Que v. Philippine Heart Center
REITERATIONFacts
The Antecedents: In May 1999, Quintin Que consulted Dr. Avelino P. Aventura at the Philippine Heart Center (PHC) for an aortic arch aneurysm. After a preliminary bypass surgery, Dr. Aventura recommended a novel, non-invasive stenting procedure as a 'less risky' alternative to traditional open-method surgery. The Que family, allegedly assured the procedure was 'virtually risk-free,' consented. The procedure was to be performed by a visiting Belgian specialist, Dr. Eric Verhoeven, using a custom-built 'Talent' brand stent graft system. Procedural History: On February 14, 2000, Dr. Verhoeven attempted the stenting procedure but was unable to deploy the device, reportedly stating it was 'faulty.' Quintin Que suffered a stroke after the incomplete procedure and passed away on February 27, 2000. An autopsy report stated death was due to complications of hypertensive atherosclerotic cardiovascular disease, triggered by catheterization, and classified the manner of death as natural. On March 18, 2002, Quintin's son, Elpidio Que, filed a Complaint for Damages against PHC, Dr. Aventura, the stent distributor FAMED, and others. The Regional Trial Court (RTC) dismissed the complaint, finding no medical malpractice and that Quintin had provided informed consent. The Court of Appeals (CA) affirmed the RTC's decision, giving weight to expert testimonies that the stroke was an inherent risk of the procedure. The Petition: Elpidio Que filed a Petition for Review on Certiorari under Rule 45 before the Supreme Court. He argued that the CA erred in finding no negligence, asserting that his family was not adequately informed of the procedure's risks. He questioned the validity of the consent forms and contended that the collective negligence of the respondents, including the use of a faulty stent, was the proximate cause of his father's death.
Issue(s)
Whether the petition raises questions of fact improper for a Rule 45 review. Whether the respondents are liable for medical negligence, particularly for lack of informed consent. Whether the doctrine of res ipsa loquitur is applicable in this case. Whether the stent distributor, FAMED, is liable for the allegedly faulty device.
Ruling
The Petition for Review on Certiorari is DENIED. The Decision dated July 3, 2023 of the Court of Appeals in CA-G.R. CV No. 115245, which affirmed the dismissal of Elpidio Que's Complaint, STANDS.
Ratio Decidendi
On the Procedural Issue: The Court held that the petition must be dismissed on procedural grounds as it primarily raises questions of fact. Issues such as the authenticity of Quintin's signature on the consent forms and the alleged 'faultiness' of the stent require an examination of the probative value of the evidence presented. This is beyond the scope of a petition for review on certiorari under Rule 45, which is limited to questions of law. The findings of fact of the trial court, when affirmed by the Court of Appeals, are generally final and conclusive. On Medical Negligence and Informed Consent: The Court found no medical negligence. To establish malpractice, the petitioner must prove the physician's breach of the standard of care was the proximate cause of the injury. The petitioner failed to present an expert witness to refute the testimonies of respondents' experts, Dr. Tuazon and Dr. Figueroa. These experts, both cardiovascular surgeons, established that stenting was the sound medical advice for Quintin's condition and that a stroke was an inherent risk of the procedure due to catheter manipulation, regardless of whether the stent was successfully deployed. Applying the doctrine from Li v. Spouses Soliman, the Court found that informed consent was obtained. Dr. Aventura's disclosure that the procedure had 'less risk' than open surgery did not mean it was 'risk-free,' and the signed consent forms, whose validity was not successfully challenged, indicated that the nature and consequences of the procedure were explained. On the Doctrine of Res Ipsa Loquitur: The Court ruled that the doctrine of res ipsa loquitur ('the thing speaks for itself') does not apply. This doctrine requires that the accident be of a kind that does not ordinarily occur in the absence of someone's negligence. Here, the expert testimonies established that a stroke is an inherent risk of the stenting procedure. Since the injury could occur even with the exercise of due care, the event itself does not automatically imply negligence, making the doctrine inapplicable. On FAMED's Liability: The Court found no basis to hold FAMED liable. The petitioner's claim that the stent was 'faulty' was a bare allegation, supported only by the family's testimony about Dr. Verhoeven's purported statement. No other evidence was presented to prove that the stent was defective upon delivery or that FAMED had any role in its manufacture. Without proof of a defect or negligence on FAMED's part, liability cannot be established.
Main Doctrine
To successfully pursue a medical malpractice claim, the plaintiff must prove by a preponderance of evidence that the physician failed to adhere to the standard of care ordinarily employed by the profession under similar circumstances, and that this breach was the proximate cause of the patient's injury. This burden generally requires expert testimony from a similarly trained physician. Under the complementary doctrine of informed consent, a physician has a duty to disclose all material risks of a proposed treatment; liability arises if it is proven that the physician's failure to disclose caused the patient to consent to a treatment they otherwise would not have, leading to injury.