SAMUEL R. RUÑEZ, JR., COMPLAINANT, VS. MARYBETH V. JURADO, RESPONDENT.

Ruñez versus Jurado

The Case

This is an administrative case brought by Samuel Ruñez, Junior against Doctor Marybeth Jurado, both of them employees of the Supreme Court. The complainant is the son of Samuel Ruñez, Senior, a driver in the Office of the Clerk of Court, who came to the Court's clinic one afternoon complaining of dizziness and was later found to have suffered a stroke. The son charges the doctor with neglect of duty for allegedly allowing his father to walk out of the clinic instead of sending him to a hospital by ambulance. The case matters because it fixes the yardstick of a physician's duty in administrative law: a doctor is bound to treat the patient who comes to her, but she is not duty-bound to track down a patient who leaves on his own, and conduct that deserves disapproval is not the same as conduct that deserves sanction.

Procedural History

This was an original administrative complaint, not a judicial action. On February 15, 2005, the complainant filed a letter-complaint with the Office of the Chief Justice. The letter was referred to the Deputy Clerk of Court and Chief of Administrative Services for investigation. She required the respondent to comment, received the complainant's reply and the respondent's rejoinder, and submitted her report on June 17, 2005. The report recommended a finding of simple neglect of duty and a suspension of one month and one day, and also recommended a flexi-time schedule for the clinic. The matter then came before the Supreme Court itself, which resolved it in its decision of December 9, 2005.

Facts

On January 12, 2005, at around 4:20 in the afternoon, Samuel Ruñez, Senior arrived alone at the Court's clinic complaining of dizziness. The reception nurse took his blood pressure and pulse rate, which registered at 210 over 100 and 112 beats a minute. What happened next is disputed. The son alleges that his father was merely advised to go to a hospital and was allowed to walk out on his own. The doctor maintains that she ordered one tablet of Capoten, an emergency drug that quickly lowers blood pressure, that she told the patient he would be taken to the hospital, and that she instructed the ambulance driver to stand by. Minutes later the patient stood up, said he would just look for a companion, and walked out. The doctor waited, asked a nurse to look for him, but he could not be found. She then left the clinic at the end of her tour of duty.

The son, upon learning of his father's condition, rushed him to the Manila Doctors Hospital, where he was treated in the emergency room for about four hours and discharged at around 8:30 in the evening. On the way home the patient began to experience nausea, abnormal palpitation and uneasiness, and had to be brought back. A scan revealed a blood clot, and he was admitted. The following morning he suffered a stroke and was transferred to the intensive care unit. He never recovered and passed away on September 12, 2005.

The investigating officer gave credence to the doctor's account, supported by the affidavits of the clinic personnel, including the ambulance driver, and found that the patient had been given proper treatment inside the clinic. She nevertheless opined that the doctor's actions after the patient left fell short of the diligence of a good father of a family, noting that the doctor herself left the clinic minutes later and that she should have exerted efforts to find the patient, informed his relatives, or turned the case over to another doctor.

Issues

• Whether or not Doctor Jurado is administratively liable for simple neglect of duty for her conduct after Samuel Ruñez, Senior left the clinic.
• Whether or not a physician is duty-bound to seek out a patient who leaves the clinic on his own contrary to medical advice.

Applicable Provisions

Article Two, Section One of the Code of Medical Ethics of the Medical Profession in the Philippines provides:

A physician should attend to his patients faithfully and conscientiously. He should secure for them all possible benefits that may depend upon his professional skill and care. As the sole tribunal to adjudge the physician's failure to fulfill his obligation to his patients is, in most cases, his own conscience, violation of this rule on his part is discreditable and inexcusable.

This ethical standard defines the duty the respondent is measured against, and the Court uses it to show that the duty is owed while the patient is under the physician's care, not after he walks away.

Ruling

On the first issue, the Court held that there is no simple neglect of duty. Simple neglect of duty is the failure to give proper attention to a task expected of an employee, resulting from carelessness or indifference. It presupposes an expected task, and it cannot be present where no task was expected. The Court measured the respondent against the standard of the medical profession, that a physician is expected to apply that degree of care and skill ordinarily employed by the profession generally under similar conditions. A doctor's duty is not extraordinary; the standard is simply the reasonable average merit among ordinarily good physicians, meaning reasonable skill and competence. The respondent met that standard inside the clinic, and the acts the investigator would require of her afterwards were not shown to be expected of physicians.

On the second issue, the Court held that a patient cannot attribute to a physician damages resulting from his own failure to follow advice, and that if a patient leaves the hospital contrary to instructions, the physician is not liable for subsequent events. There is no expectation that doctors track down each patient who missed his appointment or force him to comply, for a person is still the master of his own body. The patient's condition had temporarily stabilized, and the doctor had no authority to stop him from leaving, save in certain instances such as compulsory treatment for a communicable disease or a court order. She relied on his representation that he would return, and made no undertaking to wait beyond clinic hours or to search for him. When he failed to return, she had reason to think he had disregarded her advice, which he in fact did. The Court added that people may frown upon certain behavior, but disapproval does not translate into neglect of duty, misconduct or negligence.

Doctrine

First, simple neglect of duty requires a task expected of the employee; without an expected task, there can be no neglect. Second, a physician's duty is measured by the reasonable skill and competence of an ordinarily good physician, not by extraordinary care. Third, a physician is not liable for the subsequent condition of a patient who leaves contrary to medical advice, because a person of sound mind remains the master of his own body. Fourth, conduct that earns disapproval is not thereby an administrative offense; sanctions attach only to the failure to perform a clear duty, expectation or obligation.

Disposition

The Court dismissed the complaint against Doctor Jurado for lack of merit, and directed the preparation of a flexi-time schedule for all doctors and nurses in the clinic to improve emergency medical attention.

Remember This

Memorize the line that a person is still the master of his own body, and that simple neglect of duty presupposes an expected task. Examiners use this case in administrative law and medical negligence questions to test the distinction between conduct that deserves disapproval and conduct that deserves sanction.