Introduction

Medical negligence, more commonly referred to in Philippine jurisprudence as medical malpractice, occurs when a health care provider — physician, surgeon, dentist, nurse, hospital, or other medical institution — deviates from the accepted standards of practice in the medical community and causes injury or death to the patient.

In the Philippines, medical malpractice is governed primarily by the provisions of the Civil Code on quasi-delicts (Articles 2176–2194) and human relations (Articles 19–36), supplemented by the Revised Penal Code (criminal negligence), the Medical Act of 1959 (Republic Act No. 2382, as amended), and jurisprudence of the Supreme Court.

The Philippines follows the “bolam” or professional community standard (modified by the Supreme Court in recent cases toward a more patient-centered approach), and not the locality rule that is still used in some jurisdictions. The physician is expected to exercise the degree of care, skill, and diligence that physicians in the same line of practice ordinarily possess and exercise under similar circumstances.

Legal Framework

Civil Liability
- Articles 2176–2194, Civil Code (Quasi-Delicts)
- Articles 1156–1159, Civil Code (Obligations arising from contract and quasi-contract)
- Articles 19–21, Civil Code (Abuse of rights, acts contra bonos mores, unjust enrichment)
- Article 100, Revised Penal Code (Civil liability arising from crime)
Criminal Liability
- Article 365, Revised Penal Code (Reckless imprudence resulting in homicide, serious physical injuries, less serious physical injuries, or slight physical injuries)
- Special penal laws (e.g., R.A. 9165 on dangerous drugs, R.A. 8203 on counterfeit drugs)
Administrative Liability
- Republic Act No. 2382, as amended by R.A. 4224 and R.A. 5946 (Medical Act of 1959)
- Republic Act No. 11223 (Universal Health Care Act)
- Professional Regulation Commission (PRC) and Professional Regulatory Board of Medicine rules

Elements of Medical Malpractice (Civil Case)

The Supreme Court has consistently required the plaintiff to prove four essential elements (Reyes v. Sisters of Mercy, G.R. No. 130547, October 3, 2000; Cruz v. Court of Appeals, G.R. No. 122445, November 18, 1997):

Duty – A physician-patient relationship existed, creating a duty to exercise the standard of care.
Breach – The physician failed to exercise the degree of care, skill, and diligence possessed and exercised by physicians in good standing in the same field or specialty under similar circumstances.
Injury – The patient suffered damage (physical, emotional, financial).
Proximate Causation – The breach of duty was the direct and proximate cause of the injury. There must be a clear causal connection; mere bad result is not sufficient.

Standard of Care

The Philippines follows the national standard of care, not the locality rule. The test is:

“that degree of skill, care, and learning possessed by other physicians in good standing practicing in the same specialty under similar circumstances, taking into consideration the present state of medical science and available facilities in the Philippines.”

Specialists are held to the standard of their specialty (e.g., obstetricians to the standard of obstetricians, not general practitioners).

In recent decisions (Professional Services, Inc. v. Agana, G.R. No. 126297, January 31, 2007; Jarcia v. People, G.R. No. 187926, February 15, 2012), the Supreme Court has emphasized that the standard is determined by expert testimony and may include consideration of internationally accepted protocols when local standards are inadequate.

Doctrines Commonly Applied

Captain-of-the-Ship Doctrine
The surgeon in charge is held liable for the negligence of all members of the surgical team acting under his direct supervision and control during the operation (Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999, later clarified in Professional Services, Inc. v. Agana).
Res Ipsa Loquitur (“the thing speaks for itself”)
Applicable in obvious cases such as:
- Foreign object left inside the body after surgery
- Infection resulting from unsterilized instruments
- Removal of the wrong organ or limb
  When applicable, the plaintiff need not prove the specific act of negligence; the burden shifts to the defendant to explain (Ramos v. CA, supra).
Borrowed Servant Doctrine
Operating room nurses or anesthesiologists who are employees of the hospital but under the temporary control of the surgeon may make the surgeon vicariously liable.
Ostensible or Apparent Agency (Holding-out Theory)
A hospital may be held liable for the negligence of a physician who is not its employee if the hospital held the physician out to the public as its agent (Nogales v. Capitol Medical Center, G.R. No. 142625, December 19, 2006; Professional Services, Inc. v. Agana).

Liability of Hospitals and HMOs

Proprietary hospitals are solidarily liable with their physicians under Article 2180 (vicarious liability) if the physician is an employee.
Even for non-employee consultants, hospitals may be liable under ostensible agency if the patient looked to the hospital for care and the hospital held the physician out as its agent.
HMOs may be held liable for denial of coverage or delay in approval that results in damage (solidary liability under R.A. 10606, the National Health Insurance Act).

Informed Consent

Failure to obtain informed consent is a separate ground for liability (Li v. Soliman, G.R. No. 165279, June 7, 2011). The physician must disclose:

Diagnosis
Nature and purpose of proposed treatment
Material risks and complications
Alternatives
Prognosis if treatment is refused

The disclosure must be in a language the patient understands. Lack of informed consent can constitute negligence even if the procedure was performed skillfully.

Defenses Available to Physicians/Hospitals

Exercise of due diligence (no breach)
Patient’s contributory negligence (e.g., failure to follow post-operative instructions, concealment of medical history) – mitigates but does not completely bar recovery unless the contributory negligence was the proximate cause
Assumption of risk (rarely successful)
Emergency rule (good-faith treatment in emergency without consent)
Good Samaritan defense – limited protection under R.A. 6615 (free emergency care in rural areas) and jurisprudence for gratuitous emergency aid

Prescription and Laches

Civil action based on quasi-delict: 4 years from the date the cause of action accrued (discovery rule applies – from the time the injury was discovered or should have been discovered with reasonable diligence; Article 1146, Civil Code).
Action based on breach of contract: 10 years.
Criminal action for reckless imprudence: depends on the penalty (usually 5–10 years).
Administrative cases before the PRC Board of Medicine: 5 years from discovery (Section 26, R.A. 2382 as amended).

Damages Recoverable

Actual/Compensatory (medical expenses, loss of earning capacity, transportation, etc.)
Moral (physical suffering, mental anguish, serious anxiety) – commonly awarded in malpractice cases
Exemplary (to deter similar conduct) – frequently granted when gross negligence is shown
Temperate (when exact amount cannot be proved)
Attorney’s fees and litigation expenses
Interest at 6% per annum (2023 rules)

Death of the patient: heirs may recover civil indemnity (P100,000 as of 2024 jurisprudence), moral damages, exemplary damages, loss of earning capacity, and actual damages.

Procedure for Filing Claims

Civil Action
- File a complaint for damages in the Regional Trial Court (amount exceeds ₱2,000,000 in Metro Manila or ₱1,000,000 outside as of 2024 thresholds).
- Mandatory medical malpractice mediation under the Rules of Procedure for Medical Malpractice Cases (A.M. No. 23-08-08-SC, effective 2023).
- Discovery procedures include depositions of expert witnesses.
Criminal Action
- File with the Office of the Prosecutor (usually after medico-legal autopsy or investigation).
- Private crimes (slight physical injuries) require complaint by the offended party.
Administrative Action
- File verified complaint with the PRC Board of Medicine.
- Penalties range from reprimand to revocation of license.

Notable Supreme Court Decisions (2000–2025)

Ramos v. Court of Appeals (1999, reiterated in later cases) – landmark case on res ipsa loquitur in sponge-left-inside cases.
Nogales v. Capitol Medical Center (2006) – ostensible agency doctrine firmly established.
Professional Services, Inc. v. Agana (2007) – clarified captain-of-the-ship doctrine limits.
Li v. Soliman (2011) – informed consent as independent cause of action.
Jarcia v. People (2012) – pediatricians convicted of reckless imprudence for misdiagnosis of congenital dislocation.
Spouses Flores v. Spouses Pineda (2009) – cardiologist liable for failure to inform of risks of angiography.
Dr. Fernando Periquet v. Spouses Reyes (2014) – plastic surgeon liable for unsatisfactory rhinoplasty due to lack of informed consent.
Hipolito v. Court of Appeals (2020) – res ipsa loquitur applied in wrong-side surgery.
Recent 2023–2025 cases continue to emphasize expert testimony and patient-centered disclosure.

Conclusion

Medical malpractice litigation in the Philippines remains plaintiff-friendly compared to many jurisdictions, particularly with the application of res ipsa loquitur and ostensible agency. However, the requirement of expert testimony and the high burden of proving deviation from the national standard of care still make these cases difficult and expensive to prosecute. Physicians are well-advised to maintain meticulous documentation, obtain thorough informed consent, and secure adequate professional liability insurance. Patients who believe they have been victims of medical negligence should immediately seek legal counsel to preserve evidence and comply with prescription periods.