Digest: Casumpang vs Cortejo

G.R. No. 171127, March 11, 2015
NOEL CASUMPANG, RUBY SANGA-MIRANDA AND SAN JUAN DE DIOS HOSPITAL, Petitioners, v. NELSON CORTEJO, Respondent.
[G.R. No. 171217]
DRA. RUBY SANGA-MIRANDA, Petitioner, v. NELSON CORTEJO, Respondent.
[G.R. No. 171228]
SAN JUAN DE DIOS HOSPITAL, Petitioner, v. NELSON CORTEJO, Respondent.
[G.R. No. 171217]
BRION, J.:

 

Facts:

Mrs. Jesusa Cortejo brought her 11-year old son, Edmer Cortejo (Edmer), to the Emergency Room of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing, chest pain, stomach pain, and fever.

Dr. Ramoncito Livelo (Dr. Livelo) initially attended to and examined Edmer. In her testimony, Mrs. Cortejo narrated that in the morning of April 20, 1988, Edmer had developed a slight fever that lasted for one day; a few hours upon discovery, she brought Edmer to their family doctor; and two hours after administering medications, Edmer's fever had subsided.

Dr. Livelo diagnosed Edmer with "bronchopneumonia." Edmer's blood was also taken. Afterwards, Dr. Livelo gave Edmer an antibiotic medication to lessen his fever and to loosen his phlegm.

Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune Care card. She was thereafter assigned to Dr. Noel Casumpang (Dr. Casumpang), a pediatrician also accredited with Fortune Care. Dr. Casumpang confirmed the initial diagnosis of "Bronchopneumonia."

At that moment, Mrs. Cortejo recalled entertaining doubts on the doctor's diagnosis. She immediately advised Dr. Casumpang that Edmer had a high fever, and had no colds or cough but Dr. Casumpang merely told her that her son's "bloodpressure is just being active," and remarked that "that's the usual bronchopneumonia, no colds, no phlegm."

Still suspicious about his son's illness, Mrs. Cortejo again called Dr. Casumpang's attention, but simply nooded. Edmer vomited "phlegm with blood streak" prompting the respondent (Edmer's father) to request for a doctor at the nurses' station.

(Dr. Miranda), although aware failed to examine the blood specimen because the respondent washed it away. Dr. Miranda conducted a physical check-up.

The blood test results came, Dr. Miranda advised Edmer's parents that the blood test results showed that Edmer was suffering from "Dengue Hemorrhagic Fever." By request Edmar was to be transported to Makati Medical Center.

Dr. Casumpang immediately gave the attending physician the patient's clinical history and laboratory exam results. Upon examination, the attending physician diagnosed "Dengue Fever Stage IV" that was already in its irreversible stage.

Edmer died.  Parents Filed a case against  SJDH and the Doctors

 

Issue (s):

Whether or not  Dr. Jaudian is an expert witness

Ruling:

Dr. Jaudian 's Professional Competence and Credibility

One of the critical issues the petitioners raised in the proceedings before the lower court and before this Court was Dr. Jaudian's competence and credibility as an expert witness. The petitioners tried to discredit his expert testimony on the ground that he lacked the proper training and fellowship status in pediatrics.

Criteria in Qualifying as an Expert Witness

The competence of an expert witness is a matter for the trial court to decide upon in the exercise of its discretion. The test of qualification is necessarily a relative one, depending upon the subject matter of the investigation, and the fitness of the expert witness. In our jurisdiction, the criterion remains to be the expert witness' special knowledge experience and practical training that qualify him/her to explain highly technical medical matters to the Court.
 
In Ramos v. Court of Appeals, the Court found the expert witness, who is a pulmonologist, not qualified to testify on the field of anesthesiology. Similarly, in Cereno v. Court of Appeals, a 2012 case involving medical negligence, the Court excluded the testimony of an expert witness whose specialty was anesthesiology, and concluded that an anesthesiologist cannot be considered an expert in the field of surgery or even in surgical practices and diagnosis.

Interestingly in this case, Dr. Jaudian, the expert witness was admittedly not a pediatrician but a practicing physician who specializes in pathology. He likewise does not possess any formal residency training in pediatrics. Nonetheless, both the lower courts found his knowledge acquired through study and practical experience sufficient to advance an expert opinion on dengue-related cases.

We agree with the lower courts.

A close scrutiny of Ramos and Cereno reveals that the Court primarily based the witnesses' disqualification to testify as an expert on their incapacity to shed light on the standard of care that must be observed by the defendant-physicians. That the expert witnesses' specialties do not match the physicians' practice area only constituted, at most, one of the considerations that should not be taken out of context. After all, the sole function of a medical expert witness, regardless of his/her specialty, is to afford assistance to the courts on medical matters, and to explain the medical facts in issue.

Furthermore, there was no reasonable indication in Ramos and Cereno that the expert witnesses possess a sufficient familiarity with the standard of care applicable to the physicians' specialties.

US jurisprudence on medical malpractice demonstrated the trial courts' wide latitude of discretion in allowing a specialist from another field to testify against a defendant specialist.

In Brown v. Sims, a neurosurgeon was found competent to give expert testimony regarding a gynecologist's standard of pre-surgical care. In that case, the court held that since negligence was not predicated on the gynecologist's negligent performance of the operation, but primarily on the claim that the pre-operative histories and physicals were inadequate, the neurosurgeon was competent to testify as an expert.

Frost v. Mayo Clinic also allowed an orthopedic surgeon to testify against a neurologist in a medical malpractice action. The court considered that the orthopedic surgeon's opinion on the "immediate need for decompression" need not come from a specialist in neurosurgery. The court held that:

It is well established that "the testimony of a qualified medical doctor cannot be excluded simply because he is not a specialist x x x." The matter of "x x x training and specialization of the witness goes to the weight rather than admissibility x x x."

x x x x

It did not appear to the court that a medical doctor had to be a specialist in neurosurgery to express the opinions permitted to be expressed by plaintiffs' doctors, e.g., the immediate need for a decompression in the light of certain neurological deficits in a post-laminectomy patient. As stated above, there was no issue as to the proper execution of the neurosurgery. The medical testimony supported plaintiffs' theory of negligence and causation. (Citations omitted)

In another case, the court declared that it is the specialist's knowledge of the requisite subject matter, rather than his/her specialty that determines his/her qualification to testify.

Also in Evans v. Ohanesian, the court set a guideline in qualifying an expert witness:

To qualify a witness as a medical expert, it must be shown that the witness (1) has the required professional knowledge, learning and skill of the subject under inquiry sufficient to qualify him to speak with authority on the subject; and (2) is familiar with the standard required of a physician under similar circumstances; where a witness has disclosed sufficient knowledge of the subject to entitle his opinion to go to the jury, the question of the degree of his knowledge goes more to the weight of the evidence than to its admissibility.

x x x x

Nor is it critical whether a medical expert is a general practitioner or a specialist so long as he exhibits knowledge of the subject. Where a duly licensed and practicing physician has gained knowledge of the standard of care applicable to a specialty in which he is not directly engaged but as to which he has an opinion based on education, experience, observation, or association wit that specialty, his opinion is competent. (Emphasis supplied)

Finally, Brown v. Mladineo adhered to the principle that the witness' familiarity, and not the classification by title or specialty, which should control issues regarding the expert witness' qualifications:

The general rule as to expert testimony in medical malpractice actions is that "a specialist in a particular branch within a profession will not be required." Most courts allow a doctor to testify if they are satisfied of his familiarity with the standards of a specialty, though he may not practice the specialty himself. One court explained that "it is the scope of the witness' knowledge and not the artificial classification by title that should govern the threshold question of admissibility. (Citations omitted)

Application to the Present Case

In the case and the facts before us, we find that Dr. Jaudian is competent to testify on the standard of care in dengue fever cases.

Although he specializes in pathology, it was established during trial that he had attended not less than 30 seminars held by the Pediatric Society, had exposure in pediatrics, had been practicing medicine for 16 years, and had handled not less than 50 dengue related cases.

As a licensed medical practitioner specializing in pathology, who had practical and relevant exposure in pediatrics and dengue related cases, we are convinced that Dr. Jaudian demonstrated sufficient familiarity with the standard of care to be applied in dengue fever cases. Furthermore, we agree that he possesses knowledge and experience sufficient to qualify him to speak with authority on the subject.