In the Philippines, medical professionals and hospitals share a responsibility for patient safety, but the lines of liability can blur. This case clarifies when a hospital can be held responsible for a doctor’s negligence, even if the doctor isn’t a direct employee. The Supreme Court’s decision emphasizes that if a hospital presents a doctor as its agent and a patient relies on that representation, the hospital can be held liable for the doctor’s mistakes. This ruling protects patients by ensuring that hospitals are accountable for the quality of care provided within their facilities, even by affiliated physicians.

When Trust Fails: Can a Hospital Be Liable for a Doctor’s Misdiagnosis?

The case of Noel Casumpang, Ruby Sanga-Miranda and San Juan de Dios Hospital vs. Nelson Cortejo revolves around the tragic death of Edmer Cortejo, an 11-year-old boy, due to a misdiagnosis. Edmer was initially diagnosed with bronchopneumonia by Dr. Noel Casumpang at San Juan de Dios Hospital (SJDH). Despite Edmer’s symptoms suggesting otherwise, Dr. Casumpang stuck to his initial diagnosis, which led to delayed treatment for what turned out to be Dengue Hemorrhagic Fever. Nelson Cortejo, Edmer’s father, filed a case against SJDH and the attending physicians, arguing that their negligence led to his son’s death.

The Regional Trial Court (RTC) and the Court of Appeals (CA) both ruled in favor of the respondent, Nelson Cortejo, finding the doctors negligent and holding SJDH solidarily liable. The Supreme Court, however, modified the lower courts’ decisions. The Supreme Court focused on determining whether the petitioning doctors had committed an ‘inexcusable lack of precaution’ in diagnosing and treating the patient; whether the petitioner hospital is solidarily liable with the petitioning doctors; whether there is a causal connection between the petitioners’ negligent act/omission and the patient’s resulting death; and whether the lower courts erred in considering Dr. Rodolfo Tabangcora Jaudian as an expert witness.

The Supreme Court’s analysis hinged on the principles of medical malpractice. To establish medical negligence, the plaintiff must prove four elements: duty, breach, injury, and proximate causation. Duty refers to the standard of care a reasonably competent doctor would provide under similar circumstances. Breach occurs when the doctor fails to meet this standard. Injury is the harm suffered by the patient, and proximate causation establishes the direct link between the doctor’s negligence and the patient’s injury. In this case, the Court needed to determine if Dr. Casumpang and Dr. Miranda had a duty of care towards Edmer, whether they breached that duty, whether Edmer suffered injury as a result, and if that injury was directly caused by the doctors’ actions.

Regarding Dr. Casumpang, the Court found that he breached his duty of care. Despite multiple symptoms indicating dengue fever, Dr. Casumpang clung to his initial diagnosis of bronchopneumonia and failed to order timely and appropriate tests. As the Court noted, Dr. Casumpang “selectively appreciated some, and not all of the symptoms; worse, he casually ignored the pieces of information that could have been material in detecting dengue fever.” This delay in diagnosis and treatment constituted negligence. The Court emphasized that while a wrong diagnosis itself isn’t necessarily medical malpractice, it becomes evidence of negligence when it results from negligent conduct, such as failing to consider medical history or order appropriate tests.

The Court then addressed the liability of Dr. Miranda, the resident physician. While Dr. Miranda also initially concurred with the bronchopneumonia diagnosis, the Court differentiated her role and responsibility from that of Dr. Casumpang, the attending physician. Because he/she exercises a supervisory role over the resident, and is ultimately responsible for the diagnosis and treatment of the patient, the standards applicable to and the liability of the resident for medical malpractice is theoretically less than that of the attending physician. The Court acknowledged that as a resident, Dr. Miranda operated under the supervision of Dr. Casumpang. More importantly, Dr. Miranda’s medical assistance led to the finding of dengue fever. Thus, the Court found Dr. Miranda not liable for medical negligence.

Turning to the hospital’s liability, the Court rejected the argument that Dr. Casumpang and Dr. Miranda were merely independent contractors. Instead, it invoked the doctrine of apparent authority, also known as agency by estoppel. This doctrine states that a hospital can be held liable for the negligence of an independent contractor if the hospital acts in a way that leads a reasonable person to believe that the contractor is an employee or agent of the hospital. For instance, if the patient relied upon the hospital to provide care and treatment, rather than upon a specific physician. In this case, because Dr. Casumpang was presented as an accredited member of Fortune Care and as a member of its medical staff, SJDH was solidarity liable for negligent medical practice.

The Court also addressed the competence of Dr. Jaudian as an expert witness. The petitioners challenged his qualifications because he specialized in pathology, not pediatrics. The Court, however, upheld the lower courts’ decision to admit his testimony, emphasizing that the crucial factor is the expert’s knowledge of the relevant subject matter, rather than their specific specialty. Because Dr. Jaudian had attended numerous pediatric seminars, had practical experience with pediatric cases, and had handled many dengue-related cases, the Court found him competent to testify on the standard of care in dengue fever cases.

In conclusion, the Supreme Court partly granted the petitions, finding Dr. Casumpang and San Juan de Dios Hospital solidarily liable for negligent medical practice. The Court underscored the importance of timely and accurate diagnosis, the appropriate standard of care, and the hospital’s responsibility for the actions of its apparent agents. This ruling reinforces the need for medical professionals to diligently consider all possible diagnoses and for hospitals to be accountable for the quality of care provided within their facilities.

FAQs

What was the key issue in this case?	The key issue was whether the doctors and the hospital were negligent in diagnosing and treating Edmer Cortejo, leading to his death from Dengue Hemorrhagic Fever.
What is medical malpractice?	Medical malpractice occurs when a healthcare professional fails to meet the standards of their profession, causing injury or death to a patient. It involves proving duty, breach, injury, and causation.
What is the ‘doctrine of apparent authority’?	The ‘doctrine of apparent authority’ holds a hospital liable for the negligence of independent contractors (like doctors) if the hospital leads a patient to reasonably believe the contractor is an employee or agent of the hospital.
How did the Court assess Dr. Casumpang’s actions?	The Court found Dr. Casumpang negligent for clinging to his initial diagnosis of bronchopneumonia despite symptoms suggesting dengue fever. He failed to order appropriate tests, leading to delayed treatment.
Why was Dr. Miranda not found liable?	Dr. Miranda, as a resident physician, operated under Dr. Casumpang’s supervision, and because she was the one who eventually correctly determined that it was dengue, the court did not hold her liable.
Why was the hospital held liable?	The hospital was held liable under the doctrine of apparent authority because it presented Dr. Casumpang as part of its medical staff, leading the patient to rely on the hospital for care.
What was the significance of Dr. Jaudian’s testimony?	Dr. Jaudian’s testimony established the standard of care for diagnosing and treating dengue fever. His expertise helped demonstrate that the doctors’ actions fell below that standard.
What factors determine if a hospital is liable for a doctor’s negligence?	The hospital’s manifestations (how it presents the doctor) and the patient’s reliance on those manifestations are key factors. If the hospital leads the patient to believe the doctor is an agent, it can be held liable.

This case highlights the critical importance of accurate and timely diagnoses in medical practice, especially when symptoms suggest multiple possibilities. It also serves as a reminder of the shared responsibility between doctors and hospitals in ensuring patient safety and delivering quality care. The application of the doctrine of apparent authority underscores the need for hospitals to carefully manage how they present their affiliated physicians to the public.

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: Noel Casumpang, Ruby Sanga-Miranda And San Juan De Dios Hospital, Vs. Nelson Cortejo, G.R. No. 171217, March 11, 2015