Flores vs Pineda (GR No. 158996 November 14, 2008)

Spouses Flores vs Spouses Pineda
GR No. 158996 November 14, 2008

Facts: Teresita Pineda consulted her townmate Dr. Fredelicto Flores regarding her medical condition, complaining about general body weakness, loss of appetite, frequent urination and thirst, and on-and-off vaginal bleeding. After interviewing Teresita, Dr. Fredelicto advised her to go to United Doctors Medical Center (UDMC) in Quezon City for a general check-up the following week but the former did not. As for her other symptoms, he suspected that Teresita might be suffering from diabetes and told her to continue her medications. When her conditions persisted, she went to UDMC where Dr. Fredelictor check-up her and ordered her admission and further indicate on call D&C operation to be performed by his wife, Dra. Felicisima Flores, an Ob-Gyne. Laboratory tests were done on Teresita including internal vaginal examination, however, only the blood sugar and CBC results came out prior to operation which indicated of diabetes. D&C operations were still done and thereafter, Dra. Felicisima advised her that she can go home and continue to rest at home but Teresita opted otherwise. Two days after the operation, her condition worsened prompting further test to be done which resulted that Teresita have diabetes melitus type II. Insulin was administered but it might arrived late, she died.

Issue: Whether or not spouses petitioners are liable for medical negligence.

Held: Yes. A medical negligence case is a type of claim to redress a wrong committed by a medical professional, that caused a 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 cause.

Duty refers to the standard of behavior which imposes restrictions on one’s conduct. The standard in turn refers to the amount of competence associated with the proper discharge of the profession. A physician is expected to use at least the same level of case that any other reasonably competent doctor would use under the same circumstances. Breach of duty occurs when the physician fails to comply with those professional standards. If injury results to the patient as a result of this breach, the physician is answerable for negligence.

If a patient suffers from some disability that increases the magnitude of risk to him, that disability must be taken into account as long as it is or should have been known to the physician.

Stress, whether physical or emotional, is a factor that can aggravate diabetes; a D&C operation is a form of physical stress. Dr. Mendoza explained how surgical stress can aggravate the patient’s hyperglycemia: when stress occurs, the diabetic’s body, especially the autonomic system, reacts by secreting hormones which are counter-regulatory; she can have prolonged hyperglycemia which, if unchecked, could lead to death. Medical lecture further explains that if the blood sugar has become very high, the patient becomes comatose (diabetic coma). When this happens over several days, the body uses its own fats to produce energy, and the result is high level of waste products in the blood and urine.

These findings leads 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.

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