De Jesus vs. Uyloan

A medical malpractice action based on contract must allege an express promise by the physician to provide medical treatment or achieve a specific result; a mere reference to an implied physician-patient contract is insufficient to sustain a contractual cause of action, and the claim remains one for medical negligence under quasi-delict, subject to the four-year prescriptive period under Article 1146 of the Civil Code.

Paolo Anthony C. De Jesus was a patient who sought medical treatment from Dr. Romeo F. Uyloan, who diagnosed him with cholelithiasis and advised laparoscopic cholecystectomy at the Asian Hospital and Medical Center (AHMC), with Dr. John Francois Ojeda as assisting surgeon. The physician-patient relationship and the hospital's provision of medical services form the backdrop of the dispute, which centers on whether a complaint for damages arising from allegedly negligent medical treatment should be characterized as an action on a contract (with a six- or ten-year prescriptive period) or as a quasi-delict (with a four-year prescriptive period).

On September 13, 2010, petitioner Paolo Anthony C. De Jesus underwent an abdomino-pelvic sonogram, after which Dr. Romeo F. Uyloan diagnosed him with cholelithiasis — the presence of stones in the gall bladder — and advised him to undergo laparoscopic cholecystectomy to remove the gallstones. Petitioner agreed to have the operation at the Asian Hospital and Medical Center (AHMC). The operation was performed on September 15, 2010, with Dr. Uyloan as attending physician and principal surgeon and Dr. John Francois Ojeda as assisting surgeon.

Petitioner expected the procedure to consist of only four small incisions around his umbilical area. Instead, Dr. Uyloan and Dr. Ojeda performed an open cholecystectomy without his approval or consent. During the operation, his abdomen was opened up and he lost a substantial amount of blood, necessitating transfusion. Dr. Uyloan explained that the conversion from laparoscopic to open cholecystectomy resulted from a "punctured cystic artery."

Upon discharge from AHMC on September 19, 2010, the release forms indicated that petitioner was in "good condition" and "recovered." However, he experienced vomiting and unbearable abdominal pain, with continuous bile leak in his colostomy bag even three days after discharge. During a follow-up checkup, Dr. Uyloan told him the pains and bile leak were "part of it" and advised magnetic resonance cholangio-pancreatography. Dissatisfied, petitioner sought treatment at another hospital, where tests revealed that instead of the cystic duct, it was the common bile duct that had been cut and clipped. The transection caused bile to leak and accumulate around his liver, kidney, spleen, the spaces between the colon and abdominal wall, and in his abdomen and lower limbs. He underwent corrective surgery on November 19, 2010.

On November 10, 2015, petitioner filed a complaint for damages against Dr. Uyloan, Dr. Ojeda, and AHMC, alleging that the defendant doctors breached their professional duties under a "medical contract" with him. He sought actual, moral, and exemplary damages, attorney's fees, and litigation costs, and sought to hold AHMC solidarily liable under the doctrine of corporate responsibility. The defendants moved to dismiss on grounds of prescription, forum shopping, and lack of jurisdiction, citing Article 1146 of the Civil Code and arguing that the action, premised on quasi-delict, was filed more than four years after the cause of action accrued on September 15, 2010. The RTC denied the motions, but the CA reversed, holding that the action was time-barred under the four-year prescriptive period for quasi-delict.

• Contractual Nature of the Action: Petitioner argued that he was suing under the theory of breach of contract, stressing that the physician-patient relationship is basically a contract involving the exchange of money for services with all the elements of a valid contract (consent, determinate subject matter, and consideration). He invoked American jurisprudence (Sullivan vs. O'Connor and Colvin vs. Smith) to support the proposition that medical malpractice actions based on contract are permissible in this jurisdiction.
• Applicable Prescriptive Period: Petitioner contended that because his cause of action was based on contract, the CA erred in applying the four-year prescriptive period under Article 1146. Instead, Articles 1144 (ten years for written contracts) and 1145 (six years for oral contracts) should govern. He maintained that quasi-delict liability may co-exist with contractual relations.
• Hospital Liability: Petitioner asserted that the contractual relation between patient and hospital may be inferred from the Court's decision in Professional Services, Inc. vs. Court of Appeals, which recognized that present-day hospitals have gone beyond mere furnishing of facilities for treatment and that patients expect the hospital to attempt to cure them.
• Need for Trial: Petitioner argued that whether the defendants breached their contract deserves a full-blown trial and is not appropriate for resolution in a motion to dismiss.

• Medical Malpractice as Tort: Dr. Uyloan maintained that the Court has uniformly treated medical malpractice cases as a distinct type of tort with four elements — duty, breach, injury, and causation — consistent with quasi-delict under Article 2176. He disagreed that petitioner's action was essentially based on contract.
• Absence of Special Contract: Dr. Uyloan pointed out that the foreign jurisprudence cited by petitioner involved special contracts based on express agreements between physician and patient to achieve a specific result, which is not the same as the ordinary physician-patient relationship in this case. The allegations in the complaint did not support a contract theory.
• Prescription: Respondents contended that the complaint was readily apparent on its face as premised on quasi-delict arising from the cutting and clipping of the bile duct due to alleged misidentification of anatomy, and that the action should have been commenced within four years from September 15, 2010.

• Characterization of Cause of Action: Whether petitioner's complaint states a cause of action for medical negligence under quasi-delict or for breach of contract, thereby determining the applicable prescriptive period.
• Prescription: Whether the CA committed reversible error in ruling that the RTC gravely abused its discretion in denying the motions to dismiss on the ground of prescription.

• Characterization of Cause of Action: No. The complaint states a cause of action for medical negligence under quasi-delict, not breach of contract. A mere reference to an implied contract between physician and patient is insufficient; a contractual cause of action for medical malpractice must allege an express promise to provide medical treatment or achieve a specific result.
• Prescription: No. The CA did not commit reversible error. The cause of action accrued on September 15, 2010, and the complaint filed on November 10, 2015 was barred by the four-year prescriptive period under Article 1146 of the Civil Code.

• Characterization of Cause of Action: The Court examined the allegations of the complaint and found that while petitioner categorically declared the case was brought on the basis of a "medical contract," the rest of the allegations unmistakably showed the cause of action was premised on medical negligence under the Civil Code provisions on quasi-delict. There was no mention of any express promise by the defendant doctors to provide medical treatment or achieve a specific result. The absence of an express agreement as basis for contractual liability was evident from petitioner's plain invocation of an implied contract. The Court relied on established rules from American jurisprudence: absent an express contract, a physician does not impliedly warrant the success of treatment but only adherence to the applicable standard of care; a breach of contract complaint fails to state a cause of action without an allegation of an express promise to cure or achieve a specific result. The physician-patient relationship, while consensual, is not contractual in the sense petitioner employs the term; the medical profession is affected with public interest, and once the relationship is established, the legal duty of care follows. Breach of that duty — failure to comply with professional standards — constitutes actionable malpractice sounding in tort.

• Prescription: Because the cause of action was one for medical negligence under quasi-delict, the applicable prescriptive period was four years under Article 1146 of the Civil Code. The cause of action accrued on September 15, 2010, the date the operation was performed. The complaint was filed on November 10, 2015, more than five years later, rendering it time-barred. The issue of prescription was one of law, not fact, because the dispute lay in the applicable provision on prescription under the Civil Code, requiring only a determination of the cause of action based on the allegations in the complaint and its annexes. The CA therefore did not gravely abuse its discretion in ordering dismissal.

• Medical Negligence as Quasi-Delict — Medical malpractice or medical negligence is a particular form of negligence consisting in the failure of a physician or surgeon to apply the degree of care and skill ordinarily employed by the profession generally under similar conditions. It has four elements: duty, breach, injury, and proximate causation. For lack of a specific law, such claims are almost always anchored on Article 2176 of the Civil Code. The Court applied this framework to hold that petitioner's complaint, despite its contractual label, stated a cause of action in tort.

• Contractual Medical Malpractice Requires Express Promise — A medical malpractice action based on contract must allege an express promise by the physician to provide medical treatment or achieve a specific result. A mere reference to an implied contract between physician and patient is insufficient. Absent an express contract, a physician does not impliedly warrant the success of treatment but only adherence to the applicable standard of care. The Court established this rule to reject petitioner's attempt to characterize his claim as contractual to avail of a longer prescriptive period.

• Physician-Patient Relationship as Consensual but Not Necessarily Contractual — A physician-patient relationship is created when a patient engages the services of a physician and the latter agrees to provide care. The relationship is consensual, and consent may be express or implied from the physician's affirmative action to diagnose or treat. However, the consensual nature of the relationship does not necessarily make it contractual in the sense of an exchange of money for services with a warranty of results, because the medical profession is affected with public interest. Once established, the legal duty of care follows, and breach of that duty sounds in tort.

• Prescription as Question of Law vs. Fact — Prescription is a question of fact when the doubt arises as to the truth or falsity of a factual allegation; it is a question of law when the controversy concerns what the law is on a given state of facts. The test is whether the appellate court can determine the issue without reviewing or evaluating the evidence. Where the dispute lies in the applicable provision on prescription based on the allegations of the complaint, the issue is one of law.

• "In the light of the foregoing, We hold that a mere reference to an implied contract between the physician and the patient in general is insufficient for pleading a cause of action under the contract theory of professional malpractice. An action for medical malpractice based on contract must allege an express promise to provide medical treatment or achieve a specific result." — This is the ratio decidendi: the Court's definitive rule distinguishing contractual from quasi-delictual medical malpractice claims, directly resolving the prescription issue.

• "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." — This passage, drawn from American jurisprudence, articulates the canonical formulation adopted by the Court for why medical negligence claims sound in tort absent an express promise.

• "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." — This clarifies the doctrinal distinction between the consensual nature of the physician-patient relationship and its contractual characterization, a point central to rejecting the contract theory.

• Crisostomo vs. Garcia, 516 Phil. 743 (2006) — Cited for the rule that prescription may be a question of law or fact, and the test for distinguishing the two.
• Macababbad, Jr. vs. Masirag, 596 Phil. 76 (2009) — Followed for the principle that a ruling on prescription requires analysis of the plaintiff's cause of action based on the allegations of the complaint, and that a motion to dismiss based on prescription hypothetically admits allegations relevant to the issue.
• Lucas vs. Tuaño, 604 Phil. 98 (2009) — Cited for the definition of the physician's duty of care: to exercise the degree of care, skill, and diligence ordinarily possessed and exercised by physicians in the same general line of practice under similar circumstances.
• Casumpang vs. Cortejo, 755 Phil. 466 (2015) — Followed for the principle that the physician-patient relationship is consensual and may be implied, and that the legal duty of care follows once established.
• Reyes vs. Sisters of Mercy Hospital, 396 Phil. 87 (2000) — Cited for the definition of medical malpractice as a particular form of negligence, and for the proposition that the medical profession is affected with public interest.
• Professional Services, Inc. vs. Court of Appeals, 625 Phil. 122 (2010) — Cited by petitioner for the proposition that hospitals have gone beyond mere furnishing of facilities; the Court did not rely on it for the holding.
• Cereno vs. Court of Appeals, 695 Phil. 820 (2012) — Cited for the definition of medical negligence as the type of claim available to a patient to redress a wrong committed by a medical professional causing bodily harm.
• Garcia-Rueda vs. Pascasio, 344 Phil. 323 (1997) — Cited as underlying authority for the definition of medical negligence.

• Article 2176, Civil Code — Defines quasi-delict: 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. Applied as the primary basis for medical negligence claims, the Court emphasizing the phrase "if there is no pre-existing contractual relation" to distinguish quasi-delict from contract.
• Article 1146, Civil Code — Provides that actions upon an injury to the rights of the plaintiff and upon a quasi-delict must be instituted within four years. Applied as the governing prescriptive period, the cause of action accruing on September 15, 2010.
• Article 1144, Civil Code — Provides a ten-year prescriptive period for actions upon a written contract. Petitioner invoked it, but the Court held it inapplicable because no contractual cause of action was stated.
• Article 1145, Civil Code — Provides a six-year prescriptive period for actions upon an oral contract. Petitioner invoked it, but the Court held it inapplicable for the same reason.
• Article 1170, Civil Code — Provides that those guilty of fraud, negligence, or delay in the performance of obligations, and those who contravene the tenor thereof, are liable for damages. Cited in the complaint but not applied as basis for the ruling.
• Article 1173, Civil Code — Defines the fault or negligence of the obligor as the omission of the diligence required by the nature of the obligation. Cited in the complaint; petitioner argued it supported a contractual theory, but the Court found the allegations sounded in tort.

Caguioa, Lazaro-Javier, M. Lopez, and J. Lopez, JJ., concurred.