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NOEL CASUMPANG v. NELSON CORTEJO

FACTS:

On April 22, 1988, Mrs. Jesusa Cortejo brought her 11-year-old son, Edmer Cortejo, to the Emergency Room of the San Juan de Dios Hospital (SJDH) due to difficulty in breathing, chest pain, stomach pain, and fever. Dr. Ramoncito Livelo initially attended to Edmer, who had developed a slight fever on April 20, 1988, which subsided after medication prescribed by their family doctor. Dr. Livelo took Edmer's vital signs, body temperature, and blood pressure, and diagnosed him with bronchopneumonia based on initial examinations and a chest x-ray. Edmer was given antibiotics.

Mrs. Cortejo, using her Fortune Care card, was referred to Dr. Noel Casumpang, a pediatrician accredited with Fortune Care. Dr. Casumpang confirmed the diagnosis of bronchopneumonia using a stethoscope but did not consider other symptoms indicating dengue fever, despite Edmer's mother expressing doubts and relaying Edmer's high fever, chest pain, stomach pain, throat irritation, and traces of blood in his sputum.

On April 23, 1988, after Edmer vomited blood streaked phlegm, Dr. Ruby Sanga-Miranda examined Edmer and found signs not typical of dengue fever but suspected the possibility of an alternate diagnosis due to Edmer’s continued symptoms. Dr. Miranda conducted a tourniquet test, which was negative, and several blood tests at Dr. Casumpang’s instruction confirmed Edmer had Dengue Hemorrhagic Fever. Attempts to transfer Edmer to the Intensive Care Unit were hindered due to lack of space, prompting a transfer to Makati Medical Center, where Edmer's condition was declared irreversible. Edmer died at 4:00 in the morning on April 24, 1988, with the death certificate citing hypovolemic shock and Dengue Hemorrhagic Fever Stage IV as causes.

Nelson Cortejo, Edmer's father, filed an action for damages against SJDH and the attending physicians, Dr. Casumpang and Dr. Miranda, alleging medical negligence. The Regional Trial Court (RTC) of Makati City found the petitioning doctors guilty of negligence and awarded damages to Nelson Cortejo, a decision later affirmed by the Court of Appeals (CA).

ISSUES:

  1. Whether or not the petitioning doctors had committed "inexcusable lack of precaution" in diagnosing and in treating the patient.

  2. Whether or not the petitioner hospital is solidarily liable with the petitioning doctors.

  3. Whether or not there is a causal connection between the petitioners' negligent act/omission and the patient's resulting death.

  4. Whether or not the lower courts erred in considering Dr. Rodolfo Tabangcora Jaudian as an expert witness.

RULING:

  1. Yes, Dr. Casumpang was found to have committed inexcusable lack of precaution in diagnosing and treating the patient, leading to a breach of duty. However, Dr. Miranda was not found liable for negligence.

  2. Yes, the petitioner hospital (San Juan de Dios Hospital) is solidarily liable with Dr. Casumpang based on the doctrine of apparent authority.

  3. Yes, there is a proven causal connection between Dr. Casumpang’s negligence and the patient's resulting death.

  4. No, the lower courts did not err in considering Dr. Rodolfo Tabangcora Jaudian as an expert witness. The Supreme Court agreed with the lower courts' finding that Dr. Jaudian possessed sufficient knowledge and experience.

PRINCIPLES:

  1. Medical Malpractice as a Specialized Area of Tort Law

    • Physicians are held to a standard of behavior that requires them to act as a reasonably prudent doctor would under similar circumstances.

    • The elements of medical negligence are: duty, breach, injury, and proximate causation.

  2. Doctrine of Apparent Authority (Agency by Estoppel)

    • Hospitals can be vicariously liable for the negligent acts of independent contractor physicians if the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude that the individual was an employee or agent of the hospital, and the patient relied on this representation.

  3. Standard of Care for Medical Professionals

    • Breach of duty occurs when a medical professional fails to meet the standards of care expected from reasonably competent doctors under similar circumstances.

    • Expert testimony is necessary to establish professional standards and to show whether a physician’s conduct fell below these standards.

  4. Qualifications of Expert Witnesses

    • The competence of an expert witness depends on their special knowledge, experience, and training relevant to the subject matter, regardless of their exact specialty.

  5. Liability without Employer-Employee Relationship

  • Control over the means and manner of a medical professional's work procedure is essential to establishing an employer-employee relationship. Absent such control, a hospital may still be liable under the doctrine of apparent authority.