By: Atty. Gregorio B. Austral, CPA
Patient’s contributory negligence mitigates
physician’s liability for damages
An intrauterine device (IUD) was embedded in the uterus of Patient Pascual
twenty (20) years before she filed a case against Dr. Ramos and the hospital where she
was operated.
Sometime in December 2005, Pascual experienced excruciating pain in her back
and hip, prompting her to seek medical intervention. It was found that the pain was
brought about by the IUD, as shown by the x-ray taken at the Nazarenus College
Foundation Hospital (Nazarenus Hospital) on December 10, 2005. Pascual was referred
to Dr. Ramos, a physician specializing in Obstetrics and Gynecology at the Ramos
Hospital. Upon the advice of Dr. Ramos, Pascual underwent Gynecology and Fertility
Ultrasound.
Pascual alleged that Dr. Ramos tried to remove the IUD with her bare hands and
this procedure caused her to bleed profusely. As the IUD was already deeply embedded
and Pascual could no longer bear the pain, Dr. Ramos stopped the procedure and
instructed her to go instead to the second floor of the hospital. There, using a
speculum, Dr. Ramos tried to extract the IUD through Transvaginal Procedure.
Unsuccessful, Dr. Ramos told Pascual to return to the hospital during her menstrual
period.
On January 5, 2006, Pascual underwent another ultrasound at the Ramos
Hospital. Thereafter, Dr. Ramos prescribed certain medicines and told Pascual to buy an
IUD hook for the purpose of removing the IUD through her vagina.
On January 8, 2006, Pascual was confined at the Ramos Hospital. As efforts to
remove the IUD through transvaginal means were futile and extremely painful for her,
she was advised to undergo a hysterectomy, a surgical procedure to remove a woman’s
uterus. Dr. Ramos performed the hysterectomy procedure on January 11, 2006. After
the operation, Dr. Ramos informed Pascual that the organs that were removed were
submitted for histopathology examination.
Unfortunately, Pascual continued to experience pain in her hips. She returned to
Dr. Ramos on January 24, 2006. After conducting examination, Dr. Ramos prescribed
her the medicines she needed to take. However, despite taking the prescribed
medicines, Pascual’s back pain persisted. She then went to the Nazarenus Hospital on
March 4, 2006 to seek a second opinion. To her surprise, she was informed that the IUD
still remained inside her body.
Pascual filed a case for medical malpractice or medical negligence before the
RTC. The main issue presented before the court is whether or not Dr. Ramos and the
hospital are guilty of medical malpractice and, thus, should be held for damages.
The Court ruled in the affirmative.
A review of the facts would reveal that Dr. Ramos relied on the x-ray and
pathology reports of other physicians in assessing Pascual’s condition. To recall, Pascual
underwent an x-ray scan at the Nazarenus College Foundation Hospital, which yielded a
result that the IUD was “inplaced.” Further, Pascual was examined by Dr. Valdez on the
same date of the operation, where it was found that her cervix was infected and
inflamed, endometrial tissues in the walls of the uterus were present, and she had
lutein cysts or a corpus luteum which had undergone cystic changes or dilation.
As there was no evidence submitted by both parties regarding the established
standard procedures by medical professionals in the extraction of an IUD, the Court is
not in the position to conclude whether the negligence committed by Dr. Ramos was
simple or gross. Bad faith cannot be presumed and can only be established by clear and
convincing evidence. Without it, the Court cannot rule that Dr. Ramos committed willful
and intentional breach of duty.
However, the Court may evaluate whether Dr. Ramos exercised prudence in
relying on the x-ray report before extracting the IUD from Pascual’s uterus. As the x-ray
report was two-dimensional (2D), an exhaustive three-dimensional (3D) approach
would have accurately shown the IUD’s location. From this, it appears that Dr. Ramos
had been negligent in failing to take measures to verify the exact location of the IUD.
While it is true that there was negligence on the part of Dr. Ramos, contributory
negligence may be ascribed to Pascual, thus justifying a mitigation of the damages she
is entitled to. Contributory negligence is conduct on the part of the injured party,
contributing as a legal cause to the harm he/she has suffered, which falls below the
standard which he/she is required to conform for his/her own protection. It is an act or
omission amounting to want of ordinary care on the part of the person injured, which,
concurring with the defendant’s negligence, is the proximate cause of the injury. In the
instant case, Pascual allowed 20 years to pass before having her IUD removed,
considering that the maximum period that an IUD could remain inside a uterus is
estimated at 10 years. As there is no evidence to the contrary, it is presumed that
private transactions have been fair and regular and that the ordinary course of business
has been followed, and Pascual had been informed by the physician who installed the
IUD in her uterus that the device would expire in 10 years and that the same should be
removed. The unusual migration of the IUD could have been averted had Pascual
sought the removal of the IUD prior to its expiration. (Dr. Montano G. Ramos
General Hospital v. Pascual, G.R. No. 256651 (Notice), [August 30, 2023])