Professional Services Inc. v.

Agana
Professional Services Inc. (PSI) v. Natividad and Enrique Agana
Natividad and Enrique Agana v. Juan Fuentes
Miguel Ampil v. Natividad and Enrique Agana
2007 / Sandoval-Gutierrez / Petition for review on certiorari of CA decisions
Standard of conduct > Experts > Medical professionals
FACTS
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.
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 Natividads 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.
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. Ampils negligence. YES
RATIO
DR. AMPIL IS 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 patients abdomen because of the dangers
attendant upon delay, still, it is his legal duty to inform his patient 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. Whats 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 wouldnt 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 patients vagina
DR. FUENTES 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
1. Occurrence of injury
2. Thing which caused injury was under the control and management of the defendant
[DR. FUENTES] LACKING SINCE CTRL+MGT WAS WITH DR. AMPIL
3. Occurrence was such that in the ordinary course of things, would not have happened if
those who had control or management used proper care
4. Absence of explanation by defendant
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
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 Courts bases for sustaining PSIs liability:
Ramos v. CA doctrine on E-E relationship
For purposes of apportioning responsibility in medical negligence cases, an employeremployee relationship in effect exists between hospitals and their attending and visiting
physicians. [LABOR LESSON: power to hire, fire, power of control]
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 hospitals 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 PSIs 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

Cantre v. Sps. Go
Dr. Milagros Cantre v. Sps. John David and Nora Go
2007 / Quisumbing / Petition for review on certiorari of CA decision and resolution
FACTS
Nora Go gave birth to her 4th child. Two hours later, she suffered profuse bleeding inside her
womb due to some placenta parts which were not completely expelled after delivery. She then
suffered hypovolemic shock, so her BP dropped to 40/0. Dr. Milagros Cantre, an Ob-Gyne
specialist and Noras attending physician, together with an assisting resident physician,
performed various medical procedures to stop the bleeding and to restore Noras BP. While Dr.
Cantre was massaging Noras uterus for it to contract and stop bleeding, she ordered a
droplight to warm Nora and her baby. At that time, she was unconscious.
While in the recovery room, Noras husband John David noticed a fresh gaping wound (2 1/2
x 3 1/2 in) in the inner portion of her left arm near the armpit. When he asked the nurses about
the cause of the injury, he was informed that it was due to a burn. John David filed a request for
investigation. Dr. Cantre said that what caused the injury was the blood pressure cuff. John
David brought Nora to the NBI for a physical examination. The medico-legal said that the injury
appeared to be a burn and that a droplight when placed near the skin for about 10 minutes
could cause such burn. He dismissed the likelihood that the wound was caused by a blood
pressure cuff since the scar was not around the arm, but just on one side of the arm. Noras
injury was referred to a plastic surgeon for skin grafting. However, her arm would never be the
samethe surgery left an unsightly scar, her movements are restricted, and the injured arm
aches at the slightest touch.
Sps. Go filed a complaint for damages against Dr. Cantre, the medical director, and the
hospital. In the RTC, parties have rested their respective cases, but the court admitted
additional exhibits [consist mostly of medical records produced by the hospital during trial
pursuant to a subpoena duces tecum] offered by Sps. Go, which were not testified to by any

witness. RTC ruled in favor of the spouses. CA affirmed RTC with modification (complaint
dismissed with respect to the medical director and the hospital; only moral damages awarded).
ISSUES AND HOLDING
1. WON the questioned additional exhibits are admissible in evidence. YES
2. WON Dr. Cantre is liable for the injury suffered by Nora Go. YES
RATIO
Preliminary discussion
Dr. Cantres counsel admitted the existence of the additional exhibits when they were formally
offered for admission by the RTC. In any case, given the circumstances of this case, a ruling on
Dr. Cantres negligence may be made based on the res ipsa loquitur doctrine even in the
absence of the additional exhibits.
Backgrounder
The Hippocratic Oath mandates physicians to give primordial consideration to their patients
well-being, and if a doctor fails to live up to this precept, he is accountable for his acts. This
notwithstanding, courts face a unique restraint in adjudicating medical negligence
cases because physicians are not guarantors of care, and they never set out to
intentionally cause injury to their patients. HOWEVER, intent is immaterial in these
cases because where negligence exists and is proven, it automatically gives the injured
a right to reparation for the damage caused.
Res ipsa loquitur x Medical negligence cases
In medical negligence cases, the doctrine of res ipsa loquitur allows the mere existence
of an injury to justify a presumption of negligence on the part of the person who
controls the instrument causing the injury, provided that the following requisites concur:
1. Accident is of a kind which ordinarily does not occur absent someones negligence
Wound not an ordinary occurrence in the act of delivering a baby; could not have
happened unless negligence set in somewhere
2. Caused by an instrumentality within defendants exclusive control

 It doesnt matter WON the injury was caused by the droplight or by the blood pressure
cuff, since both are within the exclusive control of the physician in charge [Dr. Cantre]
under the captain of the ship doctrine [surgeon in charge of an operation is held liable for
his assistants negligence during the time when they are under the surgeons control].
3. Possibility

of

contributing

conduct which

would

make

plaintiff

responsible

is eliminated
Wound could only be caused by something external to and outside the control of Nora
since she was unconscious while in hypervolemic shock.
On Dr. Cantres other arguments + what would have been her saving grace
BP cuff defense does not afford her an escape. The medical practice is to deflate the cuff
immediately after use, or else, it could cause an injury similar to what happened to Nora. If the
wound was caused by the constant taking of BP, it must have been done so negligently as to
inflict a gaping wound.
The argument that the failed plastic surgery was a measure to prevent complication (and not
intended as a cosmetic procedure) does not negate negligence on Dr. Cantres part.
Dr. Cantre has been Noras ob-gyne for her past 3 deliveries, and this is the first time that Dr.
Cantre is being held liable for damages due to negligence in the practice of her profession.
She promptly took care of the wound before infection set in. Since Nora was in a critical
condition at that time, saving her life became Dr. Cantres elemental concern. Still, her good
intentions characteristics do not justify negligence.
NCC provisions applied
NCC 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. []
NCC 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury.
Though incapable of pecuniary computation, moral damages may be recovered if they are
the proximate result of the defendants wrongful act or omission. [200k moral damages
awarded]
Dr. Rubi Li, Petitioner, vs. Spouses Reynaldo and Lina Soliman, as parents/heirs of deceased
Angelica Soliman, Respondents.
G.R. No. 165279

June 7, 2011
Legal Issue: How is medical malpractice proven?
Legal Facts:
Respondents 11-year old daughter, Angelica Soliman, underwent a biopsy of the mass located
in her lower extremity at the St. Lukes Medical Center (SLMC) on July 7, 1993 and results
showed that Angelica was suffering from osteosarcoma, osteoblastic type, (highly malignant)
cancer of the bone because of that a necessity of amputation was conducted by Dr, Tamayo on
Angelicas right leg in order to remove the tumor and to prevent the metastasis that
chemotherapy was suggested by Dr. Tamayo, which he referred to petitioner Dr. Rubi Li, a
medical oncologist. The respondent was admitted to SLMC on August 18, 1993; however, she
died eleven (11) days after the (intravenous) administration of chemotherapy first cycle.
Respondents brought their daughters body to the Philippine National Police (PNP) Crime
Laboratory at Camp Crame for post-mortem examination after the refusal of the hospital to
release the death certificate without full payment of bills. The Medico-Legal Report showed that
the cause of death as "Hypovolemic shock secondary to multiple organ hemorrhages and
Disseminated Intravascular Coagulation. The respondents filed charges against the SLMC and
physicians involve for negligence and failure to observe the essential precautions in to prevent
Angelicas untimely death. Petitioner denied the allegation for damages as she observed best
known procedures, highest skill and knowledge in the administration of chemotherapy drugs
despite all efforts the patient died. The trial court was in favor of the petitioner and ordered to
pay their unpaid hospital bill in the amount of P139, 064.43, but the Court of Appeals reversed
the decision supporting the respondents pray.
Holding:
In this case medical malpractice is proven because the four essential elements of such
action are present based upon the doctrine of informed consent.
Reasoning:
There are four essential elements a plaintiff must prove in a malpractice action based upon the
doctrine of informed consent: "(1) the physician had a duty to disclose material risks; (2) he
failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result of
the failure to disclose, the patient consented to treatment she otherwise would not have
consented to; and (4) plaintiff was injured by the proposed treatment." Informed consent case
requires the plaintiff to "point to significant undisclosed information relating to the treatment that
would alter her decision to undergo. The physician is not expected to give the patient a short
medical education, the disclosure rule only requires of him a reasonable general explanation in
nontechnical terms.
Policy Formation:
In all sorts of medical procedures either invasive or not, medical institution must have a
certificate of competency in rendering standards of care to delicate medical procedures before
initiating a general protocol that would establish a guideline principle in a form of proper
disclosure of such procedure and presenting a consent or waiver to their patients so that
possible future medico-legal suits will be prevented.

Synthesis:
In Dr. Rubi Li, vs. Spouses Reynaldo and Lina Soliman, as parents/heirs of deceased
Angelica Soliman, Respondents, G.R. No. 165279, promulgated on June 7, 2011, the Court
ruled that medical malpractice is proved base on lack/impaired informed consent, and
reasonable expert testimony subject a breach of duty causing gross injury to its patient.
Rico Rommel Atienza
vs.
Board of Medicine and Editha Sioson
G.R. No. 177407
February 9. 2011
Facts:
Private respondent went to Rizal Medical Center to submit for a check up due to her lumbar
pains. Her diagnostic laboratory test results revealed that her right kidney was normal while her
left kidney was non-functioning and non-visualizing. Hence, she underwent kidney operation
under the care of the four physicians namely: Dr. Judd dela Vega, Dr. Pedro Lantin III, Dr.
Gerardo Antonio and petitioner Dr. Rico Rommel Atienza.
The said physicians removed her fully functioning right kidney instead of the left non-functioning
and non-visualizing kidney. Due to their gross negligence and incompetence, private
respondent filed a complaint against the four doctors before the Board of Medicine. Private
respondent therein offered four certified photocopies as her documentary evidence to prove that
her kidneys were both in their proper anatomical locations at the time that she was operated.
The Board of Medicine admitted the formal offer despite the objection of herein petitioner.
Petitioner contends that the documentary evidence offered were inadmissible as it were
incompetent. Further, he alleged that the same documents were not properly identified and
authenticated, violate the best evidence rule and his substantive rights, and are completely
hearsay.
Issues:
1.
Whether the exhibits are inadmissible evidence on the ground that it violates the best
evidence rule.
2.
Whether the exhibits are inadmissible evidence on the ground that they have not been
properly identified and authenticated.
3.
Whether the exhibits are inadmissible evidence on the ground that it is completely
hearsay.
4.
Whether the admission of the documents violated the substantive rights of the petitioner.
Ruling:

1.
No. The subject of the inquiry in this case is whether the doctors are liable for gross
negligence in removing the right functioning kidney of Editha instead of the left non-functioning
kidney, not the proper anatomical locations of Edithas kidneys. The proper anatomical
locations of Edithas kidneys at the time of her operation at the RMC may be established not
only through the exhibits offered in evidence.
In fact, the introduction of secondary evidence is allowed. Section 3, Rule 130 provides that
when the subject of the inquiry is the contents of the document, no evidence shall be admissible
other than the original document itself, except when the original has been lost or destroyed, or
cannot be produced in court without bad faith on the offeror. Since the original documents
cannot be produced based on the testimony of Dr. Aquino BOM properly admitted Edithas
formal offer of evidence, and thereafter, the BOM shall determine the probative value thereof
when it decides the case.
2.
No, the documentary evidence were properly identified and authenticated. The records
show that the exhibits offered by private respondent were the same evidence attached in Doctor
Lantin's counter-affidavit filed before the Office of the City Prosecutor in answer to the criminal
complaint of the respondent. To lay the predicate for her case, private respondent offered the
exhibits in evidence to prove that her kidneys were both in their proper anatomical locations at
the time of her operation.
3.
No, these exhibits do not constitute hearsay evidence. The anatomical positions whether
left or right, of Edithas kidneys, and the removal of one or both, may still be established through
a belated ultrasound or x-ray of her abdominal area.
4.
No, petitioners substantive rights were not violated when the documentary evidence were
admitted. The fact sought to be proved by the exhibits that the two kidneys of Editha were in
their proper anatomical locations at the time she was operated on is presumed under Section 3
of Rule 131 of the Rules of Court which provides that things have happened according to the
ordinary course of nature and the ordinary habits of life.
The fact sought to be established by the admission of the respondents exhibit need not be
proved as it is covered by mandatory judicial notice. Laws of nature involving the physical
science, specifically biology include the structural make-up and composition of living things
such as human beings in which the court may take judicial notice.
SOLIDUM VS PEOPLE (GR NO. 192123 MARCH 10, 2014)
Solidum vs People of the Philippines
GR No. 192123 March 10, 2014
Facts: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus. Two days
after his birth, Gerald under went colostomy, a surgical procedure to bring one end of the large
intestine out through the abdominal walls, enabling him to excrete through a colostomy bag

attached to the side of his body. On May 17, 1995, Gerald was admitted at the Ospital ng
Maynila for a pull-through operation. Dr. Leandro Resurreccionheaded the surgical team, and
was assisted by Dr. Joselito Lucerio, Dr.Donatella Valeria and Dr. Joseph Tibio. The
anesthesiologist included Drs. Abella, Razon and Solidum. During the operation, Gerald
experienced bradycardia and went into a coma. His coma lasted for two weeks , but he
regained consciousness only after a month. He could no longer see, hear, or move. A complaint
for reckless imprudence resulting in serious physical injuries were filed by Geralds parents
against the team of doctors alleging that there was failure in monitoring the anesthesia
administered to Gerald.
Issues: Whether or not petitioner is liable for medical negligence.
Whether or not res ipsa liquitor can be resorted to in medical negligence cases.
Held: No. Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution, and vigilance that the circumstances justly
demand, whereby such other person suffers injury. Reckless imprudence, on the other hand,
consists of voluntarily doing or failing to do, without malice, an act from which material damage
results by reason of an inexcusable lack of precaution on the part of the person to perform or
failing to perform such act.
The negligence must be the proximate cause of the injury. For, negligence no matter in what it
consists, cannot create a right of action unless it is the proximate cause of the injury complained
of. And the proximate cause of an injury is that cause, which, in natural and continuous
sequence and unbroken by any efficient intervening cause, produces the injury, and without
which the result would not have occurred.
An action upon medical negligence whether criminal, civil or administrative calls for the
plaintiff to prove by competent evidence each of the following four elements namely: a.) the duty
owed by the physician to the patient, as created by the physician-patient relationship, to act in
accordance with the specific norms or standards established by his profession; b.) the breach of
the duty by the physicians failing to act in accordance with the applicable standard of care; c.)
the causation, is, there must be a reasonably close and casual connection between the
negligent act or omission and the resulting injury; and d.) the damages suffered by the patient.
In the medical profession, specific norms on standard of care to protect the patient against
unreasonable risk, commonly referred to as standards of care, set the duty of the physician in
respect of the patient. The standard of care is an objective standard which conduct of a
physician sued for negligence or malpractice may be measured, and it does not depend
therefore, on any individuals physicians own knowledge either. In attempting to fix a standard
by which a court may determine whether the physician has properly performed the requisite
duty toward the patient, expert medical testimony from both plaintiff and defense experts is
required.
The doctrine of res ipsa liquitor means that where the thing which causes injury is shown to be
under the management of the defendant, and the accident is such as in ordinary course of

things does not happen if those who have management use proper care, it affords reasonable
evidence, in the absence of an explanation by defendant that the accident arose from want of
care.
Nevertheless, despite the fact that the scope of res ipsa liquitor has been measurably enlarged,
it does not automatically apply to all cases of medical negligence as to mechanically shift the
burden of proof to the defendant to show that he is not guilty of the ascribed negligence. Res
ipsa liquitor 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. It is generally restricted to situations
in malpractice cases where a layman is able to say, as a matter of common knowledge and
observation, that the consequences of professional care were not as such as would ordinarily
have followed if due care had been exercised. 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. It must be conceded that the doctrine of res ipsa liquitor can have no application in a
suit against a physician or surgeon which involves the merits of a diagnosis or of a scientific
treatment. The physician or surgeon is not required at his peril to explain why any particular
diagnosis was not correct, or why any particular scientific treatment did not produce the desired
results. Thus, res ipsa liquitor is not available in a malpractice suit if the only showing is that the
desired result of an operation or treatment was not accomplished. The real question, therefore,
is whether or not in the process of the operation any extraordinary incident or unusual event
outside 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 case or causes of the untoward consequence. If
there was such extraneous intervention, the doctrine of res ipsa liquitor may be utilized and the
dependent is called upon to explain the matter, by evidence of exculpation, if he could.
DELA TORRE VS IMBUIDO (GR NO. 192973 SEPTEMBER 29, 2014)
Dela Torre vs Imbuido
GR No. 192973 September 29, 2014
Facts: At around 3:00pm of February 3, 1992, Carmen was brought to Divine Spirit General
Hospitals operating room for her caesarian section operation, which was to be performed by
Dr. Nestor. By 5:30pm, of the same day, Pedrito was informed by his wifes delivery of a baby
boy. In the early morning of February 4, 1992, Carmen experienced abdominal pains and
difficulty in urinating. She was diagnosed to be suffering from urinary tract infection (UTI), and
was prescribed medication by Dr. Norma. On February 10, 1992, Pedrito noticed that Carmens
stomach was getting bigger, but Dr. Norma dismissed the patients condition as mere
fratulence. When Carmens stomach still grow bigger despite medications, Dr. Norma advised
Pedrito of the possibility of a second operation on Carmen. Dr. Norma, however, provided no
details on its purpose and the doctor who would perform it. At around 3:00pm on February 12,

1992 Carmen had her second operation. Later in the evening, Dr. Norma informed Pedrito that
everything was going on fine with his wife. The condition of Carmen, however, did not
improve. It instead worsened that on February 13, 1992, she vomited dark red blood. At 9:30pm
of the same day, Carmen died. Per her death certificate upon information provided by the
hospital, the immediate cause of Carmens death was cardio-respiratory arrest secondary to
cerebro vascular accident, hypertension and chronic nephritis induced by pregnancy. An
autopsy report prepared by Dr. Partilano, medico-legal officer designate of Olongapo City,
however, provided that the cause of Carmens death was shock due to peritonitis severe with
multiple intestinal adhesions; status post caesarian section and exploratory laparotomy. Pedrito
claimed in his complaint that the respondents failed to exercise the degree of diligence required
of them as members of the medical profession, and were negligent for practicing surgery on
Carmen in the most unskilled, ignorant, and cruel manner.
Issue: Whether or not respondents were liable for medical malpractice that resulted to
Carmens death.
Held: No. Medical malpractice or, more appropriately, medical negligence, is that type of claim
which a victim has available to him or her to redress a wrong committed by a medical
professional which has caused bodily harm. In order to successfully pursue such a claim, a
patient, or his or her family as in this case, must prove that healthcare provider, in most cases, a
physician, either failed to do something which a reasonably prudent health care provider would
have done, or that he or she did something that a reasonably prudent provider would not have
done; and that failure or action caused injury to the patient.
Four essential elements must be established namely: 1.) duty; 2.) breach; 3.) injury and
4.) proximate causation. All four elements must be present in order to find the
physician negligent and thus, liable for damages.
For the trial court to give weight to Dr. Partilanos report, it was necessary to show first Dr.
Partilanos specialization and competence to testify on the degree of care, skill and diligence
needed for the treatment of Carmens case. Considering that it was not duly established that Dr.
Partilano practiced and was an expert on the fields that involved Carmens condition, he could
not have accurately identified the said degree of care, skill and diligence and the medical
procedure, that should have been applied.
SANTOS v PIZARDO [G.R. No. 151452. July 29, 2005.] SPS. ANTONIO C. SANTOS and
ESPERANZA C. SANTOS, NORA BARNALO, BELINDA LUMACTAD, MARIENELA DY,
NIKKA SANTOS and LEONARDO FERRER, petitioners, vs. HON. NORMANDIE B. PIZARDO,
as Presiding Judge, RTC of Quezon City, Branch 101, DIONISIO M SIBAYAN, and VIRON
TRANSPORTATION COMPANY, INC., represented by VIRGILIO Q. RONDARIS,
President/Chairman, respondents.

FACTS:
In an Information dated April 25, 1994, Dionisio M. Sibayan (Sibayan) was charged with
Reckless Imprudence Resulting to Multiple Homicide and Multiple Physical Injuries in
connection with a vehicle collision between a southbound Viron Transit bus driven by Sibayan
and a northbound Lite Ace Van, which claimed the lives of the van's driver and three (3) of its
passengers, including a two- month old baby, and caused physical injuries to five (5) of the
van's passengers. After trial, Sibayan was convicted
and sentenced to suffer the penalty of imprisonment for two (2) years, four (4) months and one
(1) day to four (4) years and two (2) months. However, as there was a reservation to file a
separate civil action, no pronouncement of civil liability was made by the municipal circuit trial
court in its decision promulgated on December 17, 1998.
On October 20, 2000, petitioners filed a complaint for damages against Sibayan, Viron Transit
and its President/Chairman, Virgilio Q. Rondaris, with the Regional Trial Court of Quezon City,
DECISION OF LOWER COURTS:
(1) Trial Court: dismissed the complaint on the principal ground that the cause of action had
already prescribed. According to the trial court, actions based on quasi delict, as it construed
petitioners' cause of action to be, prescribe four (4) years from the accrual of the cause of
action. Hence, notwithstanding the fact that petitioners reserved the right to file a separate civil
action, the complaint ought to be dismissed on the ground of prescription.
(2) CA: dismissed the same for error in the choice or mode of appeal
ISSUE:
Has the action prescribed?
RULING:
No.
A reading of the complaint reveals that the allegations therein are consistent with petitioners'
claim that the action was brought to recover civil liability arising from crime. Although there are
allegations of negligence on the part of Sibayan and Viron Transit, such does not necessarily
mean that petitioners were pursuing a cause of action based on quasi delict, considering that at
the time of the filing of the complaint, the cause of action ex quasi delicto had already
prescribed. Besides, in cases of negligence, the offended party has the choice between an
action to enforce civil liability arising from crime under the Revised Penal Code and an action for
quasi delict under the Civil Code.
WHEN PRESCRIPTION OF ACTION EX DELICTO WILL OPERATE AS A BAR TO AN
ACTION TO ENFORCE INDEPENDENT CIVIL LIABILITY; PRESENT IN CASE AT BAR. At
the time of the filing of the complaint for damages in this case, the cause of action ex quasi
delicto had already prescribed. Nonetheless, petitioners can pursue the remaining avenue
opened for them by their reservation, i.e., the surviving cause of action ex delicto. This is so
because the prescription of the action ex quasi delicto does not operate as a bar to an action to
enforce the civil liability arising from crime especially as the latter action had been expressly
reserved. The case of Mendoza v. La Mallorca Bus Company was decided upon a similar set of
facts. . . . We held that the dismissal of the action based on culpa aquiliana is not a bar to the
enforcement of the subsidiary liability of the employer. Once there is a conviction for a felony,
final in character, the employer becomes subsidiarily liable if the commission of the crime was in

the discharge of the duties of the employees. This is so because Article 103 of the Revised
Penal Code operates with controlling force to obviate the possibility of the aggrieved party being
deprived of indemnity even after the rendition of a final judgment convicting the employee. Seen
in this light, the trial court should not have dismissed the complaint on the ground of
prescription, but instead allowed the complaint for damages ex delicto to be prosecuted on the
merits, considering petitioners' allegations in their complaint, opposition to the motion to dismiss
and motion for reconsideration of the order of dismissal, insisting that the action was to recover
civil liability arising from crime. This does not offend the policy that the reservation or institution
of a separate civil action waives the other civil actions. The rationale behind this rule is the
avoidance of multiple suits between the same litigants arising out of the same act or omission of
the offender. However, since the stale action for damages based on quasi delict should be
considered waived, there is no more occasion for petitioners to file multiple suits against private
respondents as the only recourse available to them is to pursue damages ex delicto. This
interpretation is also consistent with the bar against double recovery for obvious reasons.