Pediatric IV Injury Medical Malpractice Claim (Philippines)

This is a practical legal explainer for the Philippine context. It’s not legal advice; for a specific case, consult counsel.

1) What counts as a “pediatric IV injury”?

Intravenous (IV) injuries in children commonly involve:

Infiltration (non-vesicant fluid leaks into tissue)
Extravasation (vesicant/irritant medication leaks, causing burns/necrosis)
Phlebitis and thrombophlebitis
Compartment syndrome, nerve/tendon injury, ischemia
Scarring/contractures and functional loss

High-risk infusates include vasoactive agents (e.g., dopamine, norepinephrine), hyperosmolar solutions (TPN, dextrose 10–50%), calcium, potassium, certain antibiotics, chemotherapy, and contrast media. Neonates/infants have fragile veins and limited communication—timely monitoring is critical.

2) Legal bases for a claim

A. Civil liability

Quasi-delict (Article 2176, Civil Code) Claimant must prove duty, breach, causation, and damages by a preponderance of evidence.
Culpa contractual (breach of contract) The hospital-patient and physician-patient relationships are contractual. A breach that causes injury (e.g., failure to meet accepted standards) can give rise to damages even without proving specific negligent acts, once breach is shown.
Vicarious and corporate liability
- Article 2180: Employers (hospitals) are liable for employees’ negligent acts within the scope of duties (e.g., nurses).
- Corporate negligence: Hospitals have a direct duty to ensure patient safety—credential doctors, adopt/implement policies, supervise staff, maintain adequate nurse-to-patient ratios, functioning pumps/alarms, and extravasation protocols.
- Apparent/ostensible agency: A hospital may be liable for negligent independent-contractor physicians if it held them out as its agents and the patient relied on that representation.

B. Criminal liability

Serious cases can be prosecuted as reckless imprudence resulting in physical injuries (Article 365, Revised Penal Code). Criminal proof is beyond reasonable doubt; civil liability may be pursued alongside or separately.

C. Administrative liability

Professional Regulation Commission (PRC) boards (Medicine/Nursing): discipline for gross negligence or unprofessional conduct.
Department of Health (DOH): hospital licensure/quality compliance issues.
Data Privacy Act: governs medical-record handling (see §10).

3) Elements you must prove (and how)

Duty & Standard of Care In pediatric IV therapy, the standard typically includes:
- Proper assessment (age, weight, vein quality, comorbidities)
- Appropriate cannula size and site selection (avoid joints, compromised limbs)
- Securement that stabilizes without tourniquet effect
- Pump programming and alarms set correctly
- Monitoring frequency proportionate to risk (e.g., more frequent in neonates/high-risk drugs)
- Documentation (site checks, infiltration scale, pain/behavior cues)
- Timely response to early signs (blanching, swelling, pain, coolness, color change)
- Extravasation protocol: stop infusion, aspirate residual drug, elevate, antidotes (e.g., hyaluronidase, phentolamine for vasopressors, warm/cold compress per agent), early plastic/vascular surgery referral
- Parental/guardian education on warning signs and call-light policy
Proof tool: Expert testimony (pediatrics, neonatology, anesthesiology, nursing) generally establishes the standard and breach. In obvious mishaps (e.g., severe necrosis from an unnoticed IV in a sedated infant, or alarms ignored), courts may apply res ipsa loquitur to infer negligence unless defendants adequately explain.
Breach Examples: failure to monitor/document, ignoring pump alarms, inappropriate site/gauge, lack of antidote availability, delayed escalation, falsified notes, or understaffing that foreseeably impairs monitoring.
Causation Link the breach to the injury’s mechanism and timeline (e.g., vasopressor extravasation → vasospasm/ischemia → necrosis). Use progress notes, photos, infiltration grading, medication properties, and expert analysis.
Damages See §8 for categories and quantification.

4) Who can you sue?

Hospital (corporate negligence; vicarious liability for nurses; ostensible agency for doctors presented as staff)
Attending/pediatric/anesthesia/ER doctor (direct negligence; failure to supervise/visit; improper orders)
Resident/house officer (direct negligence)
Nurses/IV therapists (negligent insertion/monitoring/escalation) Practical tip: Plead both quasi-delict (tort) and culpa contractual (contract) theories in the alternative against all responsible parties.

5) Informed consent in pediatrics

Parental/guardian consent is ordinarily required for IV therapy and high-risk infusions; however, emergencies allow treatment without prior consent.
Proper consent covers nature/purpose, material risks (including infiltration/extravasation), alternatives, and who will perform/monitor.
Assent from a mature minor may be sought ethically, but legal consent rests with the parent/guardian (outside narrow statutory exceptions).
Documentation matters: consent forms, discussions recorded in the chart, and interpreter use when needed. Lack of informed consent is an independent ground for liability even if the technical care met standards.

6) Evidence playbook (build this early)

Medical/technical

Complete chart (orders, MAR/eMAR, nursing notes, vitals, neurovascular checks)
Pump logs, alarm histories, device maintenance records
Medication details (drug, concentration, vesicant status), infusion rate, line route
IV site evidence: photos/time-stamped videos, infiltration grading, circumference measurements
Staffing: nurse assignment sheets, shift ratios, duty rosters
Policies: extravasation protocol, pediatric IV standards, escalation pathways
Incident reports, morbidity/mortality reviews, Root Cause Analysis (if any)

External

Receipts for all expenses; rehab/therapy records
School records (to show functional impact), psychological assessments
Witness statements (parents, watchers)

Digital & authenticity

Preserve metadata when possible; apply Rules on Electronic Evidence techniques (hashing, audit trails). Send preservation letters to the hospital to avoid spoliation.

7) Procedure, venue, and prescription

Where to file: Usually the Regional Trial Court (RTC) where any party resides or where the cause of action arose. Amounts in controversy and party configuration typically place med-mal cases in the RTC.
Barangay conciliation: Not required when a corporation (hospital) is a party or parties reside in different cities/municipalities; otherwise assess applicability.
Prescription (limitations):
- Quasi-delict: generally 4 years (often reckoned from discovery of the negligence/injury in med-mal settings).
- Written contract claims: up to 10 years.
- Minors: disability can toll prescription in certain contexts; do not rely on tolling—file early. Strategy: To be safe, prepare to file within 2–3 years of the incident or discovery, and plead both tort and contract.
Burden and proof: Civil cases require preponderance; expert testimony is key unless res ipsa suitably applies.

8) Damages you may recover

Actual/Compensatory
- Past and future medical costs (surgeries, debridement, grafting, scar revision, PT/OT, splints, counseling)
- Assistive devices, home modifications if needed
- Caregiver time/value; transportation; special education support
Moral For physical pain, mental anguish, anxiety, humiliation—available to the injured child; parents may claim their own moral damages when directly aggrieved.
Exemplary To deter gross negligence, systemic disregard (e.g., chronic understaffing, ignored protocols).
Temperate/Nominal When actual amounts are proven inadequate or some injury is shown but actual loss is hard to quantify.
Attorney’s fees and costs When defendants acted in bad faith or to equitably award litigation expenses.
Legal interest Courts apply legal interest (currently 6% per annum) on monetary awards from appropriate reckoning points (e.g., filing or finality, depending on the damage type).

Functional loss in children: quantify permanent disability, impact on activities of daily living, and probable future interventions. For very young victims with non-fatal injuries, courts often award substantial moral and actual damages rather than speculative “loss of earning capacity,” unless permanent impairment is clearly established.

9) Common breaches in pediatric IV cases (with causation notes)

Inadequate monitoring (e.g., long intervals; no checks during sleep/sedation): delayed detection → larger necrosis
Wrong site/gauge/securement: mechanical irritation → phlebitis/extravasation
Ignored alarms/parent reports: prolonged infusion into tissue → ischemia/compartment syndrome
No antidote or delayed protocol: missed therapeutic window → deeper injury
Understaffing / unsafe ratios: foreseeably prevents timely checks → systemic negligence
Poor documentation or altered notes: supports adverse inference; undermines defenses

10) Defenses you will face (and how to meet them)

Inherent risk: Argue risk-benefit was reasonable and injury can occur without negligence. Response: Show deviation from monitoring/escalation standards or policy.
No causation: Claim injury due to patient movement/disease. Response: Use timeline, pump data, and expert analysis to connect breach to outcome.
Independent contractor doctor: Hospital disclaims responsibility. Response: Plead ostensible agency and corporate negligence (credentialing, supervision).
Contributory negligence by watcher/parent: Response: In pediatrics, the duty of professional vigilance is non-delegable; parents lack training and cannot override alarms/policies.

11) Litigation roadmap (typical)

Days 0–7 (post-injury)

Get second opinion and early specialist consults (plastics/hand/vascular).
Photograph progression daily.
Send preservation letter to hospital (CCTV, device logs, chart); request certified true copies of records.

Weeks 2–8

Engage counsel/experts; chart review; obtain pump/maintenance logs and policies.
Issue demand letter (optional) to open settlement dialogue.

Filing

Complaint with detailed factual chronology, attach medical records/photos, and expert certification if available.
Plead tort and contract; implead hospital, attending/resident physicians, nursing staff (by name if identifiable), and John/Jane Does.

Pre-trial to trial

Judicial dispute resolution/mediation may occur.
Expert depositions, nurse practice standards, hospital policy admissions.
Consider res ipsa instruction if facts fit.

Judgment & enforcement

Monitor interest accrual; secure writ of execution upon finality; consider administrative complaints (PRC/DOH) in parallel for systemic fixes.

12) Practical standards checklist (what “reasonable care” looks like)

Before insertion

Verify order, drug properties (vesicant? pH/osmolarity), and need for central line vs peripheral
Choose smallest effective gauge; avoid high-risk sites; pre-check distal perfusion

During insertion

Aseptic technique; confirm flashback and patency without resistance
Secure with pediatric-appropriate dressings; avoid overly tight wraps

Infusion

Program rate limits & guardrails; ensure antidotes and supplies are on hand
Educate parent/guardian on signs: swelling, coolness, pallor, child irritability

Monitoring

Frequent site checks (documented), more often for high-risk drugs/neonates
Respond to any alarm/parent concern immediately; escalate per protocol

If extravasation suspected

Stop infusion; leave cannula in to aspirate residual agent (if indicated)
Notify physician; administer antidote per agent; elevate limb; apply warm/cold as appropriate
Consult surgery early if blistering/color change/compartment signs
Document everything; start injury log with photos and measurements

13) Settlement & ADR notes

Hospitals often engage in early settlement after internal investigation.
A reasonable settlement should cover past/future care, scarring management, therapy, school accommodations, and non-economic harms.
Confidentiality clauses are common—scrutinize scope and non-disparagement terms.

14) Compliance/risk-management tips for hospitals

Maintain up-to-date extravasation protocols and readily available antidote kits.
Enforce competency assessments for IV therapy in pediatrics (initial + periodic).
Monitor nurse-to-patient ratios; deploy float staff for surges.
Audit documentation quality and alarm response times; track IV injury rates.
Use family-centered care: invite parents to report subtle changes; never dismiss complaints.

15) Quick templates (start points)

A) Preservation letter (to hospital)

We represent [Child], injured by IV infiltration/extravasation on [date/time] at [unit]. Please preserve and do not alter or destroy: complete chart/eMAR, pump/alarm logs, device maintenance records, incident reports, staffing rosters, CCTV for [areas/times], and all policies/protocols related to pediatric IV therapy/extravasation. We request certified copies within 10 days.

B) Core allegations (complaint excerpt)

Defendants owed [Child] a duty of pediatric-appropriate IV care, including risk assessment, securement, close monitoring, timely response to alarms, and implementation of extravasation protocols. Defendants breached these duties by [specific acts/omissions]. As a direct and proximate result, [Child] suffered [injuries], requiring [care], resulting in [scarring/functional limits], causing actual, moral, and exemplary damages.

16) Key takeaways

Pediatric IV injuries are often preventable with proper selection, securement, and frequent monitoring—especially for high-risk infusates.
Philippine law supports liability under tort and contract, recognizes corporate hospital negligence and apparent authority, and allows res ipsa in the right facts.
Expert testimony is usually decisive; build the record early (photos, logs, policies, staffing).
File promptly (treat 4-year tort prescription as your practical outer limit; earlier is better), and plead in the alternative.
Remedies span actual, moral, exemplary damages, attorney’s fees, and interest—aim to fully fund the child’s long-term recovery.

If you tell me your role (parent/caregiver, plaintiff’s counsel, defense counsel, or hospital risk manager), I can tailor a one-page action plan with a timeline, issue list, and discovery requests specific to your situation.