Republic of the Philippines REGIONAL TRIAL COURT First Judicial region Branch 25 Tagudin, Ilocos Sur HEIRS OF EDRALIN

ALUAD, Plaintiffs, -versus HOLY FAMILY HOSPITAL, INC., ET.AL, %efendants &------------------------------------------& Civil Case No !"#$-T

MEMORANDUM
(For the Plaintiffs)

'IT( %)* R*SP*CT T+ T(* (+N+R,-.* C+)RT.

+/*S N+' the plaintiffs, b0 the undersigned counsel, unto the (onorable Court, respectfull0 sub1its this /e1orandu1 in the above-

entitled case, and for this purpose states2 I.

STATEMENT OF FUNDAMENTAL PRINCIPLES

The 3uantu1 of evidence re3uired in civil cases is 4prep n!erance " e#$!ence%. Sec.1, Rule 133 of the Rules of Court 1 provides, vi52 Section 1. Preponderance of evidence, how determined.--- In civil cases, the party having the burden of proof must establish his case by a preponderance of evidence. In determining where the preponderance or superior weight of evidence on the issues involved lies, the court may consider all the facts and circumstances of the case, the witnesses manner of testifying , their intelligence, their means and opportunity of knowing the facts which they are testifying, the nature of the facts which they will testify, the probability or improbability of their testimony, their interest or want of interest, and also their

2 personal credibility so far as the same may legitimately appear upon the trial. he court may also consider the number of witnesses, though the preponderance is not necessarily with the greater number. This is a civil case for DAMAGES " r &e!$ca' ne('$(ence brought b0 the (eirs of *%R,.IN ,.),% against defendants %r Ra01ond 6 ,ba0a and (ol0 Fa1il0 (ospital This is a particular for1 of negligence 7hich consists in the failure of a ph0sician or surgeon to appl0 to his practice of 1edicine, that degree of care and s8ill 7hich is ordinaril0 e1plo0ed b0 the profession generall0, under si1ilar conditions, and in li8e surrounding circu1stances 9 61 Am. Jur., 2d 337, 205 on Physici ns, Sur!eons, etc., s cited in "e h Alesn Reyes, et. l #s. Sisters of $ercy %os&it l, et l., '.R. (o. 1305)7 *+cto,er 3, 2000, " -yer.s Re#ie-, (o#em,er 30, 2003, &. 2)/0 ! In order to successfull0 litigate such clai1, a patient 1ust prove that a ph0sician or surgeon either "a$'e! ) ! * &e)h$n( +h$ch a rea* na,'- pr.!en) ph-*$c$an r *.r(e n + .'! ha#e ! ne, or )ha) he r *he !$! * &e)h$n( )ha) a rea* na,'- pr.!en) ph-*$c$an r *.r(e n + .'! n ) ha#e ! ne, an! )ha) )he "a$'.re " ac)$ n ca.*e! *.ch $n/.r- ) )he pa)$en). 0GARCIA1RUEDA 2S. PASCASIO, 234 SCRA 356, 364

78663: ;, underscoring ours for e1phasis< There are thus four ele1ents involved in 1edical negligence cases, na1el02 DUTY, BREACH, IN9URY, an! PRO:IMATE CAUSATION In the present case, there is no doubt that ph0sician-patient relationship e&isted bet7een defendants %octor R,=/+N% ,-,=, and the late *%R,.IN ,.),% 1efend nt %oly 2 mily %os&it l is being i1pleaded as a co-defendant under "rticle !1#$ of the %ew &ivil &ode, > to 7it2 he obligation imposed by "rticle !1'( is demandable not only for ones own acts or omission, but also for those persons for whom one is responsible. )** he owners and managers of an establishment or enterprise are likewise responsible for damages caused by their employees in the service of their branches in which the latter are employed or on occasion of their functions. ***

3 %efendants upon proof that a patient-doctor relationship e&isted, 7ere dut0-bound to use at least the sa1e level of care that an0 reasonabl0 co1petent doctor 7ould use to treat a condition under the sa1e circu1stances It is a breach of this dut0 7hich constitutes actionable 1alpractice +Ibid, pp.''#-'',- .
STATEMENT OF FACTS

Plaintiffs are the (eirs of *%R,.IN ,.),% ?hereinafter referred to as 4*%R,.IN@: represented b0 Farida Aalaites ,luad, 7ife of the late *dralin ,luad +/*hibit 012- ( , Pablo and *rlinda ,luad, parents of the late *dralin ,luad +/*hibit 032- '

,t the ti1e of his death on Nove1ber B!, B!!!, *%R,.IN 7as ;$ 0ears old, 1arried to Franida Aalaites ,luad ?subse3uentl0 4Franida@:, childless, a graduate of Cri1inolog0 and a police officer b0 profession assigned at Tagudin, Ilocos Sur, 7ith residential address at

-aringcucurong, Su0o, Ilocos Sur + S%, Pablo "luad, 4ctober !., !$$1, pp. 5-(, S%, /ngr. 6ose Ping-ay, "pril 11, !$$., p. '-# ; %efendant %r Ra01ond 6 ,ba0a is >C 0ears old, 1arried, a doctor b0 profession 7ith specialt0 in Surger0, he is also the 1edical director of (ol0 Fa1il0 (ospital and a resident of San Jose, Candon Cit0, Ilocos Sur > %efendant (ol0 Fa1il0 (ospital, Inc is a second level hospital, a dul0 organi5ed corporation, 7here defendant %r ,ba0a is one of the 1e1bers of the board of directors and a stoc8holder and 7ith postal address at National (igh7a0, Calaoa-an, Candon Cit0 + S%, 7r. 8aymond "baya, "ugust ,, !$$., pp. 5-.- , D %efendant (ol0 Fa1il0 (ospital is being i1pleaded as a necessar0 part0 under ,rticle B$"! of the Ne7 Civil Code E *%R,.IN ,luad 7as, until the evening of Nove1ber B, B!!! a health0, robust 0oung 1an and there is no 3uestion about his ph0sical fitness, being a 1e1ber of the Philippine National Police assigned at Tagudin, Ilocos Sur + S%, /ngr. 6ose Ping-ay, "pril 11, !$$., p. '- 1$

4 C +n Nove1ber B, B!!!, *%R,.IN co1plained of sto1ach ache at "2!! oFcloc8 in the evening (e 7as brought to (ol0 Fa1il0 (ospital b0 Pablo ,luad ?*%R,.INFs father: and Franida ,luad ?*%R,.INFs 7ife: at about $!2!! oFcloc8 in the evening of the sa1e da0 " %r Ra01ond ,ba0a 7as the attending ph0sician and upon being infor1ed that *%R,.IN has sto1ach ache, he e&a1ined hi1 b0 pressing the sto1ach and pulling his leg three ?;: ti1es and he as8ed *%R,.IN if it is painful, *%R,.IN ans7ered 4N+@ (e then 7ore gloves and inserted his finger to the anus of *%R,.IN and again as8ed hi1 if it is painful, and he said 4N+, Sir@ Then %r ,ba0a repeatedl0 pressed *%R,.INFs sto1ach, and no7 he said that he feels pain # %r ,ba0a infor1ed *%R,.IN and relatives that it is appendicitis and that he 7ill be operated $! %r ,ba0a as8ed Pablo ,luad to sign a docu1ent in connection 7ith the operation to be conducted, but he refused to sign because he had second thoughts because %r ,ba0a e&a1ined *%R,.IN for a short ti1e but *%R,.IN hi1self signed the docu1ent because his sto1ach is reall0 painful + S%, Pablo "luad, 4ctober !., !$$1, pp. '-1$- 11 $$ +n Nove1ber B, B!!! *%R,.IN 7as ad1itted for the first ti1e at the (ol0 Fa1il0 (ospital, Candon Cit0 ,ccording to the /edical Records, *%R,.IN has been suffering fro1 periu1bilical ?pain around the navel:, anorrhe&ia ?lac8 of appetite: nausea and vo1iting, $E hours before ad1ission The pain persisted and fe7 1inutes prior to ad1ission the pain locali5ed at the right lo7er 3uadrant area of the abdo1en +/*hibit 09-! to 9-.2, pp. !('-!'$- 1! $B *%R,.IN 7as ad1itted b0 the resident ph0sician on dut0 of the defendant (ol0 Fa1il0 (ospital and 7as subse3uentl0 referred and attended to b0 defendant %r Ra01ond ,ba0a 7ho gave *%R,.IN a ph0sical e&a1ination, too8 his 1edical histor0 and ordered laborator0 e&a1inations (e noted that at the ti1e of his ad1ission, *%R,.IN 7as

5 a ;! 0ear old 1ale, 1arried, a resident of -aringcucurong, Su0o, Ilocos Sur *%R,.IN 7as FG% ?Fairl0 %eveloped:, FGN ?Fairl0 Nourished:, conscious, not in CP ?cardiopul1onar0: distress /ost of the findings 7ere nor1al and the significant findings 7ere found in the abdo1en as follo7s2 Flat, soft, ?H: direct and rebound tenderness at the right lo7er 3uadrant, ?H: Psoas sign, Nor1oactive - ?bo7el: sounds Rectal2 ?H: anterior tenderness R ?right: pararectal area The ad1itting I1pression ?%iagnosis:2 ,cute ,bdo1en probabl0 ,ppendicitis ?1istory and P/, /*hibit 09-! to 9-.2, pp. !('-!'$ of the 8ecords of the &ase, subse:uently 084&2 1;< S%, 7r. 8aymond "baya, "ugust !, !$$., p. .- 15 $; +n the sa1e da0, %efendant %r ,ba0a operated on *%R,.IN fro1 $$2B!P/ to $B2;D,/, Nove1ber ;, B!!! $> No pathological or histopathological e&a1ination 7as done on the appendi& that 7as re1oved on surger0I surprisingl0, nothing 7as found on the clinical records on this ver0 i1portant 1atter $D Pablo ,luad 7as able to tal8 7ith *%R,.IN after his surger0 and *%R,.IN 7as as8ing 7h0 the incision on his sto1ach is ver0 big and the0 Just operated for ,ppendicitis $E Pablo ,luad tal8ed 7ith %r ,ba0a and as8ed hi1 7hat is to condition of his son and he ans7ered that it is good and even told hi1 that he &a!e a ,$( $nc$*$ n ,eca.*e he ,r .(h) .) h$* $n)e*)$ne* ) *ee $" )here are )her *$c;ne**<$n/.r$e*. ,nd that he could go ho1e in three ?;: da0s +n Nove1ber ;, B!!!, EDRALIN c &p'a$ne! )ha) )here +a* n $&pr #e&en) $n h$* c n!$)$ n an! $) e#en ,eca&e + r*). + S%, Pablo "luad, 4ctober !., !$$1, pp. 11-1!- 1. $C +n Nove1ber D, B!!! or on the ; rd hospital da0, patient 7as discharged b0 %r ,ba0a 7ith ho1e 1edications and 7as advised to co1e bac8 for follo7 up after D da0s + S%, 7r. 8aymond "baya, "ugust $!, !$$., p. (-'1(

$" +n Nove1ber D, B!!!, in the evening after his discharge, *%R,.IN co1plained that he could not again bear the pain of his sto1ach + S%, Pablo "luad, 4ctober !., !$$1, p. 1;- 1'

6 $# +n Nove1ber E, B!!!, one ?$: da0 after discharge, *%R,.IN had slight fever, abdo1inal pain and vo1iting + S%, 7r. 6uan =omiya, 6anuary 1(, !$$;, p. .-. 1# B! +n Nove1ber C, B!!!, *%R,.INFs condition 7orsened, he 7as pale and ver0 7ea8 (e li8e7ise e&perienced abdo1inal distention ?bloating sensation: associated 7ith nausea follo7ed b0 vo1iting of previousl0 ingested food B$ +n Nove1ber C, B!!! at about 1idnight, *%R,.IN 7as brought bac8 at the (ol0 Fa1il0 (ospital and 7as subse3uentl0 ad1itted b0 the resident on dut0 at the defendant (ol0 Fa1il0 (ospital at about ;2;! ,/ on Nove1ber ", B!!!, for the second ti1e 7ithin a period of five ?D: da0s BB ,t that ti1e, defendant %r ,ba0a 7as in /anila but the ad1itting resident ph0sician, %ra Pascua referred the patient b0 phone to defendant %r ,ba0a B; +n the sa1e da0 at B2!! oFcloc8 P/, %r ,ba0a arrived and e&a1ined

*%R,.IN 7ith the follo7ing findings2 FG%, FGN, conscious, alert, a7a8e, oriented, not in an0 for1 of distressI -P ?-lood pressure: - $BDG"E PR ?pulse rate: "CG1in RR ?respirator0 rate: BBG1in Te1p ;C C S8in2 no s8in lesion, no Jaundice .ungs2 clear breath sounds (eart2 regular rh0th1, no 1ur1ur noted ,bdo1en2 slightl0 distended, soft, no tenderness, operation 7ound is apparentl0 7ell, clean K dr0, h0poactive bo7el sounds Rectal e&a1ination2 slight tenderness in the anterior Rt ?right: pararectal area ,d1itting I1pression2 Ileus probabl0 B= postoperative infection, )TI ?)rinar0 Tract Infection:, RG+ ?Rule +ut: Postoperative 'ound Infection, RG+ Intrabdo1inal Post-operative Infection +/*hibit 04-52 to 4-.2, pp. !;.!;( 84&< /*hibit 0!2 1,B> +n ad1ission, he 7as given I6 fluids, Nasogastric tube 7as inserted, L-ra0 of the abdo1en, laborator0 e&a1inations and Chlora1phenicol ?antibiotics: 7as started This 1ode of treat1ent is called conservative 1anage1ent BD %r ,ba0a continued 7ith the conservative 1anage1ent up to Nove1ber $!, B!!! BE %espite these 1easures, *%R,.IN 7as unrelieved of the s01pto1s and for the abdo1inal pain and 7as given Nubain IGB a1pule, I6 ad1inistered, on a regular basis +/*hibit 04-#2, p. !;, 84&- B!

7 BC There 7as no i1prove1ent in the condition of the patient and as a 1atter of fact, he 7as getting 7orst (e had on and off fever, his abdo1inal girth ?circu1ference: 1easured fro1 ;C D c1 on Nove1ber #, B!!! to "> D c1 on Nove1ber $!, B!!! *%R,.IN 7as in severe pain +/*hibit 04-1(2, 04-1'2, pp. !5'-!5#, 84&-!1 B" %r ,ba0a still insisted and continued 7ith his conservative 1anage1ent of the patient, *%R,.IN, stating that, to 7it2 "tty. 3albin> ?> "nd did you make the necessary medications or surgical measures to heal the patient@ 7r. "baya> "> 0 he conservative approach for that time, the management at that time. +sic- I mean conservative in the sense that the patient might improve with conser# ti#e m n !ement 3ust li4e decom&ression, !i#in! nti,iotics nd fluids, restin! the ,domen may become normal so I waited a certain period of time to observe the patient and 5 ! #e the & tient 12 hours to o,ser#e, if he will not improve then a diagnostic tool will come in, sir.2 ?> "fter that period past that you have to wait what was the result@ "> he ne6t d y when I saw the patient 1! hours after, at (>$$ oclock in the afternoon he is beginning to deteriorate and again with fever, the patient again vomited so I placed the patient again on %A and I decompress the abdomen and still observed for the reaction to the management that I did, sir. ?> "fter that what else@

"> "nd on the ne6t d y since he has not been improving already, +sic- I told the family that there is a need to do a diagnosis which is, I was thinking at that time a & scan of the abdomen so that the & scan for me at that time is also important which will secure as diagnostic tool. here are also services as a management tool. 7iagnostic tool in the sense that I will do a & scan so I can ascertain whether the patient has a beginning infection, localiBed abscess versus a generaliBed peritonitis or a generaliBed abscess so that the & scan will reveal a localiBed abscess, then I can do a more conservative approach and I will do a needle aspiration and drain that abscess and that is already the management or if it is generaliBed peritonitis, then I will do a prompt surgery. I really want to do the procedure to be done at that time, that is what I told the family, sir.2 + S%, 7r. "baya, "ugust !, !$$., pp. 1$-11- !!

8 B# +n Nove1ber $!, B!!!, defendant %r ,ba0a 1ade an order on the patientFs chart that the patient be transferred to St .u8eFs /edical Center, Mue5on Cit0 and to notif0 the fa1il0 of the patient for the conduction per a1bulance +/*hibit 04-1$2, p. !51 of the 84&-!; ;! Pablo ,luad, noting the precarious condition of his son, tal8ed 7ith defendant %r ,ba0a and Pablo ,luad suggested that he be transferred to another hospital %r ,ba0a 7anted that *%R,.IN be transferred to St .u8eFs (ospital ?/etro /anila: 7here the0 have enough facilities to e&a1ine hi1 Pablo ,luad did not agree, especiall0 because *%R,.IN told hi1 that he 7as too 7ea8 and canFt bear the pain and could no longer bear to travel to St .u8eFs (ospital 7hich it is too far In consultation 7ith the ,luad fa1il0, the0 decided to transfer *%,R.IN to a nearer hospital, .or1a (ospital and /edical Center ?subse3uentl0 .+R/, (ospital: in San Fernando Cit0, .a )nion, instead of bringing *%R,.IN all the 7a0 to St .u8eFs /edical Center in /anila + S%, Pablo "luad, 4ctober !., !$$., pp. 1.-1(- !5 ;$ +n the sa1e da0, *%R,.IN 7as transported b0 a1bulance acco1panied b0 his father 7ho 7as 7ith *%R,.IN attending to hi1 7hile !e"en!an) Dr. A,a-a, +a* *ea)e! a) )he "r n) *ea) ,e*$!e )he a&,.'ance !r$#er. ,fter, *%R,.IN 7as brought to the e1ergenc0 roo1 of .or1a, defendant %r ,-,=, i11ediatel0 left 7ith the a1bulance 7ithout proper endorse1ent of the patient to .or1a /edical Center ;B Pablo ,luad testified that %r ,ba0a 7as in a hurr0 to leave as he said he is going bac8 to /anila (e left riding the a1bulance that earlier transported *%R,.IN ? S%, Pablo "luad, 4ctober 1,, !$$(- !. ;; ,t .or1a /edical Center, %r Juan No1i0a, the (ospital %irector therein, personall0 attended to *%R,.IN and after his initial assess1ent told *%R,.INFs relatives that the patient is in a ver0 serious condition and hopeless and 7as hesitant to ad1it hi1 stating 4because he 7as ver0 7ea8@ and the situation is hopeless . + S%, Pablo "luad, 4ctober !., !$$., p. 15- !' ;> *ngr Jose Ping-a0, *%R,.INFs cousin and Pablo ,luad pleaded and persuaded %r No1i0a to ad1it, attend to and help *%R,.IN and do the best he can + S% Pablo "luad, 4ctober !., !$$., p.1.- !#

9 ;D %r No1i0a reconsidered, ad1itted *%R,.IN under his care and his initial findings 7ere2 ,bdo1inal distention and h0peractive bo7el sounds and 7ith a histor0 of previous surger0, 7hich correlated to the te&tboo8 diagnosis of intestinal obstruction Fever and Jaundice ?0ello7ish discoloration of the s8in: 1eans that there is infection going on in the bod0 including the liver This 7as confir1ed b0 &-ra0 of the abdo1en 7hich sho7ed so1e air-fluid portion ?level: 7hich sho7ed fro1 a te&tboo8 point of vie7 is a sign of obstruction. + S%, 7r. 6uan =omiya, 6anuary 1(, !$$;, pp. (-'- !, ;E %r No1i0a testified that the patient needed surger0, ho7ever, surger0 cannot be done right a7a0 because he said that2 0*** if you operate without a good preparation, you will see a dead person on the operating table.2 he patient was anemic, very, very low hemoglobin and upon determining that the patient was blood type ", 7r. =omiya started blood transfusion. + S%, 7r. 6uan =omiya, 6anuary 1(, !$$;, pp. #-,- ;$ 4n %ovember 1', !$$$, 7r. =omiya testified that the patient was now ready for surgery. 7uring surgery, before opening up the patient, the e*ternal e*amination showed that the area around the wound of the previous appendectomy is grayish and some of it blackish in color. his signifies that there is some sort of severe infection going on. here is a tender mass in the right lower part of the abdomen. +Ibid, pp. 11-1;- ;1 7uring surgery, upon opening up of the abdomen, 7r. =omiya testified that there is a chocolate color, thick, foul smelling fluid amounting to about two +!- liters inside the abdomen which he removed and cleaned by suction. here he came to find out that the sm ll intestines, & rticul rly the &ro6im l &ortion of the ileum is ! n!renous nd &erfor ted, the middle ileum is ! n!renous, dherent to one nother -ith tremendous dhesions nd the ,l c4ish tissue in the inner linin! of the ,domin l - ll c lled the &eritoneum, u& to the muscles nd the f sci -hich corres&onds e6tern lly to the ri!ht lo-er 7u dr nt -here corres&ondin! to the re -here the &re#ious sur!ery - s done -hich is tr nsmitted to the re u& to the &oint of the s4in -here there - s the -ound from the &re#ious o&er tion. +Ibid, pp. 1;-1(- ;! ;C Post-operativel0, the patient did not i1prove, fever and Jaundice persisted despite 1assive antibiotics and 1ulti-technical apparatus support and treat1ents, the patient deteriorated 7ith 1ulti-organ failure ;" +n Nove1ber B!, B!!!, ; da0s after the second surger0, the patient died The %eath Certificate stated as the cause of death2

10 Septice1ia 7ith (epato-renal Failure secondar0 to /assive Peritonitis +/*hibit 0"2 and series- ;; >! %uring the 7hole period of his confine1ent, *%R,.IN incurred hospital bills a1ounting to PB>, DE" !! on his first ad1ission, dated Nove1ber D, B!!! +/*hibit 09!#, p. !,;, 84&- ;5I P$!, C>; !! on his second ad1ission, dated Nove1ber $!, B!!! ?*&hibit 4/-B#@, found on p B#>, R+C: ;D, P$!B, EC" !! +/*hibit 0/2, found on p. 1!, 84&- ;(, Funeral e&penses in the total a1ount of P$>!,!!! !!, bro8en do7n as follo7s2 P$!!,!!! e&penses covering the 7a8e and P>!,!!! !! for funeral services and burial dated Nove1ber BC, B!!! + S%, Pablo "luad, 4ctober !., !$$1, pp. 1.-1'- ;' >$ ,fter the unti1el0 death of *%R,.IN ,luad, on the testi1on0 of Pablo ,luad, that because of the negligence of the (ol0 Fa1il0 (ospital and %r Ra01ond ,ba0a he e&perienced hurt feelings and during his testi1on0 on +ctober $#, B!!E, he bro8e do7n in tears on reliving his sonFs ordeal before his death >B In litigating this case, the Plaintiffs paid for ,ttorne0Fs fees in the a1ount of P$!!,!!! !! as ,ttorne0Fs acceptance fee and PD,!!! !! per hearing + S%, Pablo "luad, 4ctober !., !$$1, p. 1'- ;"

STATEMENT OF THE CASE

Thus, on ,pril D, B!!$, Plaintiffs filed a civil case for %a1ages 7ith the Regional Trial Court, First Judicial Region, -ranch BD, Tagudin, Ilocos Sur, against herein defendants %r Ra1ond 6 ,ba0a and (ol0 Fa1il0 (ospital alleging negligence in the 1anage1ent and care of *%R,.IN ,.),%

+n Jul0 B>, B!!$, pre-trial of the case 7as conducted 7herein the defendants 7ere represented b0 ,tt0 Candido -albin, Jr , later b0 ,tt0 ,ntonio Rebosa 7ho appeared in collaboration 7ith ,tt0 -albin, Jr I

,tt0 .auro Aaca0an represented the Plaintiffs, later b0 ,tt0 /oll0 Cr ,biog, entered her appearance as collaborating counsel 7ith ,tt0 .auro Aaca0an

11 > The trial on 1erits started on Septe1ber $B, B!!$ and 7as ter1inated on /a0 ", B!!C D The Plaintiffs presented the five ?D: 7itnesses2 Pablo ,luad, father of the late *%R,.IN ,luadI %r Ronaldo /ende5, N-I 1edico-legal officer, 7ho conducted the autops0 on the late *%R,.IN ,luadI %r Cesar -is3uera, N-I /edico-legal +fficer 7ho conducted the histopathological e&a1ination of certain speci1en ta8en b0 %r /ende5 during autops0I %r Juan No1i0a, /edical %irector, Surgeon of .or1a /edical Center, 7ho conducted the second surger0 on deceased *%R,.IN ,luad and 7as presented as an e&pert 7itnessI *ngr Jose Ping-a0, cousin of the deceased *%R,.IN ,luadI Far$!a A'.a!, +$"e " EDRALIN +a* n )$"$e!

*e#era' )$&e* ,.) "a$'e! ) appear !.r$n( *a$! hear$n( $n!$ca)$n( a* per Sher$"">* re).rn )ha) *he $* n ) $n)ere*)e! ) p.r*.e )he ca*e. Ta;e n )e, h +e#er, )ha) *$nce )he 'a)e E!ra'$n an! Far$!a ha! n ch$'! .) " )he$r &arr$a(e, )he paren)* " E!ra'$n are c 1he$r* " )he *.r#$#$n( h .*e n a 5=15= ,a*$* .n!er Ar)$c'e 663 " )he Ne+ C$#$' C !e " )he Ph$'$pp$ne*. A* *.ch, )he- c .'! c n)$n.e pr *ec.)$n( )h$* ca*e e#en $n )he a,*ence " )he *.r#$#$n( *p .*e ? +/*hibit 01-12- ;, E The defendants presented T7o ?B: 7itnesses2 %r Ra01ond 6 ,ba0a, defendant in this case and %r -u Castro, 7ho is also a la70er, and 7ho 7as presented as an e&pert 7itness C +n Rebuttal, the Plaintiffs presented Pablo ,luad .i8e7ise, Plaintiffs 7anted to present the Records +fficer of (ol0 Fa1il0 (ospital, subpoena and subpoena duces tecu1 7ere issued b0 this (onorable Court to bring to this Court the follo7ing2 , +perating Roo1 .ogboo8I - +perating Roo1 Techni3ueI C other Clinical Records of patient *%R,.IN ,luad and to testif0 thereat but failed to appear on three ?;: scheduled settings despite receipt of notice Surprisingl0, ,tt0 -albin 1anifested to the (onorable Court that the Records of *%R,.IN ,.),% cannot be located b0 defendant (ol0 Fa1il0 (ospital and that the Records +fficer is

12 no longer connected 7ith (ol0 Fa1il0 (ospital, thus the difficult0 of finding the records " )pon the suggestion of this (onorable Court, ,tt0 /oll0 ,biog, plaintiffsF counsel obligated herself to go to the defendant (ol0 Fa1il0 (ospital, Candon Cit0 and for her to secure copies or entries in the logboo8 andGor to photocop0 the sa1e # .i8e7ise defendantsF counsel, ,tt0 -albin 1a0be present therein and to coordinate 7ith the (ead of said hospitalGestablish1ent andGor 7ith the Chair1an of the -oard or an0 responsible person of the (ol0 Fa1il0 (ospital, Candon Cit0 and not to refuse entr0 andGor ta8ing of photograph andGor photocop0 the records sought for 7hatsoever reason plaintiffsF counsel 1ight thin8 favorable for her client, the plaintiffs +&ourt 4rder, 9arch 1;, !$$', 8 & 3ranch !.- 5$ $! Thus, in obedience to the order of this Court, PlaintiffFs counsel in the presence of defendantsF counsel proceeded to Candon Cit0 on ,pril BC, B!!C and surprisingl0, the Records 7ere there, read0 for inspection $$ )pon agree1ent of both counsels the docu1entar0 evidences photocopied fro1 the 1edical records of the late *%R,.IN ,luad 7as offered as rebuttal evidence for the plaintiff sans the presentation of the Records +fficer of %efendant (ol0 Fa1il0 (ospital $B Plaintiffs endeavored to present other doctors as e&pert 7itnesses but all refused to testif0 'hile it is apparent that the e&pert 7itnesses are going to pla0 an i1portant role in the trial of this 1edical 1alpractice case, plaintiffs 1ust find innovative 7a0s of overco1ing this proble1 and 1a&i1i5e its resources 7ith the testi1on0 of at least three ?;: doctor7itnesses, t7o ?B: fro1 N-I and one ?$: the second surgeon 7ho did corrective surger0 This is the obstacle that has proved difficult but not insur1ountable not onl0 in this case but in 1an0, 1an0 cases of si1ilar nature

13 $; 6er0 fe7 ph0sicians are 7illing to state on the 7itness stand before a public trial that a fello7 ph0sicianFs professional conduct did not 1easure up to the standard of his colleagues ,lthough doctors 1a0 co1plain privatel0 to each other about the inco1petence of other doctors, the0 are e&tre1el0 reluctant to air the 1atter publicl0 In fact, the Plaintiff 7as fortunate enough to get the testi1on0 of %r Juan No1i0a, the second surgeon fro1 .+RN, (ospital, obtaining a forthright opinion has proven difficult This is 7hat 7e call a @c n*p$rac- " *$'ence%. $> ,s earlier stated, Plaintiffs 1ust find 7a0s in order to overco1e this difficult0 to obtain ade3uate 1edical evidence Five possibilities present the1selves2 $ B ; > D the application of the doctrine of res ipsa lo:uitorI the application of co11on 8no7ledge b0 the trier of factsI the use of 1edical te&tboo8s as reference 1aterialI the use of the 1edical records of the patientI the use of defendantFs testi1on0

The Plaintiffs for1all0 offered the follo7ing docu1entar0 evidences2 E:HIBIT NO. 4,@ K 4,-E@ 4-@ NATURE OF DOCUMENT<E:HIBIT %eath Certificate of *dralin ,luad -irth Certificate of decedent *%R,.IN PINA-,= ,.),% ?Found on page " of the records of the Case: 4C@ Philippine National Police Pa0 slips of decedent *%R,.IN PINA-,= ,.),% ?found on page # of the Records of the Case: @D% ?cancelled: is a &ero& cop0 of *&hibit 4J@ For purpose of presenting the original docu1ent authenticated and testified to b0 %r Juan No1i0a 'e shall be canceling *&hibit 4%@ but instead for1all0 offer *&hibit 4J@ and series found in pages $$B to $$; of the Records of the case

4J@ and 4J-$@ to 4J-E@2 Clinical Su11ar0, .+R/, /*%IC,. C*NT*R, San Fernando, .a )nion, signed b0 %R J),N N+/I=,

14 ?Found on pages $!-$$ and Pages $$B-$$;, of the Records of the Case: 4*@ State1ent of ,ccount of decedent *%R,.IN PINA-,= ,.),% fro1 .+R/, (+SPIT,. and /*%IC,.

C*NT*R dated Februar0 B>, B!!$ ?Found on page $B of the records of the case: 4F@ Special +rder D$C! dated Nove1ber B$, B!!! co11anding %r Ronaldo - /ende5 to conduct an autops0 on the person of decedent ,.),% 4(@ Certificate of /arriage bet7een *%R,.IN ,.),% and Nida Procerfida 4FR,NI%,@ ,.),% ?Found on page C of the Records of the Case: 4(-$@ Return of Process Server %I+NISI+ / M)I..,=*N -* /,RN*% ,S *&hibit 4(-$@ ? found in the Records of the case:

4I@

Clinical ,bstract issued b0 %r Ra01ond 6 ,ba0a, defendant ,s co11on *&hibit, found in the Records of the case

4N@ and series ,utops0 Report b0 %r Ronaldo - /ende5, /edico-legal +fficer of National -ureau of Investigation ?Found on page $; of the Records of the Case : 4.@ and series .aborator0 Report on Patholog0 dated Nove1ber $C, B!!! b0 C*S,R -ISM)*R,, / % of the National -ureau of

Investigation ?Found on page $> of the Records of the Case: F r $)* re,.))a' e#$!ence, )he P'a$n)$""* " r&a''- ""ere! )he " '' +$n( ! c.&en)ar- eAh$,$)*B *&hibit 4/@ to 4/-B#@-Rebuttal Clinical Records of *dralin ,luad, first ad1ission dated Nove1ber B, B!!! as found on the records of the case, pp BED-B#> This docu1ent 7as earlier 1ar8ed as *&hibit 4.@ and series but 7as not for1all0 offered because it 7as noted to be inco1plete

15 *&hibit 4N@-Rebuttal deno1inated as 4Surgical Protocol@ ? +perating Roo1 Techni3ue: *&hibits 4+@ to 4+-;;@-Rebuttal earlier 1ar8ed as *&hibt 4N@ to 4N-;;@ found on pp B;$-BED of the Records of the case deno1inated as 4Patient Record@, of the second ad1ission dated Nove1ber ", B!!! *&hibit 4P@ and series-Rebuttal +perating Roo1 ?+R: .ogboo8 of (ol0 Fa1il0 (ospital, cover page and entr0 re2 Patient ,.),%, *dralin

The defendants for1all0 offered the follo7ing docu1entar0 evidences2 E:HIBIT NO. *&hibit 4$@ NATURE OF DOCUMENT<E:HIBIT

, ',I6*R signed b0 the relatives of the patient relative to the procedure ,ppendecto10

*&hibit 4B@

Clinical ,bstract allegedl0 b0 %r Ra01ond ,ba0a, undated, unsigned and not authenticated b0 %r ,ba0a during his testi1on0

*&hibit 4;@

/edical ,bstract prepared b0 %r ,ba0a but appears no7 7ith a signature different fro1 7hat appears on the record and ho7 it 7as 7ritten, one t0pe7ritten and the other one is b0 co1puter This 7as conditionall0 ad1itted subJect to the presentation of the docu1ent itself b0 the defendant No docu1ent 7as subse3uentl0 sub1itted b0 defendants The %efendants 7aived presentation of surrebuttal evidence I2 STATEMENT OF THE ISSUES

, CHETHER OR DEFENDANTS ARE LIABLE MEDICAL NEGLIGENCE CON2ERSELY B NOT FOR AND

16 CHETHER OR NOT THE PLAINTIFFS ARE ENTITLED TO DAMAGESD 2 DISCUSSIONS AND ARGUMENTS

, CHETHER OR DEFENDANTS ARE LIABLE MEDICAL NEGLIGENCE CON2ERSELY B CHETHER OR NOT THE PLAINTIFFS ARE ENTITLED TO DAMAGESD The above issues being interrelated, are hereb0 discussed Jointl0 in the follo7ing The %efendants are liable for 1edical negligence and therefore, the Plaintiffs are entitled to da1ages 89he %i&&ocr tic + th m nd tes &hysici ns to !i#e &rimordi l consider tion to the he lth nd -elf re of their & tients. 5f doctor f ils to li#e u& to this &rece&t, he is NOT FOR AND

m de ccount ,le for his cts. A mist 4e, throu!h !ross ne!li!ence or incom&etence or &l in hum n error, m y s&ell the difference ,et-een life nd de th. 5n this sense, the doctor &l ys 'od on his & tient. f tes @ +RAMOS ET. AL. 2S. COURT OF APPEALS, DELOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAEA AND DRA. PERFECTA GUTIERREF, G.R. NO. 82GH5G, 8666 DEC 26, 8ST DI2ISION/51 In the case at bar, the (onorable Court is called upon to rule 7hether a surgeon and a hospital should be 1ade liable for the unfortunate and unti1el0 death of the late *%R,.IN ,.),% 7ho 7as at the pri1e of his life There are thus four ele1ents involved in 1edical negligence cases, na1el02 DUTY, BREACH, IN9URY, an! PRO:IMATE CAUSATION The ele1ent of !.)- 7as established b0 proof of a patient-doctor relationship bet7een *%R,.IN and %efendant %r ,ba0a as this fact 7as unconditionall0 ad1itted

17 b0 the latter +/*hibits 092 and series, pp. !(.-!5, of the 84&- 5; .ogicall0, the ne&t step is to establish that defendantsF conduct did not confor1 to the applicable standard of care ordinaril0 e1plo0ed b0 the profession generall0 and under si1ilar circu1stances This is the concept of the loc lity rule. ?Proof of Facts, /alpractice-.ocalit0 Rule, 6olu1e BC, pp B-;: >> This is a particular for1 of negligence 7hich consists in the failure of a ph0sician or surgeon to appl0 to his practice of 1edicine, that degree of care and s8ill 7hich is ordinaril0 e1plo0ed b0 the profession generall0, under si1ilar conditions, and in li8e surrounding circu1stances C61 Am. Jur., 2d 337, 205 on Physici ns, Sur!eons, etc., s cited in "e h Alesn Reyes, et. l #s. Sisters of $ercy %os&it l, et l., '.R. (o. 1305)7 *+cto,er 3, 2000, " -yer.s Re#ie-, (o#em,er 30, 2003, &. 2)-D 5. In the case of "eonil ' rci :Rued ;. <ilfred ". P c sio, et. l, '.R. (o. 11=1)1, Se&tem,er 5, 1>>7, )7 to 7it2 0 *** this &ourt stated that in accepting a case, a doctor in effect represents that, having the needed training and skill possessed by physicians and surgeons practicing in the same field, he will employ such training, care and skill in the treatment of his patients. 1e therefore has the duty to use at least the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. It is in this aspect of medical malpractice that e*pert testimony is essential to establish not only the standard of care of the profession but also that the physicians conduct in the treatment and care falls below such standard. Eurther, inasmuch as the causes of the inFuries involved in the malpractice actions are determinable only in the light of scientific knowledge, it has been recogniBed that the e*pert testimony is usually necessary to support the conclusion as to causation.2 ,s earlier stated, 7e repeat, because there is a need for it2 Plaintiffs endeavored to present other doctors as e&pert 7itnesses but all refused to testif0 'hile it is apparent that the testi1onies of e&pert 7itness are going to pla0 an i1portant role in the trial of this 1edical 1alpractice case, plaintiffs 1ust find innovative 7a0s of overco1ing this proble1 ,nd this is the obstacle that has proved difficult but
5!

and 042 and series, pp. !;1-!(.

18 definitel0 not insur1ountable not onl0 in this case but in 1an0, 1an0 cases of si1ilar nature 6er0 fe7 ph0sicians are 7illing to state on the 7itness stand before a public trial that a fello7 ph0sicianFs professional conduct did not 1easure up to the 7or8 of his colleagues ,lthough doctors 1a0 co1plain privatel0 to each other about the

inco1petence of other doctors, the0 are e&tre1el0 reluctant to air the 1atter publicl0 *ven if the Plaintiff 7as fortunate enough to get the testi1on0 of %r Juan No1i0a, obtaining a forthright opinion has proven difficult The reason for this difficult0 is the incontrovertible fact that ph0sicians, surgeons, nurses, and others in the 1edical field are generall0 un7illing to testif0 against each other The reluctance has been called the @c n*p$rac- " *$'ence% It is an understandable hu1an reaction of individuals 7ho 1ust 7or8 dail0 7ith one another and is based on fear of loss of e1plo01ent opportunities, loss of referrals of patients and other 1atters (o7ever, the nature of a JudgeFs 7or8 e&poses hi1 to 1uch education concerning actual 1edical practices and for this reason, the strict application of the localit0 rule and the e&pert 1edical 7itness rule 1a0 a1ount to a denial of Justice in 1an0 instances ,dditionall0, Judges recogni5e that as long as the control of e&pert 1edical testi1on0 re1ained 7ith the 1edical profession, it 7as unli8el0 that plaintiffs 7ith legiti1ate 1alpractice co1plaints 7ould be able to present the1 for trial ,s earlier stated, Plaintiffs 1ust find 7a0s in order to overco1e this inabilit0 to obtain ade3uate 1edical evidence Five possibilities present the1selves2 8. )he app'$ca)$ n " )he ! c)r$ne " res i&s lo7uitor 2. )he app'$ca)$ n " c && n ;n +'e!(e ,- )he )r$er " "ac)? H. )he .*e " &e!$ca' )eA), ;* a* re"erence &a)er$a'? G. )he .*e " )he &e!$ca' rec r!* " )he pa)$en)? 5. )he .*e " !e"en!an)>* )e*)$& n-. %r ,ba0a testified that, to 7it2 0*** an intestinal obstruction can be managed conservatively or any aggressive approach depending upon the signs and symptoms of intestinal obstruction that is partial as '$-#$G that will be managed conservatively because they respond well to conservative management with no surgery but once we have a complete obstruction then that necessitates surgery as the saying goes> Hdo not

19 let the sun shine on the intestinal obstruction that is complete.2 ? S%, 7r. "baya, "ugust $,, !$$., p. 1$- 5# Contrar0 to 7hat he stated above, defendant %r ,ba0a 4let the sun shine three ?;: ti1es on *%R,.IN, and refused to 1a8e up his 1ind about the 4te&tboo8@ signs and s01pto1s, the available laborator0 results, &-ra0 and I6P e&a1inations done at his disposal at (ol0 Fa1il0 (ospital, that *%R,.IN has INT**STIN,. +-STR)CTI+N, 7herein an i11ediate surgical intervention is a 1ust, 7ithout 7asting ti1e 7aiting for i1prove1ent in a conservative 1anage1ent that has proven futile or 7orst suggesting the transfer of the patient to St .u8eFs (ospital in /etro /anila for a CT Scan 7hen *%R,.IN 7as alread0 in a ver0 serious condition, and 7here death in transit is a certaint0 The &-ra0 results dated Nove1ber ", B!!! reads2 +/*hibit 04-!,2, p. !($ 84&5,

, to 7it2 0I9P8/SSI4%> -&4%SI7/8 P84)I9"I 34J/I I44P 43S 8K& I4%L -E4II4J MKP )-8"N "E /8 !5 14K8S IS SKAA/S /72 The &-ra0 results points to pro&i1al bo7el ?intestinal: obstruction as earl0 as

N #e&,er 4, 2===, the first da0 of the second ad1ission The proble1 is that at the onset and even up to the ti1e *%R,.IN 7as transferred to .+R/, (ospital, %r ,ba0a 7as insistent that *%R,.INFs proble1 is because of )TI ?)rinar0 Tract Infection: 7hich is causing ileus and therefore conservative 1anage1ent is the treat1ent of choice---7hich turned out to be a ver0 grave 1ista8eO " N. "3I4A>

?> 9r. Jitness being a physician yourself, and being a surgeon, when you operated a patient which you did in this case and the patient came back to you as in this case, Isnt it logical to think that the infection would be coming from the surgery and not from any other source@ 78. "3"N"> "> Intra abdominal infection, it may not come from the surgery but it may come from another disease process like for e*ample intestinal infection as a result of probably typhoid fever and if the patient has a history way back on

20 the first admission two weeks prior to the admission of the patient is being obtained and consulted a private physician and in ultrasound and after three weeks the patient have this abdominal pain and usually with typhoid fever and the clinical type there might be %orman and again on the third week it will resent as abdominal distention, fever and vomiting. ?> 7id you do any blood test to eliminate that thinking of yours that the patient is suffering from typhoid fever@ "> here was no blood test but &3& was done to the patient because initially I - s thin4: in! of ?95, m . m. ?> Nou said you were thinking of a K I@ " doctor of your stature 9r. Jitness logically shouldnt you think first of the invasive procedure that was done in the previous surgery@ "> Nes, maam. ?> Is that not correct and the conservative management you have done since the patient was admitted on %ovember #, !$$$ up to when you transferred him on %ovember 11, !$$$, you think that is sufficient@ "> It does not removed +sic- from the consideration that post appendectomy, first you have to do a more conservative approach to the patient than to do a prompt surgery at once. I have to localiBe where is the source of the infection, maam. ?> Nou were not able to localiBe the infection from the time of admission on %ovember # up to %ovember 1$, is that what you are trying to say@ "> Nes, maam. I have to find the focus of the infection, where was the infection going because it may not be related to the post surgery which maybe related from a disease process. ?> @ou did not see the su&&ur tion *&us/ th t - s found ,y 1r. Aomiy on dmission ,y the & tient on the -ound itself. In the physical e*amination of 7r. =omiya there was fever and Faundice already, nausea and vomiting as you have said, should have these localiBed the infection in the abdomen@ "> Nes, maam. ?> Shouldnt you think first and foremost that something happened to the surgery that was initially done by you@ "> hat was also one consideration that I think the most common cause of infection, maam. ?> Jhich is K I@

21

"> @es, m . m ,ec use 5 - s confident of the o&er tion th t 5 did plus the fact that I had a laboratory findings undergone !$-!. pus cells on urinalysis. ?> Nou did not consider that, as a symptom +signof a generaliBed peritonitis or septicemia that the patient is suffering at that time@ "> Precisely that is why I want a more diagnostic tool so I can see if there is a peritonitis through a & scan, maam. *9S(, 1r. A, y , Au!ust 2, 2005, &&.15:17/ .$ The blind confidence of %r ,ba0a in his previous surger0 of appendecto10, has apparentl0 fa5ed his obJectivit0 7ith respect to the 1anage1ent of *%R,.IN 7hen he 7as ad1itted for the second ti1e ,fter failing to get positive results in his 4conservative 1anage1ent@, he 7ants 1ore diagnostic e&a1ination, a CT Scan to be done at St .u8eFs (ospital in Mue5on Cit0, /etro /anila, 7hile the patientFs condition had alread0 deteriorated and his resistance has plu11eted do7n giving hi1 ver0 little chance to recover, so that even 7ith the corrective surger0 done b0 %r Juan No1i0a, *%R,.IN died +n the other hand, Pablo ,luad, father of *%R,.IN, a 1ere tric0cle driver, has perceived the precarious condition of his son and instead 7anted hi1 transferred to .+R/, (ospital in San Fernando Cit0, .a )nion under the care of another doctor finding this suggestion of %r ,ba0a to bring *%R,.IN to St .u8eFs (ospital is ridiculous if not do7nright stupid Pablo ,luad, at this point has obviousl0 lost his confidence because of %r ,ba0aFs obvious inco1petence The failure of %r ,ba0a to use his training as a doctorGsurgeon, to ta8e i11ediate action in an e1ergenc0 situation cannot b0 an0 stretch of i1agination, be construed as a 1ere 1ista8e in Judg1ent ,t 1ost, 7e call this 4palusot@ in the vernacular It 7as a clear case of ine&cusable negligence 'hat he 7ants to do at that ti1e is contrar0 to co11on hu1an e&perience under such condition +n the other hand, %r No1i0a did not need a CT Scan to 1a8e a diagnosis and testified that on ad1ission on Nove1ber $!, B!!!, i11ediatel0, after e&a1ining the patient, to 7it2 7r. =omiya>

22 "> 9y initial impression when I saw this patient was, there is some kind of infection going on inside the abdomen, there is some sort of abdominal distention which gave me an inclination that he is also suffering from intestinal obstruction and because of the presence of fever, I know that this patient is suffering from some sort infection. ***. he reason why I entertained intestinal obstruction is first, the bowel sounds is hyperactive. he sounds correlate to the te*tbook description of intestinal obstruction because of the hyperactive sounds of the bowel. Second, the abdomen is distended or bloated. hird, is the presence or the history given to me that he underwent surgery. "tty. "biog> ?> "nd you also said that you observed fever and Faundice on the patient, please e*plain to us what Faundice mean@ "> *** he presence of fever usually is interpreted in +sic- the presence of infection running +sic- lower portion of the body. %ow, the Faundice is a sort of change in the color of the skin and the white part of the eye which is the sclera meaning Faundice or yellowish. It means to say that there is sort of infection going on affecting the liver. So, we have this Faundice, and through +sic- enough when all the e*aminations that we ordered like the u&&er ,domin l 6:r y, sho-ed some ir fluid &ortion of the 6: r y -hich sho-ed from the te6t,oo4 &oint of #ie- is si!n of intestin l o,struction. 7TSN, Dr. 9.an E &$-a, 9an.ar- 85, 2==H, pp. 513, .n!er*c r$n( .r* " r e&pha*$*I 58 The reliance of %r ,ba0a in his conservative 1anage1ent of *%R,.INFs proble1 is 1isplaced, considering that the patient did not i1prove 7ith such treat1ent for 1ore than B> hours Co11on sense dictates that a different approached should have tried under the circu1stances This is proven b0 his testi1on0 as follo7s, to 7it2 "tty. 3albin> ?> "nd did you make the necessary medications or surgical measures to heal the patient@ 7r. "baya> "> 0 he conservative approach for that time, the management at that time. +sic- I mean conservative in the sense that the patient might improve with conservative management Fust like decompression, giving antibiotics and fluids, resting the abdomen may become normal so I waited a certain period of time to observe the patient and I gave the patient 1! hours to observe, if he will not improve then a diagnostic tool will come in, sir.2

23

?> "fter that period past that you have to wait what was the result@ "> he ne6t d y when I saw the patient 12 hours fter, t 6B00 o.cloc4 in the afternoon he is beginning to deteriorate and again with fever, the patient again vomited so I placed the patient again on %A and I decompress the abdomen and still observed for the reaction to the management that I did, sir. ?> "fter that what else@

"> "nd on the ne6t d y since he has not been improving already, +sic- I told the family that there is a need to do a diagnosis which is, I was thinking at that time a & scan of the abdomen so that the & scan for me at that time is also important which will secure as diagnostic tool. here are also services as a management tool. 7iagnostic tool in the sense that I will do a & scan so I can ascertain whether the patient has a beginning infection, localiBed abscess versus a generaliBed peritonitis or a generaliBed abscess so that the & scan will reveal a localiBed abscess, then I can do a more conservative approach and I will do a needle aspiration and drain that abscess and that is already the management or if it is generaliBed peritonitis, then I will do a prompt surgery. I really want to do the procedure to be done at that time, that is what I told the family, sir.2 + S%, 7r. "baya, "ugust !, !$$., pp. 1$-11- .! %r ,ba0a ad1itted that fro1 the ti1e of ad1ission on Nove1ber ", B!!! up to the ti1e the patient 7as transferred to .or1a (ospital, he 7as not able to locali5e the infection that is 7h0 he needed to do a CT Scan The CT scan is to be done as per his suggestion at St .u8eFs (ospital in /etro /anila 7hich is al1ost >!! 8ilo1eters %r No1i0a testified, to 7it2 "tty. "biog> ?> 7octor, you said that on admission, the very apparent findings that you saw on the patient was> one, the grayish discoloration on the operative side +sic, should be site- on the operative wound, two, fever and three, abdominal distention. "lright now, having the background of this, that he had a previous operation ' days before admission, what was your first impression when he came into your hospital@ "> 9here - s n infection second ry to &re#ious sur!ery. + S%, 7r. =omiya, %ovember 11, !$$5, p. 15- .;

24 To further elucidate that intestinal obstruction is a surgical e1ergenc0, 7e refer to the follo7ing 1edical references2 In the e*tbook in Surgery, 1$th edition, 1,'!, 7avis - &hristopher Intestinal 4bstruction, p. ##$ .5 states to 7it2 8+cclusion of intestine ,y dhesions from &re#ious sur!ery or infl mm tion is the le din! c use of intestin l o,struction. "dhesion may produce obstruction by kinking or angulation, or by creating bands of tissue that compress the bowel. 9he most common c uses of intestin l o,struction in dults re dhesions, usu lly resultin! from &re#ious sur!ery, hernias and neoplas1s ?Ibid, p ""$: DD Jhen crampy abdominal pain is succeeded by continuous severe abdominal pain, strangulation with peritonitis should be suspected. Eever suggests the possibility of strangulation. "bdominal tenderness is a characteristic finding in patients with intestinal obstruction, however, localiBed tenderness, rebound tenderness and guarding suggests peritonitis and the likelihood of strangulation. Ac.)e $n)e*)$na' ,*)r.c)$ n can .*.a''- ,e !$a(n *e! n )he ,a*$* " h$*) r- an! ph-*$ca' eAa&$na)$ n*. An- pa)$en) ha#$n( cra&p- a,! &$na' pa$n, # &$)$n(, ,*)$pa)$ n, a,! &$na' !$*)en)$ n, a,! &$na' )en!erne** r per$*)a')$c r.*he* *h .'! ,e c n*$!ere! ) ha#e $n)e*)$na' ,*)r.c)$ n .n)$' )ha) !$a(n *$* can ,e c n"$!en)'- eAc'.!e!. +Ibid, p. ##.- .( 8adiologic /*amination> Kpright or lateral decubitus position in patients with mechanical small bowel obstruction usually show multiple gas-filled levels, with distended bowels resembling an inverted K. 4ne radiographic feature of paralytic ileus is that the gaseous distention occurs somewhat uniformly in the stomach, small bowel and colon. Aas-filled levels may be seen in paralytic ileus. +Ibid, p. ##.- .' Jith few e*ceptions, the appropriate treatment for intestinal obstruction is sur!ic l relief of the o,struction. +Ibid, p. ##(- .# he mortality from intestinal obstruction with intestinal gangrene is ;1G, while in sim&le mech nic l o,struction -hen o&er tion is done -ithin 2) hours, the mort lity r te is 1C. Since there is no reliable way to

25 detect strangulation pre-operatively, operation should be performed as soon as is reasonable. +Ibid, p. ##(- ., This si1pl0 1eans that had defendant %r ,ba0a onl0 used his clinical e0e, as e&pected of an0 ph0sician treating a patient 7ith an acute abdo1en, considering the signs and s01pto1s of the patient, the &-ra0 results dated Nove1ber ", B!!! all pointing to intestinal obstruction, death should not have resulted on the unfortunate patient, *%R,.IN If he did, as e&pected of hi1, earl0 surger0 should have been done and the chances that *%R,.IN 7ill recover is ##P O A & tient -ith sym&toms of short dur tion, 2):30 hours, -ith minim l met ,olic distur, nce nd no &re: e6istin! &ulmon ry, c rdi c or ren l dise se, c n ,e o&er ted u&on -hen the di !nosis is m de. +Ibid, p. ##(($

+&er tion for intestin l o,struction should !ener lly not ,e del yed if the ,o-el is not successfully intu, ted or decom&ressed &reo&er ti#ely. +Ibid, p. ##', underscoring ours for emphasis- (1 Surger0 is the onl0 cureG1ode of 1anage1ent for intestinal obstruction 7hen conservative 1anage1ent fails to i1prove the condition of the patient 7ithin B> hoursO +n the other hand, *%R,.IN 7as under the care of %r ,ba0a for three ?;: da0s on 4conservative 1anage1ent@ 'hile 7e agree 7ith %r ,ba0a 7ith his 1anage1ent of Paral0tic ileus, ho7ever, after B> hours 7ithout i1prove1ent, he should have reassessed his 1ode of treat1ent Paralytic ileus is treated by nasogastric suction and IO fluid administration. &orrection of electrolyte imbalance, especially hypocalemia is particularly important in managing this disorder. Passage of a 9iller"bbot tube provides superior intestinal decompression. 9ost often, ileus develops after an abdominal surgery and is transient l stin! only 2:3 d ys. Jhen ileus persists or occurs without obvious etiology, one should ende #or to rule out mech nic l o,struction or intr : ,domin l se&sis nd l & rotomy m y ,e necess ry to e6clude confidently those f ctors. Do-el sounds in & r lytic ileus re hy&o cti#e or ,sent, in contr st to hy&er cti#e ,o-el sounds ssoci ted -ith o,struction. +Ibid, p. ##'- (! To further e&plain Intestinal 4bstruction> %ARR5S+(.S PR5(C5P"ES +2 5(9ER(A" $E15C5(E, 79h ed., 1>7) 63 , ) +$)B

26

here are two types of Intestinal 4bstruction> 1. 9echanical> ?su lly re7uires sur!ic l inter#ention for its correction. his type is due either to intraluminal obstruction or to mural obstruction due to encroachment by compression of the intestinal wall, as in dhesions, stenosis, hernia, volvulus, intususception, tumors, and atresia. !. %on-mechanical> ;. Is also referred to as ileus. Jhich could either be> a. adynamic +paralytic- or b. dynamic +spastic- +Ibid, p. 15#;- (5 reatment> 1. !. ;. 5. .. correcting fluid and electrolyte imbalance< alleviating vomiting and distention by intubation and decompression< &ontrol of peritonitis, if present and blood transfusion for shock if present< removal of obstruction and restoration of bowel continuity and function< 1ydration> administration of saline solution and =&l is indicated and e*tra water should be given in the form of .G glucose. "de:uate hydration can be gauged by measuring urinary e*cretion which should be kept near one liter Lday. +Ibid, p. 15#5- (. 1ematocrit , %a &l, =, and 1&4! in the serum !*Lday-as a guide to electrolyte therapy and control of acidosis and alkalosis. 7ecompression is best achieved by intubation with one of the long, weighted intestinal tubes attached to a gentle, continuous suction. 1owever, there is !re t d n!er in relyin! solely on intu, tion for relie#in! mech nic l o,struction -hene#er there is ny 7uestion of str n!ul tion of ,o-el or when large bowel obstruction occurs in the presence of competent ileocecal valve. Ear'- pera)$#e $n)er#en)$ n $* reJ.$re! $n a'' *.ch ca*e*. +Ibid, p. 15#.- (. 5n the m 3ority of c ses, sur!ic l inter#ention is necess ry to remo#e the o,structin! !ent nd restore norm l function. $ ny c ses of dyn mic ileus re cured ,y decom&ression lone. %o-e#er, if the & tient does not im&ro#e on such conser# ti#e me sures, o&er tion -ithin 2) hours is indic ted to est ,lish n ccur te e# lu tion

(. '.

27 of the c use of o,struction nd to effect 15#.- (( cure. +Ibid, p.

Jhen severe distention is not relieved promptly by intubation or when there is *-ray evidence of a closed loop type of obstruction +due to obstruction of both the inlet and outlet of a segment of herniated bowel-, sur!ic l inter#ention is re7uired for immedi te decom&ression by means of enterostomy, colostomy or resection. 9he com&lic tions of &&endicitis such s loc l ,scess, &eritonitis -ith ileus nd intestin l o,struction re7uire sur!ic l inter#ention such as drainage or lysis of adhesions, prolonged hospitaliBation, energetic treatment with AI intubation, antibiotics and careful control of fluids, glucose, and electrolyte balance by parenteral means. +Ibid, p. 15#'- (' *stablished 1edical procedures and practices as above outlined are devised for the purpose of preventing co1plications 'hen co1plications arise, there is another set of established procedures and practices 'hen failure to follo7 established procedure results in the evil precisel0 sought to be averted b0 observance of the procedure and a ne&us is 1ade bet7een the deviation and the inJur0 or da1age, the ph0sician 7ould necessaril0 be called upon to account for it S?R'5CA" 1EC5S5+( $AA5(', 2(1
E1.,

"A<RE(CE <. (+R9+(, $.1.,

E9 A",

1>=6 discusses through a flo7 chart the 1anage1ent of S1all -o7el +bstruction, .,P,R+T+/=? e&plorator0 surger0: is the treat1ent of choice after Nasogastric Suction, Fluids and *lectrol0tes, 7ith hourl0 assess1ent has failed +Surgical 7ecision 9aking, !nd ed., Iawrence J. %orton, 9.7., et al, 1,#(, pp. 15$-151- E" %r No1i0a testified that on ad1ission of *%R,.IN at .+R/, (ospital, )here $* a nee! " r $&&e!$a)e *.r(er- but he postponed it because he got the patient 7hen he 7as alread0 in a ver0 serious condition 'h0Q -ecause %r ,ba0a failed to do ?negligence b0 o1ission: 7hat a prudent doctor should have done on a patient he previousl0 operated on, 7asting precious 4golden ti1e@ to catch the patientFs proble1 7ithin the B> hour period as 1andated b0 surgical protocol in ,cute ,bdo1en %r No1i0a testified as follo7s, to 7it2 ?uestion from the &4K8 > ?> &an you tell more or less, doctor, what was the general physical condition of the patient when he was admitted at your hospital@

28

7r. =omiya> "> Eirst of all there was vomiting, there was abdominal distention, there was fever, and there was grayish discoloration of the place where the operation was done appendectomy, your 1onor. ?> So, in other words, the patient was in serious condition as far as you are concerned at that time@ "> @es, @our %onor. 5n f ct, 5 - nt to o&er te on him u&on dmission ,ut s 5 h #e s id, s 5 mentioned e rlier, you h #e to ,e e6ercisin! !ood &re:o&er ti#e o&er tion *sic, should ,e &re& r tion/, !ood &ost:o& tre tment, your %onor. ?> 7id you conduct immediately those steps before as you stated@ "> Nes, Nour 1onor, because from our records, it says, we have ordered blood chemistry, *-rays, /&A, "bdominal *-ray, both barium enema and intravenous pyelography because we want to know whether the kidney or the other intestines are infected or involved, your 1onor. ?> Jas the patient *-rayed upon admission at your hospital@ "> ?> Nes, Nour 1onor. Jhat was your finding@

"> he finding in the chest *-ray was, there is no pneumonia, there is no infection in the lungs, your 1onor. ?> Jhen you admitted before this &ourt that the patient was in serious condition at the time of admission at your hospital why did you not conduct immediately the surgical operation@ "> 3ecause, pre-operation, the patient is anemic. Nou cannot operate when the patient is suffering from anemia. Nou have to correct first by doing transfusion to the patient. Secondly, you do not know which one is correct, whether the heart or the kidney or other part of the liver is involved or not, so we have to do work-up first, so everything that we come to know working up, preoperatively in this patient because 100C 5.m sure th t this & tient -ill under!o o&er tion but as I have said, we have to prepare the patient, maintain that patient in good condition before operating and then the operation. "s I have said, and then the post-operative. So we observed properly the procedure before we operate, but basing on the patient himself, the & tient needs ctu l sur!ery, your %onor. )** +TSN, Dr. E &$-a, N #e&,er 88, 2==G, pp.618=- (,

29

The abnor1al post-operative course of *%R,.IN after his appendecto10 is another 1atter that should have been a of great concern, 7hich should have alerted %r ,ba0a that so1ething 7ent 7rong 7ith the first surger0, but instead, in his atte1pt to avoid liabilit0, is putting the bla1e on the patient for allegedl0 having hi1self discharged on the third da0 after his surger0 because that da0, Nove1ber D, B!!! is *%R,.INFs birthda0 Such an e&planation 7as obviousl0 advanced in order to pass-on liabilit0 for contributor0 negligence to *%R,.IN Pablo ,luad testified that after the operation of his son, he tal8ed 7ith %r ,ba0a and as8ed hi1 7hat is to condition of his son and he ans7ered that it is good and even told hi1 that he 1ade a big incision because he brought out his intestines to see if there are other sic8nessGinJuries ,nd that he could go ho1e in three ?;: da0s +n Nove1ber ;, B!!!, *%R,.IN co1plained that there 7as no i1prove1ent in his condition and it even beca1e 7orst + S%, Pablo "luad, 4ctober !., !$$1, pp. 111!-'$ +n Nove1ber D, B!!! or on the ; rd hospital da0, patient 7as discharged b0 %r ,ba0a 7ith ho1e 1edications and 7as advised to co1e bac8 for follo7 up after D da0s + S%, 7r. 8aymond "baya, "ugust $!, !$$., p. (-'- '1 *&hibit 4$@ of the Plaintiff, a co11on *&hibit found in *&hibit /-$, p B;B, of the R+C CB sho7s at the lo7er portion of this sa1e page, another docu1ent deno1inated as 4%ISC(,RA*% ,A,INST ,%6IC*@, 7hich notabl0 7as not signed b0 the patient or his relatives if it 7as indeed true, that *%R,.IN sought discharge against doctorFs advice This is a livid proof that the discharge of *%R,.IN on Nove1ber D, B!!! 7as 7ith the approval of %r ,ba0a It is therefore obvious that %efendant %r ,ba0a cannot bla1e his patient for his o7n decision to discharge hi1 or subse3uentl0 7hat happened after his discharge ,fter all, it is 7ithin the 1edical e&pertise of %r ,ba0a to decide if the patient is read0 for discharge or not %r Ronaldo /ende5, N-I /edico-legal +fficer, perfor1ed the autops0 on the bod0 of the late *%R,.IN and testified as follo7s2 "tty. "biog>

30 ?> Nou said that you opened up the body, what are your more significant findings@ 7r. 8onaldo 9endeB> "> 9h t there - s !ener liFed infection of the ,domin l c #ity nd intern l or! ns, $ . m )** ?> Jhat did you actually see when you opened up the body@ "> )** ?> Jhen you talk of generaliBed infection and you saw it with your own eyes, what e*actly did you see 7octor, will you please describe to the 1onorable &ourt@ "> ?> "> )** ?> Jhat do you mean when you say that there was pus formation what does that indicate@ "> )** ?> 3ased on your autopsy findings and the medical history that was related to you by the wife of the deceased, do you have an opinion as to the cause of death of the deceased, /78"II% "IK"7@ "> AeneraliBed Peritonitis, 9aam. Infection, 9aam he formation of pus, 9aam. Jhere did you see this pus formation@ he whole abdominal cavity, maam. AeneraliBed infection, 9aam.

?> Jhen you say generaliBed peritonitis, e*actly what do you mean by this in laymans term@ "> Inflammation of the lining and the organs of the abdomen plus the internal organs. ?> Jhat could possibly have caused this generaliBed peritonitis@ "> <ell, it seems th t the dece sed under-ent sur!ery, it could h #e ,een due to the o&er tion, $ . m. )** ?> 9r. Jitness, you said here that the appendi* was missing, stump sutured with signs of infection, you said earlier and you e*plained that the

31 appendi* was missing possibly due to the surgery that was done@ "> Nes, maam.

?> &ould you correlate the missing appendi* with your findings with respect to the other organs in the abdominal cavity, could there be a possible relation@ "> Since the +sic-, If I remember it right, the o&er tion done - s &&endectomy, since the &&endi6 - s missin!, nd there - s si!n of infection, in my o&inion, &ro, ,ly, this is the source of infection, $ . m. )** ?> &ould you give an opinion why there should be a repair done on the large intestine@ "> If the operation done was only appendectomy and the other operation done was on the large intestine, then there must be something wrong with the large intestine probably gangrene or death of the tissues of the segment of the large intestine 9aam, ?> Jhat could have possibly caused the death of the tissue of the portion of the large intestine that could have been resected by surgery@ "> Since there was already a repair on the portion of the large intestine that could have been resected by surgery, 9aam. ?> by that@ "> Jhen you say resected, what do you mean 8emoved, cut, 9aam.

?> "nd you said that the the cause , the most probable cause of would be gangrene, considering the factual backdrop of this case that you have autopsied@ "> )** ?> he cause of death you said is peritonitis, generaliBed, how do you relate this cause of death of Peritonitis generaliBed to all the other findings that found, would it correlate with all the findings that you made on autopsy@ "> Nes, 9aam. 7TSN, Dr. Men!eK, N #e&,er 24, 2==8, pp. 8G12G- '; The Clinical Su11ar0 ?*&hibit 4J and series@: 7it2 %iagnosis2
C>

9y opinion would be o,struction, 9aam.

R na'!

b0 %r Juan No1i0a stated2 to

32 -S*PT*C*/I, S*C+N%,R= T+ /,SSI6* INTR,P*RIT+N*,. P*RIT+NITIS 'IT( +RA,N F,I.)R*- .I6*R ,N% NI%N*= -C+/P.*T* INT*STIN,. +-STR)CTI+N- S/,.. INT*STIN* -/,SSI6* INT*STIN,. ,%(*SI+N 'IT( A,NAR*N+)S .++P +F /I%-I.*)/ ,N% PR+LI/,. I.*/ P*RF+R,TI+N -/,SSI6* ,-SC*SS +peration done2 *LP.+R,T+R= .,P,R+T+/=2 -Intestinal Resection -Closure of Intestinal Perforation -*vacuation of ,bscess -%rainage The testi1on0 of %r -u Castro ?even assu1ing 7ithout ad1itting that he is indeed an 4e&pert@: should not be given credence b0 this (onorable Court because he 7as harping on the presence of infection long before the first surger0 ?,ppendecto10: 7ithout basis, not borne b0 the facts of the case Sadl0, %r -u Castro did not even e&a1ine all available records particularl0 *%R,.INFs /edical Records (is reliance on the /edical ,bstract of %r ,ba0a ?unsigned for that 1atter:, the ,utops0 Reports, 7hich resulted fro1 the autops0, done after the death of *%R,.IN cannot b0 an0 1easure be used to conclude that there 7as no negligence involved in this case The ne('$(ence ,- &$**$ n 7e are tr0ing to prove is that 7hich occurred specificall0 on the second ad1ission of *%R,.IN at (ol0 Fa1il0 (ospital "tty. 8ebosa> ?> 9r. Jitness, awhile ago during the direct you stated that with the evaluation or you evaluated the transcript of stenographic notes of 7r. =omiya and 7r. 9endeB, the autopsy 8eport of 7r. 9endeB and 7r. 3is:uera and some other documents and you stated from the record that the cause of death of the patient is not related to any faulty or negligent act of the defendant, thats your opinion. %ow, that the medical records of the case was shown to you by the distinguished counsel for the plaintiff, would you still be of the same opinion@ 7r. 3u &astro> "> %o, I have not gone for the record sir. ?> hat is part of the 8ecord if shown to you, would you still be of the same opinion that the defendant doctor was not remiss in his duty as a doctor@ "> 3ecause I did not go over the records, if I may be given then.

33 ?> "s part of the 8ecord 9r. Jitness@

">, Nes, anyway the pertinent thing as I did e*amine the clinical abstract, autopsy and histopath report. ?> "nd part of the medical record@

,2 @es, s f r s 5 - s sho-n + S%, 7r. 3u &astro, 7ecember #, !$$., pp. ;(-;'- '. (e testified on re-cross e&a1ination, as follo7s to 7it2 "tty. "biog> ?> 9r. Jitness, you said in your opinion there was no negligence involved insofar as the surgery done by 7r. "baya is concerned@ 7r. 3u &astro> "> GB AB Nes, 9aam. Dut you h #e not seen the recordsH @es, $ . m.

?> "nd therefore, your opinion is simply based on the +unsigned- medical abstract done by 7r. "baya, you have not seen the complete 8ecords of the case@ If you are confronted with records where the admitting notes, the discharge notes, the operative findings and 48 techni:ue in other words are not present in the records, would you think that the records will be a good basis for you to change your opinion@ "> Jell, I saw the clinical abstract +unsigned by 7r. "baya, /*hibit 0!2- which is a summary of the clinical records so, I saw the summary on what events that went on in the first and second surgery and I also went into the transcript. So, I have some knowledge of what transpired in the confinement also, ,ut loo4in! t the records itself, 5 did not. +Ibid, p. ;#- '( %r -u Castro li8e7ise testified on cross-e&a1ination as follo7s, to 7it2 "tty. "biog> ?> Nou got the diagnosis of Su&&ur ti#e A&&endicitis from the testimony of 7r. "baya, the defendant , is that correct@

7r. 3u &astro> ?< "tty. 8ebosa> 5n the ,str ct -hich - s not si!ned.

34 Its previously signed. 7r. 3u &astro> %o, but I read the unsigned one. "tty. "biog,> ?> "> ?> %o other source@ %o 9aam. 6ust the abstract of 7r. "baya@

"> Nes, 9aam. +TSN, Dr. B. Ca*)r , Dece&,er 4, 2==5, pp. HH1HG- '' %r -u Castro 1ade s7eeping state1ents, such as2 @A* "ar a* )h *e !a)a* 7*$cI +ere pr #$!e! ) &e, I CAN SAY THAT 7IFI THERE CAS SOMETHING CRONG CITH THE SURGERY DONE, IT CAS NOT THE FAULT OF THE SURGEON.% +Ibid, p. ;'- '# So, 7hose fault is it 7hen %r ,ba0a is the onl0 surgeon 7ho perfor1ed the surger0Q %r -u Castro obviousl0 has not e&ercised his obJectivit0, neutralit0,

independence and sincerit0 in the assess1ent of this case +bviousl0, he 7as acting as an advocate in favor of %efendant %r ,ba0a, 7ho re3uested hi1 to be his 7itness, 7ho is a consultant of St .u8eFs (ospital, 7here %r ,ba0a is also a visiting ph0sician (e could have been the best person to interpret scientific evidence, for1 a conclusion about it, and provide an opinion about its significance in the conte&t of the case 7hich opinion should be reached independentl0 of interests of litigants )nfortunatel0, he 1iserabl0 failed in this instance To %r -u Castro, this is a relevant state1ent for hi1, and 7e 3uote2 85f the l - m de you -itness, rem in m n of science. @ou h #e no #ictim to #en!e, no !uilty or innocent &erson to ruin or s #e. @ou must ,e r -ithin the limits of science.I *P ul %. Drouss rd, Ch ir of 2orensic $edicine, Sor,onne, 1=>7/ ', 'hile it is true that, ph0sicians are not insurers of life and the0 rarel0 set out to intentionall0 cause inJur0 or death to their patients, the0 should treat their patients in accordance 7ith the accepted nor1s of the profession +ther7ise, pre1iu1 7ill be given

35 to the negligence of a surgeon 7ho 7ill no longer e&ercise due care in the perfor1ance of his duties to his patients (o7ever, intent is i11aterial in negligence cases because 7here negligence e&ists and is proven, the sa1e auto1aticall0 gives the inJured part0 a right for reparation for the da1age caused 7ROGELIO RAMOS AND ERLINDA RAMOS, ET AL. 2S. COURT OF APPEALS, ET AL., G.R. NO. 82GH5G, 8666, DECEMBER 26, 8ST DI2.I #$ Aiven the above set of facts, 7e even seriousl0 doubt that *%R,.IN had indeed ,cute Suppurative ,ppendicitis as %efendant %r ,ba0a 7ants this (onorable Court to believe because2 $ ,cute Suppurative ,ppendicitis did not appear on the Records of the Case e&cept those docu1ents 7hich 7ere ta1pered and replaced b0 a ne7 one The diagnosis of Suppurative ,ppendicitis 7as found on the Clinical ,bstract, ?unsigned: b0 %r ,ba0a 7hen presented in Court and an earlier Clinical ,bstract dated Nove1ber !D, B!!! also b0 %r ,ba0aI B The +R ProtocolG+R Techni3ue 7as noted as 1erel0 inserted in the Records of the Case at a 1uch later date as noted b0 counsel for the Plaintiffs in their /anifestationG For1al +ffer of Rebuttal *vidence dated /a0 $C, B!!C ; %r ,ba0a did not report an0 signs of peritonitis intraoperativel0 on Nove1ber B, B!!! despite the fact that he 1ade a large incision, brought out the intestines to see if there are other sic8nessG inJuries ?TSN, Pablo ,luad, +ctober BD, B!!$, pp $$-$B:
"$

None is found in the Clinical Records

?*&hibit 4/@ and series: "B earlier sub1itted to this (onorable Court b0 %r ,ba0a: of the patient and nothing 7as noted in the +R .ogboo8 > The +R Protocol or the +R techni3ue, for 7hich he perJured hi1self and 1ade a 1isrepresentation that it 7as in the +R logboo8 7here he placed his +R Techni3ue or +R Protocol The sa1e docu1ent 7as 1erel0 inserted to the Clinical Records at a later date because it is not found in the /edical Records earlier sub1itted b0 hi1 to this (onorable Court D %r ,ba0a changed the 7hole docu1ent of the ,d1itting Notes and %ischarged Notes in the Clinical Records both for the first and second

36 ad1issions of *%R,.IN as 1anifested b0 PlaintiffsF counsel in the For1al +ffer of Rebuttal *vidence dated /a0 $C, B!!C, found in the Records of the CaseI %r ,ba0a ta1pered 7ith the Clinical Records as noted b0 Counsel for the Plaintiff, to 7it2 &ourt> "re you referring to the clinical records@ "tty. "biog> Nes, your 1onor the hospital records for the second admission. Je are referring to the doctors admitting history and physical e*amination which looks like a new page and we have here another +page- which is the discharge summary which does not confer with the color of the other pages. &ourt> Is that a manifestation@ "tty. "biog> Nes, your 1onor that is my manifestation. &ourt> Iet that manifestation appear on record. "ny counter manifestation panero@ "tty. 3albin> Nes, your 1onor but we would like also to manifest that this is a set which is shall we say stapled and there is no sign that there was an effort to remove the staples and replace with another. "tty. "biog> Je would like to make a manifestation that as a matter of fact, there are several holes here +referring to the 9edical 8ecords- which would indicate that that the staples were removed, as a matter of fact, the staples are brand new and you have here rusted part under the new staple, a rusted part under it , which would indicate that there was an old staple here and a new one was placed. *** + S%, 7r. "baya, "ugust ,, !$$., pp. 1'-1#- "; *ven 1edical students and 1ore so 1edical practitioners 8no7 the

i1portance of the sanctit0 of the /edical Records because the sa1e has been inculcated in 1edical schools, to 7it2

37 89he Clinic l Record documents the & tient.s history nd &hysic l findin!s. 5t sho-s ho- clinici ns ssess the & tient, -h t &l ns they m 4e on the & tient.s ,eh lf, -h t ctions they t 4e, nd ho- the & tient res&onds to their efforts. An ccur te, cle r, -ell: or! niFed record reflects nd f cilit tes sound clinic l thin4in!. 5t le ds to !ood communic tion mon! the m ny &rofession ls -ho & rtici& te in c rin! for the & tient, nd hel&s to coordin te their cti#ities. 5t lso ser#es to document the & tient.s &ro,lems nd he lth c re for medico:le! l &ur&oses.I ? 3ates, 3. " guide to Physical /*amination and 1istory taking, (th ed., c. 1,,., p. (5,, underscoring ours for emphasis- "> The bare assertions of defendant %r ,ba0a cannot be substantiated b0 evidence and should not be given credence b0 this (onorable Court in the light of the discover0 of the C+RR)PTI+N of the Clinical Records of patient *%R,.IN 7hich 7as sub1itted to this (onorable Court +/*hibit 04-5 and 04-52, pp. !;.-!;(, 84&, "D 04-;$2, p. !(1, 84& "E< : b0 %r ,ba0a hi1self, 7hich 7as not onl0 inco1plete and but corrupted as 7ellO Can 7e therefore believe his testi1on0 7hich is contrar0 to co11on hu1an e&perienceQ 'hen it 7as alread0 sho7n that he lied in a ver0 i1portant aspect of his testi1on0Q State1ents 1ade b0 a 7itness that are not onl0 in conflict 7ith e&perience of co11on life and of the ordinar0 instincts and pro1ptings of hu1an nature, but are also negatived b0 surrounding circu1stances, 1a0 be, and should be, DISBELIE2ED. 7CHAMPAGNE 2S. HAMORY, 864 M . 3=6, 4H SN 62? BUREETT 2S. GERTH, 7N . AppI 85H S.C. 866I , 7itness is not entitled to credit 7hose testi1on0 is contrar0 to the natural course of things, or inconsistent 7ith the co11on principles b0 7hich the conduct of 1an8ind is governed 7PEOPLE 2S. DINO, G5 Ph$'. H65? CLARE 2S. PUBLIC SER2ICE ELECTRIC CO., 68 A. 4H45 N.9. La+, 8GGI 'ould it even be credible for an0 one to 1a8e such a clai1Q *vidence to be 7orth0 of credit, 1ust not onl0 proceed fro1 a credible source, but 1ust, in addition, be credible in itself ,nd b0 this is 1eant that it shall be natural, reasonable and probable as to 1a8e it eas0 to believe 7TUAFON 2S. LUFON STE2EDORING, ET AL., G.R. N .L18H5G8, 9an.ar-, 8658I

38 ,gain, does this not run Jcontr ry to the n tur l course of thin!s, or inconsistent -ith the common &rinci&les ,y -hich the conduct of m n4ind is !o#ernedJ and is also Jin conflict -ith e6&erience of common life nd of the ordin ry instincts nd &rom&tin!s of hum n n tureHJ 'ith that trait of her in 1ind, can 7e rel0 on hi1Q Jhen it is clear that a witness has been guilty of deliberate falsehood under oath as to a material fact in a case, courts of Fustice Pare bound upon principles of law and morality and Fustice, to apply the ma*im falsus uno, falsus in omnibusP said 9r. 6ustice Story. PJhat ground of Fudicial belief can there be leftP, he continued, Pwhen the party has shown such gross insensibility to the difference between right and wrong, between truth and falsehoodPQ 7MOORE ON FACTS, pp. 82=61 828=I The reason for this is that once a person 8no7ingl0 and deliberatel0 states a falsehood in one 1aterial aspect, he 1ust have done so as to the rest 7PEOPLE 2S. DASIG, G.R. N . L15235, A.(.*) 25, 865HI Considering the undisputed fact that the PatientFs Clinical Records are in the possession and control of the %efendants and as ad1itted b0 defendant %r ,ba0a that he has access to said records, as he personall0 brought the said /edical Records to Court and considering further that upon co1parison 7ith the original records b0 plaintiffs counsel in the presence of defendantsF counsel, again found the +R Protocol inserted therein, these 7ill onl0 lead to the inevitable conclusion that the corruption of the Clinical Records 7ere done intentionall0 b0 the defendants in order to advance their case %efendants 7ere 4doctoring@ even the /edical Records of *%R,.INO Res Ipsa .o3uitor is a .atin phrase 7hich literall0 1eans 4the thing or the transaction spea8s for itself @ +n the other hand, the Plaintiffs, 7ith the corruption of the records, have no other conclusion but that it 7as done because there are so1e ver0 valuable evidence in the records that 7hen ta8en as is, is presu1abl0 against the defendants The integrit0 of the /edical Records having been lost because of its corruption, the circu1stances are such that the true e&planation of the event of the clinical course of

39 the patient and the actual findings during the appendecto10 is 1ore accessible to the defendants than to the plaintiffs for the0 had the e&clusive control of the Records The Records 7ould have been helpful in furnishing this (onorable Court, not onl0 the logical evidence of 7hat 7as actuall0 operated on, but also the histopathological e&a1ination of the ,ppendi& that 7as re1oved, and the legal ne&us upon 7hich liabilit0 for negligence 1a0 be based but 7e cannot do that no7 This duplicit0, this dishonest0 is reprehensible even to fello7 doctors, 7ho hold the patient clinical records sacrosanct This alone should convince this (onorable Court that defendants did not co1e to court 7ith clean hands The0 7ere hiding so1ething that the0 do not 7ant the (onorable Court to see and consider in this case This leads us to the conclusion that if the sa1e 7ill be sho7n to the (onorable Court, it 7ill be unfavorable to the defendants Thus Section ; 9e<, Rule $;$ of the Ne7 Rules on *vidence provides2

@0eL Tha) e#$!ence +$''".''- *.ppre**e! + .'! ,e a!#er*e $" pr !.ce!.>

,s 7e have sho7n earlier, the defendant %r ,ba0aFs o7n testi1onies and the opinions for7arded b0 %r -u Castro 7hich are reflected in the transcript of stenographic notes cannot hold 7ater against the proof of corruption of the /edical Records of *%R,.IN The %eath Certificate +/*hibit 0"2- "C of *%R,.IN ,.),% signed %r Juan No1i0a states2 C uses of 1e thB 5mmedi te C useB SEP95CE$5A <59% %EPA9+:RE(A" 2A5"?RE Antecedent C useB $ASS5;E PER59+(595S 9he Auto&sy Re&ort of 1r. Ron ldo $endeF *E6hi,it 8AI nd series/ == C use of 1e thB Peritonitis, 'ener liFed 9he " ,or tory Re&ort on P tholo!y ,y 1r. Ces r Dis7uerr *E6hi,it 8":6I to -itB %isto& tholo!ic l findin!sB :5ntestin l 9issue -ith mild to moder te &eritonitis -ith mesenteric fi,rosis nd hemorrh !es. :2oc l myoc rdi l ischemi , mild, -ith sc ttered infl mm tory cells, mild, he rt. re s of
=>

correl tes -ith the !ross findin!s of 1r. Ron ldo $endeF on uto&sy nd st te

40 :;iscer l or! n con!estion. Pro6im te c use has been defined as that 7hich, in the natural and continuous se3uence, unbro8en b0 an0 efficient intervening cause, produces inJur0, and 7ithout 7hich the result 7ould have not occurred 9? 3lacks Iaw 7ictionary, .th /dition, p.11$; +1,',-D
,$

,n inJur0 or da1age is the pro&i1atel0 caused b0 an act or a failure to act,

7henever it appears fro1 the evidence in the case, that the act or o1ission pla0ed a substantial part in bringing about or actuall0 causing the inJur0 or da1ageI and that the inJur0 or da1age 7as either the direct result or reasonabl0 probable conse3uence of the act or o1ission +Ibid- It is the do1inant, 1oving or producing cause ,ppl0ing the above definition in relation to the evidence at hand, the lac8adaisical, if not outright negligent 1anage1ent and care b0 defendant ,ba0a, is undeniabl0 the pro&i1ate cause 7hich triggered the chain of events leading to the death of *%R,.IN *%R,.IN 7as brought to .+R/, (ospital at a ti1e 7hen it 7as too late save his life ,nd it 7as because of the obvious negligence of %r ,ba0a 7ho insisted on so1ething 7hich he has seen to be of no effect on the condition of the patient The responsibilit0 of (ol0 Fa1il0 (ospital is onl0 but apparent In the first place, hospitals e&ercise significant control in the hiring and firing of consultants and in the conduct of their 7or8 7ithin the hospital pre1ises %r ,ba0a testified that he is a stoc8holder of (ol0 Fa1il0 (ospital, therefore a part o7ner of said hospital Considering further that he is also the 1edical director of the sa1e hospital, he therefore he e&ercises supervision and control over hospital e1plo0ees including other consultants, visiting ph0sicians, nurses, residents or interns In this dual capacit0, he is a part-o7ner at the sa1e ti1e e1plo0ee of the (ospital ,ccordingl0, an e1plo0ee-e1plo0er relationship e&ist bet7een hospitals and their attending and visiting ph0sicians, including defendant %r ,ba0a This being the case, defendant (ol0 Fa1il0 (ospital 1ust be held solidaril0 liable 7ith defendant %r ,ba0a The basis for holding an e1plo0er solidaril0 responsible for the negligence of its e1plo0ee is found in ,rticle B$"! of the Civil Code 7hich considers a person accountable not onl0 for his o7n acts but also for others based on the for1erFs

41 responsibilit0 under a relationship of & tri &otest s +Oitug, &ompendium of &ivil Iaw and 6urisprudence, p. #!! +1,,;- #$ Such responsibilit0 ceases 7hen the persons or entit0 concerned 7ill be able to prove that the0 observed the due diligence of a good father of the fa1il0 to prevent da1age +"rticle !1',, &ivil &ode#B

%efendant (ol0 Fa1il0 (ospital utterl0 failed to

adduce an0 evidence in its behalf In neglecting to offer such proof, or proof of si1ilar nature, defendant (ol0 Fa1il0 (ospital therefore failed to discharge its burden under the last paragraph of ,rticle B$"! (aving failed to do this, defendant Fa1il0 (ospital is conse3uentl0 solidaril0 responsible 7ith its co-defendant %r ,ba0a Fro1 the above evidence, both docu1entar0 and testi1onies of e&pert 7itnesses, including the testi1on0 of defendant %r ,ba0a, are proof that %efendant %r ,ba0aFs conduct 7as 7a0 belo7 the standards of practice in his chosen profession %espite the heroic efforts in 1anage1ent, 1assive antibiotics, advanced technological i1peratives of .+R/, (ospital and %r No1i0a, *%R,.IN died on Nove1ber B!, B!!!---$" da0s after he 7as ad1itted at the defendant hospital fro1 a ver0 1inor ail1ent *%R,.IN ca1e to the right doctor but too late *%R,.INFS natural defenses called 4i11une s0ste1@ is co1pro1ised and he succu1bed to Septice1ia 7ith (epato-renal Failure secondar0 to /assive Peritonitis The perpetual 3uestion is2 'ould *%R,.IN have suffered all these co1plications if %r ,ba0a 7as not N*A.IA*NTQ *%R,.IN 7as a 0oung, health0 0oung 1an before his surger0 for appendecto10, 7hich 7ith the nor1al course in postappendecto10 surger0, the healing is dra1atic 0Kncomplicated appendicitis results in prompt recovery< with early ambulation. he patient may be able to eat in ! days and may be discharged within a few days. +1arrisons Principles of Internal 9edicine, 'th ed., 1,'5, p. 15#'- #; ,s to *%R,.INFs post-operative course, there 7as no pro1pt i1prove1ent 7ith his co1plaints after his first surger0 ?,ppendecto10:, he continued to have abdo1inal pain follo7ed b0 vo1iting, fever and abdo1inal distention ,d1ittedl0, there is al7a0s a ris8 of infection, post-operativel0, the reason 7h0 a second ad1ission 7as sought under %r ,ba0a -ut the series of 1ista8es b0 o1ission2

42 failure to follo7 protocol in acute abdo1en, failure to 1onitorGassess the patient hourl0, failure to refer for 1anage1ent or a second opinion caused the precious life of

*%R,.IN, his failure to even locali5e an infection that has been there staring at his face +n the other hand, %r No1i0a noted on *%R,.INFs ad1ission, to 7it2 "tty. "biog> ?> Jhy did you make that conclusion that there was hesitancy on the part of the personnel of Iorma 1ospital to admit him to the hospital cobnsidering the seriousness of the situation@ /ngr. 6ose Ping-ay> "> Nes, maam because the statement of the doctor was, 0/ngr. Pray to Aod that he could still survive within the ne*t seven +'- days.2 So, I was very surprised. Jhy doctor@ I asked him, and he said massive infection is with your nephew. )** ?> So, after 7r. =omiya made that statement what if any did you do@ "> I said> 0please do something, do everything that you can to save the life of my nephew2. 4kay, yes but let us rest everything to Aod but I will try my very best, I will do everything to save his life but the rest is with Aod. +TSN, En(r. 9 *e P$n(1a-, Apr$' 88, 2==5, pp. 515- #> 'e are 7ell a7are that there is a dinstion bet7een the failure to secure results, and the occurrence of so1ething 1ore unusual and not ordinaril0 found if the service or treat1ent rendered follo7ed the usual procedure of those s8illed in that particular practice In the lac8adaisical 1anage1ent of *%R,.INFs ail1ent b0 defendant %r ,ba0a 7ould reasonabl0 spea8 to the average 1an as the negligent cause or cause of the unti1el0 death of *%R,.IN )pon these facts and under these circu1stances of professional treat1ent or non-action, a la01an 7ould be able to sa0, as Pablo ,luad, a tric0cle driver, has observed that as a 1atter of co11on 8no7ledge and observation, that the conse3uences of the 4professional treat1ent@ 7ere not as such as 7ould ordinaril0 have follo7ed if due care has been e&ercised Farida ,luad, 7ife of *%R,.IN 7as notified several ti1es but failed to appear during said hearing indicating as per SheriffFs return that she is not interested to pursue

43 the caseI /*hibit 01-12 follo7s, to 7it2 $st *ndorse1ent /a0 BE, B!!D Respectfull0 sub1itted to the (onorable Court 7ith the infor1ation that the undersigned Process Server of this Court together 7ith the Cler8 III, Florentino / Rivera personall0 7ent to the house of Franida ,luad of -aringcucurong, Su0o, Ilocos Sur and 7ido7 of the late *dralin ,luad subJect of the present Civil ,ction for %a1ages, pending before this Court She refused to sign the notice personall0 served upon her and infor1ed us, her lac8 of interest in further pursuing the Civil ,ction for %a1ages against defendant , (ol0 Fa1il0 (ospital and %octor ,ba0a, no reason 7as given for her state1ent S)-/ITT*% Tagudin, I.ocos Sur, /a0 BE, B!!D, $!2!! ,/ Signed2 %I+NISI+ / M)I..,=*N Process Server
#D

is the return of the Process Server, %ionisio / Muilla0en as

For reasons that 7e do not 8no7, Franida ,luad refused not testif0 in Court despite notice Counsel for Plaintiff 1ade a 1anifestation in court that considering that FR,NI%, ,luad is no longer interested to pursue this case as she even refuse to testif0 7hen called upon b0 the +rder of this (onorable Court, then this leaves the parents of *%R,.IN, Pablo and *rlinda ,luad as the onl0 Plaintiffs in this case since the0 are coheir of the surviving spouse The0 are not estopped fro1 pursuing this case Just because the 7ife 7ho is not a blood relative of the victi1 is no longer interested for an0 reason The fa1il0Fs 1oral and e1otional inJur0 and suffering because of *%R,.INFs unti1el0 death at a 0oung age of ;$ 0ears old is clearl0 a real one and 7ould virtuall0 be i1possible to 3uantif0 ,s the onl0 son of Pablo and *rlinda ,luad, 7ho are no7 in their advanced 0ears, *%R,.IN 7ould have been there for the1 in their old age (e 7as a Police +fficer of Tagudin at the ti1e of his death and earning P$$, >#C !!G1onth +/*hibit 0&2, on page , of the 84&#E

, for the foregoing reasons, an a7ard +N*

/I..I+N ?P$,!!!,!!! !!: P*S+S b0 7a0 of 1oral da1ages is being pra0ed for to assuage this hurt feelings

44 For defendantsF bad faith and the 1alicious corruption of the clinical records, b0 7a0 of e&a1ple to others, FI6* ()N%R*% T(+)S,N% ?PD!!,!!! !!: P*S+S is being pra0ed for b0 7a0 of e&e1plar0 da1ages -0 7a0 of actual da1ages, during the 7hole period of his confine1ent, *%R,.IN incurred hospital bills a1ounting to P2G, 554.== n h$* "$r*) a!&$**$ n, !a)e! N #e&,er 5, 2=== +/*hibit 09-!#, p. !,;, 84&- #CI P8=, 3GH.== n h$* *ec n! a!&$**$ n, !a)e! N #e&,er 8=, 2=== +/*hibit 09-!,2, found on p. !,5, 84&- #", P8=2, 534.== +/*hibit 0/2, found on p. 1!, 84&- ##, F.nera' eApen*e* $n )he ) )a' a& .n) " P8G=,===.==, bro8en do7n as follo7s2 P$!!,!!! e&penses covering the 7a8e and P>!,!!! !! for funeral services and burial dated Nove1ber BC, B!!! + S%, Pablo "luad, 4ctober !., !$$1, pp. 1.-1'- $!! In litigating this case, the Plaintiffs paid for ,ttorne0Fs fees in the a1ount of P8==,===.== a* A)) rne->* accep)ance "ee an! P5,===.== per hear$n( , considering the length, the distance and the nature of this case + S%, Pablo "luad, 4ctober !., !$$1, p. 1'- $!$ The defendants are li8e7ise liable for the lost inco1e on the part of the victi1 7hich shall inure to his heirs, particularl0 his parents, since he died at the age of ;$ and at the sa1e ti1e, gainfull0 e1plo0ed -asicall0, the a1ounts recoverable b0 the heirs of a deceased person arising fro1 a cri1e or negligent act of another 7ere su11ari5ed b0 the Supre1e Court in the case " HEIRS OF RAYMUNDO CASTRO 2S. BUSTOS, 23 SCRA H23 , though the a1ounts 7ere later on increased to 1eet the changing needs of our ti1es in BALICAG TRANSIT, INC M PEOPLE 2S. CORDERO, ET AL , infra , as follo7s2 A* ) )he $n!e&n$)- " r )he !ea)h " )he #$c)$& " )he ""en*e111

P5=,===.==111)h .(h r$($na''- pe((e! a) PH,===.== ,- Ar). 22=5 " )he Ne+ C$#$' C !e, )hen $ncrea*e! ) P82,===.== +$)h .) )he nee! " ane#$!ence " pr " " !a&a(e*, an! e#en )h .(h )here &a- ha#e ,een &$)$(a)$n( c$rc.&*)ance* a))en!$n( )he c &&$**$ n " )he ""en*e.

Th$* a& .n) +a* *.,*eJ.en)'- a,an! ne! ,- )he S.pre&e C .r) an! $ncrea*e! )he *a&e ) PH=,===.== an! .')$&a)e'- ) P5=,==== $n )he

45 ca*e* " BALICAG TRANSIT, INC. 2S. COURT OF

APPEALSH an! PEOPLE OF THE PHILIPPINES 2S. CORDERO, ET ALG?

A& .n) repre*en)$n( ' ** " earn$n( capac$)- ) ,e c &p.)e! ,a*e! n )he A&er$can EApec)anc- )a,'e " M r)a'$)- r " )he Ac).ar$a' " C &,$ne! EAper$ence Ta,'e " M r)a'$)- a* " '' +e! ,- )he S.pre&e C .r) $n )he ca*e " 2ILLA REY TRANSIT 2S. COURT OF

APPEALS5?
A& .n) repre*en)$n( )he ac).a' !a&a(e* $nc.rre! '$;e h *p$)a'$Ka)$ n an! ,.r$a' eApen*e*? an! M ra' Da&a(e*, eAe&p'ar- !a&a(e* an! a)) rne->* "ee*, )he !e)er&$na)$ n " +h$ch $* 'e") ) )he * .n! !$*cre)$ n " )he )r$a' c .r). 'e shall therefore sho7 the total civil liabilit0 of the accused based on e&isting la7s and Jurisprudence

DAMAGES REPRESENTING THE LOSS OF EARNING CAPACITY 0AL A* a &e&,er " )he PNP +$)h a & n)h'- *a'ar- " 88,G63.==
,s to the co1putation of the earning capacit0 of the decedent 7hich 7as lost 7as a result of his unti1el0 death, the Supre1e Court had consistentl0 used the A&er$can EApec)anc- Ta,'e " M r)a'$)- , the for1ula of 7hich is as follo7s2 .ife e&pectanc0 R BG; & ?"!-,ge at the ti1e of death: ,1ount of inde1nit0 representing lost inco1e R .ife e&pectanc0 & inco1e =earl0

The life e&pectanc0 of the decedent 7ho died at the age of ;$ 9Please see the death certificate< , is as follo7s2 2<H A 74=1H8I N
; >

BEB SCR, B;! BE; SCR, $BB D ;$ SCR, D$$

46 2<H A G6I N -ear*

LIFE E:PECTANCY N H2.55 YEARS

The foregoing sho7s that the decedent is e&pected to have ;B EE 1ore of fruitful 0ears ahead of hi1 7here she could have earned an inco1e for hi1self and his fa1il0 Since it 7as proven that the decedent 7as earning at least P$$,>#C !! per 1onth, his 0earl0 inco1e should be P8H3,65G.== per ann.& L *) Inc &e R .ife e&pectanc0 & 0earl0 Inco1e R ;B EE 0ears & P$;C,#E> !! per 0ear

LOST INCOME

= P4,505,904.20

The su11ar0 of da1ages in 7hich the plaintiffs are entitled to receive fro1 the defendant are co1puted as follo7s, to 7it2

,ttorne0Fs and ,ppearance Fees

B ; >

D E

P$!!,!!! !! plus PD,!!! !! as appearance fee per hearing .oss of *arning Capacit0 P>,D!D,#!> B! Funeral *&penses and e&penses P$>!,!!! !! during the 7a8e (ospital e&penses PB>,DE" !! H P$!,C>; !! H P$!B,EC" !! or a total of P$;C,#"# !! /oral da1ages P$,!!!,!!! !! *&e1plar0 %a1ages PD!!,!!! !!

Gran! T )a'B P5,H4H,46H.2=8

PRAYER '(*R*F+R*, pre1ises considered, it is respectfull0 pra0ed of the (onorable Court to decide this case in favor of the Plaintiffs P,-.+ and *R.IN%, ,.),% finding solidaril0 defendants liable and order an a7ard b0 7a0 of da1ages as follo7s2
$

*&cluding appearance fees of PD,!!! !! per hearing 7hich could be chec8ed fro1 the records of this case

47 $ for the 1oral and e1otional inJur0 and suffering an a7ard +N* /I..I+N 7P8,===,===.==I P*S+S I B b0 7a0 of e&a1ple to others and for public good, FI6* ()N%R*% T(+)S,N% 7P5==,===.==: P*S+S is being pra0ed for b0 7a0 of e&e1plar0 da1agesI ; %a1ages as a result of .oss of earning capacit0 in the a1ount of PG,5=5,6=G.2=I > b0 7a0 of ,ctual %a1ages2 hospital bills a1ounting to P2G, 554.== on his first ad1ission, dated Nove1ber D, B!!! +/*hibit 09-!#, p. !,;, 84&- $!BI P8=, 3GH.== on his second ad1ission, dated Nove1ber $!, B!!! +/*hibit 09-!,2
$!;

, found on p. !,5, 84&-

$!>

, and P8=2, 534.==

+/*hibit 0/2 $!D, found on p. 1!, 84&- $!C, Funeral e&penses in the total a1ount of P8G=,===.==, bro8en do7n as follo7s2 P$!!,!!! e&penses covering the 7a8e and P>!,!!! !! for funeral services and burial dated Nove1ber BC, B!!! + S%, Pablo "luad, 4ctober !., !$$1, pp. 1.-1'- $!" D ,ttorne0Fs fees in the a1ount of P8==,===.== as ,ttorne0Fs acceptance fee and P5,===.== per hear$n(, considering the length and nature of this caseI E Costs of suit

+ther reliefs, Just and e3uitable under the pre1ises, are li8e7ise pra0ed for -,A)I+ CIT= for Tagudin, Ilocos Sur, Philippines ,ugust E, B!!C

GACAYAN PAREDES AGMATA & ASSOCIATES LAW OFFICES

$$-- )rbano St , -aguio Cit0

b02 LAURO D. GACAYAN

Roll No ;>;;", June ;, $#"E

48
I-P + R No E#;$EB, Januar0 #, B!!C -aguio Cit0 PTR No $#$E>;", Januar0 #, B!!C -aguio Cit0

-and-

ATTY. MOLLY CR. ABIOG, M.D. &ollaborating counsel Roll of ,ttorne0s2 >>>C"2DG$$G## PTR No $#$C;DC2!$G$!G!C2 -aguio Cit0I I-P No E#;$">2!$G$!G!C2 -aguio--enguet Chapter

EXPLANATION
?Re2 Section $$, Rule $; of the $##C Rules of Civil Procedure:

The r$($na' c p- " )h$* p'ea!$n( +a*2

9 < Filed directl0 7ith this (onorable CourtG+fficeI 9& < Filed 7ith this (onorable CourtG+ffice b0 Registered /ail 7ith Return Card because2
9 & < The distance bet7een this (onorable CourtG+ffice and the +ffice of the undersigned counsel 1a8es personal filing i1practicableI 9 & < .ac8 of office staffGpersonnel to effect personal serviceI 9 < Ti1e constraintsI 9 < )nfavorable 7eather conditions prevents personal serviceI 9 < Pleading is not urgent in nature

C p-<c p$e* " )h$* p'ea!$n( +a*<+ere2

9 < Personall0 served on counsel of the adverse part0I 9 & < Sent to counsel of the adverse part0 b0 Registered /ail 7ith Return Card due to the follo7ing reason2
9 & < The distance bet7een the offices of counsels 1a8es personal filing i1practicableI 9 & < .ac8 of office staffGpersonnel to effect personal serviceI 9 < Ti1e constraintsI 9 < )nfavorable 7eather conditions prevents personal serviceI 9 < Pleading is not urgent in nature

ATTY. MOLLY CR ABIOG, MD. Cop0 furnished 2 ATTY. CANDIDO BALBIN Candon Cit0

ATTY. LAURO D. GACAYAN

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