Medical malpractice is the failure of a physician or surgeon to apply to the practice of medicine that degree of care and skill which is ordinarily employed by the profession, under similar conditions, and in like surrounding circumstances. To be liable for this particular form of negligence, the act or failure to act on the part of the physician must be the immediate and proximate cause of the injury to the patient. If the proximate cause of the injury is the patient’s negligence the physician is not liable. But if patient’s negligence is merely contributory, the doctor may still be liable for damages although the court may mitigate the award. This rule is illustrated in this case of Rina.
Rina was three months pregnant when she was admitted in a hospital upon advice of her physician, Dr. Carla, due to vaginal bleeding. The pelvic sonogram conducted on Rina revealed the fetus’ weak cardiac pulsation. A repeat pelvic sonogram the following day showed that aside from the fetus’ weak cardiac pulsation, there was no fetal movement. Due to persistent and profuse vaginal bleeding, Dr. Carla advised Rina to undergo Dilatation and Curettage Procedure (D&C) or “raspa”. So the following day, Dr. Carla performed the D&C procedure.
The day after the D&C, Rina told Dr. Carla that she wanted to be discharged from the hospital already. Due to her insistence, Dr. Carla agreed but in her discharge sheet Dr. Carla gave instructions that she return after four days for follow-up evaluation.
But Rina did not return. One and a half months later, she was again brought to the hospital due to vomiting and severe abdominal pains. One of the three hospital doctors who examined Rina told her that she had a dead fetus in her womb with massive intra-abdominal hemorrhage and a ruptured uterus. Thus Rina had to undergo hysterectomy and as a result she had no more chance to bear a child.
Thereafter, Rina and her husband filed a complaint for gross negligence and malpractice against Dr. Carla before the Professional Regulations Commission. For her defense Dr. Carla contended that it was Rina’s gross negligence and/or omission in insisting to be discharged against doctor’s advice and her unjustified failure to return for check up as directed that contributed to her life threatening condition one and half months later. Dr. Carla argued that whether or not a D&C procedure was done by her or any other doctor, there would be no difference at all because at any stage of gestation before the term, the uterus would rupture just the same. So it was not the proximate cause of Rina’s ruptured uterus. Was Dr. Carla correct?
Yes. Proximate cause is that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury and without which the result would not have occurred. Contributory negligence on the other hand is the act or omission amounting to want of ordinary care on the part of the person injured, which, concurring with the defendant’s negligence, causes the injury.
In this case, it is clear that the D&C procedure was conducted in accordance with the standard practice, with the same level of care that any reasonably competent doctor would use to treat a condition under the same circumstances and that there was nothing irregular in the way Dr. Carla treated Rina.
However, Rina did not return after the D&C for follow-up evaluation in defiance of Dr. Carla’s advice. She omitted the diligence required by the circumstances which could have avoided the injury. Such omission played a substantial part in bringing about her injury. Had Rina returned, Dr. Carla could have conducted the proper medical tests and procedure necessary to determine Rina’s health condition and applied the corresponding treatment which could have prevented the rupture of Rina’s uterus. The D&C procedure having been conducted in accordance with the standard medical practice, it is clear that the immediate and proximate cause of Rina’s injury was her own omission when she did not return for a follow-up check up in defiance of Dr. Carla’s order. Rina’s omission is the proximate cause of he own injury and not merely contributory negligence on her part thus she cannot recover damages from the injury. Dr. Carla should be exonerated (Lasam vs. Spouse Ramolete, G.R. 159132, December 18, 2008).
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