Facts: Respondents’ 11-year old daughter, Angelica Soliman, underwent a biopsy of the mass located in her lower extremity at the St. Luke’s Medical Center (SLMC). Results showed that she was suffering from osteosarcoma, osteoblastic type, a high-grade (highly malignant) cancer of the bone. Following this diagnosis, Angelica’s right leg was amputated and her doctor suggested that she undergo chemotherapy to eliminate any remaining cancer cells. She was then referred to herein petitioner Dr. Rubi Li, a medical oncologist.
On August 18, 1993, Angelica was admitted to SLMC, and died on September 1, 1993, just eleven days after the administration of the first cycle of the chemotherapy regimen. The post-mortem examination of the PNP Crime Laboratory indicated the cause of death as “Hypovolemic shock secondary to multiple organ hemorrhages and Disseminated Intravascular Coagulation.” SLMC issued its own Certificate of Death showing the cause of death as Osteosarcoma, Status Post AKA.
Respondents sued the petitioner (among others) and SLMC for damages, alleging negligence by their careless administration of the chemotherapy drugs, their failure to observe the essential precautions in detecting early the symptoms of fatal blood platelet decrease and failure to fully inform them of the possible side effects of its administration.
Petitioner denied having been negligent in administering the chemotherapy drugs to Angelica and asserted that she had fully explained to respondents how the chemotherapy will affect not only the cancer cells but also the patient’s normal body parts, including the lowering of white and red blood cells and platelets. She claimed that Angelica died of sepsis which is a complication of the cancer itself.
The trial court dismissed the complaint; CA concurred, but found petitioner negligent in failing to fully explain all the known side effects of chemotherapy which entitled respondents to their claim for damages.
Issues: Can the petitioner be held liable for failure to fully disclose serious side effects to the parents of the child patient who died while undergoing chemotherapy?
Ruling: From a purely ethical norm, the doctrine of informed consent evolved into a general principle of law that a physician has a duty to disclose what a reasonably prudent physician in the medical community in the exercise of reasonable care would disclose to his patient as to whatever grave risks of injury might be incurred from a proposed course of treatment, so that a patient, exercising ordinary care for his own welfare, and faced with a choice of undergoing the proposed treatment, or alternative treatment, or none at all, may intelligently exercise his judgment by reasonably balancing the probable risks against the probable benefits.
There are four essential elements a plaintiff must prove in a malpractice action based upon the doctrine of informed consent: “(1) the physician had a duty to disclose material risks; (2) he failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result of the failure to disclose, the patient consented to treatment she otherwise would not have consented to; and (4) plaintiff was injured by the proposed treatment.” The gravamen in an informed consent case requires the plaintiff to “point to significant undisclosed information relating to the treatment which would have altered her decision to undergo it.
Examining the evidence on record, we hold that there was adequate disclosure of material risks inherent in the chemotherapy procedure performed with the consent of Angelica’s parents. Respondents could not have been unaware in the course of initial treatment and amputation of Angelica’s lower extremity, that her immune system was already weak on account of the malignant tumor in her knee. When petitioner informed the respondents beforehand of the side effects of chemotherapy which includes lowered counts of white and red blood cells, decrease in blood platelets, possible kidney or heart damage and skin darkening, there is reasonable expectation on the part of the doctor that the respondents understood very well that the severity of these side effects will not be the same for all patients undergoing the procedure. In other words, by the nature of the disease itself, each patient’s reaction to the chemical agents even with pre-treatment laboratory tests cannot be precisely determined by the physician. That death can possibly result from complications of the treatment or the underlying cancer itself, immediately or sometime after the administration of chemotherapy drugs, is a risk that cannot be ruled out, as with most other major medical procedures, but such conclusion can be reasonably drawn from the general side effects of chemotherapy already disclosed.