Dr. Cruz v. Agas, Jr. G.R. No. 204095 June 15, 2015

STATEMENT OF FACTS:

Dr. Jaime Cruz (Cruz)
engaged the services ofSt. Lukes Medical Center (SLMC)for a medical check-up. He underwent stool, urine, bloody and other body fluid tests. He was then sent to the Gastro-Enterology Department for a scheduled gastroscopy and colonoscopy. The specialist assigned to him was absent, so he gave the colonoscopy results to the attending female anesthesiologist. Thereafter he underwent the procedure, but when he woke up he felt something was wrong. He felt dizzy, cold clammy perspiration and pain in his abdomen, and when he tried to urinate he collapsed. He tried to consult the specialist who treated him, but was nowhere to be found. He then found his cardiologist

Dra. Agnes Del Rosario (Rosario)
who observed his condition and referred him to the surgical department which suspected that he had a hemorrhage. Dr. Cruz agreed, and upon waking up in the ICU, he found that 6-8 inches of his colon was missing. It was found out that there was a tear in the colonic wall which caused the bleeding. During his recuperation, despite the painkillers, he was in under so much pain. Dr. Cruz claimed that
Dr. FelicismoAgas (Agas)admitted that he was the one who conducted the colonoscopy procedure, but insisted that nothing was wrong. Dr. Cruz was discharged from SLMC, nevertheless he complained of having a hard time digesting his food, he had to be fed every 2 hours because he easily got full, and had fresh blood stools every time he moved his bowel, and had lost his appetite and had gastric acidity. He claimed that he was in good condition prior to the surgery.

Dr. Cruz filed a complaint for serious physical injuries, through reckless imprudence and medical malpractice against Dr. Agas before office of the prosecutor. Dr. Agas had countered that Dr. Cruz failed to prove the basic elements of reckless impudence or medical negligence. Furthermore, the procedure was conducted properly considering there did not manifest any significant adverse reaction or body resistance during the procedures. Finally he had added certifications and sworn statements by the: Assistant Medical Directior for Professional Services, the Director of the Institute of Digestive Diseases, the anesthesiologist, and the gospital nurse that testitfied that the intraperonial bleeding was immediately managed and cure. The office of the prosecutor however dismissed the case, Dr. Cruz appealed of the DOJ which likewise dismissed the case. The case was then elevated to the CA which also dismissed the case, hence this petition.

ISSUES: 1)
Whether Dr. Agas is guilty of reckless imprudence and medical negligence 2) Whether the doctrine of Res Ipsa Loquitur is applicable in the case at hand

RULING: 1)
NO. In the case at hand, Dr. Cruz failed to show that the DOJ gravely abused its discretion in finding that there was lack of probable cause and dismissing the complaint against Dr. Agas for Serious Physical Injuries through Reckless Imprudence and Medical Malpractice. A medical negligence case can prosper if the patient can present solid proof that the doctor, like in this case, either failed to do something which a reasonably prudent doctor would have done, or that he did something that a reasonably prudent doctor would not have done, and such failure or action caused injury to the patient. To successfully pursue this kind of case, a patient must only prove that a health care provider either failed to do something which a reasonably prudent health care provider would have done, or that he did something that a reasonably prudent provider would not have done; and that failure or action caused injury to the patient. Simply put, the elements are duty, breach, injury and proximate causation. In this case, Dr. Cruz has the burden of showing the negligence or recklessness of Dr. Agas. Although there is no dispute that Dr. Cruz sustained internal hemorrhage due to a tear in the serosa
of his sigmoid colon, he failed to show that it was caused by Dr. Agas’s negligent and reckless conduct of the colonoscopy procedure. In other words, Dr. Cruz failed to show and explain that particular negligent or reckless act or omission committed by Dr. Agas. Stated differently, Dr. Cruz did not demonstrate that there was “inexcusable lack of precaution” on the part of Dr. Agas. 2) NO. The requisites for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence of an injury; (2) the thing which caused the injury was under the control and management of the defendant; (3) the occurrence was such that in the ordinary course of things, would not have happened if those who had control or management used proper care; and (4) the absence of explanation by the defendant. Of the foregoing requisites, the most instrumental is the control and management of the thing which caused the injury. In this case, the Court agrees with Dr. Agas that his purported negligence in performing the colonoscopy on Dr. Cruz was not immediately apparent to a layman to justify the application of res ipsa loquitur doctrine. Dr. Agas was able to establish that the internal bleeding sustained by Dr. Cruz was due to the abnormal condition and configuration of his sigmoid colon which was beyond his control considering that the said condition could not be detected before a colonoscopic procedure. Dr. Agas adequately explained that no clinical findings, laboratory tests, or diagnostic imaging, such as x-rays, ultrasound or computed tomography (CT) scan of the abdomen, could have detected this condition prior to an endoscopic procedure.

On the other hand, in the present case, the correlation between petitioner’s injury, i.e., tear in the serosa of sigmoid colon, and the colonoscopy conducted by respondent to the petitioner clearly requires the presentation of an expert opinion considering that no perforation of the sigmoid colon was ever noted during the laparotomy. It cannot be overemphasized that the colonoscope inserted by the respondent only passed through the inside of petitioner’s sigmoid colon while the damaged tissue, i.e., serosa, which caused the bleeding, is located in the outermost layer of the colon. It is therefore impossible for the colonoscope to touch, scratch, or even tear the serosa since the said membrane is beyond reach of the colonoscope in the absence of perforation on the colon.

credit:

Jaivee Bermudez 

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