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Lorenzo A.

1. Batiquin v. Court of Appeals
Dr. Batiquin was a Resident Physician at the Negros Oriental Provincial Hospital,
Dumaguete City from January 9, 1978 to September 1989. Mrs. Villegas is a married
woman who submitted to Dr. Batiquin for parental care as the latters private patient
sometime before Sept. 21, 1988. Dr. Batiquin underwent a cesarean section on Mrs.
Villegas who delivered her first born child. Soon after leaving the Hospital, Mrs. Villegas
began to suffer abdominal pains and complained of being feverish. She gradually lost her
appetite, so she went back to Dr. Batuquin and was prescribed certain medicines until
December of 1988. The abdominal pains and fever kept on recurring and bothered Mrs.
Villegas no end despite the medications administered by Dr. Batiquin. When it became
unbearable and she was rapidly losing weight she consulted Dr. Kho. Dr. Kho examined
Mrs. Villegas, she found Mrs. Villegas to be feverish, pale and was breathing fast. Upon
further examination she felt an abdominal mass one finger below the umbilicus which
suspected to be either of which she suspected to be either a tumor of the uterus or an
ovarian cyst, either of which could be cancerous. A blood count showed that Mrs.
Villegas had an infection inside her abdominal cavity, due to this Dr. Kho submitted her
into another surgery and she agreed. During the surgery, Dr. Kho found an ovarian cyst
on each of the ovaries and a piece of rubber material on the right side of the uterus, which
was then described as rubber-drain like that could be a torn section of a surgeons
glove. However, the piece of rubber was not admitted into evidence but it was testified by
Dr. Kho in the proceedings.
Whether or not Dr. Batiquin was negligent.
YES. The doctrine of res ipsa loquitur applies in this case. The focal point of the
appeal is Dr. Khos testimony. There were inconsistencies within her own, which led to
the different decision of the RTC and CA. The CA was correct in saying that the trial
court erred when it isolated the disputed portion of Dr. Khos testimony and did not
consider it with other portions of Dr. Khos testimony. Also, the phrase relied upon by the
trial court does not negate the fact that Dr. Kho saw a piece of rubber in Mrs. Villegas
abdomen, and that she sent it to a laboratory and then to Cebu City for examination by a
pathologist. Furthermore, Dr. Khos knowledge of the piece of rubber could not be based
on other than first hand knowledge for, as she asserted in the trial court.

2. Garcia-Rueda v. Pascasio
Florencio Rueda, husband of petitioner Leonila Garcia-Rueda, underwent surgical
operation at the UST hospital for the removal of a stone blocking his ureter. Dr. Domingo
Antonio, Jr. was the surgeon and the anesthesiologist was Dr. Erlinda Batbat-Reyes.
According to the officials of UST hospital, Florencio died of complications of unknown
cause. Petitioner then requested the NBI to conduct an autopsy on her husbands body.
The NBI ruled that Florencios death was due to lack of care by the attending physician in
administering anesthesia. With this, the NBI recommended that Dr. Antonio and Dr.
Batbat-Reyes be charged for Homicide through Reckless imprudence.
Whether or not expert testimony is necessary to prove the negligent act of the
YES. 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. He therefore has
a 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 expert testimony is essential to establish not only the standard of
care of the profession but also that the physician's conduct in the treatment and care falls
below such standard. Further, inasmuch as the causes of the injuries involved in
malpractice actions are determinable only in the light of scientific knowledge, it has been
recognized that expert testimony is usually necessary to support the conclusion as to

3. Cruz v. Court of Appeals

Lydia Umali was examined by Dr. Cruz who found a myoma in her uterus, and
scheduled her for a hysterectomy operation. Rowena Umali De Ocampo accompanied her
mother to the hospital a day before the operation, and they spent the night there. Rowena
noticed that the clinic was untidy, so she tried to persuade her mother not to proceed with
the operation. The next day, Rowena asked Dr. Cruz to postpone the operation, but Lydia
told her that Dr. Cruz said that the operation must go on as scheduled. During the
operation, Dr. Ercillo, anesthesiologist, told them to buy Tagamet ampules, and Rowenas
sister went to buy some. The said doctor told them again to buy blood for Lydia.
Additional blood was needed, but there was no more type A blood available in the blood
bank. A person arrived to donate blood which was later on transfused to Lydia. Rowena
noticed that Lydia was gasping for breath, apparently the oxygen supply had run out, so
they bought oxygen. Later in the evening, she went into shock and her blood pressure
dropped. She was then transferred to another hospital so she could be connected to a
respirator and be further examined. However, this transfer was done without the consent
of the family, who later on found out about it when an ambulance arrived to transfer
Lydia. In the new hospital, she was re-operated by Dr. Cruz and Dr. Ercillo beause blood
was oozing out from her incision. They summoned Dr. Angeles, Ob-Gyne head of the
new hospital, but when he arrived, Lydia was already in shock and possibly dead. Dr.
Angeles told the two doctors that there is nothing he could do because Lydia died when
Dr. Cruz was closing up her abdominal wall. Dr. Cruz and Dr. Ercillo were charged with
reckless imprudence and negligence resulting in homicide.
Whether or not Dr. Cruz is criminally liable for the death of Lydia.
NO. Dr. Cruz is not criminally liable but she is civilly liable. The testimonies of
the doctors presented by the prosecution establish hemorrhage / hemorrhagic shock as the
cause of death, which may be caused by several different factors. Autopsy did not reveal
any untied cut blood vessel, nor was there a tie of a cut blood vessel that became
loose. The findings of the doctors do not preclude the probability that a clotting defect
(DIC) caused the hemorrhage and consequently, Lydias death. The Court has no recourse
but to rely on the expert testimonies that substantiate Dr. Cruz allegation that the cause
of Lydias death was DIC, which cannot be attributed to Dr. Cruz fault or negligence.
This probability was unrebutted during trial.

4. Ramos v. Court of Appeals

Erlinda Ramos, a 47-year old robust woman, was normal except her experiencing
occasional pains due to the precesence of stones in her gall baldder. She was advised to
undergo an operation for its removal. The results in the examinations she underwent that
she was fit for the operation. She and her husband, Rogelio met Dr. Hosaka, who advised
that she should undergo cholecystectomy. He assured that he will get a good
anesthesiologist. The day of the operation, 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. Guiterrez was to administer the anesthesia. Dr. Hosaka arrived only at 12:15
pm. Herminda saw Dr. Guitierrez intubating the patient, and heard the latter say Ang
hirap ma-intubate nito, mali yata ang pagkapasok. O, lumalaki na ang tiyan. Herminda
saw bluish discoloration of the nailbeds of the patient. She heard Dr. Hosaka issue an
order to call Dr. Calderon. The doctor arrived and placed the patient in tredelenburg
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 but Erlinda was
taken to the ICU and became comatose. Rogelio filed a civil case for damages.
Whether or not the doctors and the hospital are liable for damages.
Yes. The private respondents were unable to disprove the presumption of
negligence on their part in the care of Erlinda and their negligence was the proximate
case of her piteous condition. Scientific studies point out that intubation problems are
responsible for 1/3 of deaths and serious injuries associated with anesthesia.
Nevertheless, 98% or the vast majority of difficult intubation may be anticipated by
performing a thorough evaluation of the patients airway prior to the operation. As stated
beforehand, respondent, Dra. Guttierez failed to observe the proper pre-operative
protocol which could have prevented this unfortunate incident. Had appropriate diligence
and reasonable care been used in the pre-operative evaluation, respondent physician
could have been more prepared to meet the contingency brought about by the perceived
atomic variations in the patients neck and oral area; defects which could have been easily
overcome by a prior knowledge of those variations together with a change in technique.
In other words, an experienced anesthesiologist, adequately alerted by a thorough preoperative evaluation, would have had little difficulty going around the short neck and
protruding teeth. Having failed to observe common medical standards in pre-operative
management and intubation, respondent Dra. Guttierez negligence resulted in cerebral
anoxia and eventual coma of Erlinda.

5. Reyes v. Sisters of Mercy

Jorge Reyes has been suffering from recurring fever with chills for around days.
Home medication afforded him no relief so he went to Mercy Community Clinic. He was
then attended by Dr. Marlyn Rico. Since typhoid fever was common at that time, the
Widal test was performed and he was found positive for typhoid. Thereafter, Dr. Marlyn
Rico indorse Jorge Reyes to Dr. Marvie Blanes. Suspecting that that Jorge had typhoid
fever, Dr. Marvie Blanes ordered that Jorge be tested for compatibility with
chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente. As there was no
adverse reaction, Dr. Blanes administered 500 mg of the antibiotic. Another dose was
given 3 hours later. Subsequently, Jorge Reyes developed high fever and experienced
vomiting and convulsions. He then turned blue due to deficiency in oxygen cyanosis
and died. The cause of death was stated to be ventricular arrhythmia secondary to
hyperpyrexia and typhoid fever. The heirs of Reyes filed with the RTC a complaint for
damages against Sisters of Mercy, Sister Rose Palacio, Dr. Blanes, Dr. Rico and Mercy
Community Clinic contending that the death of Jorge was due to the wrongful
administration of chloromycetin. Petitioners contend that: Dr. Marlyn Rico hastily and
erroneously relied upon the Widal test, diagnosed Jorges illness as typhoid fever, and
immediately prescribed the administration of the antibiotic chloromycetin. Dr. Marvie
Blanes erred in ordering the administration of the second dose of 500 milligrams of
chloromycetin barely 3 hours after the first was given. Dr. Apolinar Vacalares, (Chief
Pathologist of the Northern Mindanao Training Hospital) who performed an autopsy on
the body Dr. Vacalares testified that Reyes did not die of typhoid fever but of shock
undetermined, which could be due to allergic reaction or chloromycetin overdose.
Whether or not Sisters of Mercy Hospital is liable for the death of Jorge Reyes.
NO. Sisters of Mercy Hospital is not liable. There is no showing that the attending
physician in this case deviated from the usual course of treatment with respect to typhoid
fever. Jorge was given antibiotic choloromycetin and some dose of triglobe after
compatibility test was made by the doctor and found that no adverse reactions manifested
which would necessitate replacement of the medicines. Indeed, the standard contemplated
is not what is actually the average merit among all known practitioners from the best to
the worst and from the most to the least experienced, but the reasonable average merit
among the ordinarily good physicians. Here, the doctors did not depart from the
reasonable standard recommended by the experts as they in fact observed the due care
required under the circumstances.

6. Professional Services v. Agana

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. 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 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, 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. Mr. Agana also filed
an administrative complaint for gross negligence and malpractice against the two doctors
with the PRC Pending the outcome of the cases, Natividad died.
Whether or not Dr. Ampil and Professional Services Inc. are solidarily liable.
YES. Dr. Ampil and Professional Services Inc. are solidarily liable. 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.
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.
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 respondent superior.

7. Li v. Soliman
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.
Whether or not Li is liable for failure to fully disclose serious side effects.
NO. Li is not liable. Examining the evidence on record, we hold that there was
adequate disclosure of material risks inherent in the chemotherapy procedure performed
with the consent of Angelicas parents. Respondents could not have been unaware in the
course of initial treatment and amputation of Angelicas lower extremity, that her immune
system was already weak on account of the malignant tumor in her knee. When petitioner
informed the respondents beforehand of the side effects of chemotherapy which includes
lowered counts of white and red blood cells, decrease in blood platelets, possible kidney
or heart damage and skin darkening, there is reasonable expectation on the part of the
doctor that the respondents understood very well that the severity of these side effects
will not be the same for all patients undergoing the procedure. In other words, by the
nature of the disease itself, each patients reaction to the chemical agents even with pretreatment laboratory tests cannot be precisely determined by the physician. That death
can possibly result from complications of the treatment or the underlying cancer itself,
immediately or sometime after the administration of chemotherapy drugs, is a risk that
cannot be ruled out, as with most other major medical procedures, but such conclusion
can be reasonably drawn from the general side effects of chemotherapy already disclosed.

8. Jarcia v. People
Belinda Santiago (Mrs. Santiago) lodged a complaint with the National Bureau of
Investigation (NBI) against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr.
Marilou Bastan (Dr. Bastan), for their alleged neglect of professional duty which caused
her son, Roy Alfonso Santiago (Roy Jr.), to suffer serious physical injuries. Upon
investigation, the NBI found that Roy Jr. was hit by a taxicab; that he was rushed to the
Manila Doctors Hospital for an emergency medical treatment; that an X-ray of the
victims ankle was ordered; that the Xray result showed no fracture as read by Dr. Jarcia;
that Dr. Bastan entered the emergency room (ER) and, after conducting her own
examination of the victim, informed Mrs. Santiago that since it was only the ankle that
was hit, there was no need to examine the upper leg; that eleven (11) days later, Roy Jr.
developed fever, swelling of the right leg and misalignment of the right foot; that Mrs.
Santiago brought him back to the hospital; and that the X-ray revealed a right midtibial
fracture and a linear hairline fracture in the shaft of the bone. The NBI indorsed the
matter to the Office of the City Prosecutor of Manila for preliminary investigation.
Probable cause was found and a criminal case for reckless imprudence resulting to
serious physical injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr. Pamittan, before
the RTC, docketed as Criminal Case No. 01196646.
Whether or not Dr. Jarcia and Dr. Bastan are criminally liable.
NO. Drs. Jarcia and Bastan are not criminally liable but they are civilly liable. The
totality of the evidence on record clearly points to the negligence of the petitioners. At the
risk of being repetitious, the Court, however, is not satisfied that Dr. Jarcia and Dr. Bastan
are criminally negligent in this case. Negligence is defined as the failure to observe for
the protection of the interests of another person that degree of care, precaution, and
vigilance which the circumstances justly demand, whereby such other person suffers
injury. Reckless imprudence 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 performing or failing to perform such act. In this case, the Court
is not convinced with moral certainty that the petitioners are guilty of reckless
imprudence or simple negligence. The elements thereof were not proved by the
prosecution beyond reasonable doubt. The testimony of Dr. Tacata, a specialist in
pediatric orthopedic, although pointing to some medical procedures that could have been
done by Dr. Jarcia and Dr. Bastan, as physicians on duty, was not clear as to whether the
injuries suffered by patient Roy Jr. were indeed aggravated by the petitioners judgment
call and their diagnosis or appreciation of the condition of the victim at the time they
assessed him.

9. Solidum v. People of the Philippines

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 Resurreccion headed 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.
Whether or not Dr. Solidum is criminally liable.
NO. Dr. Solidum is not criminally liable. 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. 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.