REACTION PAPERS

MEDICAL MALPRACTICE
LABORATORY ERRORS THAT LEAD TO LAWSUIT
ABORTION: A PHILOSOPHICAL DEBATE
ASSISTED SUICIDE: HARRIET SCOTT’S STORY
G.R. No. 171127: March 11, 2015 NOEL CASUMPANG, RUBY SANGA-
MIRANDA and SAN JUAN DEDIOS HOSPITAL, Petitioners, vs. NELSON
CORTEJO, Respondent.

ISRAHIA JOY COPIOCO

BSMT2A
 1. Medical Malpractice
Medical malpractice is defined as any act or omission by a physician during treatment
of a patient that deviates from accepted norms of practice in the medical community and causes
an injury to the patient. Medical malpractice is a specific subset of tort law that deals with
professional negligence. “Tort” is the Norman word for “wrong,” and tort law is a body of law
that creates and provides remedies for civil wrongs that are distinct from contractual duties or
criminal wrongs. “Negligence” is generally defined as conduct that falls short of a standard; the
most commonly used standard in tort law is that of a so-called “reasonable person.” The
reasonable person standard is a legal fiction, created so the law can have a reference standard of
reasoned conduct that a person in similar circumstances would do, or not do, in order to protect
another person from a foreseeable risk of harm.
Lawsuits alleging medical malpractice are generally filed in a state trial court. Such
trial courts are said to have jurisdiction over medical malpractice cases, which is the legal
authority to hear and decide the case. Legal rules guide venue and jurisdiction in each state.
Some towns may be located in two judicial districts, thereby giving the aggrieved patient an
option to file suit in more than one trial court. If the malpractice claim involves the federal
government acting through a federally funded clinic or a Veteran’s Administration facility, then
the action is filed in a federal district court. Each state has at least one such federal district court.
Federal courts may also be appropriate for filing malpractice claims where a complete diversity
of state citizenship exists, i.e., if the parties to the litigation are from different states, or if a
federal question is invoked, such as violation of a fundamental constitutional right during the
allegedly negligent conduct.
Under limited circumstances, a medical malpractice case may be filed or moved to a federal
court. This can occur if the underlying case invokes a federal question or federal constitutional
issue or if the parties live in different states. The federal equivalent of state trial courts consists of
a system of 94 United States district courts; at least one is located in each state. Like state courts,
U.S. district courts have a judge and a jury panel that hear the case. While the rules that apply to
legal procedures in U.S. district courts are uniquely federal, they are similar to state rules of legal
procedure. The substantive law applied by federal courts to resolve legal disputes, ie, statutory
law or legal precedent, is derived from the state in which the district court is located. Thus, if a
medical malpractice case is tried in federal court, state malpractice law still applies, with federal
procedural rules of jurisprudence. Procedural rules have to do with legal housekeeping functions
that guide the litigation process. In the United States, the patient alleging medical malpractice
must generally four elements or legal requirements to make out a successful claim of medical
malpractice. These elements include: (1) the existence of a legal duty on the part of the doctor to
provide care or treatment to the patient; (2) a breach of this duty by a failure of the treating
doctor to adhere to the standards of the profession; (3) a causal relationship between such breach
of duty and injury to the patient; and (4) the existence of damages that flow from the injury such
that the legal system can provide redress.
Increasing medical malpractice litigation relates to increased medical expenditures,
because of increased resource utilization from defensive practices to avoid claims. The concern
has been raised that physician may settle cases to avoid the nuisance, harassment, and financial
risk inherent in jury trials. Monetary payments, even if through pretrial settlement, are usually
reported to a national practitioner databank and to state medical licensing boards and medical
societies. While the goals of such reporting are related to ensuring quality of care, the advantages
of these mechanisms remain unclear. The role of lawsuits and pretrial settlement in contributing
to the large costs of the U.S. healthcare system are a subject of an intense national debate.

For many physicians, the deposition under oath is the most vivid encounter with the legal system
during a medical malpractice suit. In law, a deposition is a witness testimony that is given under
oath, and recorded for use in court at a later date. In the United States, a deposition is part of the
discovery process by which litigants gather information in preparation for trial. Federal Rules of
Civil Procedure and their corresponding state counterparts govern the taking of testimony by
deposition. Typically, the patient’s attorney will file notice with the attorney defending the
doctor that a deposition is needed. All parties agree upon a convenient time and place. In many
cases, the place is the doctor’s office, preferred by the defense lawyers since physicians are
comfortable in their offices, and have books and other reference materials available, in case they
are needed. A deposition begins with a court reporter administering the same oath or affirmation
that the party being deposed would take if the testimony were to be in court, before a judge and
jury. Then a verbatim stenographic record of all that is said during the deposition is taken, just
like a recording in court. A written record of the testimony, or a video record, is then available to
all parties in the litigation.

Medical malpractice occurs when a health care professional or provider neglects to

provide appropriate treatment, omits to take an appropriate action, or gives substandard treatment
that causes harm, injury, or death to a patient. A malpractice suit can have a devastating impact
on a practitioner's professional and personal life. The physician's reaction to this event is
profound, affecting his own life-style and that of family, colleagues, and patients.
 2. LABORATORY ERRORS THAT LEAD TO LAWSUIT
All providers know medical errors create a serious public health problem that poses a
substantial threat to patient safety.  Yet, one of the most challenging unanswered questions is
"What constitutes a medical error?" The answer to this basic question has not been clearly
established. Due to unclear definitions, “medical errors” are difficult to scientifically measure. A
lack of standardized nomenclature and overlapping definitions of medical errors has hindered
data analysis, synthesis, and evaluation. laboratories have a major impact on patient safety as 80–
90 % of all the diagnosis are made on the basis of laboratory tests. Laboratory errors have a
reported frequency of 0.012–0.6 % of all test results. Patient safety is a managerial issue which
can be enhanced by implementing active system to identify and monitor quality failures. This
can be facilitated by reactive method which includes incident reporting followed by root cause
analysis. This leads to identification and correction of weaknesses in policies and procedures in
the system. Another way is proactive method like Failure Mode and Effect Analysis. In this
focus is on entire examination process, anticipating major adverse events and pre-emptively
prevent them from occurring. It is used for prospective risk analysis of high-risk processes to
reduce the chance of errors in the laboratory and other patient care areas.
Health care professionals experience profound psychological effects such as anger, guilt,
inadequacy, depression, and suicide due to real or perceived errors. The threat of impending
legal action may compound these feelings. This can also lead to a loss of clinical confidence.
Clinicians equate errors with failure, with a breach of public trust, and with harming patients
despite their mandate to “first do no harm. “Fear of punishment makes healthcare professionals
reluctant to report errors. While they fear for patients’ safety, they also dread disciplinary action,
including the fear of losing their jobs if they report an incident. Unfortunately, failing to report
contributes to the likelihood of serious patient harm. Many healthcare institutions have rigid
policies in place that also create an adversarial environment.  This can cause staff to hesitate to
report an error, minimize the problem, or even fail to document the issue. These actions or lack
thereof can contribute to an evolving cycle of medical errors.  When these errors come to light,
they can tarnish the reputation of the healthcare institution and the workers.  Some experts hold
that the term “error” is excessively negative, antagonistic and perpetuates a culture of blame. A
professional whose confidence and morale has been damaged as a result of an error may work
less effectively and may abandon a career in medicine. Many experts suggest the term “error”
should not be used at all. Due to the negative connotation, it is prudent to limit the use of the
term “error” when documenting in the public medical record. However, adverse patient
outcomes may occur because of errors; to delete the term obscures the goal of preventing and
managing its causes and effects. 
Errors, no matter the nomenclature, typically occur from the convergence of multiple
contributing factors. Public and legislative intolerance for medical errors typically illustrates a
lack of understanding that some errors may not, in fact, be preventable with current technology
or the resources available to the practitioner. Human factors are always a problem, and
identifying errors permits improvement strategies to be undertaken. In particular, blaming or
punishing individuals for errors due to systemic causes does not address the causes nor prevent a
repetition of the error. The trend is for patient safety experts to focus on improving the safety of
health care systems to reduce the probability of errors and mitigate their effects rather than focus
on an individual’s actions. Errors represent an opportunity for constructive changes and
improved education in health care delivery.
Governmental, legal, and medical institutions must work collaboratively to remove the culture of
blame while retaining accountability. When this challenge is met, health care institutions will not
be constrained from measuring targets for process improvement, including all errors, even with
adverse outcomes. Healthcare providers want to improve outcomes while reducing the risk of
patient harm. Despite provider best efforts, medical error rates remain high with significant
disability and death. Preventable medical errors contribute substantially to healthcare costs,
including higher health insurance costs per person expenses. Only by health professionals
working together will the cost and injury associated with medical errors be mitigated.
Medical laboratories play a pivotal role in the diagnosis and management of patient.
With approximately 60–70 % of medical decisions related to diagnosis and treatment involve
laboratories; quality failures in laboratory medicine have potential to jeopardize patient safety.
Hence, laboratories have been at the forefront to enhance patient safety. With increased
automation in manual processes occurring in laboratories, reduction has been observed in quality
failure rate in last 10 years. However, it mainly focused on the analytical phase. Hence, in
addition to advancement in technology, there is requirement for vigilance among laboratory
personnel regarding prompt reporting of possible quality failures followed by investigations.
Such systemic approach seeking identification of weakness in total testing process followed by
correction in policies and procedures require openness among laboratory staff, rather than to
apportion blame to individual staff members. Hence, it is important for all laboratories to identify
quality failures, classify it by cause (i.e. pre-analytical, analytical, post-analytical) followed by
grading the seriousness of quality failure. Classifying the quality failure directs the attention to
the step in total testing process requiring scrutiny and is useful for monitoring the quality
performance and grading helps in prioritizing the corrective action.
3.ABORTION: A PHILOSOPHICAL DEBATE

Philosophical debate about the ethics of abortion has reached stalemate on two key
issues. First, the claim that fetuses have moral standing that entitles them to protections for their
lives has been neither convincingly established nor refuted. Second, the question of a pregnant
woman's obligation to allow the gestating fetus the use of her body has not been resolved. Both
issues are deadlocked because philosophers addressing them invariably rely on intuitions and
analogies, and such arguments have weaknesses that make them unfit for resolving the abortion
issue. Analogical arguments work by building a kind of consensus, and such a consensus is
virtually unimaginable because (1) intuitions are revisable, and in the abortion debate there is
great motive to revise them, (2) one's position on abortion influences judgments about other
issues, making it difficult to leverage intuitions about other ethical questions into changing
peoples' minds about abortion, and (3) the extent of shared values in the abortion debate is
overstated. Arguments by analogy rely on an assumption of the commensurability of moral
worldviews. But the abortion debate is currently unfolding in a context of genuinely
incommensurable moral worldviews. The article ends by arguing that the default position must
be to permit abortion as a consequence of the freedom of conscience protected in liberal
societies.
Abortion is a philosophically interesting issue because both sides seem so certain of their
conclusions, yet the issue is at the same time clearly a derivative one. It is also highly political, and
needs to be seen within the context of the growth of the women's movement. A philosophical
overview of the issue in section 1 construes the central claims of the pro-choice and anti-abortion
positions as moral and conceptual constructions, which extend everyday moral thinking into the area
of abortion. It notes the interesting relation between such constructions and other arguments about
abortion, and how this is responsible for their social and historical specificity. Section 2 defends the
pro-choice position as a victory of moral sensitivity over linguistic guile. Section 3 situates the
argument within the politics of feminism, and recognizes the limited contribution which philosophy is
able to make.
Abortion is the termination of a pregnancy. The kind of abortion that is controversial is induced
abortion, in which the embryo or fetus is prematurely removed or caused to be expelled. Induced
abortions are commonly voluntary (elective). Induced, elective abortion is in contrast to
spontaneous abortion, or miscarriage, in which the embryo or fetus is involuntarily expelled
because of accidental trauma or disease.
The two chief positions on the morality of abortion can be called the “pro-life”
position and the “pro-choice” position. The basic pro-life position holds that induced abortions
are morally impermissible (morally wrong, morally prohibited). The basic pro-choice position
holds that induced abortions are morally permissible (morally allowable, not morally wrong).
All humans develop from a zygote which is formed when a human sperm fertilizes a human
ovum. The zygote undergoes a process of cellular multiplication as it slowly moves through the
fallopian tube to be implanted in the uterine wall. The zygote is called a conceptus during the
process of fertilization. This process takes place between seven (7) to nine (9) days. The
embryonic stage begins on the third week after fertilization and continues until the eighth week
of pregnancy. By the end of the eighth week, the embryo is called a fetus because it has
sufficiently developed and begins to look human. At this stage, brain waves can be monitored.
Quickening which occurs by about the eighteenth week is another milestone in the developing
pregnancy.

When a fetus starts living can’t be determined but according to facts, the heart beats
after 16-25 days and the brain works after 40 days. Some people think that after conception you
become a person whereas others think otherwise. But suppose you have 50 pills on a table and
one is poisonous. Would you randomly swallow a pill not caring if it’s is a normal pill or poison?
No, you value your life so why not a fetus? The fetus could be alive and abortion could be
murder. Because abortion is legal, whether or not the fetus lives to be born depends on people
and whether the unborn are protected by rights.Pro-Choice believes women have the freedom to
choose abortion. This group believes abortion is a personally protected choice. They think if
abortion is illegal, it will increase in “back alley” abortions, or self-abortions or worse, the
mother may kill the baby, as some young mothers have. They believe the fetus is a “mass of
tissue” (Wilke, 1) instead of human. Pro-choice believes personhood begins after birth. They
think kids should be wanted and reducing unwanted children will lower child abuse. They also
believe the world is way overpopulated. But since when does a person’s life depend on the
amount of people in the world.
 4. ASSISTED SUICIDE: HARRIET SCOTT’S STORY

Harriet Robinson Scott could not have known that her legal fight for freedom, first
started when she was about thirty in 1846, would eventually contribute to civil war and the end
of slavery in America. Her decision to file a suit for freedom and to stay with it until its final
conclusion were acts of high courage and determination. These traits would give strength to the
long and difficult struggle for civil rights that Harriet Robinson Scott’s descendants would
endure for the next hundred years.
Assisted Suicide: Harry Scott’s Story followed a terminally ill woman as she prepared
for the end of her life. Scott was a woman who led a life of independence and was highly
pragmatic about her death. At the start of the interview, she had arranged nearly all aspects of the
end of her life. That is, all aspects that she was legally allowed to arrange. Prior to having
endured intolerable pain, Scott wished she could call on “assistance” so that when the pain did
escalate she could end her life and further suffering. In Canada physician assisted death is illegal.
However, these types of laws are now under scrutiny as they may hinder patient autonomy.
Patient choice is virtually always the primary guiding principle for medical professionals when
determining care for mentally competent patients. Scott likens having the ability to choose
physician assisted death to having the ability to pursue an abortion; not all women will choose to
have an abortion but it is having the choice that is so important. Once a controversial topic,
Canada legalized abortion in 1969. Scott believed that access to physician assisted suicide would
also soon become accepted as a basic human right. For some then, the right to die is simply a
patient’s choice and should be respected as such. Opponents claim that these types of actions are
more than “a matter of free will” as they disrespect the sanctity of life. They believe other
measures could be taken to alleviate suffering at the end of life. There seems to be an association
between tremendous pain, depression, and requests for assisted death: In one study of terminally
ill patients 58.8% of those with a “desire to die” had diagnosable symptoms of depressive
disorders*. Thus, a more vigorous palliative care treatment would be appropriate to treat both
pain and depressive symptoms. This could offer patients respite while still respecting the
inviolability of life. Nevertheless, avoidance of pain is not the only reason people request
physician assisted death. Deficits in quality of life, loss of sense of self, loss of function and
desire for control** are all valid rationales supplied by terminally ill patients for ending their
lives in this manner. Palliative care would likely not assuage all of these factors. In summary, a
disreputable lapse in respect for patient autonomy is present when the right to physician assisted
death is denied.
 5. G.R. No. 171127: March 11, 2015 NOEL CASUMPANG, RUBY SANGA-
MIRANDA and SAN JUAN DEDIOS HOSPITAL, Petitioners, vs. NELSON
CORTEJO, Respondent.

Mrs. Jesusa Cortejo brought her 11-year-old son, Edmer Cortejo (Edmer), to the
Emergency Room of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing,
chest pain, stomach pain, and fever.Dr. Ramoncito Livelo (Dr. Livelo) initially attended to and
examined Edmer. In her testimony, Mrs. Cortejo narrated that in the morning of April 20, 1988,
Edmer had developed a slight fever that lasted for one day; a few hours upon discovery, she
brought Edmer to their family doctor; and two hours after administering medications, Edmer's
fever had subsided.Dr. Livelo diagnosed Edmer with "bronchopneumonia." Edmer's blood was
also taken. Afterwards, Dr. Livelo gave Edmer an antibiotic medication to lessen his fever and to
loosen his phlegm.Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune Care
card. She was thereafter assigned to Dr. Noel Casumpang (Dr. Casumpang), a pediatrician also
accredited with Fortune Care. Dr. Casumpang confirmed the initial diagnosis of
"Bronchopneumonia."At that moment, Mrs. Cortejo recalled entertaining doubts on the doctor's
diagnosis. She immediately advised Dr. Casumpang that Edmer had a high fever, and had no
colds or cough but Dr. Casumpang merely told her that her son's "bloodpressure is just being
active," and remarked that "that's the usual bronchopneumonia, no colds, no phlegm."Still
suspicious about his son's illness, Mrs. Cortejo again called Dr. Casumpang's attention, but
simply nooded. Edmer vomited "phlegm with blood streak" prompting the respondent (Edmer's
father) to request for a doctor at the nurses' station.(Dr. Miranda), although aware failed to
examine the blood specimen because the respondent washed it away. Dr. Miranda conducted a
physical check-up.The blood test results came, Dr. Miranda advised Edmer's parents that the
blood test results showed that Edmer was suffering from "Dengue Hemorrhagic Fever." By
request Edmar was to be transported to Makati Medical Center.Dr. Casumpang immediately
gave the attending physician the patient's clinical history and laboratory exam results. Upon
examination, the attending physician diagnosed "Dengue Fever Stage IV" that was already in its
irreversible stage.
Edmer died.  Parents Filed a case against SJDH and the Doctors

One of the critical issues the petitioners raised in the proceedings before the lower
court and before this Court was Dr. Jaudian's competence and credibility as an expert witness.
The petitioners tried to discredit his expert testimony on the ground that he lacked the proper
training and fellowship status in pediatrics. A close scrutiny of Ramos and Cereno reveals that
the Court primarily based the witnesses' disqualification to testify as an expert on
their incapacity to shed light on the standard of care that must be observed by the defendant-
physicians. That the expert witnesses' specialties do not match the physicians' practice area only
constituted, at most, one of the considerations that should not be taken out of context. After all,
the sole function of a medical expert witness, regardless of his/her specialty, is to afford
assistance to the courts on medical matters, and to explain the medical facts in issue.

Furthermore, there was no reasonable indication in Ramos and Cereno that the

expert witnesses possess a sufficient familiarity with the standard of care applicable to the
physicians' specialties.US jurisprudence on medical malpractice demonstrated the trial courts'
wide latitude of discretion in allowing a specialist from another field to testify against a
defendant specialist. In Brown v. Sims, a neurosurgeon was found competent to give expert
testimony regarding a gynecologist's standard of pre-surgical care. In that case, the court held
that since negligence was not predicated on the gynecologist's negligent performance of the
operation, but primarily on the claim that the pre-operative histories and physicals were
inadequate, the neurosurgeon was competent to testify as an expert. Frost v. Mayo Clinic also
allowed an orthopedic surgeon to testify against a neurologist in a medical malpractice action.
The court considered that the orthopedic surgeon's opinion on the "immediate need for
decompression" need not come from a specialist in neurosurgery. The court held that: It is well
established that "the testimony of a qualified medical doctor cannot be excluded simply because
he is not a specialist x x x." The matter of "x x x training and specialization of the witness goes
to the weight rather than admissibility x x the general rule as to expert testimony in medical
malpractice actions is that "a specialist in a particular branch within a profession will not be
required." Most courts allow a doctor to testify if they are satisfied of his familiarity with the
standards of a specialty, though he may not practice the specialty himself. One court explained
that "it is the scope of the witness' knowledge and not the artificial classification by title that
should govern the threshold question of admissibility. In the case and the facts before us, we find
that Dr. Jaudian is competent to testify on the standard of care in dengue fever cases. Although
he specializes in pathology, it was established during trial that he had attended not less than 30
seminars held by the Pediatric Society, had exposure in pediatrics, had been practicing medicine
for 16 years, and had handled not less than 50 dengue related cases.

As a licensed medical practitioner specializing in pathology, who had practical and

relevant exposure in pediatrics and dengue related cases, we are convinced that Dr. Jaudian
demonstrated sufficient familiarity with the standard of care to be applied in dengue fever cases.
Furthermore, we agree that he possesses knowledge and experience sufficient to qualify him to
speak with authority on the subject.

Edmer Cortejo (Edmer) was brought to the emergency room of San Juan de Dios Hospital
(SJDH) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty in breathing, chest
pains,
stomach pain, and fever. Dr. Ramoncito Livelo (Livelo), a family doctor, initially attended to
Edmer
and after a few tests had the initial impression of Bronchopneumonia. Dr. Livelo then gave
Edmer
some antibiotics to lessen his fever and loosen his phlegm.

Jesusa did not know anyone from SJDH. Jesusa used her fortune card and was referred to a
Fortune Care Coordinator, who was then absent. She got assigned to Dr. Noel
Casumpang
(Casumpang) who appeared to be an employee of the hospital. Dr. Casumpang examined Edmer
for
the first time and merely used a stethoscope and determined that it was Bronchopneumonia. Not
satisfied, she stated that Edmer had high fever, no colds or cough; Dr. Casumpang that it was
normal
for Bronchopneumonia. The following day early morning, Edmer had now a fever, throat
irritation
and even stomach and chest pains. Despite being known to such information, Dr. Casumpang
mere
inquired if Edmer had asthma, reassured that the illness was Bronchopneumonia.

Later in the morning, Edmer began vomiting phlegm with blood streak. Nelson Cortejo
(Nelson), Edmers father, thus called for a doctor and Dr. Ruby Miranda-Sanga (Sanga) came to
their
call. Dr. Sanga examined Edmer and found that he had a low grade non continuing fever, rashes
that were not typical of dengue fever. Dr. Rubi had told Dr. Casumpang of the symptoms.

She failed to positively diagnose the patient immediately because the blood streak was
washed by the Nelson, thus she ordered the next time it occurred Nelson should preserve the
same.
Upon acquiring a sample she positively determined that it was Dengue Hemorrahgic
Fever. Dr.
Casumpang advised that Edmer be bought to the ICU, to which the spouses Cortejo agreed to but
the ICU was full, thus they opted to go to Makati Medical Center. Upon arriving it was declared
that
it was already at stage IV and thus irreversible. Edmer died.

STATEMENT OF THE CASE:

Nelson instituted an action for damages against Dr. Casumpang, Dr. Sanga,
SJDH before
the RTC of Makati City for the negligent and erroneous diagnosis of his doctors. RTC ruled in
favor
of Nelson and deemed Drs. Casumpang and Sanga liable since Dengue was foreseeable based on
the medical record of Edmer, and that their testimonies were self-serving providing no other
evidence. The CA affirmed the decision of the RTC in toto, hence this petition.

One of the critical issues the petitioners raised in the proceedings before the lower court and
before this Court was Dr. Jaudian's competence and credibility as an expert witness. The
petitioners tried to discredit his expert testimony on the ground that he lacked the proper training
and fellowship status in pediatrics.
Edmer Cortejo (Edmer) was brought to the emergency room of San Juan de Dios Hospital
(SJDH) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty in breathing, chest
pains,
stomach pain, and fever. Dr. Ramoncito Livelo (Livelo), a family doctor, initially attended to
Edmer
and after a few tests had the initial impression of Bronchopneumonia. Dr. Livelo then gave
Edmer
some antibiotics to lessen his fever and loosen his phlegm.

Jesusa did not know anyone from SJDH. Jesusa used her fortune card and was referred to a
Fortune Care Coordinator, who was then absent. She got assigned to Dr. Noel
Casumpang
(Casumpang) who appeared to be an employee of the hospital. Dr. Casumpang examined Edmer
for
the first time and merely used a stethoscope and determined that it was Bronchopneumonia. Not
satisfied, she stated that Edmer had high fever, no colds or cough; Dr. Casumpang that it was
normal
for Bronchopneumonia. The following day early morning, Edmer had now a fever, throat
irritation
and even stomach and chest pains. Despite being known to such information, Dr. Casumpang
mere
inquired if Edmer had asthma, reassured that the illness was Bronchopneumonia.

Later in the morning, Edmer began vomiting phlegm with blood streak. Nelson Cortejo
(Nelson), Edmers father, thus called for a doctor and Dr. Ruby Miranda-Sanga (Sanga) came to
their
call. Dr. Sanga examined Edmer and found that he had a low grade non continuing fever, rashes
that were not typical of dengue fever. Dr. Rubi had told Dr. Casumpang of the symptoms.

She failed to positively diagnose the patient immediately because the blood streak was
washed by the Nelson, thus she ordered the next time it occurred Nelson should preserve the
same.
Upon acquiring a sample she positively determined that it was Dengue Hemorrahgic
Fever. Dr.
Casumpang advised that Edmer be bought to the ICU, to which the spouses Cortejo agreed to but
the ICU was full, thus they opted to go to Makati Medical Center. Upon arriving it was declared
that
it was already at stage IV and thus irreversible. Edmer died.

STATEMENT OF THE CASE:

Nelson instituted an action for damages against Dr. Casumpang, Dr. Sanga,
SJDH before
the RTC of Makati City for the negligent and erroneous diagnosis of his doctors. RTC ruled in
favor
of Nelson and deemed Drs. Casumpang and Sanga liable since Dengue was foreseeable based on
the medical record of Edmer, and that their testimonies were self-serving providing no other
evidence. The CA affirmed the decision of the RTC in toto, hence this petition.

Edmer Cortejo (Edmer) was brought to the emergency room of San Juan de Dios Hospital
(SJDH) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty in breathing, chest
pains,
stomach pain, and fever. Dr. Ramoncito Livelo (Livelo), a family doctor, initially attended to
Edmer
and after a few tests had the initial impression of Bronchopneumonia. Dr. Livelo then gave
Edmer
some antibiotics to lessen his fever and loosen his phlegm.

Jesusa did not know anyone from SJDH. Jesusa used her fortune card and was referred to a
Fortune Care Coordinator, who was then absent. She got assigned to Dr. Noel
Casumpang
(Casumpang) who appeared to be an employee of the hospital. Dr. Casumpang examined Edmer
for
the first time and merely used a stethoscope and determined that it was Bronchopneumonia. Not
satisfied, she stated that Edmer had high fever, no colds or cough; Dr. Casumpang that it was
normal
for Bronchopneumonia. The following day early morning, Edmer had now a fever, throat
irritation
and even stomach and chest pains. Despite being known to such information, Dr. Casumpang
mere
inquired if Edmer had asthma, reassured that the illness was Bronchopneumonia.

Later in the morning, Edmer began vomiting phlegm with blood streak. Nelson Cortejo
(Nelson), Edmers father, thus called for a doctor and Dr. Ruby Miranda-Sanga (Sanga) came to
their
call. Dr. Sanga examined Edmer and found that he had a low grade non continuing fever, rashes
that were not typical of dengue fever. Dr. Rubi had told Dr. Casumpang of the symptoms.

She failed to positively diagnose the patient immediately because the blood streak was
washed by the Nelson, thus she ordered the next time it occurred Nelson should preserve the
same.
Upon acquiring a sample she positively determined that it was Dengue Hemorrahgic
Fever. Dr.
Casumpang advised that Edmer be bought to the ICU, to which the spouses Cortejo agreed to but
the ICU was full, thus they opted to go to Makati Medical Center. Upon arriving it was declared
that
it was already at stage IV and thus irreversible. Edmer died.

STATEMENT OF THE CASE:

Nelson instituted an action for damages against Dr. Casumpang, Dr. Sanga,
SJDH before
the RTC of Makati City for the negligent and erroneous diagnosis of his doctors. RTC ruled in
favor
of Nelson and deemed Drs. Casumpang and Sanga liable since Dengue was foreseeable based on
the medical record of Edmer, and that their testimonies were self-serving providing no other
evidence. The CA affirmed the decision of the RTC in toto, hence this petition.
) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty in breathing, chest pains,
stomach pain, and fever. Dr. Ramoncito Livelo (Livelo), a family doctor, initially attended to
Edmer
and after a few tests had the initial impression of Bronchopneumonia. Dr. Livelo then gave
Edmer
some antibiotics t