FACTS:

In this case, respondents' 11-year old daughter, Angelica Soliman, was diagnosed with osteosarcoma, a highly malignant cancer of the bone. She underwent a biopsy and her right leg was amputated to remove the tumor. Chemotherapy was suggested as adjuvant treatment to eliminate any remaining cancer cells. Dr. Rubi Li, a medical oncologist, was referred to Angelica for the chemotherapy. Angelica was admitted to St. Luke's Medical Center (SLMC) and died just eleven days after the first cycle of chemotherapy. SLMC refused to release a death certificate without full payment, so respondents brought the cadaver to the PNP Crime Laboratory for examination. The Medico-Legal Report indicated the cause of death as hypovolemic shock secondary to multiple organ hemorrhages and Disseminated Intravascular Coagulation. The Certificate of Death issued by SLMC stated the cause of death as osteosarcoma, status post amputation of the leg, and status post chemotherapy. Respondents filed a damage suit against Dr. Li and other parties, alleging negligence and disregard for Angelica's safety. They claimed that Dr. Li falsely assured them of the side effects of chemotherapy, which led to their consent. Dr. Li denied negligence and explained that what happened to Angelica may be attributed to malignant tumor cells left behind after surgery. The medical records of Angelica were not produced in court, so the trial and appellate courts relied on testimonial evidence.

In another case, petitioner, a pediatric oncologist, recommended chemotherapy treatment for Angelica, a four-year-old child diagnosed with acute lymphoblastic leukemia. Petitioner informed respondents, Angelica's parents, that there was a 95% chance of healing if Angelica undergoes chemotherapy treatment. Petitioner also mentioned that the only side effects of the treatment were nausea, vomiting, and hair loss.

On July 27, 1993, Angelica was discharged from the hospital with instructions to be readmitted after two or three weeks for chemotherapy. On August 18, respondents brought Angelica back to the hospital for chemotherapy. Petitioner administered hydration fluids to Angelica and began administering three chemotherapy drugs - Cisplatin, Doxorubicin, and Cosmegen. Petitioner was supposedly assisted by two trainee doctors, but one of them denied having any participation in administering the drugs.

During the days of chemotherapy, respondents noticed reddish discoloration on Angelica's face, which extended to her neck. Petitioner dismissed it as merely the effect of the medicines. Angelica also experienced difficulty breathing, for which she was provided with oxygen inhalation apparatus. Respondents pleaded with petitioner to stop the chemotherapy on August 22, as Angelica could no longer bear the pain. Petitioner replied, "Dapat 15 Cosmegen pa iyan. Okay, let's observe. If pwede na, bigyan uli ng chemo." Respondents asked for permission to bring their child home but Angelica remained in confinement due to continued convulsions and loose bowel movement.

On August 24, respondents claimed that Angelica still suffered from convulsions, fever, and difficulty breathing. Petitioner insisted it was carpo-pedal spasm, not convulsions. Angelica continued to deteriorate, bleeding through the mouth, anus, and urine. She developed ulcers in her mouth and passed blood clots through her anus. Angelica bled continuously and required platelet transfusions, fresh whole blood, and other medication.

Angelica's condition worsened, and she had to have endotracheal and nasogastric tubes inserted into her weakened body. She continued to bleed and required more blood transfusions.

In yet another case, Angelica Santos, a nine-year-old girl, was admitted to St. Luke's Medical Center (SLMC) for the treatment of osteosarcoma. Angelica underwent surgery to amputate her right leg and subsequently received chemotherapy. Petitioner, Dr. Jacqueline Dominguez, was the attending physician.

According to respondents, after the chemotherapy session, Angelica experienced various complications. She vomited blood, her body turned black, and her skin started shredding. Her condition deteriorated rapidly, with difficulty in breathing, blood being suctioned from her stomach, and difficulty in urinating. Angelica eventually died from septicemia, or overwhelming infection.

Respondents also alleged that petitioner acted arrogantly and called them names while they were seeking the release of Angelica's cadaver from SLMC. They were also asked to sign a promissory note as they did not have cash to pay the hospital bill.

Dr. Jesusa Nieves-Vergara, a Medico-Legal Officer, conducted an autopsy on Angelica's cadaver and found hemorrhages and bleeding in multiple organs, which she attributed to the chemical agents in the drugs given to the victim.

Dr. Melinda Vergara Balmaceda, a Medical Specialist, testified that it is the physician's duty to inform the patient or their relatives of known side effects of procedures or therapeutic agents before obtaining consent.

Dr. Jaime Tamayo, the orthopaedic surgeon who operated on Angelica's lower extremity, explained that surgery alone is not enough to cure osteosarcoma and that chemotherapy is necessary, but carries risks and side effects.

ISSUES:

1. Whether petitioner Dr. Rubi Li can be held liable for failure to fully disclose serious side effects to the parents of the child patient

2. Whether petitioner was negligent in administering chemotherapy treatment to Angelica Soliman

RULING:

1. The Supreme Court held that there was adequate disclosure of material risks inherent in the chemotherapy procedure performed with the consent of Angelica's parents. Given the nature of the disease and the side effects initially disclosed, the severity of these effects could not be precisely determined.

2. The Supreme Court found that the alleged negligence in the administration of chemotherapy drugs to Angelica was not proven since the expert testimonies presented by the respondents were not from oncologists or cancer specialists. Thus, there was no proximate cause of the patient's death attributed to any lack of skill, knowledge, or professional competence on the part of Dr. Rubi Li.

PRINCIPLES:

1. Medical Negligence (Malpractice)

   • To prove medical negligence, a patient must demonstrate that a health care provider either failed to do something that a reasonably prudent healthcare provider would have done, or did something that a reasonably prudent provider would not have done; and that such failure or action caused injury to the patient.

2. Doctrine of Informed Consent

   • A physician must disclose what a reasonably prudent physician in the medical community would disclose about the risks of injury that might be incurred from a proposed treatment, enabling the patient to make an intelligent decision by balancing the risks against the probable benefits.

3. Scope of Disclosure

   • The patient must be adequately informed in nontechnical terms about what is at stake, the therapy alternatives, expected goals, and potential risks. However, there is recognition that not every potential risk needs to be disclosed, especially those that are relatively minor or well-known.

4. Standard of Care and Expert Testimony

   • The standard of care in medical malpractice cases must generally be established through expert testimony from qualified practitioners in the same field as the defendant.