You are on page 1of 11


Spouses Pomasin - Doria

Facts: Vehicular collision involving two vehicles, a tractor-trailer and a jitney (i.e. share taxi or minibus) along Maharlika highway resulting in multiple death and injuries to those in the jitney driven by Laarni Pomasin Spouses Pomasin et al filed a complaint for damages against Tison, the owner of the truck, and Jabon, the driver TC: dismissed complaint because it was Pomasin who was negligent and this was proximate cause CA: Jabons reckless driving caused collision CA also noted that the restriction in Jabons drivers license was violated, thus giving rise to the presumption that he was negligent at the time of the accident Issue: w/n Jabon was negligent Held: No. Actually it was Laarni, the jitney driver, who was negligent and that this was the proximate cause of the accident. Case dismissed. The court noted that it was indeed true that at the time of the incident, Jabon was prohibited from driving the truck due to the restriction imposed on his drivers license. Jabon even asked that the LTO reinstate his articulate license containing restriction code to allow him to drive a tractor-trailer. However, although driving without a proper license is a violation of traffic regulation, and vis-a-vis Art. 2185, the legal presumption of negligence arises if at the time of the mishap, a person is violating any traffic regulation, a causal connection must exist between the injury received and the violation of the traffic regulation. It must be proven that the violation of the traffic regulation was the proximate or legal cause of the injury or that it substantially contributed thereto (Sanitary Steam Laundry, Inc. v. CA). Negligence, consisting in whole or in part, of violation of law, like any other negligence, is without legal consequence unless it is a contributing cause of the injury. WISE WORDS FROM THE GOOD BOOK: The highlighted portion should not be interpreted to mean that the presumption of negligence only arises when the traffic violation was the proximate cause of the injury.

1. There is nothing in the text of the article which would suggest such a requirement. 2. Such a requirement would put the cart before the horse, so to speak. A presumption of negligence only provides evidence of negligence in the absence of proof to the contrary. To establish proximate cause, one would have to prove that the negligent act in question is the legal cause of the injury. If one were able to prove that a negligent act is the proximate cause, the one would not need a presumption any more. Instead, the Courts statements in Tison should be interpreted to mean that despite the presumption of negligence arising from the traffic regulation violation, the claimant must still prove that such negligence was the proximate cause in order to successfully claim for damages.

2. Professional Services v Agana - Enteria Professional Services Inc. (PSI) v. Natividad and Enrique Agana Natividad and Enrique Agana v. Juan Fuentes Miguel Ampil v. Natividad and Enrique Agana
January 31, 2007 FACTS 1. Natividad Agana was rushed to Medical City because of difficulty of bowel movement and bloody anal discharge. Dr. Ampil diagnosed her to be suffering from cancer of the sigmoid. Dr. Ampil performed an anterior resection surgery on her, and finding that the malignancy spread on her left ovary, he obtained the consent of her husband, Enrique, to permit Dr. Fuentes to perform hysterectomy on her. After the hysterectomy, Dr. Fuentes showed his work to Dr. Ampil, who examined it and found it in order, so he allowed Dr. Fuentes to leave the operating room. Dr. Ampil was about to complete the procedure when the attending nurses made some remarks on the Record of Operation: "sponge count lacking 2; announced to surgeon search done but to no avail continue for closure" (two pieces of gauze were missing). A "diligent search" was conducted but they could not be found. Dr. Ampil then directed that the incision be closed. 2. A couple of days after, she complained of pain in her anal region, but the doctors told her that it was just a natural consequence of the surgery. Dr. Ampil recommended that she consult an oncologist to


examine the cancerous nodes which were not removed during the operation. After months of consultations and examinations in the US, she was told that she was free of cancer. Weeks after coming back, her daughter found a piece of gauze (1.5 in) protruding from her vagina, so Dr. Ampil manually extracted this, assuring Natividad that the pains will go away. However, the pain worsened, so she sought treatment at a hospital, where another 1.5 in piece of gauze was found in her vagina. She underwent another surgery. Sps. Agana filed a complaint for damages against PSI (owner of Medical City), Dr. Ampil, and Dr. Fuentes, alleging that the latter are liable for negligence for leaving 2 pieces of gauze in Natividad's body, and malpractice for concealing their acts of negligence. Enrique Agana also filed an administrative complaint for gross negligence and malpractice against the two doctors with the PRC (although only the case against Dr. Fuentes was heard since Dr. Ampil was abroad). Pending the outcome of the cases, Natividad died (now substituted by her children). RTC found PSI and the two doctors liable for negligence and malpractice. PRC dismissed the case against Dr. Fuentes. CA dismissed only the case against Fuentes.

within a reasonable time by advising her of what he had been compelled to do, so she can seek relief from the effects of the foreign object left in her body as her condition might permit. What's worse in this case is that he misled her by saying that the pain was an ordinary consequence of her operation.

Medical negligence; standard of diligence To successfully pursue this case of medical negligence, a patient must only prove that a health care provider either failed to do something [or did something] which a reasonably prudent health care provider would have done [or wouldn't have done], and that the failure or action caused injury to the patient. Duty - to remove all foreign objects from the body before closure of the incision; if he fails to do so, it was his duty to inform the patient about it Breach - failed to remove foreign objects; failed to inform patient Injury - suffered pain that necessitated examination and another surgery Proximate Causation - breach caused this injury; could be traced from his act of closing the incision despite information given by the attendant nurses that 2 pieces of gauze were still missing; what established causal link: gauze pieces later extracted from patient's vagina 2. Whether the Court of Appeals Erred in Absolving Dr. Fuentes of any Liability Dr. Fuentes is not liable. The res ipsa loquitur [thing speaks for itself] argument of the Aganas' does not convince the court. Mere invocation and application of this doctrine does not dispense with the requirement of proof of negligence. Requisites for the applicability of res ipsa loquitur Occurrence of injury 1. Thing which caused injury was under the control and management of the defendant [DR. FUENTES] -- LACKING SINCE CTRL+MGT WAS WITH DR. AMPIL 2. Occurrence was such that in the ordinary course of things, would not have happened if those who had control or management used proper care 3. Absence of explanation by defendant

ISSUE AND HOLDING 1. WON CA erred in holding Dr. Ampil liable for negligence and malpractice. NO; DR. AMPIL IS GUILTY 2. WON CA erred in absolving Dr. Fuentes of any liability. NO 3. WON PSI may be held solidarily liable for Dr. Ampil's negligence. YES RATIO 1. Whether the Court of Appeals Erred in Holding Dr. Ampil Liable for Negligence and Malpractice. His arguments are without basis [did not prove that the American doctors were the ones who put / left the gauzes; did not submit evidence to rebut the correctness of the operation record (re: number of gauzes used); re: Dr. Fuentes' alleged negligence, Dr. Ampil examined his work and found it in order]. Leaving foreign substances in the wound after incision has been closed is at least prima facie negligence by the operating surgeon. Even if it has been shown that a surgeon was required to leave a sponge in his patient's abdomen because of the dangers attendant upon delay, still, it is his legal duty to inform his patient

Under the Captain of the Ship rule, the operating surgeon is the person in complete charge of the surgery room and all personnel connected with the operation. That Dr. Ampil discharged such role is evident from the following: He called Dr. Fuentes to perform a hysterectomy He examined Dr. Fuentes' work and found it in order He granted Dr. Fuentes permission to leave He ordered the closure of the incision

3. Whether PSI Is Liable for the Negligence of Dr. Ampil HOSPITAL OWNER PSI SOLIDARILY LIABLE WITH DR. AMPIL [NCC 2180], AND DIRECTLY LIABLE TO SPS. AGANAS [NCC 2176] Previously, employers cannot be held liable for the fault or negligence of its professionals. However, this doctrine has weakened since courts came to realize that modern hospitals are taking a more active role in supplying and regulating medical care to its patients, by employing staff of physicians, among others. Hence, there is no reason to exempt hospitals from the universal rule of respondeat superior. Here are the Court's bases for sustaining PSI's liability: Ramos v. CA doctrine on E-E relationship For purposes of apportioning responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. Agency principle of apparent authority / agency by estoppel Imposes liability because of the actions of a principal or employer in somehow misleading the public into believing that the relationship or the authority exists [see NCC 1869] PSI publicly displays in the Medical City lobby the names and specializations of their physicians. Hence, PSI is now estopped from passing all the blame to the physicians whose names it proudly paraded in the public directory, leading the public to believe that it vouched for their skill and competence. If doctors do well, hospital profits financially, so when negligence mars the quality of its services, the hospital should not be allowed to escape liability for its agents' acts. Doctrine of corporate negligence / corporate responsibility This is the judicial answer to the problem of allocating hospital's liability for the negligent acts of health

practitioners, absent facts to support the application of respondeat superior. This provides for the duties expected [from hospitals]. In this case, PSI failed to perform the duty of exercising reasonable care to protect from harm all patients admitted into its facility for medical treatment. PSI failed to conduct an investigation of the matter reported in the note of the count nurse, and this established PSI's part in the dark conspiracy of silence and concealment about the gauzes. PSI has actual / constructive knowledge of the matter, through the report of the attending nurses + the fact that the operation was carried on with the assistance of various hospital staff It also breached its duties to oversee or supervise all persons who practice medicine within its walls and take an active step in fixing the negligence committed PSI also liable under NCC 2180- It failed to adduce evidence to show that it exercised the diligence of a good father of the family in the accreditation and supervision of Dr. Ampil

3. Layugan v. IAC Escalona

1988 Res Ipsa Loquitur not applicable if Direct Evidence is available While Layugan and a companion were repairing the tire of their cargo truck parked along the right side of the National Highway, defendant Isidros truck, driven recklessly by Serrano, bumped Layugan = injury, hospital costs: 10K; lifetime income allegedly lost: 70K (security guard and truck-helper) + his wife left him and the kids. Layugan filed an action for damages Answer: o that the plaintiff was merely a bystander, not a truck helper being a brother-in-law law of the driver; that the truck allegedly being repaired was parked, occupying almost half of the right lane, right after the curve; that the proximate cause of the incident was the failure of the driver of the parked truck in installing the early warning device; a third-party complaint was filed by the defendant against his insurer, the Travellers Multi Indemnity Corp (P50K indemnity limit) RTC for plaintiff: 70K AD, 2K AF, 5K MD, From Ins Co: 50K AD IAC reversed and dismissed the complaint

because of its weight the truck could not have been driven to the shoulder of the road and concluded that the same was parked on a portion of the road at the time of the accident. So the mishap was due to the negligence of the driver of the parked truck (SC: this inference is erroneous; grounded on speculation, surmise, or conjecture) ISSUES: WHETHER IAC CORRECT IN DISMISSING THE COMPLAINT; WHETHER THE IAC CORRECT IN APPLYING "RES IPSA LOQUITUR" o Picart vs. Smith the test by which to determine the existence of negligence is: Did the defendant in doing the alleged negligent act use that reasonable care and caution which an ordinarily prudent person would have used in the same situation? If not, then he is guilty of negligence. The law here in effect adopts the standard supposed to be supplied by the imaginary conduct of the discreet paterfamilias of the Roman law. o The evidence on record discloses that 3-4 meters from the rear of the parked truck, a lighted kerosene lamp was placed (constitutes sufficient warning). Moreover, there is the admission of respondent Isidro's driver, Serrano, that: another vehicle with glaring lights from opposite direction momentarily blinded him so he didnt notice the parked truck; that when he stepped on the brake, it didnt function, hence he hit Layugan. He found out later that his trucks fluid pipe was cut. o It is clear from the foregoing disquisition that the absence or want of care of driver Serrano has been established by clear and convincing evidence. It follows that Res ipsa loquitur cannot be applied. o RES IPSA LOQUITUR: This doctrine is stated thus: "Where the thing which causes injury is shown to be under the management of the defendant, and the accident is such as in the ordinary course of things does not happen if those who have the management use proper care, it affords reasonable evidence, in the absence of an explanation by the defendant, that the accident arose from want of care. Black's Law Dictionary: Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption or inference that defendant was negligent, which arises upon proof that instrumentality causing injury was in defendant's exclusive control, and that the accident was one which ordinarily does not happen in absence of negligence. Under doctrine of "res ipsa loquitur" the happening of an injury permits an inference of negligence where o

plaintiff produces substantial evidence that injury was caused by an agency or instrumentality under exclusive control and management of defendant, and that the occurrence was such that in the ordinary course of things would not happen if reasonable care had been used. The doctrine of Res ipsa loquitur as a rule of evidence is peculiar to the law of negligence which recognizes that prima facie negligence may be established without direct proof and furnishes a substitute for specific proof of negligence. The doctrine can be invoked when and only when, under the circumstances involved, direct evidence is absent and not readily available. Hence, it has generally been held that the presumption of inference arising from the doctrine cannot be availed of, or is overcome, where plaintiff has knowledge and testifies or presents evidence as to the specific act of negligence which is the cause of the injury complained of or where there is direct evidence as to the precise cause of the accident. Isidro is being sued under Art. 2176 in rel to Art. 2180, par 5. In the latter, when an injury is caused by the negligence of a servant or employee there instantly arises a presumption of law that there was negligence on the part of the master or employer either in the selection of the servant or employee, or in supervision over him after selection, or both.


4. Tan v. Jam Transit Fullecido

Tan is an owner of a passenger type jitney which was involved in an accident at an intersection along Maharlika Highway with JAM Transit passenger bus which was driven by Eddie Dimayuga The jitney is loaded with quail egg and duck egg The jitney is driven by Alexander Ramirez Tan alleged that Dimayuga was reckless, negligent, imprudent, and not observing traffic rules and regulations Essentially, it was due to the fact that Dimayuga failed to obey the proper light directions signals in relation to negotiating a left turn towards the feeder or barangay road which caused the collision with the jitney resulting to the cargo being destroyed and Ramirez and helper to be injured.

Issue: WON the doctrine of Res Ipsa Loquitor is applicable in this case

Held: No. Ratio: Res ipsa loquitur is a Latin phrase that literally means "the thing or the transaction speaks for itself." o Where the thing that caused the injury complained of is shown to be under the management of the defendant or his servants; and o the accident, in the ordinary course of things, would not happen if those who had management or control used proper care, it affords reasonable evidence in the absence of a sufficient, reasonable and logical explanation by defendant -that the accident arose from or was caused by the defendants want of care This rule is grounded on the superior logic of ordinary human experience, and it is on the basis of such experience or common knowledge that negligence may be deduced from the mere occurrence of the accident itself. Hence, the rule is applied in conjunction with the doctrine of common knowledge res ipsa loquitur is not a rule of substantive law and does not constitute an independent or separate ground for liability. Instead, it is considered as merely evidentiary, a mode of proof, or a mere procedural convenience In other words, mere invocation and application of the doctrine do not dispense with the requirement of proof of negligence. The following are the requisites o The accident is of a kind which ordinarily does not occur in the absence of someones negligence o It is caused by an instrumentality within the exclusive control of the defendant or defendants; and o The possibility of contributing conduct which would make the plaintiff responsible is eliminated The SC deemed the following requisite are present in the case The SC do not adhere to the finding of CA that the petitioner has direct access to the evidence What was testified was that Ramirez drove along Maharlika Highway Ramirez has no vivid recollection on how the passenger jitney was hit by JAM The SC appreciated that in absence of testimonial or direct evidence, the petitioner can still be provided with remedies. Indeed, no two motor vehicles traversing the same lane of a highway with double yellow center lines will collide as a matter of

course, both ending up on the opposite lane,unless someone is negligent. Driving the bus gave Dimayuga exclusive management and control over it. no contributory negligence could be attributed to Ramirez relative to the incident on the basis of the available evidence No direct evidence was presented with respect to the exact road position of the bus and the jitney at the time of the collision such that the same can only be inferred from the pictures of the colliding vehicles taken immediately after the incident

AUSTRIA-MARTINEZ, J.: FACTS: Belfranlt Development, Inc. is the owner of Belfranlt Building in Angeles City, Pampanga. It leased to petitioners College Assurance Plan Phil., Inc. (CAP) and Comprehensive Annuity Plans and Pension Corporation (CAPP) several units on the second and third floors of the building. On October 8, 1994, a fire destroyed portions of the building, including the third floor units being occupied by petitioners. An October 20, 1994 field investigation report by an unnamed arson investigator assigned to the case disclosed that the origin of fire was in the store room occupied by CAP, located at the 3rd floor of the building and the cause of fire was the overheated coffee percolator. Citing the foregoing findings, respondent sent petitioners on November 3, 1994 a notice to vacate the leased premises to make way for repairs, and to pay reparation estimated at P1.5 million. On November 11, 1994, petitioners vacated the leased premises, including the units on the second floor, but they did not act on the demand for reparation. Respondent wrote petitioners another letter, reiterating its claim for reparation, this time estimated by professionals to be no less than P2 million. It also clarified that, as the leased units on the second floor were not affected by the fire, petitioners had no reason to vacate the same; hence, their lease on said units is deemed still subsisting, along with their obligation to pay for the rent. In reply, petitioners explained that they could no longer re-occupy the units on the second floor of the building for they had already moved to a new location and entered into a binding contract with a new lessor. Petitioners also disclaimed liability for reparation, pointing out that the fire was a fortuitous event for which they could not be held responsible.

After its third demand went unheeded, respondent filed with the RTC a complaint against petitioners for damages. The RTC rendered a Decision against the plaintiff. CA modified the RTC Decision as to the damages. ISSUE FOR TORTS: WON the CA erred in applying the doctrine of res ipsa loquitur. HELD: NO. The CA correctly applied the doctrine of res ipsa loquitur. The petition is DENIED for lack of merit. RATIO: The CA correctly applied the doctrine of res ipsa loquitur under which expert testimony may be dispensed with to sustain an allegation of negligence if the following requisites obtain: a) the accident is of a kind which does not ordinarily occur unless someone is negligent; b) the cause of the injury was under the exclusive control of the person in charge and c) the injury suffered must not have been due to any voluntary action or contribution on the part of the person injured. The fire that damaged Belfranlt Building was not a spontaneous natural occurrence but the outcome of a human act or omission. It originated in the store room which petitioners had possession and control of. Respondent had no hand in the incident. Hence, the convergence of these facts and circumstances speaks for itself: petitioners alone having knowledge of the cause of the fire or the best opportunity to ascertain it, and respondent having no means to find out for itself, it is sufficient for the latter to merely allege that the cause of the fire was the negligence of the former and to rely on the occurrence of the fire as proof of such negligence. It was all up to petitioners to dispel such inference of negligence, but their bare denial only left the matter unanswered. The CA therefore correctly affirmed the RTC in holding petitioners liable to respondent for actual damages consisting of unpaid rentals for the units they leased. The CA deleted the award of actual damages of P2.2 million which the RTC had granted respondent to cover costs of building repairs. In lieu of actual damages, temperate damages in the amount of P500,000.00 were awarded by the CA. The SC found this in order.

At around 1:30 p.m., November 2, 1990, Jose Juego, a construction worker of D. M. Consunji, Inc., fell 14 floors from the Renaissance Tower, Pasig City to his death. On May 9, 1991, Jose Juegos widow, Maria, filed in the Regional Trial Court (RTC) of Pasig a complaint for damages against the deceaseds employer, D.M. Consunji, Inc. The employer raised, among other defenses, the widows prior availment of the benefits from the State Insurance Fund. After trial, the RTC rendered a decision in favor of the widow Maria Juego. On appeal by D. M. Consunji, the Court of Appeals (CA) affirmed the decision of the RTC in toto. D. M. Consunji then sought the reversal of the CA decision. ISSUES: 1. 2. Whether or not the petitioner is held liable under the grounds of negligence. Whether or not the injured employee or his heirs in case of death have a right of selection or choice of action between availing themselves of the workers right under the Workmens Compensation Act and suing in the regular courts under the Civil Code for higher damages (actual, moral and exemplary) from the employers by virtue of the negligence or fault of the employers or whether they may avail themselves cumulatively of both actions,

RULING: 1. YES. DM CONSUNJI IS NEGLIGENT. All the requisites for the application of the rule of res ipsa loquitur are present in the case at bar, thus a reasonable presumption or inference of appellants negligence arises. Petitioner does not cite any other evidence to rebut the inference or presumption of negligence arising from the application of res ipsa loquitur, or to establish any defense relating to the incident. The doctrine of res ipsa loquitur (the thing or transaction speaks for itself) is peculiar to the law of negligence which recognizes that prima facie negligence may be established without direct proof and furnishes a substitute for specific proof of negligence. It has the following requisites: (1) the accident was of a kind which does not ordinarily occur unless someone is negligent;

6. DM Consunji vs. Court of Appeals - CarlosTheFierce


(2) the instrumentality or agency which caused the injury was under the exclusive control of the person charged with negligence; and (3)the injury suffered must not have been due to any voluntary action or contribution on the part of the person injured. 2. The claims for damages sustained by workers in the course of their employment could be filed only under the Workmens Compensation Law, to the exclusion of all further claims under other laws. In the course of availing the remedies provided under the Workmens Compensation law, the claimants are deemed to have waived theirknown right of the remedies provided by other laws. The Court of Appeals, however, held that the case at bar came under exception because private respondent was unaware of petitioners negligence when she filed her claim for death benefits from the State Insurance Fund. Had the claimant been aware, she wouldve opted to avail of a better remedy than that of which she already had. JUSTIFICATION FOR THE RULE ON RES IPSA LOQUITUR One of the theoretical basis for the doctrine is its necessity, i.e., that necessary evidence is absent or not available. The res ipsa loquitur doctrine is based in part upon the theory that the defendant in charge of the instrumentality which causes the injury either knows the cause of the accident or has the best opportunity of ascertaining it and that the plaintiff has no such knowledge, and therefore is compelled to allege negligence in general terms and to rely upon the proof of the happening of the accident in order to establish negligence. The inference which the doctrine permits is grounded upon the fact that the chief evidence of the true cause, whether culpable or innocent, is practically accessible to the defendant but inaccessible to the injured person. It has been said that the doctrine of res ipsa loquitur furnishes a bridge by which a plaintiff, without knowledge of the cause, reaches over to defendant who knows or should know the cause, for any explanation of care exercised by the defendant in respect of the matter of which the plaintiff complains. The res ipsa loquitur doctrine, another court has said, is a rule of necessity, in that it proceeds on the theory that under the peculiar circumstances in which the doctrine is applicable, it is within the power of the defendant to show that there was no negligence on his part, and direct proof of defendants negligence is beyond plaintiffs power. Accordingly, some court add to the

three prerequisites for the application of the res ipsa loquitur doctrine the further requirement that for the res ipsa loquitur doctrine to apply, it must appear that the injured party had no knowledge or means of knowledge as to the cause of the accident, or that the party to be charged with negligence has superior knowledge or opportunity for explanation of the accident.23

7. Fe Cayao-Salam v. Sps. Ramolete (GR No. 159132) Manalo

FACTS: On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was brought to the Lorma Medical Center (LMC) in San Fernando, La Union due to vaginal bleeding. Upon advice of petitioner relayed via telephone, Editha was admitted to the LMC on the same day. A pelvic sonogram2 was then conducted on Editha revealing the fetus weak cardiac pulsation. The following day, Edithas repeat pelvic sonogram showed that aside from the fetus weak cardiac pulsation, no fetal movement was also appreciated. Due to persistent and profuse vaginal bleeding, petitioner advised Editha to undergo a Dilatation and Curettage Procedure (D&C) or " raspa." The procedure was performed by the petitioner and Editha was discharged the next day. On September 16, 1994, Editha was once again brought at the LMC, as she was suffering from vomiting and severe abdominal pains. She was found to have a massive intraabdominal hemorrhage and a ruptured uterus. Thus, Editha had to undergo a procedure for hysterectomy and as aresult, she has no more chance to bear a child. Respondents: first, petitioners failure to check up, visit or administer medication on Editha during her first day of confinement at the LMC; second, petitioner recommended that a D&C procedure be performed on Editha without conducting any internal examination prior to the procedure; third, petitioner immediately suggested a D&C procedure instead of closely monitoring the state of pregnancy of Editha. Petitioner: it was Edithas gross negligence and/or omissio n in insisting to be discharged against doctors advice and her unjustified failure to return for check-up as directed by petitioner that contributed to her life-threatening condition on; that Edithas hysterectomy was brought about by her very abnormal pregnancy known as placenta increta, which was an extremely rare and very unusual case of abdominal placental implantation; that whether or not a D&C procedure was done by her or any other doctor, there would be no difference at all because at any stage of gestation before term, the uterus would rupture just the same. RULING: Medical malpractice is a particular form of negligence which consists in the failure of a physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions, and in like surrounding circumstances. There are four elements involved in medical negligence cases: duty, breach, injury and proximate causation.

In the present case, respondents did not present any expert testimony to support their claim that petitioner failed to do something which a reasonably prudent physician or surgeon would have done. Petitioner, on the other hand, presented the testimony of Dr. Augusto M. Manalo, who was clearly an expert on the subject. He testified that the rupture occurred minutes prior to the hysterectomy or right upon admission on September 15, 1994 which is about 1 months after the patient wasdischarged, after the D&C was conducted. It is evident thatthe D&C procedure was not the proximate cause of therupture of Edithas uterus. The defenses in an action for damages, provided for under Article 2179 of the Civil Code are: Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause of his injury, he cannot recover damages. But if his negligence was only contributory, the immediate and proximate cause of the injury being the defendants lack of due care, the plaintiff may recover damages, but the courts shall mitigate the damages to be awarded. Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result would not have occurred.55 An injury or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence in the case that the act or omission played a substantial part in bringing about or actually causing the injury or damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. The Court notes the findings of the Board of Medicine: When complainant was discharged on July 31, 1994, herein respondent advised her to return on August 4, 1994 or four (4) days after the D&C. This advise was clear in complainants Discharge Sheet. However, complainant failed to do so. This being the case, the chain of continuity as required in order that the doctrine of proximate cause can be validly invoked was interrupted. Had she returned, the respondent could have examined her thoroughly. Contributory negligence is the act or omission amounting to want of ordinary care on the part of the person injured, which, concurring with the defendants negligence, is the proximate cause of the injury. Difficulty seems to be apprehended in deciding which acts of the injured party shall be considered immediate causes of the accident.60 Where the immediate cause of an accident resulting in an injury is the plaintiffs own act, which contributed to the principal occurrence as one of its determining factors, he cannot recover damages for the injury.

Note: Sorry for the lengthy digest. I just took this from the web. Im not able to read the case in the original yet. Its a very lengthy case. Ill try to upload my version before 4 pm. Im just kinda busy at work talaga. Sorry. Ramos v. CA Kapunan, 1999 Facts: Erlinda Ramos, a 47-year old robust woman, was normal except for her experiencing occasional pain due to the presence of stone in her gall bladder. She was advised to undergo an operation for its removal. The results in the examinations she underwent indicate that she was fit for the operation. She and her husband Rogelio met Dr. Hosaka, one of the defendants, who advised that she should undergo cholecystectomy. Dr. Hosaka assured them that he will get a good anaesthesiologist. At 7:30 a.m. on the day of the operation at Delos Santos Medical Center, Herminda Cruz, Erlindas sister in-law and the dean of the College of Nursing in Capitol Medical Center, was there to provide moral support. Dr. Perfecta Gutierrez was to administer the anaesthesia. Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr. Gutierrez intubating the patient, and heard the latter say Ang hirap ma intubate nito, mali yata ang pagkakapasok. O, lumalaki ang tiyan. Herminda saw bluish discoloration of the nailbeds of the patient. She heard Dr. Hosaka issue an order for someone to call Dr. Calderon. The doctor arrived and placed the patient in trendelenburg position, wherein the head of the patient is positioned lower than the feet, which indicates a decrease of blood supply in the brain. Herminda knew and told Rogelio that something wrong was happening. Dr. Calderon was able to intubate the patient. Erlinda was taken to the ICU and became comatose. Rogelio filed a civil case for damages. The trial court ruled in his favor, finding Dr. Gutierrez, Dr. Hosaka, and the hospital, guilty of negligence, but the Court of Appeals reversed the decision. Hence, petitioner filed a Motion for Reconsideration, which the Court of Appeals denied for having been filed beyond the reglementary period. However, it was found that the notice of the decision was never sent to the petitioners counsel. Rather, it was sent to the petitioner, addressing him as Atty. Rogelio Ramos, as if he was the legal counsel. The petitioner filed the instant petition for certiorari. On the procedural issue, the Supreme Court rules that since the notice did not reach the petitioners then legal counsel, the motion was filed on time. Issue:

8. Ramos v. CA Millena

Whether a surgeon, an anaesthesiologist, and a hospital, should be made liable for the unfortunate comatose condition of a patient scheduled for cholecystectomy Held: Res Ipsa Loquitor Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for itself." The phrase " res ipsa loquitur'' is a maxim for the rule that the fact of the occurrence of an injury, taken with the surrounding circumstances, may permit an inference or raise a presumption of negligence, or make out a plaintiff's prima facie case, and present a question of fact for defendant to meet with an explanation. Where the thing which caused the injury complained of is shown to be under the management of the defendant or his servants and the accident is such as in ordinary course of things does not happen if those who have its management or control use proper care, it affords reasonable evidence, in the absence of explanation by the defendant, that the accident arose from or was caused by the defendant's want of care. It is grounded in the superior logic of ordinary human experience and on the basis of such experience or common knowledge, negligence may be deduced from the mere occurrence of the accident itself. However, much has been said that res ipsa loquitur is not a rule of substantive law and, as such, does not create or constitute an independent or separate ground of liability. Mere invocation and application of the doctrine does not dispense with the requirement of proof of negligence. It is simply a step in the process of such proof, permitting the plaintiff to present along with the proof of the accident, enough of the attending circumstances to invoke the doctrine, creating an inference or presumption of negligence, and to thereby place on the defendant the burden of going forward with the proof. Still, before resort to the doctrine may be allowed, the following requisites must be satisfactorily shown. (1) The accident is of a kind which ordinarily does not occur in the absence of someone's negligence; (2) It is caused by an instrumentality within the exclusive control of the defendant or defendants; and (3) The possibility of contributing conduct which would make the plaintiff responsible is eliminated. Medical malpractice cases do not escape the application of this doctrine. Thus, res ipsa loquitur has been applied when the circumstances attendant upon the harm are themselves of such a character as to justify an inference of

negligence as the cause of that harm. Although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or that he has deviated from the standard medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed with because the injury itself provides the proof of negligence. Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common knowledge can determine the proper standard of care. When the doctrine is appropriate, all that the patient must do is prove a nexus between the particular act or omission complained of and the injury sustained while under the custody and management of the defendant without need to produce expert medical testimony to establish the standard of care. Resort to res ipsa loquitur is allowed because there is no other way, under usual and ordinary conditions, by which the patient can obtain redress for injury suffered by him. Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied, depending upon the circumstances of each case. A distinction must be made between the failure to secure results, and the occurrence of something more unusual and not ordinarily found if the service or treatment rendered followed the usual procedure of those skilled in that particular practice. The real question, therefore, is whether or not in the process of the operation any extraordinary incident or unusual event outside of the routine performance occurred which is beyond the regular scope of customary professional activity in such operations, which, if unexplained would themselves reasonably speak to the average man as the negligent cause or causes of the untoward consequence. We find the doctrine of res ipsa loquitur appropriate in the case at bar. Erlinda submitted herself for cholecystectomy and expected a routine general surgery to be performed on her gall bladder. On that fateful day she delivered her person over to the care, custody and control of private respondents who exercised complete and exclusive control over her. At the time of submission, Erlinda was neurologically sound and, except for a few minor discomforts, was likewise physically fit in mind and body. However, during the administration of anesthesia and prior to the performance of cholecystectomy she suffered irreparable damage to her brain. Thus, without undergoing surgery, she went out of the operating room already decerebrate and totally incapacitated. Obviously, brain damage, which Erlinda sustained, is an injury which does not normally occur in the process of a gall bladder operation. In fact, this kind of situation does not in the absence of negligence of someone in the administration of anesthesia and in the use of endotracheal tube. Furthermore, the instruments used in the administration of anesthesia, including the endotracheal tube, were all under the exclusive control of private respondents, who are the physicians-in-charge. Likewise, petitioner

Erlinda could not have been guilty of contributory negligence because she was under the influence of anesthetics which rendered her unconscious. Negligence of the Anaesthesiologist The pre-operative evaluation of a patient prior to the administration of anesthesia is universally observed to lessen the possibility of anesthetic accidents. Respondent Dra. Gutierrez' act of seeing her patient for the first time only an hour before the scheduled operative procedure was, therefore, an act of exceptional negligence and professional irresponsibility. Her failure to follow this medical procedure is, therefore, a clear indicia of her negligence. Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had all the time to make a thorough evaluation of Erlinda's case prior to the operation and prepare her for anesthesia. However, she never saw the patient at the bedside. She herself admitted that she had seen petitioner only in the operating room, and only on the actual date of the cholecystectomy. She negligently failed to take advantage of this important opportunity. As such, her attempt to exculpate herself must fail. Opinion of Expert Witness An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within the fields of anesthesia, internal medicine-allergy, and clinical pharmacology. The resulting anoxic encephalopathy belongs to the field of neurology. While admittedly, many bronchospastic-mediated pulmonary diseases are within the expertise of pulmonary medicine, Dr. Jamora's field, the anesthetic drug-induced, allergic mediated bronchospasm alleged in this case is within the disciplines of anesthesiology, allergology and pharmacology. On the basis of the foregoing transcript, in which the pulmonologist himself admitted that he could not testify about the drug with medical authority, it is clear that the appellate court erred in giving weight to Dr. Jamora's testimony as an expert in the administration of Thiopental Sodium. Generally, to qualify as an expert witness, one must have acquired special knowledge of the subject matter about which he or she is to testify, either by the study of recognized authorities on the subject or by practical experience. Clearly, Dr. Jamora does not qualify as an expert witness based on the above standard since he lacks the necessary knowledge, skill, and training in the field of anesthesiology. Oddly, apart from submitting testimony from a specialist in the wrong field, private respondents' intentionally avoided providing testimony by competent and independent experts in the proper areas. Proximate Cause Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and

without which the result would not have occurred. An injury or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence in the case, that the act or omission played a substantial part in bringing about or actually causing the injury or damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. Instead of the intended endotracheal intubation what actually took place was an esophageal intubation. During intubation, such distention indicates that air has entered the gastrointestinal tract through the esophagus instead of the lungs through the trachea. Entry into the esophagus would certainly cause some delay in oxygen delivery into the lungs as the tube which carries oxygen is in the wrong place. That abdominal distention had been observed during the first intubation suggests that the length of time utilized in inserting the endotracheal tube (up to the time the tube was withdrawn for the second attempt) was fairly significant. Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of cyanosis. Responsibility of the Surgeon As the so-called "captain of the ship," it is the surgeon's responsibility to see to it that those under him perform their task in the proper manner. Respondent Dr. Hosaka's negligence can be found in his failure to exercise the proper authority in not determining if his anesthesiologist observed proper anesthesia protocols. In fact, no evidence on record exists to show that respondent Dr. Hosaka verified if respondent Dra. Gutierrez properly intubated the patient. Furthermore, it does not escape us that respondent Dr. Hosaka had scheduled another procedure in a different hospital at the same time as Erlinda's cholecystectomy, and was in fact over three hours late for the latter's operation. Because of this, he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his professional duties towards his patient. Thus, he shares equal responsibility for the events which resulted in Erlinda's condition. Responsibility of the Hospital Hospitals hire, fire and exercise real control over their attending and visiting "consultant" staff. While "consultants" are not, technically employees, a point which respondent hospital asserts in denying all responsibility for the patient's condition, the control exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks of an employeremployee relationship, with the exception of the payment of wages. In assessing whether such a relationship in fact exists, the control test is determining. Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility in medical negligence cases, an employeremployee relationship in effect exists between hospitals and their attending and visiting physicians.

The basis for holding an employer solidarily responsible for the negligence of its employee is found in Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also for those of others based on the former's responsibility under a relationship of patria potestas. Such responsibility ceases when the persons or entity concerned prove that they have observed the diligence of a good father of the family to prevent damage. In the instant case, respondent hospital, apart from a general denial of its responsibility over respondent physicians, failed to adduce evidence showing that it exercised the diligence of a good father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard to the degree of supervision which it exercised over its physicians. In neglecting to offer such proof, or proof of a similar nature, respondent hospital thereby failed to discharge its burden under the last paragraph of Article 2180. Having failed to do this, respondent hospital is consequently solidarily responsible with its physicians for Erlinda's condition. DISPOSITION: WHEREFORE, the decision and resolution of the appellate court appealed from are hereby modified so as to award in favor of petitioners, and solidarily against private respondents the following: 1) P1,352,000.00 as actual damages computed as of the date of promulgation of this decision plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000.00 as moral damages, 3) P1,500,000.00 as temperate damages; 4) P100,000.00 each as exemplary damages and attorney's fees; and, 5) the costs of the suit.