Injured, Silenced, Denied: The Real Cost of Medical Negligence
A child dies after a routine circumcision. A nurse pleads for PPE and dies alone. A mayor recovers from COVID—only to contract a fatal infection in the ICU. Each of these stories ends in mourning. But few end in court.
In country of more than 118 million people, where medical decisions are made daily across thousands of clinics, hospitals, and birthing centers, the Philippine Supreme Court has decided only 28 cases that mention either “medical negligence”or “medical malpractice” from 1990 to 2025.
Fewer than 50 cases in 35 years. This isn’t a sign of perfection. It’s a sign of silence.
What we see on record is a trickle. The rest stays unspoken.
This is not a system that encourages justice. It is a system that quietly, persistently shuts the door.
Cases Die Without Experts
In Philippine courtrooms, medical negligence cases rarely survive without the testimony of a physician from the same field as the accused. Without that expert, the case often dies on arrival—unless the doctrine of res ipsa loquitur clearly applies.
No expert, no case. Even when complainants present witnesses, the testimony must come from someone credentialed in the field directly related to the alleged act of negligence.
In Que v. Philippine Heart Center (2025), the Supreme Court made this threshold even more explicit:
“As a forensic pathologist, Dr. Fortun cannot qualify as an expert witness in so far as to determine whether Dr. Aventura exercised the norm observed by other reasonably competent members of the profession.”
In Borromeo v. Family Care Hospital (2016), the Court rejected testimony from a general practitioner and a legal expert in medical jurisprudence:
“Dr. Reyes is not an expert witness who could prove Dr. Inso’s alleged negligence… His testimony cannot be relied upon to determine if Dr. Inso committed errors during the operation.”
“Dr. Avila… testified in his capacity as an expert in medical jurisprudence, not as an expert in medicine, surgery, or pathology. His testimony fails to shed any light on the actual cause of Lilian’s death.”
Instead, the Court gave greater weight to the defense’s experts—Dr. Ramos, a board-certified pathologist, and Dr. Hernandez, a seasoned general surgeon:
“To our mind, the testimonies of expert witnesses Dr. Hernandez and Dr. Ramos carry far greater weight… The petitioner’s failure to present expert witnesses resulted in his failure to prove the respondents’ negligence.”
In theory, this evidentiary rule filters out unreliable testimony. In practice, it narrows the gate so tightly that many valid claims are shut out. Across jurisdictions, legal scholars and medical commentators have noted how few specialists are willing to testify against their peers. The reasons range from professional loyalty to reputational risk. This dynamic is often referred to as the “conspiracy of silence” within the medical profession (Okoli, 2019; Wood, 1986). The result? Legitimate complaints wither for lack of qualified expert witnesses.
Technical Barriers to Justice
The law gives patients four years to file a malpractice complaint. That clock starts ticking from the time the cause of action accrues—often interpreted as the time of injury, not necessarily the time the patient understands what went wrong.
In De Jesus v. Uyloan (2022), the Supreme Court dismissed a gallbladder surgery case—not because negligence was disproven, but because it was filed outside the prescriptive period. The patient underwent a corrective surgery two months after the first procedure, yet the complaint was filed nearly five years later.
The reasons for delayed filing? We can only guess. The case was silent.
This silence is deafening. It hints at something more complex—perhaps emotional exhaustion, financial paralysis, or simply confusion. Perhaps the patient wasn’t sure she had a case. Perhaps she hoped the second surgery had fixed what went wrong. Perhaps she was afraid to confront the system that failed her.
Some researchers suggest that psychological trauma, avoidance behaviors, or loss of trust in the system can delay patients from confronting malpractice. But more empirical studies are needed to understand these patterns fully. In the Uyloan case, there was no indication as to why the delay occurred.
Adding to this fog is a legal ambiguity rarely acknowledged outside courtrooms: was the claim one of breach of contract or of quasi-delict? The prescriptive periods differ—six years for the former, four for the latter. In Uyloan, this lack of clarity may have further delayed the decision to file. The very act of choosing the legal theory becomes a strategic gamble—and for many, a trapdoor.
These are the technical barriers to justice. A procedural rule meant to protect against stale claims becomes, in effect, a barricade. And patients, already reeling, are forced to navigate a legal minefield without a map.
The Cost of Filing a Case Is Higher Than Most Can Afford
Pursuing a malpractice claim isn’t just about courage—it’s about capacity. Filing fees. Expert opinions. Lawyer’s fees. Court appearances. These costs accumulate long before a judge hears the case.
Years ago, I assisted a client in a physical injury case. We sought a medico-legal expert. She was reputable and upfront:
“I charge ₱5,000 per court appearance.”
Now imagine a malpractice case that spans years, with multiple hearings and possible appeals. Even a conservative estimate balloons into a financial burden, especially for families already reeling from hospital bills and lost wages.
In another experience involving a case of psychological incapacity, one expert charged ₱100,000 as an acceptance fee, which included the preparation of the report. Another charged ₱30,000 per appearance in court. When these figures were laid out, clients balked. One even considered withdrawing the case.
This isn’t meant to disparage expert witnesses—their time, expertise, and credibility matter. But it’s a stark reality: many middle-income Filipinos simply can’t afford the price tag attached to justice. And if middle-income Filipinos struggle to afford these fees, how much more for the poor?
When Faith Replaces Fight
In many Filipino households, when tragedy strikes, the response isn’t legal—it’s spiritual.
Kalooban ng Diyos. God’s will. A phrase whispered over hospital beds, funeral parlors, and even courtroom steps. It offers comfort, yes—but it can also cloud accountability.
The idea that suffering has divine purpose is deeply rooted in Filipino culture. When a medical procedure goes wrong, many families are more likely to pray than to pursue. They focus on healing or mourning—not hiring a lawyer.
This fatalism, while rooted in resilience, can delay or derail a family’s pursuit of justice. There is often a quiet, unspoken belief that suing a doctor—even a negligent one—is wrong. Some see it as karma, others as pasalamat na lang buhay pa(“at least they survived”), and still others as too much emotional energy in a system they don’t trust to begin with.
Legal remedies are viewed not just as inaccessible—but inappropriate. Especially in the provinces, community ties with local doctors, small-town dynamics, and respect for authority figures mean that filing a case is not only a legal act—it’s a social rupture.
This is not to say that Filipinos do not care about justice. But many believe that justice, like healing, should be left to God.
The result? Valid complaints are never filed. Not because they lack merit, but because they’re buried under silence, fear, and faith.
When They Don’t Know What To Do
Sometimes, people simply don’t know where to begin. I once received a message from a friend, a nurse, who confided her deep regret after her mother passed away following surgery. She had a gut feeling something went wrong, but she didn’t know how—or whether—to act. That hesitation never left her.
This is another silent barrier: uncertainty. The legal system is foreign to many, especially in times of grief. They don’t know what documents to gather, whom to consult, or what steps to take. Inaction is not apathy. It’s paralysis.
In a country where health literacy and legal literacy do not always intersect, even educated professionals can feel lost. And so another valid case quietly disappears—not for lack of cause, but for lack of compass.
In contrast, in Ramos v. Court of Appeals, the Supreme Court upheld the testimony of a nurse who was a relative of the patient as valid, relying on the doctrine of res ipsa loquitur:
“Testimony as to the statements and acts of physicians and surgeons, external appearances, and manifest conditions which are observable by anyone may be given by non-expert witnesses.” — Ramos v. Court of Appeals, Delos Santos Medical Center, et al., G.R. No. 124354, December 29, 1999.
The Court also documented her observations:
“At about 12:15 P.M., Herminda Cruz, who was inside the operating room with the patient… heard Dr. Gutierrez say, ‘ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.’… She thereafter noticed bluish discoloration of the nailbeds of the left hand… [which] is an indication that there is a decrease of blood supply to the patient’s brain.”
The ruling shows that courage to step forward and assert one’s observations can sometimes break through the barriers. Patients and families must be empowered to ask the right questions—and the right people.
Silence in the System: Settlements and Non-Disclosure
Sometimes, cases don’t reach court—not because the harm was minor, but because the settlement was enough. Hospitals and doctors may offer financial settlements early in the process, sometimes before a formal complaint is filed. In other cases, a family may agree to stop pursuing the case in exchange for a lump sum or written apology.
But not all settlements are signs of closure. They may reflect exhaustion, intimidation, or sheer economic necessity. For many families, the weight of daily survival is heavier than the weight of pursuing justice.
Settlements can bring relief. But they also reinforce a culture of non-accountability. When complaints are withdrawn, patterns of neglect can remain hidden.
The Burden of Trauma and Double Victimization
For victims of medical harm, coming forward means reliving the worst chapter of their lives. Legal processes require statements, affidavits, cross-examinations—each one a re-opening of wounds.
Some patients, already grieving, fear the emotional toll of litigation. They worry they won’t be believed, that their grief will be dissected in court, or that they’ll be blamed for not speaking up sooner.
This is what experts call “double victimization” — first at the hands of the negligent act, and then again through the adversarial legal system. When the process feels punishing rather than protective, silence becomes safer.
Lack of Awareness and Legal Literacy
Many Filipinos simply don’t know that malpractice is actionable. Others know—but don’t know how. The medical field is technical; the legal field, no less so. When these two systems collide, ordinary patients feel out of place.
There is little public education around medical rights. Few hospitals display information on how to file a complaint or what red flags to watch for. This vacuum of knowledge keeps people passive.
Justice is a right—but it’s not common knowledge. Until that changes, many wrongs will remain untouched. Especially among Filipinos, who are non-litigious by nature.
Conclusion: When Knowledge Becomes Power
Medical harm doesn’t always leave bruises. Sometimes, it leaves questions—unanswered, unheard, unfiled.
In the Philippines, the greatest barrier to accountability isn’t just the law or the cost. It’s the quiet. The hush after the surgery. The whispered regrets. The absence of names in court records. Justice, it turns out, is not just a right—it’s a language. And too few are taught to speak it.
Until we give ordinary patients the tools to ask, to understand, and to act, medical negligence will remain a wound that festers in silence.
If this blog made you pause, or think of a story untold, maybe that’s where it starts: not with a lawsuit, but with knowing you could.
Read. Reflect. Speak.
Because knowledge isn’t just power—it’s protection.
