Legal Aspects in Nursing
Atty. Jan Igor Galinato
14 Landmark Medico-legal Philippine Jurisprudence 1946 to
2021 and Theory U
[video 1]
Theory U, Organizational Development, and Landmark Nursing-
related Philippine Jurisprudence from 1946 to 2021
In this paper the author explicates how the Theory U of
organizational development can be used to analyze the 14
landmark nursing-related Philippine jurisprudence
 to improve the organization and performance of
hospitals and even nursing schools
 to improve patient care and decrease the risk of legal
liability
Theory U or U Process
 a process where leaders have to operate from the
highest possible future rather than being stuck in the
patterns of our past experiences
 the process pulls people into an emerging possibility
and allows us to operate from that altered state rather
than simply reflecting and reacting to past experiences
 the theory averted that we need to be aware of a
profound blind spot in leadership and everyday life
Presencing
 a concept in theory U which means operating from the
future as it emerges
 a blending of two words presence and sensing
 it means to sense, tune in, and act from one's highest
future potential, the future that depends on us to bring
it into being
 to achieve said future there has to be an Archimedean
point or an enabling condition to the degree that we
can see our attention and its source we can change
the system
 but to do it we have to shift the uneven place from
where we operate
 to better ourselves by gathering a much more subtle
set of data and experiences from within
 Theory U is a phenomenon where people are
awakening to a deeper awareness of a creative
process
 it is a framework and a language there is an
architecture to it and a way to talking about it
 when people create or constantly innovate they take a
journey from the visible to the invisible as inspiration
comes from the invisible
see figure 1 (the architecture of theory you) (kapoy copy paste
sa picture oy)
 in theory U the person is required to open his mind
heart and will in order to transition from the visible to
the invisible then back to the visible
 Mind - is what we think see feel touch smell and hear
o it is the universe that we can observe
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 Heart – means that whatever is sensed and created
must feel right
o if one does not have a good feeling about
something that part will not be taken
o the heart is used the levels of co-sensing
and co-creating
 Will – what makes you do things and take actions
o at the bottom
o it responds to you, to your source, your
intuition and is used in co-presencing
once one has opened his mind heart and will:
 the will causes the person to find presence or the
“source of knowing”
 Presence – is connecting with the source
o how we know what we know
o it is a spirit
o the center that requires us to open our will
o it is the willingness to let go of past
thoughts, beliefs , actions and a willingness
to let come new ideas new beliefs and new
actions
 the usefulness of theory U is in facing the future that
none of us can name by connecting with our deepest
sources of knowing
 the word “co” abounds in theory u – it means
“together”
 Co-initiating – is a dialogue that identifies an issue and
the roots of an issue
 Co-sensing – is acting together with the group's
senses or feels that the issue and its roots need
change
 Co-presencing – is discovering what is in your
collective field or collective way of knowing
 is the only phase that use other ways to get in touch
with the source besides dialogue
 Co-creating – means developing prototypes to test
ideas
 Co-evolving – means continuing to test prototypes
until things coalesce into a solution. the continuing to
ask: “is it working?”, “what else can we do?” and “who
else wants to play?”
 co-initiating co-sensing and co-evolving use
transformational dialogue
[see figure 2, theory u and the deep dive (but wala gud
picture?)]
 theory U also makes a distinction between
conversation and dialogue to bring about change
 Conversation – is an informal interchange of
thoughts and or information by spoken words; oral
communication between persons
 Dialogue – is an exchange of ideas or opinion and
a particular issue with a view to reaching an
amicable agreement or settlement
Legal Aspects in Nursing
Atty. Jan Igor Galinato
 Transformational Dialogue – is dialogue initiated for
the purpose of change and has four characteristics
1. move – tell me where to go and why and
invites a response
2. oppose – talks back to the move. this
creates a dialogue instead of a
monologue and creates robustness
3. bystand – considers and reflects on the
dynamics of the dialogue and names it
for the group
4. follow – asks the questions that help the
group understand
Good dialogue
 is a balance of advocacy and inquiry
 dialogue not conversation steals the negative voices
 this is the voices of doom the ones that blocks the
mind and heart
 the voices of cynicism the ones that blocks the heart
and says that never is going to work and the voices of
fear the ones that block the wheel and says I can't do
that
 it's very important because the whole purpose of this
endeavor is to initiate dialogue with the members of
the healthcare community
[figure 2: theory U and the deep dive]
 the idea is in order to transform a person must
descend from the visible to the invisible and back to
the visible by opening mind heart and open will to do
presencing and co-presencing
The Principles and Practices of Theory U
1. Attend: listen to what life calls you to do
2. Connect: listen to a dialogue with the interesting
players in the field
3. Co-initiate: a diverse group that inspires common
intent
4. Form a highly committed team and clarify essential
questions
5. Deep dive: take these journeys to places of most
potential
6. Observe, observe, observe: suspend your voice of
judgment and connect with your sense of wonder
7. Practice deep listening and dialogue connect to others
with your heart mind heart and will wide open
8. Create collective sensing organs that allow the system
to see itself
9. Letting go: let go of your old self and stuff that must
die
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10. Intentional silence: pick a practice that helps you
connect with your source
11. Follow your journey: though do what you love love
what you do
12. Letting come: connect and surrender to the future that
wants to emerge through you
13. Places of presence: create circles in which you hold
one another in the highest future intention
14. Power of intention: connect to the future instead stays
in need of you crystallize vision and intent
15. Form core groups: five people can change the world
16. Prototype strategic microcosms as a landing strip for
the emerging future
17. Integrate head heart and hand seek it with your hands
don't think about it feel it
18. Iterate, iterate, iterate: create and adapt and always
be in dialogue with other in the universe
19. Co-evolve innovation ecosystems that create and
renew by seeing from the emerging whole
20. Create innovation infrastructure by shaping rhythm
and safe practice safe places for peer coaching
21. Social presencing theater: evolve collective
awareness to world café
22. Intentional grounding: always seen as an instrument
for the whole
23. Relational grounding: connect and dialogue with a
global field
24. Authentic grounding: connect your highest self as a
vehicle for the future to emerge
[table 1 shows the 14 landmark nursing related Philippine
jurisprudence healthcare workers were held liable]
 the vertical axis shows the years in which those
judgments were promulgated by the Philippine
supreme court
 the horizontal axis shows in which phase of the
nursing process the medical legal error could be
attributed to whether assessment, diagnosis, planning,
implementation, or evaluation
 hopefully using theory U, we can analyze how the
healthcare system in the Philippines could improve to
avoid legal liabilities in the future and improve patient
care
[here is a brief outline of the cases]
Case #1: People versus Dr. Leon Castillo, Nena Tanalega
Raymundo
 Dr. Leon Castillo (MD) & Nena Tanalega Raymundo
(Pharmacist)
 C.A/ 227
Legal Aspects in Nursing
Atty. Jan Igor Galinato
 February 1,1946
 Supreme court En Banc
 Assessment problem
 Pharmacist was convicted of frustrated murder by
poisoning through reckless imprudence and sentenced
to four months in prison and to pay a fine of Php 200
 Castillo was acquitted
 “The Wrong Drug”
 classified by the authors, an assessment problem
 a pharmacist gave the wrong drug: Strychnine (spastic
paralytic) instead of Spartein (an antiarrhythmic drug)
 the paralytic drug almost killed the client
 the pharmacist was convicted of frustrated murder by
poisoning through reckless imprudence and
sentenced to four months in prison and to pay a fine of
200 pesos
 the client brought Spartein Sulfate an antiarrhythmic
drug from a pharmacy but the pharmacist gave the
client Strychnine Sulfate a poisonous substance which
is paralytic
 the regional trial court acquitted Dr. Castillo: He was
the manager but found a pharmacist Tana Lega
Remundo liable for frustrated murder by poisoning
through reckless imprudence punished by a fine 200
pesos and four months imprisonment which was a
large sum at that time in 1946
o Dr. Leon Castillo was acquitted because he
was just the manager and did not participate
in the preparation of the drug
 The principle of conspiracy does NOT apply to
culpable felonies like reckless imprudence as in this
case
 the private prosecution also reserved the right to file
separate civil action
Case #2: Victoria Batikin versus Court of Appeals et al
 GR No. 118231
 July 5, 1996
 Evaluation problem
 MDs held liable for Php 166,900
 “a piece of rubber glove”
 This case classified by the author as an evaluation
problem
 A doctor left behind a piece of rubber glove after a
cesarean section
 After leaving the hospital, the client experienced
abdominal pain, fever, and loss of appetite
 An examination by another doctor revealed the client
had infection in her ovaries causing ovarian cysts in
her left and right ovaries
 Doctors victoria batikin and Alan batikin were held
liable for a total of 166,900 pesos
Case #3: Dr. Ninevitch Cruz versus the Court of Appeals and
Lydia O’Malley
 GR No. 122445
 November 18, 1997
 Planning Problem
 Doctor was charged with Reckless Imprudence resulting
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to homicide
 Doctor was acquitted: bc it was established in trial that
the patient died from disseminated intravascular
coagulation and unpreventable clotting disorder
 Although civilly liable for: Php 200,000
 “ran out of supplies”
 classified as a planning problem
 a surgeon ran out of oxygen and medication in the
middle of a hysterectomy surgery for a myoma
 the surgeon went out of the surgery and instructed the
patient's relatives to buy Tagamet ampules, type A
blood, oxygen supply all while the patient was
experiencing shock with blood pressure plummeting to
60 over 50.
 the patient was transferred to another hospital where
she eventually died from shock
 the doctor was charged with reckless imprudence
resulting to homicide that was acquitted because it
was established in trial that the patient died from
disseminated intravascular coagulation and
unpreventable clotting disorder however the supreme
court still found the doctors civilly liable for two
hundred thousand pesos
Case #4: Ramos et al versus Court of Appeals and Delos
Santos Medical Center, Dr. Hosaka and Dr. Gutierresz
 GR No. 124345
 April 11, 2002
 Assessment Problem
 SC absolved hospital from liability
 MDs liable for Php 2,200,200
 “surgery gone wrong”
 Classified as a problem in assessment
 the surgeon, Dr. Hosaka, was late for the
cholecystectomy operation. Causing the patient to be
anxious “affecting the administration of anesthesia on
her”, as outpouring of adrenaline resulting in high
blood pressure and disturbance of heart rhythm
 the anesthesiologist, Dr. Gutierrez also did not
perform the standard pre-anesthetic or pre-operative
evaluation the day before which caused him to
intubate wrongfully
 the patient's sister-in-law Herminda Cruz who was
with the patient in the operating room witnessed the
patient become cyanotic before dying as she testified
in the case
 the Supreme Court absolved the hospital from liability
but found the doctors liable for two million two
hundred thousand pesos
Case #5 Professional Services Incorporated (PSI) versus Agana
 GR No. 126297 / January 31, 2007 First division
 motion for reconsideration  final case was decided
 GR No. 126297
 February 2, 2010 En Banc
 Evaluation Problem
 Nurse and Dr. Fuentes absolved
 Dr. Ampil and hospital liable for Php 3,034,442.50
 In 2010: supreme court castigating the hospital for failing
to pay for 24 years  held the hospital liable for 15
Legal Aspects in Nursing
Atty. Jan Igor Galinato
million pesos
 “sponge count lacking two”
 Classified as a problem in evaluation
 a patient with sigmoid colon cancer was admitted for
surgery on April 4, 1984 in the Medical City General
Hospital under Professional Services Incorporated
 Dr. Ampil is the head surgeon, performed anterior
resection surgery while Dr. Fuentes performed the
hysterectomy
 after the operation and before the closing of the
sutures the attending nurse reported to Dr. Ampil, the
two sponges were missing. Still Dr. Ampil closed the
sutures.
 the nurse documented in the chart: sponge count
lacking 2. Announced the surgeon's search done but
to no avail continue foreclosure
 several weeks after leaving the hospital the patient
experienced pain in the anal region, the doctor told
her it was okay.
 then in August 31, 1984 a 1.5 inch width sponge
came out of the patient's vagina
 she was later admitted to Polymedic General Hospital
where the doctor there discovered a 1.5 inch gauze
had created a rectal vaginal fistula in her body it had
formed in her reproductive organs which forced stool
to excrete through the vagina she had another
operation she filed a case and later died in 1986
 the nurse was absolved so was Dr. Fuentes because
he had no control of the entire surgery, he only did a
hysterectomy and he left before the sutures were
even closed
 the Supreme Court found the hospital and Dr. Ampil
solidarily liable for three million pesos, three million
thirty thousand four hundred forty two and fifty cents to
be exact
 invoking the doctrine of Captain of The Ship and res
ipsa loquitir or “the thing speaks for itself”
 the hospital dilly-dallied in pain and filed a motion for
reconsideration which was resolved by the Supreme
Court En Banc with finality on February 2, 2010: in GR
No.126297 the supreme court castigating the hospital
for failing to pay for 24 years  held the hospital liable
for 15 million pesos
Case #6: Orlando D. Garcia Jr., Community Diagnostic Center,
Dr. Bo Castro versus Salvador
 GR No. 168512
 March 20, 2007
 Assessment problem
 Respondents held liable for Php 125,000
 “false positive”
 classified as a problem of assessment
 Garcia Jr. (medtech) and Dr. Bu Castro (pathologist)
were found by the supreme court to be liable for
causing a false positive Hepatitis B result on Ranida
Salvador causing her to be terminated from her
employment and causing her father to die from heart
attack when he heard of the news
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 the respondents were held liable for Php 125,000
Case #7: Ilao-Oreta versus Ronquillo
 GR No. 172406
 October, 11 2007
 Planning problem
 MD civilly liable for Php 2,711.30
 “missing doctor”
 Classified as a problem in planning
 a surgeon didn't arrive at scheduled diagnostic
surgery of a patient, a laparoscopic procedure would
have been done to check why the client couldn't
conceive a child. This is all because a surgeon was on
her honeymoon outside the country.
 the supreme court found the doctors civilly liable for
Php 2,711.30
Case #8: Spouses Flores versus Spouses Pineda
 GR No. 158996
 November 14, 2008
 Assessment problem
 SC ruled yes
 MDs and hospital liable for Php 686,000
 “diabetes mellitus + DNC”
 Doctor Fredelicto Flores (an anesthesiologist)
scheduled the dilation and curettage (DNC) to be
performed by his wife Dr. Felissima Flores of a woman
with vaginal bleeding despite the fact that said woman
also has diabetes mellitus
 the issue here is whether or not the doctors are
solidarily civilly liable
 the supreme court ruled: yes
 The supreme court held that the surgical stress
aggravated the patient's hyperglycemia, killing her.
The evidence strongly suggests that the preoperative
evaluation was less than complete : as the laboratory
results were fully reported only on the day following
the DNC operation
 the doctors and hospital were found solidarily liable for
Php 686,000
Case#9: Dr. Jarcia Jr. and Dr. Bastan versus People
 GR No. 187926
 February 15, 2012
 Assessment problem
 MDs charged of simple imprudence resulting to serious
physical injuries but was acquitted but civilly liable for
Php 133,850
 “fracture”
 a child was hit by a motorcycle, was admitted in the
emergency room
 the doctors failed to diagnose the child's fracture in the
right leg because the doctor only ordered an x-ray of
the right foot
 the child suffered pain as a consequence
Legal Aspects in Nursing
Atty. Jan Igor Galinato

 the supreme court acquitted the doctors of the charge eligibility forfeiting his retirement benefits and
of simple imprudence resulting to serious physical perpetually disqualified him from re-employment in the
injuries but found them civilly liable for Php 133,850 government service pursuant to section 58 rule 4 of
the uniform rules or administrative cases in the civil
service
Case #10: Dr. Cabugao, Dr. Ynzon versus People  the governor of oriental Mindoro implemented the
judgment the court of appeals affirmed the
 GR No. 163879 ombudsman
 July 30, 2014  the issue in this case is whether Dr. Bondoc’s indeed
 Cabugao – acquitted guilty of grave misconduct. The supreme court ruled:
 Ynzon guilty of reckless imprudence resulting to
homicide yes
 Assessment problem
 “appendicitis” Case#12: Casumpang et al versus Nelson Cortejo

 the accused Dr. Ynzon (surgeon) did not personally
monitor the child in order to check on subtle changes
that may occur he left the monitoring an actual
observation to resident physicians who were just
under residency training the child wasn't operated
when he manifested symptoms of acute appendicitis
and died
 Dr. Cabugao was acquitted because he was just a
family physician not a surgeon
 Dr. Ynzon guilty of reckless imprudence resulting to
homicide but he died on December 23, 2011of multi-
organ failure prior to final judgment
Case #11: Dr. Idol L. Bondoc versus Marilou R. Mantala
 GR No. 20308
 Nov 12, 2014
 Implementation problem
 MD guilty of grave misconduct
 “fundal push”
 GR No. 171127
 promulgated March 11, 2015
 implementation problem
 “dengue”
 Dr. Casumpang diagnosed a child with
bronchopneumonia even though the child showed sign
symptoms of dengue
 high fever no colds or cough, chest and stomach pain,
and traces of blood in the sputum
 the supreme court found that his examination was not
comprehensive enough as he only used a stethoscope
in coming up with a diagnosis of bronchopneumonia
and didn't use a bronchoscope
 Dr. Casumpang selectively appreciated some and not
all of the symptoms presented and failed to promptly
conduct the appropriate test to confirm his findings
 the child died
 Dr. Casumpang and the hospital (San Juan Dios
Hospital) were held solidarily liable for Php 545,000

 a mother with polyhydramnios (large amounts of

Case #13: Nilo B. Rosit versus Davao Doctor’s Hospital
amniotic fluid) and macrosomia (a large baby) was
struggling to give birth
 GR No. 210445
 instead of transferring the woman to the operating  promulgated December 7, 2015.
room for caesarean section Dr. Bondoc left the  Implementation problem
delivery room, just instructed the midwife and two  MD violated requirements of informed consent
younger assistants to press down on the respondents  “broken mandible”
 the doctor used large screws to immobilize the
abdomen – a practice known as the fundal push
patient's mandible. The patient had been a victim of a
 the midwife and the younger assistants pressed down
motorcycle accident
repeatedly on the woman's abdomen causing
 the doctor didn't inform the patient that smaller screws
excruciating pain on her ribs and made her very weak
were available but at a higher price as he assumed
 they repeatedly did this pressing until the baby and
that the patient will not be able to afford them
the placenta came out meanwhile dr dr bundock was
 as a result of the large screws the patient suffered
overheard by a fellow physician named Dr. Faban
constant pain in his jaw and could not open or close
saying “meron pa nga kami sa DR, macrosomia,
his jaw properly
polyhydramnios pa! paanakin nalang yun abnormal
 another operation was needed to correct the jaw
naman din yung bata kahit mabuhay” when she
 the supreme court ruled that the doctor violated the
regained consciousness the mother was already in the
requirements of informed consent and apply the
recovery room.
doctrine of res ipsa loquitir
 she learned that an operation was performed on her
 the doctor was held liable for Php 379,267.13
by Dr. Bondoc to remove the ruptured uterus
 her uterus had ruptured because of the fundal push
Case #14: Our Lady Of Lourdes Hospital versus Spouses
 she was depressed the most because her stillborn
Capanzana
baby and her loss of a reproductive capacity
 the ombudsman found Dr. Bondoc guilty of grave
GR No. 189218
misconduct dismissed him from service canceled his

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Legal Aspects in Nursing
Atty. Jan Igor Galinato
promulgated March 22, 2017
planning problem
“out of air”
 a patient with rheumatic heart disease suffered
hypoxic encephalopathy, underwent a vegetative state
and died because the nurse was negligent in not
having promptly giving oxygen
 the hospital was also found to be equally negligent for
not making available and accessible the oxygen unit
on that same hospital floor at the time
 the supreme court found the nurse and hospital, so
they are reliable for Php 2,419,102
table 2 shows a deeper analysis of the Landmark Philippine
Nursing Related Medical Jurisprudence where healthcare
workers were held liable
 if one reads case number 5 (PSI vs Ugana) it is
noticeable that the highest ever civil award in the
medical legal suit 15 million pesos was made possible
because of the attending nurse's assertive
documentation of the following phrase “sponge count
lacking 2”
 and if one reads case number 4 (Ramos versus CA)
with liability at 2.2 million pesos and compare it to
case number 14 (Our Lady Of Lourdes Hospital
versus Spouses Capanzana) liability at 2.4 million
pesos but both look like polar opposites of each other
 while the nurse helped her relatives attain justice
through her vigilance and assertiveness in Ramos
another nurse's negligence and passivity in Lourdes
caused said nurse and the hospital to be solidary
liable for millions
 looking at table 2 it is apparent that it is in the
assessment phase of the nursing process where most
of the medical legal errors occurs
 cases 1, 4, 6, 8, 9,10 and 12 are 50 percent of the
landmark jurisprudence or all problems in assessment
 as to the amount of civil liability however it is
ostensible that nurses played a significant role
whether positively or negatively in such cases
 in case number 4 (Ramos vs CA) and case number 5
(PSI vs Ugana) the vigilance and assertiveness of the
nurse and documentation and assessment
respectively help the wrong parties attain justice
 while in case number 14 (our lady of lourdes hospital
versus spouses capanzana) it is the negligence and
passivity of the nurse that caused harm to the patient
and made the hospital and the nurse solidarily reliable
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 looking at table 2 it can also be noticed that there is a
variety in the cases which awarded the greatest civil
liability
 case number five (PSI versus Ugana) with 15 million
pesos is a problem in evaluation case number 14 (Our
Lady Of Lourdes Hospital)versus prosecutor with 2.4
million is a problem with planning
 case number four (Ramos et al versus CA) with 2.2
million is a problem implementation while case
number eight (Spouses Flores Versus Spouses
Pineda) with Php 686,000 is a problem in assessment
 thus the errors apparent in the landmark medical legal
jurisprudence are scattered in the different phases of
the nursing process
 premise is considered and based on the foregoing
disquisition the importance of assertiveness and
vigilant assessment, accurate documentation, careful
planning have been shown to be the most significant
factors around which many variables of nursing
jurisprudence in the Philippines have revolved in the
past 75 years from 1946 to 2021
 thus, this author humbly averse the through the
transformational dialogue of Theory U
 the conveyance of the said disquisition to the nurses
and hospitals and in the academe will foster vigilance
in the area of nursing legal aspects and improve
patient care and reduce the risk of legal liability
 TOD intervention proposed in line with your Theory U
would be in line with the technostructural methods
directed at organization technology and structures for
linking people and technology advocating for
enhanced supervision and monitoring of medical and
nursing personnel ensuring that the numbers are
adequate for the number of patients admitted and
ensuring that the necessary supplies like medications
on oxygen for instance would be available always
especially during surgeries in the evaluation stage
consultation with both supervisors and nurses and
doctors in the floor could be done to see if the
changes had indeed become institutionalized