Statutes of limitation for medical malpractice in the Philippines

The law sets time limits for filing court cases called statutes of limitations. Prescriptive periods also apply to medical malpractice cases. How long can someone sue for medical malpractice before it's too late?

Such quandary was answered in De Jesus v. Dr. Uyloang, Asian Hospital and Medical Center, and Dr. John Francois Ojeda (G.R. No. 234851, February 15, 2022).

The case involved a failed surgery by Drs. Uyloang and Ojeda on De Jesus for gallstones. De Jesus later had abdominal pains and bile leakage, which Dr. Uyloang said was normal.De Jesus sought a second opinion, confirming the wrong duct was clipped, leading to bile leakage. Another surgery was needed on November 19, 2010.

On November 10, 2015, after five years, De Jesus lodged a medical malpractice case against Dr. Uyloan, Asian Hospital and Medical Center and Dr. Ojeda. All of them moved for the case’s dismissal invoking that the time to file the action already prescribed.

Now, the crux of the controversy: did the action grounded on medical malpractice already prescribe?

De Jesus argued that, since the action was based on a contract between the defendant doctors and hospital, the action prescribes in six or ten years under Article 1145 and 1144 of the Civil Code, respectively.

To determine whether the De Jesus’ medical malpractice suit was barred by the statutes of limitation, the Philippine Supreme Court had to define the nature of a medical malpractice suit.

Medical Malpractice defined: contract or quasi-delict?
While jurisprudence is clear as to the requisites of establishing a physician-patient relationship, there appears to be a lacunae in what the nature of the relationship is. Does it constitute a contract?

As defined in the earlier Casumpang v. Cortejo (G.R. No. 171127, March 11, 2015), “a physician-patient relationship is created when a patient engages the services of a physician, and the latter accepts or agrees to provide care to the patient. The establishment of this relationship is consensual, and the acceptance by the physician essential.” It can be gleaned from this jurisprudential definition that the first requisite of a contract — consent — is satisfied. Does this mean that this meeting the minds between a physician and patient ourightly establishes a contractual relationship between them?

After all, contracts are born with concurrence of three : (a) consent of the contracting parties; (b) object certain which is the subject matter of the contract; and (c) cause of the obligation which is established (Art. 1318, Civil Code).

The Philippine Supreme Court held that a physician-patient relationship is not contractual. It explained:

The fact that the physician-patient relationship is consensual does not necessarily mean it is a contractual relation, in the sense in which petitioner employs this term by equating it with any other transaction involving exchange of money for services. Indeed, the medical profession is affected with public interest. Once a physician-patient relationship is established, the legal duty of care follows. The doctor accordingly becomes duty-bound to use at least the same standard of care that a reasonably competent doctor would use to treat a medical condition under similar circumstances. Breach of duty occurs when the doctor fails to comply with, or improperly performs his duties under professional standards. This determination is both factual and legal, and is specific to each individual case. If the patient, as a result of the breach of duty, is injured in body or in health, actionable malpractice is committed, entitling the patient to damages. (De Jesus v. Dr. Uyloang, et. al, supra.)

Does this pronouncement therefore foreclose any contractual relationship between a physician and a patient? Interestingly, the Philippine Supreme Court hinted that it was also possible that an action for medical malpractice can be based on contract, specifically when the plaintiff “allege[s] an express promise to provide treatment or achieve a specific result.”

Citing a textbook on American malpractice jurisprudence, “The Preparation and Trial of Medical Malpractice Cases[,]” the Philippine Supreme Court expounded that:

Absent an express contract, a physician does not impliedly warrant the success of his or her treatment but only that he or she will adhere to the applicable standard of care. Thus, there is no cause of action for breach of implied contract or implied warranty arising from an alleged failure to provide adequate medical treatment. This allegation clearly sounds in tort, not in contract; therefore, the plaintiff's remedy is an action for malpractice, not breach of contract. A breach of contract complaint fails to state a cause of action if there is no allegation of any express promise to cure or to achieve a specific result. A physician's statements of opinion regarding the likely result of a medical procedure are insufficient to impose contractual liability, even if they ultimately prove incorrect. (Shandell and Smith, 2006)

Following this logic, we can draw this conclusion: absent any specific promise to cure or achieve a definite result, no contractual relationship between them arises notwithstanding the physician’s acceptance of the patient’s engagement. Supporting this conclusion are rulings of the Philippine Supreme Court in earlier cases which recognizes that physicians are not insurers of life (Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999) and good result of treatment (Lucas v. Dr. Tuaño, G.R. No. 178763, April 21, 2009). 

Verily, that physicians cannot and do not guarantee that a patient will be cured is already well-entrenched in Philippine jurisprudence. Seemingly, this jurisprudential trend will not favor award of damages based on contract liability theory in medical malpractice suits, notwithstanding the the settled doctrine that liability for quasi-delict may co-exist in the presence of contractual relations.

The inescapable conclusion then is the period of prescription for quasi-delict applies in medical malpractice cases. 

Nature of medical malpractice cases

American legal system classifies medical malpractice or medical negligence as a form of “tort.” The Philippines, however, does not have “tort” imbedded in its legal system. Instead, the Civil Code of the Philippines provides for a system of quasi-delict. Chief Justice Alexander Gesmundo speaking in De Jesus eruditely explains:

For lack of a specific law geared towards the type of negligence committed by members of the medical profession in this jurisdiction, such claim for damages is almost always anchored on the alleged violation of Art. 2176 of the Civil Code, which states that:

ART. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties, is called a quasi-delict and is governed by the provisions of this Chapter.

Medical malpractice is a particular form of negligence which 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. In order to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed to do something which a reasonably prudent physician or surgeon would have done, or that he or she did something that a reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient. There are thus four elements involved in medical negligence cases, namely: duty, breach, injury, and proximate causation. (De Jesus v. Dr. Uyloang, et. al, supra.)

While the contract theory of medical malpractice cases was debunked, it does not mean that victim of medical malpractice or medical negligence are without recourse. The Philippine Supreme Court’s pronouncement in De Jesus only indicates that medical malpractice victims may vindicate their rights by filing an action for damages based on quasi-delict. Parenthetically, they can also file a case for criminal negligence under Article 365 of the Revised Penal Code (on Quasi-Crimes). 

Drawing lessons from the De Jesus case, victims of medical malpractice should ever be mindful of the prescriptive period in filing the suit within the prescriptive period. Simply put, as in any case, time is of the essence.

Revisiting statute of limitations in civil cases

Generally, statutes of limitation are provided for in specific laws. In so far as civil cases are concerned, absent specific prescriptive period under special law, the Civil Code applies. Determinative in the case of De Jesus are Articles 1144, 1145 and 1146 of the Civil Code, to wit:

ARTICLE 1144. The following actions must be brought within ten years from the time the right of action accrues:

(1) Upon a written contract;

(2) Upon an obligation created by law;

(3) Upon a judgment.

ARTICLE 1145. The following actions must be commenced within six years:

(1) Upon an oral contract;

(2) Upon a quasi-contract.

ARTICLE 1146. The following actions must be instituted within four years:

(1) Upon an injury to the rights of the plaintiff;

(2) Upon a quasi-delict;

However, when the action arises from or out of any act, activity, or conduct of any public officer involving the exercise of powers or authority arising from Martial Law including the arrest, detention and/or trial of the plaintiff, the same must be brought within one (1) year.

Falling under the broad concept of quasi-delict, medical malpractice cases prescribe within four-years from the commission of such wrongful act or omission. Clearly, De Jesus’ medical malpractice suit came one year too late. It took him five years to pursue his claim against Drs. Uyloang and Ojeda, as well as Asian Hospital and Medical Center. As to why he waited for time to slip away, we could only surmise. This curious case serves as a reminder and a caveat what tons of law books have been saying all along: “the law helps the vigilant but not those who sleep on their rights.” Vigilantibus, sed non dormientibus jura subverniunt.