997): found doctors negligent; SJDH vicariously liable; awarded moral ₱500,000; burial costs ₱45,000; attorney’s fees ₱50,000; costs.
- CA Decision (Oct. 29, 2004) and Resolution (Jan. 12, 2006): affirmed RTC en toto; accepted Dr. Jaudian as expert; held SJDH solidarily liable under Art. 2180.
- Petitioners filed separate Rule 45 petitions to the Supreme Court (G.R. No. 171127, 171217, 171228).
Issues
- Did the attending physicians commit inexcusable lack of precaution in diagnosis or treatment?
- Is SJDH solidarily liable with the petitioning doctors despite their status as consultants?
- Was there a proximate causal link between the alleged negligence and Edmer’s deat