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AT A GLANCE:
According to the case of ELPIDIO QUE VS. PHILIPPINE HEART CENTER, G.R. No. 268308, April 02, 2025, a medical professional has the duty to observe the standard of care and exercise the degree of skill, knowledge, and training ordinarily expected of other similarly trained medical professionals acting under the same circumstances. A breach of the accepted standard of care constitutes negligence or malpractice and renders the defendant liable for the resulting injury to his patient.
In May 1999, Quintin was brought to Dr. Aventura, Head of the Department of Surgery at the PHC, for medical consultation, due to an aneurysm in the aortic arch, which affected Quintin’s vocal cords.
Dr. Aventura advised Quintin to undergo an angiogram and aortogram at the PHC. In June 1999, Quintin underwent an angiogram and aortogram. Further, Dr. Aventura performed a three-vessel coronary aorta bypass surgery on Quintin.
He told the Que family that an open-method surgery would be performed on Quintin after a month, depending on his condition. However, some time in October 1999, Dr. Aventura recommended a new non-invasive treatment for an aneurysm, a “state-of-the-art” procedure that uses a custom-built gadget called a stent and is an alternative to open-method surgery. The Que family was hesitant at first but decided to push through with the stenting procedure after getting assurance from Dr. Aventura that the stenting procedure was “virtually risk-free.”
On the scheduled operation on February 14, 2000, Dr. Aventura introduced Dr. Verhoeven to the Que family as the Belgian doctor specializing in stenting procedures. At noon, Dr. Verhoeven came out of the operating room “looking sad and tired.” When the Que family inquired about the result of Quintin’s procedure, he responded that he could not complete the operation because he could not go through the bend/curve where the stent should have been deployed. After all, the device on hand was “faulty.”
Quintin never woke up and suffered a stroke after the incomplete stenting procedure. From February 15, 2000 until Quintin’s death on February 27, 2000, the Que family constantly communicated with Dr. Aventura, but the latter “turned his back” on them. Suspecting that human error caused the death of Quintin, the family had Quintin’s body autopsied by Dr. Raquel B. Del Rosario-Fortun (Dr. Fortun), who issued a Report stating that “Autopsy findings show multiple hemorrhagic infarcts of the brain due to thrombotic/atheromatous emboli probably arising from the aortic aneurysm and triggered by the catheterization. Based on available information on the circumstances surrounding death and the autopsy findings, death is due to complications of hypertensive atherosclerotic cardiovascular disease and the manner of death is therefore classified as natural.” The Que family also discovered that Dr. Verhoeven was not qualified or admitted to practice medicine in the Philippines.
Elpidio filed a Complaint for Damages against the PHC, FAMED, Medtronic, Dr. Aventura, and Dr. Verhoeven.
The issue at hand is whether or not the respondents herein were guilty of medical malpractice.
The Supreme Court Decides
Respondents are not liable for medical negligence.
Medical malpractice is a particular form of negligence that consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. We declared in Borromeo v. Family Care Hospital, Inc.:
A medical professional has the duty to observe the standard of care and exercise the degree of skill, knowledge, and training ordinarily expected of other similarly trained medical professionals acting under the same circumstances. A breach of the accepted standard of care constitutes negligence or malpractice and renders the defendant liable for the resulting injury to his patient.
Therefore, to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed to do something that a reasonably prudent physician or surgeon would have done or that they did something that a reasonably prudent physician or surgeon would not have done and that the failure or action caused injury to the patient. In a lack of informed consent litigation, the plaintiff must prove the following: (1) the physician had a duty to disclose material risks; (2) the physician failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result of the failure to disclose, the patient consented to the treatment they otherwise would not have consented to; and (4) the patient was injured by the proposed treatment.
It is without doubt that, as Quintin’s physician, Dr. Aventura has to use the same level of care that any reasonably competent doctor would use to treat Quintin’s condition.
The facts would show that Dr. Aventura informed the Que family, most especially Quintin, of the material risks inherent in the stenting procedure, and that includes death. Dr. Aventura also informed the family that if they decide to continue the operation, another physician will operate on Quintin because he does not specialize in stenting procedures. The trial court observed:
Dr. Aventura openly disclosed to the Que’s that he was not a specialist in stenting procedure and it would be a foreign doctor specializing in stenting to do the job on Quintin.
In contrast, Dr. Aventura was able to clearly explain the limits of his participation in the stenting procedure done on Quintin Que. He in fact, does not deny that the use of the stent involved risk but vigorously denied telling the Ques that the procedure was “virtually risk-free.” This was the reason why he made it a point to explain the procedure to the Que family and the coming of foreign specialist or expert to do the procedure since he was not trained to do it. Such fact was known to the Ques right from the start. The records show that Dr. Aventura has the necessary training and skill to practice his chosen field. Elpidio did not rebut the evidence presented by Dr. Aventura regarding his qualifications – that he has been a physician for decades at the time Elpidio brought his father to him; that the doctor has had various medical trainings here and abroad; he was the first Director of the PHC and he specializes in cardiothoracic and vascular surgery. Jurisprudence provides that when the qualifications of a physician are admitted, there is a presumption that in proper cases, he takes the necessary precaution and employs the best of his knowledge and skill in attending to his clients. Even Dr. Figueroa declared that Dr. Aventura at all times followed standard operating procedure and exercise his sound judgment that are supported by medical science.
To be sure, Quintin signed the Consent for Endovascular Stenting and the Consent to Operation, Administration of Anesthesia, and the Rendering of Other Medical Services. His signature appeared in these documents. On the other hand, Elpidio did not categorically dispute the veracity of Quintin’s signature. Absent proof that Quintin’s signature was forged or Quintin was incapable of giving intelligent consent when he signed the two documents, we upheld the validity of the consent forms. Accordingly, the lack of signatures of witnesses is irrelevant.
Furthermore, expert witnesses Dr. Tuazon and Dr. Figueroa, both experts in the field of cardiovascular and endovascular surgery, testified that stenting would still be the sound medical advice and treatment for Quintin rather than the open-method surgery, considering his underlying condition. As to Dr. Verhoeven’ s authority to operate on Quintin, Section 5 of Presidential Decree No. 673, the PHC allows the hospital to “invite foreign heart specialists and similar experts in the various medical fields to train the personnel or trainees or residents of the PHC.” Dr. Ludgerio D. Torres, former director of the PHC, issued a Certification dated January 25, 2013, listing Dr. Verhoeven as one of the experts in his field to have operated in the PHC.
Moreover, the doctrine of res ipsa loquitor, translated as “the thing speaks for itself,” does not apply in this case. The doctrine requires the concurrence of the following elements: (1) the accident was of a kind that does not ordinarily occur unless someone is negligent; (2) the instrumentality or agency which caused the injury was under the exclusive control of the person charged with negligence; and (3) the injury suffered must not have been due to any voluntary action or contribution from the injured person. The cause of Quintin’s death was not due to the negligence of Dr. Aventura but was due to one of the inherent risks of the stenting procedure.
Finally, we cannot subscribe to Elpidio’s claim that the “faulty” stent hastened the death of his father. Bare allegations are not proof. The trial court noted that other than the testimonies of Elpidio and his sister, Elisa Que, the records do not show how faulty the stent used on Quintin was.
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