G.R. No. 158996 November 14, 2008
FACTS
Teresita
Pineda, 51 and unmarried from Nueva Ecija consulted her townmate, Dr.
Fredelicto Flores, regarding her medical condition. She complained of general body
weakness, loss of appetite, frequent urination and thirst, and on-and-off
vaginal bleeding. Dr. Fredelicto initially interviewed the patient and advised
her to return the following week or to go to the United Doctors Medical Center (UDMC) in Quezon City for a general check-up. He
suspected that Teresita might be suffering from diabetes and told her to
continue her medications. Teresita did not return the next week as
advised. However, when her condition persisted, she went to further consult Dr.
Flores at his UDMC clinic. Upon arrival, she felt weak that she had to
lie down on the couch of the clinic while they waited for the doctor. When Dr.
Fredelicto arrived, he did a routine check-up and ordered Teresita's admission
to the hospital directing the staff to prepare the patient for an "on call" D&C operation to
be performed by his wife, Dr. Felicisima Flores. The hospital staff took her blood and
urine samples for the laboratory tests which Dr. Fredelicto
ordered.
That same day, Teresita was taken to the operating room.
She met Dr. Felicisima, an obstetrician and gynecologist, and Dr.
Fredelicto. Dr. Felicisima thereafter called up the laboratory for the
results of the tests which at that time, the only the results are the blood
sugar, uric acid determination, cholesterol determination, and complete blood
coun. Dr. Felicisima
proceeded with the D&C operation with Dr. Fredelicto administering the
general anesthesia. The D&C operation lasted for about 10 to 15 minutes.
A day after the operation, Teresita was subjected to an ultrasound examination
as a confirmatory procedure. The results showed that she had an enlarged uterus
and myoma uteri. Dr. Felicisima, however, advised Teresita
that she could spend her recovery period at home but since she still feels weak,
she opted for hospital confinement. Teresita's complete laboratory
examination results came only on that day. Her urinalysis indicated that the
sugar in her urine was very high. She was then placed under the care of Dr.
Amado Jorge, an internist. Teresita's condition had worsened and was
rushed to the intensive care unit. Further tests confirmed that she was
suffering from Diabetes Mellitus Type II. Insulin
was administered on her but due to complications induced by diabetes, Teresita
died.
Believing
that Teresita's death resulted from the negligent handling of her medical
needs, her family instituted an action for damages against Dr. Fredelicto
Flores and Dr. Felicisima Flores before the RTC.
ISSUE
Whether
or not there is medical negligence on the part of the petitioner spouses.
RULING
A medical negligence
case is a type
of claim to redress a wrong committed by a medical professional, that has
caused bodily harm to or the death of a patient. There are four elements
involved in a medical negligence case, namely: duty, breach,
injury, and proximate causation. To
successfully pursue a claim, the plaintiff must prove by preponderance of
evidence that, one, the physician either
failed to do something which a reasonably prudent health care provider would
have done, or that he did something that a reasonably prudent provider would
not have done; and two, the failure or action caused injury to the patient. Expert
testimony is therefore essential since the factual issue of whether a physician
or surgeon has exercised the requisite degree of skill and care in the
treatment of his patient is generally a matter of expert opinion.
The
petitioner spouses' contentions, in our view, miss several points:
First, Teresita was already suspected to be suffering
from diabetes. This
suspicion again arose right before the D&C operation when the
laboratory result revealed Teresita's increased blood sugar level. The petitioner spouses did not wait
for the full medical laboratory results before proceeding with the D&C.
Second, the petitioner spouses were duly advised that
the patient was experiencing general body weakness, loss of appetite, frequent
urination, and thirst - all of which are classic symptoms of diabetes. These symptoms should, at the very
least, alert the physician of the possibility that the patient may be afflicted
with the suspected disease
Third, the petitioner spouses cannot claim that their principal concern was the
vaginal bleeding and should not therefore be held accountable for complications
coming from other sources. This is a very narrow and self-serving view that
even reflects on their competence.
Taken together, we find that reasonable
prudence would have shown that diabetes and its complications were foreseeable
harm that should have been taken into consideration by the petitioner spouses. If a patient suffers from some
disability that increases the magnitude of risk to him, that disability must be
taken into account so long as it is or should have been known to the physician. And when the patient is exposed to an
increased risk, it is incumbent upon the physician to take commensurate and
adequate precautions. Although Teresita
experienced vaginal bleeding, it was not sufficiently profuse to necessitate an
immediate emergency D&C operation.
That
the D&C operation was conducted principally to diagnose the cause of the
vaginal bleeding further leads us to conclude that it was merely an elective
procedure, not an emergency case. In an elective procedure, the physician must
conduct a thorough pre-operative evaluation of the patient in order to
adequately prepare her for the operation and minimize possible risks and
complications. Significantly, the
evidence strongly suggests that the pre-operative evaluation was less than
complete as the laboratory results were fully reported only on the day
following the D&C operation. Dr. Felicisima only secured a telephone report
which did not include the 3+ status of sugar in the patient's urine - a result highly confirmatory of
diabetes.
The
prudent move is to address the patient's hyperglycemic state immediately and
promptly before any other procedure is undertaken. In this case, there was no
evidence that the patient’s state was immediately addressed. The petitioner
spouses, therefore, failed, as medical professionals, to comply with their duty
to observe the standard of care to be given to hyperglycemic/diabetic patients
undergoing surgery.
This
breach of duty was the proximate cause of Teresita's death. The critical and
clinching factor in a medical negligence case is proof of the causal
connection between the negligence which the evidence established and the
plaintiff's injuries. Medical literature explains that if the blood
sugar has become very high, the patient becomes comatose (diabetic coma) which
apparently what happened in Teresita's case. Laboratory test showed that
her blood sugar level shot up way above the normal blood sugar range. Thus,
between the D&C and death was the diabetic complication that could have
been prevented with the observance of standard medical precautions. The D&C
operation and Teresita's death due to aggravated diabetic condition is
therefore sufficiently established.
However,
we clarify that Dr. Fredelicto's negligence is not solely the act of ordering
an "on call" D&C operation when he was mainly an anaesthesiologist who had made a very cursory
examination of the patient's vaginal bleeding complaint. Rather, it was his failure from the very start to
identify and confirm, despite the patient's complaints and his own suspicions,
that diabetes was a risk factor that should be guarded against, and his
participation in the imprudent decision to proceed with the D&C operation
despite his early suspicion and the confirmatory early laboratory results.
If Dr. Fredelicto believed himself to be
incompetent to treat the diabetes, not being an internist or a diabetologist, he
should have likewise refrained from making a decision to proceed with the
D&C operation since he was neither an obstetrician nor a gynecologist.
These findings lead us to the
conclusion that the decision to proceed with the D&C operation,
notwithstanding Teresita's hyperglycemia and without adequately preparing her
for the procedure, was contrary to the standards observed by the medical
profession. Deviation from this standard amounted to a breach of duty which
resulted in the patient's death. Due to
this negligent conduct, liability must attach to the petitioner spouses.
Comments
Post a Comment