In Spouses Flores v. Spouses Pineda, the Supreme Court of the Philippines ruled that medical professionals have a duty to consider a patient’s known pre-existing conditions when deciding on and performing medical procedures. This means doctors must take extra precautions if a patient has a condition that increases the risk of complications. Failure to do so can result in liability for medical negligence if the patient suffers harm or death.

When Diabetes Complicates Diagnosis: Did Doctors’ Actions Lead to Patient’s Death?

This case arose from the death of Teresita Pineda, who consulted Dr. Fredelicto Flores regarding vaginal bleeding. Suspecting diabetes, Dr. Flores advised her to get a check-up. Upon further consultation, Dr. Flores and his wife, Dr. Felicisima Flores, proceeded with a D&C (dilation and curettage) operation, despite Teresita’s elevated blood sugar levels. Teresita’s condition worsened after the surgery, and she eventually died due to complications from Diabetes Mellitus Type II. Her family filed a suit for damages, alleging negligence in the handling of her medical needs.

The court’s decision hinged on the principles of medical negligence, which requires proof of duty, breach, injury, and proximate causation. The duty refers to the standard of care expected of a reasonably competent doctor under similar circumstances. A breach occurs when the physician fails to meet this standard. If this breach causes injury to the patient, the physician can be held liable for negligence. Proving these elements requires a “preponderance of evidence”, meaning it’s more likely than not that the physician’s actions fell below the accepted standard of care.

The respondents presented expert testimony objecting to the timing of the D&C operation, arguing that Teresita’s blood sugar should have been addressed first. Dr. Mercado, one of the expert witnesses, testified that based on the urinalysis and blood sugar level of the patient the D&C should have been postponed. He noted that the urinalysis, indicating spillage, together with a blood sugar level of 10.67, typically means diabetes mellitus. The key point, according to expert testimony, was that the D&C should have been postponed for a day or two.

The doctors claimed there was no proof that the patient was a diabetic, and blood sugar level does not necessarily mean a patient has diabetes because it was a “random blood sugar”. However, the court found that the doctors had suspected Teresita had diabetes as early as April 17. Also, the patient’s symptoms, such as general weakness, loss of appetite, frequent urination, and thirst—classic symptoms of diabetes—should have put the doctors on high alert.

The court emphasized that the doctors should have taken Teresita’s suspected diabetes into account as it could increase her risks. They cited the following statement from case law: “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.” If Teresita’s diabetes could cause the operation to be more risky then it was the duty of the physicians to make reasonable adequate preparations for the operation.

Considering the doctors’ negligence, the Court determined that the trial court and the appellate court’s decision to put the liability for Teresita’s death on both spouses was accurate. Although Dr. Fredelicto was mainly an anaesthesiologist, it was his job from the beginning to identify that the patient had diabetes, and for making the imprudent decision to proceed with the D&C operation despite his initial suspicion and first laboratory results. If Dr. Fredelicto was unqualified to treat diabetes then he should have likewise abstained from making a decision on the operation of the D&C because he was neither a obstetrician nor a gynecologist.

The Supreme Court upheld the actual damages, moral damages, and exemplary damages awarded by the lower courts. It also added an award for death indemnity, finding it was missed by the appellate court. Additionally, it reinstated attorney’s fees and costs of litigation against the petitioner spouses, acknowledging the protracted legal battle the respondents had to endure. These findings underscore the importance of medical practitioners considering the foreseeable risks and taking the necessary precautions to protect their patients’ well-being.

FAQs

What was the key issue in this case?	The central issue was whether the doctors’ decision to proceed with a D&C operation on a patient with suspected diabetes, without proper pre-operative evaluation and management of her condition, constituted medical negligence.
What is a D&C operation?	D&C stands for dilation and curettage, a gynecological procedure used to evaluate and treat abnormal vaginal bleeding. The cervix is dilated, and the uterine lining is scraped with a curet.
What are the elements of medical negligence?	The elements are duty (standard of care), breach (failure to meet the standard), injury (harm to the patient), and proximate causation (the breach directly caused the injury).
Why did the court find the doctors negligent?	The court found that the doctors suspected diabetes but did not wait for the full medical laboratory results, failed to account for all the symptoms presented, and proceeded with the D&C procedure which deviated from the standards observed by the medical profession.
What damages were awarded to the family?	The court awarded actual damages (hospital expenses), death indemnity, moral damages, exemplary damages, and attorney’s fees.
What is death indemnity?	Death indemnity is a sum of money awarded to the heirs of a person who dies as a result of a quasi-delict, such as medical negligence.
Why were exemplary damages awarded?	Exemplary damages were awarded as a way of example or correction for the public good, in light of the negligent medical practice.
What is the implication of this ruling for medical professionals?	The ruling reinforces the duty of medical professionals to consider a patient’s pre-existing conditions and take necessary precautions, failing which could result in medical malpractice suits.

This case serves as a reminder to medical professionals of their responsibility to provide appropriate care to patients, taking into account all relevant factors. It reinforces that pre-existing conditions need to be considered to ensure their well-being is being prioritized and that patient safety is prioritized above all else.

For inquiries regarding the application of this ruling to specific circumstances, please contact ASG Law through contact or via email at frontdesk@asglawpartners.com.

Disclaimer: This analysis is provided for informational purposes only and does not constitute legal advice. For specific legal guidance tailored to your situation, please consult with a qualified attorney.
Source: Spouses Flores v. Spouses Pineda, G.R. No. 158996, November 14, 2008