In this day and age, we have seen several biomedical innovations due to the progress in the application of scientific knowledge and the availability of several resources for its further enhancement. This swift advance has proved to be a huge factor in the immerse improvement of the quality of healthcare not only in other countries, but also in the Philippines. By the introduction of technological medical innovations, we have seen its positive effect in the delivery of new drugs, devices, and procedures, which prove to be helpful in treating a wide array of sickness and diseases.

Just in 2024, we saw the use of nanocomposite seaweed in sensors to monitor health, the inactivation of viruses with the use of air curtains, the mapping of microbiome onto personalized healthcare products, to name a few. However, the advent of new technology, with all of its benefits and offer of efficiency, also comes with the risk of becoming its guinea pig, due to it being performed or tested on few individuals. Thus, its use raises serious legal implications, as several risks are involved, including the death of an individual. Truly, innovation comes with risk. However, from a legal standpoint, what are the safeguards that medical professionals should employ in order to eliminate, or at least mitigate, the risk of similar tragedies? 

This Article thus focuses on medical malpractice laws in the Philippines vis-à-vis the risks involved in the use of relatively new technology on a patient, and the case of Elpidio Que v. Philippine Heart Center, et al. (G.R. No. 268308, 2 April 2025).

Factual backdrop of Que v. Philippine Heart Center

This case finds its roots to sometime in May 1999, when Quintin Que had a medical consultation with a certain Dr. Avelino P. Aventura at the Philippine Heart Center due to an aneurysm in the aortic arch, which affected Quintin’s vocal cords. When it was confirmed that Quintin had an aneurysm, he was informed by Dr. Aventura that he had to undergo an open-method surgery. However, in October 1999, Dr. Aventura recommended a new non-invasive treatment for an aneurysm, a state-of-the-art procedure that uses a custom-built gadget called a stent, which is an alternative to the open-method surgery.

After some hesitation, the Que family decided to push through with the stent procedure since Quintin’s aneurysm was fatal, and the stenting procedure was virtually risk-free. When Quintin was admitted, Dr. Aventura introduced a certain Dr. Eric Verhoeven, a Belgian doctor specializing in stenting procedures. Dr. Verhoeven announced the system product as state-of-the-art and it would be the first time it would be used in Asia.

After the scheduled operation on 14 February 2025, Dr. Verhoeven, after the procedure, relayed to the family of Quintin that he could not complete the operation because he could not go through the curve where the stent should have been deployed. After all, the device on hand was faulty. Quintin never woke up and suffered stroke after the incomplete procedure. He died on 27 February 2000. This led to Elpidio filing a complaint for damages against the hospital, Dr. Aventura, and Dr. Verhoeven, among others.

Counterarguments of Dr. Aventura

In his Answer, Dr. Aventura argues that he gave several options to the Que Family, which, like any other medical procedure, have no guarantee of success: (1) aneurysmectomy and replacement and (2) endovascular stenting, which would expose Quintin to the risk of death. After being informed of the risks of and introduced to Dr. Verhoeven, Quintin consented to the stenting procedure.

Ruling of the Regional Trial Court and the Court of Appeals

The RTC ruled that no medical malpractice or negligence on the part of Dr. Aventura, taking into consideration his qualifications and years of expertise, which raised the presumption that he takes the necessary precautions and employs the best knowledge and skill in attending to his patients. On appeal, the Court of Appeals affirmed the Decision of the RTC. It also took into consideration the testimony of expert witnesses, which revealed that Dr. Aventura gave sound medical advice and treatment to Quintin. It also held that there was adequate disclosure of material risks inherent in the stenting procedure. It likewise noted that during the pre-trial conference, one of the stipulations of the parties is that the stenting procedure entails “less risk”. However, “less risk” is not “risk-free”.

Supreme Court Decision: There is no medical negligence

As defined, medical malpractice is a particular form of negligence that 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 a lack of informed consent litigation, the plaintiff must prove the following: (1) the physician had a duty to disclose material risks; (2) the physician failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result of the failure to disclose, the patient consented to the treatment they otherwise would not have consented to; and (4) the patient was injured by the proposed treatment.

Here, the Supreme Court ruled that Dr. Aventura informed the Que family, most especially Quintin, of the material risks inherent in the stenting procedure, and that includes death. He also informed the family that if they decide to continue the operation, another physician will operate on Quintin because he does not specialize in stenting procedures. Also, expert witnesses testified that stenting would be the sound medical advice and treatment considering the risk factor for thromboembolism. They likewise testified that the stroke which led to Quintin’s death, was one of the inherent risks involved in a stenting procedure. Quintin would have had a stroke regardless of whether device was successfully deployed on him.

Conclusion

As held in several cases, a medical professional has the duty to observe the standard of care and exercise the degree of skill, knowledge, and training ordinarily expected of other similarly trained medical professionals acting under the same circumstances.

In our jurisdiction, which has upheld the basic right of a patient to give consent to any medical procedure or treatment, it is a medical professional’s duty to warn his patient of the dangers lurking in the proposed treatment and to impart information which the patient has every right to expect. The physician is required to give his patient a reasonable explanation, which means generally informing the patient in nontechnical terms as to what is at stake, the alternatives open to him, the goals to be achieved, and the risks that may ensue from a particular treatment or no treatment at all. 

Ergo, in this era of medical technological developments and in the rise of artificial intelligence, physicians and other medical professionals should exert their best efforts in informing their patients of all potential risks that the latter might suffer should they wish to proceed in an unconventional way of treating their respective illnesses. Consent forms should likewise detail said treatment by stating what are to be expected, the possible complications that might be encountered, and the period of recovery, among others. It must be emphasized that patients are normally people not learned in the medical sciences. Providing them the sufficient and understandable information gives them an opportunity to decide for themselves whether they would voluntarily submit to said procedure or treatment.

The case of Que underscores the fact that the duty of reasonable disclosure of available choices with respect to the proposed course of action and of dangers inherently and potentially involved in each is an integral part of a physician’s overall obligation to the patient. Failing in these obligations, the medical professional risk of subjecting himself to a long and arduous litigation.