Dengue Case bronchopneumonia even though the

child had high fever and no cough or

Dr Casumpang v Cortejo colds.
2015
The next day, the mother reported to
the doctor that the child had fever,
GR 171127, March 11, 2015 throat irritation, chest and stomach
pain and traces of blood in the sputum,
In this case, classified by this author as
still the doctor stuck to his diagnosis
a problem in implementation, Dr.
of bronchopneumonia, running no
Casumpang diagnosed a child with
further diagnostic tests.
bronchopneumonia even though the
child showed signs and symptoms of When the resident doctor, Dr. Ruby
dengue: high fever, no colds or cough, Sanga Miranda arrived, the child
chest and stomach pain, and traces of already had severe stomach pain and
blood in the sputum. The Supreme difficulty moving the right leg.
Court found that his examination was
The child was diagnosed with dengue
not comprehensive enough, as he only
hemorrhagic fever by Dr. Ruby Sanga
used a stethoscope in coming up with
Miranda and transferred to Makati
the diagnosis of bronchopneumonia,
Medical Hospital where the child was
and didn’t use a bronchoscope. “Dr.
diagnosed with dengue fever stage 4,
Casumpang selectively appreciated
which is already irreversible.
some and not all of the symptoms
presented and failed to promptly The child died at 4 am of April 24,
conduct the appropriate tests to 1988. The parents filed civil suit
confirm his findings.” Dr. Casumpang against both Dr. Casumpang and Dr.
and the hospital (San Juan de Dios Sanga Miranda. The regional trial court
Hospital) were held solidarily liable for found both doctors and the hospital
Php 545, 000.000.00. solidarily liable because Dr.
Casumpang, as a consultant is an
ostensible agent of San Juan de Dios
Mrs. Cortejo brought her 11 y.o son Hospital. While Dr. Sanga Miranda as a
Edmer Cortejo to the emergency room resident physician, an employee of the
of San Juan de Dios Hospital because said hospital.
the child had difficulty breathing, chest
Upon appeal, the court of appeals
pain, stomach pain, and fever. The
affirmed in total rtc ruling that the
child was assigned to Dr. Casumpang,
doctor’s failure to read, even the most
a pediatrician who used a stethoscope
basic signs of dengue fever expected
alone to diagnose the child with
of an ordinary doctor constituted Dr. Haudyan, although not a
medical negligence. pediatrician but a practicing
physician who specializes in
The court of appeals also gave merit
pathology, that Dr. Casumpang’s
to the testimony of the expert witness
medical examination was not
Dr. Rodolfo Haudyan that the hospital
comprehensive enough to reasonably
san juan de dios is also negligent
lead to a correct diagnosis
because it was not equipped with
proper paging system. It has no Dr. Casumpang only used a
bronchoscope and its doctors are not stethoscope
proportionate to the number of its in coming up with the diagnosis that
patients. Edmer was suffering from
bronchopneumonia, he never
And of the seven resident physicians,
confirmed this finding with the use of
only two resident physicians were
a bronchoscope
doing rounds at the time of the child’s
confinement.
Furthermore, Dr. Casumpang bases
The issue in this case is whether or not diagnosis largely on the chest x-ray
the doctors in the hospital are result that is generally inconclusive
solidarily liable for medical negligence.
The supreme court ruled YES, Dr. A wrong diagnosis is not by itself
Casumpang and Hospital San Juan de medical malpractice, the question in
Dios are both solidarily liable. professional malpractice suits is not

The supreme court ruled that the whether a physician had made a

elements of medical malpractice were mistake but whether he or she used

duly proven in this case. Namely duty, ordinary care.

breach of duty, injury and proximate

causation. When a physician's erroneous
diagnosis was a result of erroneous
On the other hand Dr. Sanga Miranda, conduct.
the resident physician was acquitted, Example, neglect of medical history,
because she was actually the one failure to order the appropriate test,
who correctly diagnosed the child failure to recognize symptoms, then
with dengue, gave due care and it becomes an evidence of medical
referred the child to Makati men. malpractice.
But Dr. Casumpang, the consultant
pediatrician was held liable because At the present case, the evidence on
it was opined by the expert witness record established that in confirming
the diagnosis of bronchopneumonia,
Dr. Casumpang selectively placing his name in the lobby of the
appreciated some and not all of the hospital or failing to advise the
symptoms presented and failed to patient that they are being treated by
promptly conduct the appropriate the hospital's agent and not its
test to confirm his findings. employee and;

In some, Dr. Casumpang was Number two, the patients reliance on

negligent when he failed to exercise their own, for example, a patient
reasonable prudence in timely entering the hospital to the
detecting dengue fever. emergency room could properly
assume that the treating doctors and
Furthermore, medical literature in staff of the hospital were acting on
dengue shows that early diagnosis its behalf.
and management of dengue is
critical in reducing the risk of In this case the court considered the
complications and avoiding further act of the hospital of holding itself
spread of the virus out as a provider of complete
medical care, and considering that
Supreme court citing the WHO, that the hospital to have impliedly created
Edmer later died of hypovolemic the appearance of authority, thus San
shock, hemorrhagic fever stage four, Juan de Dios excluded (?) Dr.
a severe and fatal form of dengue Casumphang with apparent
fever. Established the causal link authority.
between Dr. Casumpang's
negligence and the injury. The The supreme court found Dr.
hospital san juan de dios is solidarily Casumpang, San Juan de Dios
liable because based on the principle solidarily liable for negligent medical
of agency or the doctrine of a parent practice, civil award consists of
authority, a hospital can be held moral damages of 500, 000 pesos
vicariously liable for the negligent burial and funeral expenses of 45,
acts of a physician or an 000
independent, contractor providing pesos for a total of 545, 000 pesos.
care at the hospital if the plaintiff
can prove these two factors: The liability of Dr. Sanga Miranda
was set aside.
Number one, the hospital's
manifestations that the doctor is its
employee, like
 Facts: Raro worked as clerk of the
Bureau of Mines and Geosciences at
Daet. Started in 1975. Four years
later, she had severe and recurrent
headaches with blowing a vision, she
then lost her memory, sense of time,
vision and reasoning power. She was
diagnosed with brain tumor. She filed
for disability compensation. GSIS
denied claim. ECC affirmed the GSIS.

Issue: Whether brain tumor which

causes are unknown but contracted
during employment is compensable
under present compensation laws.

At that time, the Supreme Court said:

NO. The supreme court cited Navalta
vs GSIS, the supreme court said this
court recognized the fact that cancer
is a disease of still unknown origin,
which strikes people in all walks of
life, employed or unemployed
Unless it be shown that a particular
form of cancer is caused by specific
working conditions (like chemical
Medico-legal case involving fumes, nuclear radiation, asbestos,
dust, etc) we cannot conclude it was
brain tumor the employment which increased the
risk of contracting the disease.
Case #15
The petition was dismissed.
Brain Tumor

Zaida G. Raro vs. Employees Lesson: there has to be a work

Compensation Commission and disease connection. It has to be
Government Service Insurance System proven.
(GR No L-58445, April 27, 1989, En
Banc. Per J. Gutierrez Jr)
However in this case, there was a Eulalio Galanida vs Employees
dissenting opinion by a justice, Compensation Commission and
stated that just because the cause of Government Service Insurance System
brain tumor is not yet established (GR No. 70660, Sept 24, 1987. 3rd
doesn't mean that all the more the division. Pre J. Guiterrez JR)
reason that the employee should not
Facts: Galanida started working for
be made to establish the connection
the government in 1948 as a
between the employment and the
messenger/janitor then progressed
disease, justice was saying that just
to become clerk, then admin officer.
because the disease occurred during
Sometime in 1955, he experienced
the employment, that should be
facial distortion, numbness
enough to make the disability
accompanied by blurring of vision,
compensable.
and headache. He files for disability
compensation. Denied by GSIS. The
Note that dissenting opinion would
GSIS decision was affirmed by the
be used in a latter case, which upheld
Employees Compensation
that a form of bone tumor was
Commission.
compensable, a disability, even
though the cause is unknown.
The ECC cited a medical source
which stated that: Bell’s Palsy is an
acute lower motor neuron palsy of
the facial nerve, characterized by
pain, weakness or paralysis of the
affected side of the face

Issue: Whether Galanida’s illness

Bell’s Palsy is compensable

The supreme court ruled: NO.

Petitioner was not able to show that
his work as janitor caused or
contributed to his illness.
Medico-legal case involving
bell's palsy Now what we do know is that Bell’s
Case #14 Palsy is caused by an inflamed nerve
possibly due to an infectious process
Bell’s Palsy
The problem here is that he could
have proven the Bell’s Palsy to be
Medico-legal case involving
work connected, had he presented
expert witness, medical records, Traumatic brain injury
evidence to correlate his condition
with the work employment Case #13
Traumatic Brain Injury
But another issue also is that bill's People of the Philippines vs. Claudio
policy is not a permanent disorder, Teehankee Jr (GR No. 111206-08,
it's reversible, I think it heals in about Oct 6, 1995. 2 nd division. J. Puno)
two months so in terms of
permanent disability, I submit that Facts: On July 12, 1991, accused
Bell’s Palsy does not cause alighted from
permanent disability his car, and shot three people for no
apparent reason. Only one survived.
In this case the petitioner failed to Roland John Chapman was shot in
present evidence that Bell’s Palsy the chest which killed him. Jussi
was work connected and so that's Leino was made to sit before he was
why his petition failed um shot in the head, he survived. Dr
Pedro Solis testified that the bullet
It's also nice to note here that Bell’s entered the left temple of Leino.
Palsy in the nursing profession, we After entering Leino's head, it
are often thought that it causes fractured his upper jaw at his front
paralysis of the face, but it's a little teeth.
known fact for us, but now it's the
court affirmed the fact that Bell’s Some of the bullet fragments pierced
Palsy can also be associated with his palette and tongue. Brain
pain in the face and of course scanning revealed contusions of the
evidence must be presented to prove temporal lobe and hemorrhage at the
a legal claim. covering of the brain, the meninges.

Physical deformity resulted as a

consequence of the gunshot wound
because of the fractured upper jaw
and the loss of the front teeth.
Sutures were performed on the upper
portion of his tongue. Nonetheless,
Leino’s injuries on the tongue caused
him difficulty in speaking Lesson: the plasticity of the brain,
the fact Leino’s temporal lobe was
Dr Pedro Solis testified that Maureen injured, yet he had no problem in the
Hultman was shot at the left side of sense of taste or the sense of touch
the forehead. Bullet entry was 1.5 and he's still alive, shows the brain's
centimeter above the eyebrow. Upon ability to compensate for lost parts.
entering the forehead, the bullet
fragmented into pieces and went
from the left to the right side of the
temple, fracturing the frontal bone of
the skull.
Medico-legal case involving
The bullet eventually settled behind cataract with glaucoma
the right jaw of Maureen. Brain
tissues were oozing out of her
Case #4
nostrils and on the left side of the
forehead where the bullet entered. Cataract with Glaucoma
CT scan revealed she had
Angelo Loyola vs. Government Service
hemorrhagic lesion on the ventricles
Insurance System and Employees
of the brain and the second covering
Compensation Commission (GR No.
of the brain. She died after 97 days in
89097, Aug. 24, 1990. 1st division. Per
the ICU.
J. Gancayco)

Accused tried to blame Maureen's

father, with witness saying Maureen
Facts: Loyola worked as a district
allegedly said “huwag, daddy”. But
supervisor of DepEd Cavite. He
the trial revealed Maureen couldn't
experienced progressive blurring of
speak tagalog and called her
vision with slight discomfort in the
adopted father “papa”. Accused was
left eye. He was diagnosed with
also positively identified by multiple
cataract with glaucoma of the left
witnesses and by one of the victims
eye. He filed a claim for
who survived (Leino)
compensation benefits with GSIS.
GSIS denied his claim and the
The accused was convicted of
Employee's Compensation
homicide for the killing of Chapman,
Commission affirmed the GSIS.
murder for Hultman, and frustrated
murder for Leino.
Issue: whether or not the illness of factors (Merck Manual of Diagnosis
the petitioner, cataract with &Therapy, p. 433)
glaucoma is compensable?
Senile cataract is an opacity of the
Supreme court ruled: YES. Loyola lens resulting from degenerative
proved that his job involved changes recurring concomitant with
attendance at the athletic meets and aging (N.W. Ophthalmology
managing the training of division Principles and Concepts, 2 nd Ed.
athletes, too much exposure to 1969, p. 300)
environmental climatic conditions
particularly direct heat from the sun,
strong winds, dirty dust, rains, and
unfavorable weather conditions
contributing to, if not aggravate his
illness. Loyola is entitled to
compensation of Php 18, 193.55 and
Php 3, 000 of Atty’s fees

Lesson: it affirms that the heat of the

sun and other environmental factors
can contribute to cataract and
glaucoma

ECC cited the following medical

books;

Glaucoma is a disease of the eye

characterized by increased
intraocular tension and commonly
causing impairment division ranging
from slight abnormalities to absolute
blindness

The initial causes are not known.

Advanced age, arteriosclerotic
vasomotor instability, hyperopia and
heredity are among predisposing