General information only; not legal advice.

Post-operative infections are among the most common—and most disputed—bases for malpractice complaints. In Philippine law, an infection after surgery is not automatically “malpractice.” Liability usually turns on whether the infection was a recognized risk despite proper care or a preventable harm caused (or worsened) by negligent acts/omissions by the surgeon, staff, and/or the hospital as an institution.

This article explains the legal theories, proof requirements, who may be liable, where to file, what evidence matters, common defenses, and practical realities in Philippine practice.

1) Understanding the event: infection as a complication vs. infection as negligence

A. Infections can occur even with proper care

Even in top facilities, surgical site infections (SSIs) may occur due to:

patient risk factors (diabetes, obesity, smoking, immunosuppression, malnutrition),
emergency surgery or prolonged surgery,
wound class/contamination level,
implanted foreign material,
unavoidable exposure to bacteria.

Because of this, Philippine courts generally require proof of breach of the standard of care, not merely proof that an infection happened.

B. Infections become legally actionable when linked to preventable failures

Common negligence allegations in infection cases include:

failure to maintain sterile technique (OR field contamination, improper gowning/gloving),
improper sterilization of instruments or reuse of single-use items,
inadequate OR sanitation/airflow controls or environmental cleaning,
improper skin preparation, draping, or antibiotic prophylaxis timing,
poor post-operative monitoring (missed early signs of infection/sepsis),
delay in cultures, imaging, or escalation to infectious disease/surgery review,
improper wound care instructions or nursing wound care deviations,
unsafe discharge (too early; no follow-up; no warning signs explained),
breakdowns in infection control policies (hand hygiene enforcement, isolation, outbreak response).

2) What “medical malpractice” means under Philippine law

There is no single “Medical Malpractice Code.” Claims are usually pursued through combinations of:

A. Civil liability (most common for compensation)

Quasi-delict / tort (Civil Code, Article 2176) You must prove: duty → breach → causation → damages by preponderance of evidence.
Breach of contract The physician-patient relationship and hospital admission create contractual duties (express or implied). A patient may sue for breach when the provider fails to exercise the level of care expected under the engagement.

Often, complaints plead both quasi-delict and breach of contract (in the alternative), depending on facts and defendants.

B. Criminal liability (harder proof standard)

If the facts show negligent acts causing injuries or death, a complaint may be filed under Article 365 of the Revised Penal Code (Imprudence and Negligence), such as reckless imprudence resulting in physical injuries or homicide (where applicable). Proof is beyond reasonable doubt.

C. Administrative/professional discipline

PRC / Professional Regulatory Board of Medicine (for physicians) under the Medical Act (RA 2382) and related rules
PRC / Board of Nursing under the Philippine Nursing Act (RA 9173) Sanctions may include suspension or revocation of license, independent of civil/criminal outcomes.

D. Regulatory/operational complaints against the hospital

Hospitals are licensed and regulated (primarily through the Department of Health and its rules). Complaints may be directed to regulators when the issue involves facility standards, infection control systems, staffing, or institutional safety.

3) Who can be held liable: it’s rarely “hospital only”

Post-surgery infection cases often involve multiple actors. Potential defendants include:

A. The surgeon (and sometimes the anesthesiologist/attending physicians)

Because key infection-prevention decisions are medical: operative technique, prophylactic antibiotics, drains, wound closure, post-op management, timely intervention.

B. Nurses and OR staff

Because execution failures can directly cause contamination or delayed detection: wound care, catheter care, hand hygiene, sterile field discipline, documentation of vital signs and signs of infection.

C. The hospital as an institution

Hospitals can be liable through several pathways (often pleaded together):

Vicarious liability for employees (Civil Code, Article 2180) If negligent staff are hospital employees acting within their duties, the hospital may be liable.
Corporate negligence (institutional negligence) Even if a doctor is not an employee, a hospital may be liable for its own failures, such as:

negligent hiring/credentialing/privileging,
failure to maintain safe facilities, infection control systems, adequate staffing,
failure to supervise or monitor quality/safety,
failure to enforce policies designed to prevent infections.

Apparent authority / ostensible agency (fact-dependent) If the hospital holds out a physician as part of its service and the patient reasonably relies on that representation, the hospital may be treated as responsible for that physician’s negligence, depending on evidence of hospital representations and patient reliance.

Key practical point: Many hospitals characterize doctors as “independent contractors.” That label does not automatically defeat hospital liability; courts look at control, representations, and institutional duties.

4) The legal “core”: elements you must prove in an infection-based malpractice claim

1) Duty of care

Doctors owe the professional duty to exercise the care, skill, and diligence expected of reasonably competent practitioners in similar circumstances.
Hospitals owe duties to provide safe facilities, competent staff, and systems that protect patient safety.

2) Breach (deviation from standard of care)

This is usually the hardest part in infection cases. The claimant must show what should have been done—and what was actually done—then prove the gap is a negligent deviation, not a reasonable medical choice.

Expert testimony is commonly needed to establish the medical standard of care and how it was breached.

3) Causation (the “because of” link)

You must prove that the breach probably caused the infection or materially contributed to it, or that it caused a delay in diagnosis/treatment that led to worse outcomes (e.g., sepsis, longer hospitalization, disability).

Causation is often contested using:

patient comorbidities,
community-acquired infection possibility,
proper prophylaxis and sterile technique documentation,
timing of symptoms versus expected post-op inflammation,
evidence the infection source was unrelated to the surgery.

4) Damages

Common damages claimed:

additional hospitalization, ICU, antibiotics, repeat surgeries/debridement,
loss of income, disability, rehabilitation,
pain and suffering (moral damages in appropriate cases),
in death cases: funeral costs, loss of earning capacity, indemnities, and related damages.

5) “Res ipsa loquitur” and why it’s difficult for infection cases

Philippine jurisprudence recognizes that in limited circumstances, negligence may be inferred when:

the event ordinarily does not happen without negligence,
the instrumentality was under defendant’s control,
the patient did not contribute to the harm.

Post-operative infection alone usually does not fit neatly because infections can occur without negligence. Res ipsa arguments are stronger when combined with facts suggesting a breakdown that should not occur absent negligence, such as:

proven use of unsterilized instruments,
documented OR contamination event ignored,
outbreak traced to facility lapses,
foreign object left inside the patient (where infection is a consequence),
tampering or clear violation of sterile protocols.

6) Hospital-focused theories in post-surgery infection complaints

If the target is the hospital, complaints typically emphasize institutional duties and systems:

A. Infection prevention and control program failures

Examples of allegations:

no functional infection control committee or inadequate oversight,
poor compliance enforcement (hand hygiene, isolation protocols),
inadequate sterilization processes or monitoring,
improper OR maintenance/cleaning schedules,
understaffing causing shortcuts in aseptic practices,
failure to act on infection clusters or known hazards.

B. Credentialing/privileging and supervision failures

allowing incompetent practitioners to operate,
granting privileges without proper training/track record,
failure to investigate prior incidents or complaints.

C. Facility and equipment negligence

defective sterilizers/autoclaves,
inadequate water quality controls for surgical areas,
improper storage and handling of sterile supplies,
poor ventilation/filtration where required.

D. Documentation and continuity failures

missing or altered records (raised as adverse inference issues, depending on circumstances),
delayed charting that obscures the clinical timeline,
lack of discharge instructions or follow-up planning.

7) Evidence that matters most in infection-based cases

A. Medical records (core)

admission and progress notes,
operative report, anesthesia record,
nurses’ notes and vital signs flow sheets,
medication administration record (antibiotic timing, dosing),
wound care documentation,
discharge summary and instructions,
readmission records (if infection led to return).

B. Microbiology and diagnostics

culture and sensitivity results,
blood cultures (if sepsis),
imaging (ultrasound/CT for abscess),
inflammatory markers and trends.

C. Facility/process records (for hospital-liability theories)

sterilization logs (autoclave cycles, biological indicators),
OR cleaning logs,
infection control surveillance reports (if obtainable),
staffing schedules and nurse-to-patient ratios for the relevant shifts,
incident reports (may be contested; availability depends on rules and discovery).

D. Expert opinions

Typically needed to explain:

expected infection risks for the procedure,
whether prophylaxis and technique were appropriate,
whether the response to early symptoms met standard care,
whether delay caused worse outcome.

E. Timeline evidence

Infection cases are timeline-driven. Clear chronology often decides:

when fever/pain/redness/drainage began,
when the team acted,
when cultures were ordered,
when antibiotics were started/changed,
whether discharge was premature.

8) Obtaining records and preserving evidence (Philippine realities)

A. Requesting records

Patients generally request copies from the hospital’s medical records department. While providers may withhold certain internal documents, clinical records about the patient’s care are usually accessible through proper requests and compliance with hospital policy and data privacy procedures.

The Data Privacy Act (RA 10173) frames medical information as sensitive personal information; access is controlled, but it also supports the patient’s right to access their own data, subject to lawful limitations and reasonable fees for reproduction.

B. Preserve physical evidence where relevant

If there are removed implants, wound swabs, or retained foreign material, chain of custody and documentation can matter.

C. Don’t rely only on screenshots and partial summaries

Full records (including nurses’ notes and medication charts) often reveal whether prophylactic antibiotics were timely and whether symptoms were escalated promptly.

9) Where and how to file a complaint

A post-surgery infection dispute can proceed on multiple tracks at once:

A. Civil case (damages)

Filed in the appropriate trial court depending on the amount and venue rules.
Defendants can include the hospital, surgeon, and involved staff.
Relief sought: reimbursement, damages, attorney’s fees (when warranted), and sometimes injunctive relief for record access.

Civil route strengths: compensation focus; preponderance standard. Civil route challenges: cost, time, expert testimony.

B. Criminal complaint (negligence under Article 365, RPC)

Usually initiated through a complaint with the prosecutor’s office.
Requires strong proof of negligent act and causation meeting the criminal standard.
Often used when there is severe injury, disability, or death.

Criminal route strengths: leverage; public accountability. Criminal route challenges: beyond reasonable doubt; higher risk of dismissal without strong expert support.

C. Administrative complaint (PRC)

Against physicians/nurses for professional misconduct, gross negligence, incompetence, unethical conduct.
Outcomes: reprimand to suspension/revocation.

Administrative route strengths: professional accountability; lower evidentiary threshold than criminal. Administrative route challenges: may not result in compensation.

D. DOH / regulatory complaint (hospital systems)

Used when issues appear systemic: infection control lapses, unsafe practices, facility deficiencies.
Outcomes can include orders to correct, sanctions, or licensing actions depending on findings.

10) Prescription (time limits) to keep in mind

Prescription can be outcome-determinative. Common reference points include:

Quasi-delict: generally 4 years from the date of injury (Civil Code, Article 1146).
Contracts: prescription varies (commonly 10 years for written contracts; 6 years for oral contracts under Civil Code rules).
Criminal negligence: depends on the offense and penalty, with varying prescriptive periods.

In infection cases, disputes may arise about when the “injury” occurred (date of surgery vs. date infection manifested vs. date of reoperation/diagnosis). Because timing can be contested, documenting symptom onset and diagnosis dates is critical.

11) Defenses hospitals commonly raise in infection-related malpractice complaints

Infection is a known risk/complication and was disclosed in consent.
No breach: sterile protocols were followed; prophylaxis given; appropriate monitoring.
Causation failure: infection likely due to patient factors or non-hospital sources.
Contributory negligence: patient failed to follow wound care instructions or follow-ups (fact-dependent).
Independent contractor defense: doctor not hospital employee.
No corporate negligence: hospital had systems; isolated lapse not attributable to institution.
Prescription: action filed out of time.
Damages not proven: claims unsupported by receipts or credible computation.

12) Drafting a strong complaint: what successful cases usually include

A well-built complaint typically contains:

A. A precise clinical narrative

procedure details,
baseline condition and risk factors,
day-by-day symptom progression,
what was reported and what actions were taken (or not taken),
when infection was confirmed and how it was managed.

B. Specific alleged breaches (not general accusations)

Instead of “they were negligent,” specify:

failure to administer prophylactic antibiotics within appropriate timing,
failure to maintain sterile field (identify event if known),
failure to monitor and act on signs of infection,
failure to order cultures or imaging promptly,
delayed debridement despite indications.

C. A causation story that matches medical science and timing

how the breach plausibly led to infection or delay-worsened outcome,
why alternative causes are less probable (supported by labs, cultures, clinical course).

D. Institutional theory (if suing the hospital)

identify policy/system lapses: sterilization validation, staffing, infection control oversight, credentialing,
link these to the patient’s harm.

E. A damages schedule supported by documents

hospital bills, medicines, professional fees,
receipts for home care/wound supplies,
proof of income loss,
medical prognosis for long-term impairment.

13) Remedies and damages typically pursued

Depending on proof and circumstances, courts may award:

actual damages (documented expenses),
temperate damages (when loss is certain but exact amount hard to prove),
moral damages (where warranted by suffering and bad faith circumstances),
exemplary damages (in cases involving wanton or reckless conduct, plus legal requisites),
attorney’s fees (in specific situations recognized by law and jurisprudence),
interest as allowed.

14) Practical realities: why these cases are challenging—and what tends to move them

Expert testimony often decides the case. Courts are cautious about second-guessing medicine without competent expert guidance.
Documentation quality is pivotal. Missing timing entries, antibiotic records, or nursing notes can shift the case.
Systemic evidence (outbreaks, repeated infections, sterilization failures) can transform a “complication” narrative into a “preventable institutional failure” narrative—if provable.
Severity matters. Claims involving sepsis, disability, repeat surgeries, or death tend to be pursued more vigorously and evaluated more seriously.
Settlement dynamics are common, but outcomes vary widely based on proof strength.

15) Key takeaways

Post-surgery infection ≠ automatic malpractice under Philippine law.
A viable complaint usually requires proof of specific breaches and a credible causal link.
Hospitals may be liable not only through staff negligence but also through institutional/corporate negligence and, in some cases, apparent authority.
Multiple pathways exist—civil, criminal, administrative, and regulatory—each with different standards and remedies.
Records, timelines, and qualified expert support are the backbone of an infection-based malpractice case.