UP Law F2021 Borromeo v Family Care Hospital
Medical Jurisprudence 2016 Brion
SUMMARY
Carlos Borromeo lost his wife Lillian when she died after undergoing a routine appendectomy. The hospital
and the attending surgeon submit that Lillian bled to death due to a rare, life-threatening condition that
prevented her blood from clotting normally. Carlos believes, however, that the hospital and the surgeon
were simply negligent in the care of his late wife. While SC sympathizes with the petitioner’s loss, the
petitioner failed to present sufficient convincing evidence to establish: (1) the standard of care expected of
the respondent and (2) the fact that Dr. Inso fell short of this expected standard. Considering further that
the respondents established that the cause of Lilian’s uncontrollable bleeding (and, ultimately, her death)
was a medical disorder – Disseminated Intravascular Coagulation – we find no reversible errors in the CA’s
dismissal of the complaint on appeal.
FACTS
July 13 1999: Carlo Borromeo brought his wife 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 placed under the care of Dr. Inso.
Dr. Inso suspected that Lilian might be suffering from acute appendicitis. However, there was
insufficient data to rule out other possible causes and to proceed with an appendectomy. Thus, he
ordered Lilian’s confinement for testing and evaluation. However, the tests were not conclusive enough
to confirm that she had appendicitis. Lilian abruptly developed an acute surgical abdomen.
July 15, 1999: Dr. Inso decided to conduct an exploratory laparotomy on Lilian because of the findings
on her abdomen and his fear that she might have a ruptured appendix.
o During the operation, Dr. Inso confirmed that Lilian was suffering from acute appendicitis. He
proceeded to remove her appendix which was already infected and congested with pus. The
operation was successful.
o Six hours after Lilian was brought back to her room, Dr. Inso was informed that her blood
pressure was low. After assessing her condition, he ordered the infusion of more intravenous
(IV) fluids which somehow raised her blood pressure.
o Subsequently, a nurse informed him that Lilian was becoming restless. Dr. Inso immediately went
to Lilian and saw that she was quite pale. He immediately requested a blood transfusion. Lilian
did not respond to the blood transfusion even after receiving two 500 cc-units of blood.
o Eventually, an endotracheal tube connected to an oxygen tank was inserted into Lilian to ensure
her airway was clear and to compensate for the lack of circulating oxygen in her body from the
loss of red blood cells.
o Her condition continued to deteriorate. Dr. Inso suspected that Lilian had Disseminated
Intravascular Coagulation (DIC), 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.
o However, Dr. Inso did not have the luxury to conduct further tests because the immediate need
was to resuscitate Lilian. Dr. Inso and the nurses performed CPR on Lilian. 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 (ICU).
o Unfortunately, Family Care did not have an ICU because it was only a secondary hospital and was
not required by the Department of Health to have one. Dr. Inso then personally coordinated with
the Muntinlupa Medical Center (MMC) which had an available bed. Upon reaching the MMC, a
medical team was on hand to resuscitate.
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 hemorrhage due to bleeding petechial blood
vessels: internal bleeding.
o He further concluded that the internal bleeding was caused by the 0.5 x 0.5 cm opening in the
repair site. He opined that the bleeding could have been avoided if the site was repaired with
double suturing instead of the single continuous suture repair that he found. Based on the
autopsy, the petitioner filed a complaint for damages against Family Care and against Dr. Inso for
medical negligence.
ISSUE: W/N respondents are guilty of medical negligence (NO)
RATIO
A medical professional has the duty to observe the standard of care and exercise the degree of skill,
knowledge, and training ordinarily expected of other similarly trained medical professionals acting under
the same circumstances. A breach of the accepted standard of care constitutes negligence or malpractice
and renders the defendant liable for the resulting injury to his patient.
The standard is based on the norm observed by other reasonably competent members of the profession
practicing the same field of medicine. 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.
The expert witness must be a similarly trained and experienced physician. Thus, a pulmonologist is not
qualified to testify as to the standard of care required of an anesthesiologist and an autopsy expert is not
qualified to testify as a specialist in infectious diseases.
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Dr. Reyes is not an expert witness who could prove Dr. Inso’s alleged negligence. His testimony could not
have established the standard of care that Dr. Inso was expected to observe nor assessed Dr. Inso’s failure
to observe this standard. 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.
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The petitioner cannot invoke the doctrine of res ipsa loquitur to shift the burden of evidence onto the
respondent. Res ipsa loquitur, literally, “the thing speaks for itself;” is a rule of evidence that presumes
negligence from the very nature of the accident itself using common human knowledge or experience.
The application of this rule requires: (1) that the accident was of a kind which does not ordinarily occur
unless someone is negligent; (2) that the instrumentality or agency which caused the injury was under the
exclusive control of the person charged with negligence; and (3) that the injury suffered must not have been
due to any voluntary action or contribution from the injured person. The concurrence of these elements
creates a presumption of negligence that, if unrebutted, overcomes the plaintiff’s burden of proof.
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The rule is not applicable in cases such as the present one where the defendant’s alleged failure to observe
due care is not immediately apparent to a layman. These instances 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. While this Court sympathizes with the petitioner’s loss, the petitioner failed
to present sufficient convincing evidence to establish: (1) the standard of care expected of the respondent
and (2) the fact that Dr. Inso fell short of this expected standard. Considering further that the respondents
established that the cause of Lilian’s uncontrollable bleeding (and, ultimately, her death) was a medical
disorder – Disseminated Intravascular Coagulation – we find no reversible errors in the CA’s dismissal of
the complaint on appeal.
FALLO DENIED the petition for lack of merit. No costs. SO ORDERED.