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SECOND DIVISION

DR. MILAGROS L. CANTRE, G.R. No. 160889
Petitioner,
Present:

QUISUMBING, J., Chairperson,

CARPIO,

- versus - CARPIO MORALES,

TINGA, and

VELASCO, JR., JJ.

SPS. JOHN DAVID Z. GO and Promulgated:
NORA S. GO,

Respondents.
April 27, 2007

x------------------------------------------------x

DECISION

QUISUMBING, J.:

Consequently. of April 20. culled from the records. a baby boy. 3[3] Records. 2003 of the Court of Appeals in CA-G. Q- 93-16562. who was admitted at the said hospital on April 19. The facts. resulting in a drop in her blood pressure to 40 over 0. 218-227. 43-68. 2002 and Resolution2[2] dated November 19. Milagros L. Nora gave birth to her fourth child. 58184. are as follows: Petitioner Dr. at around 3:30 a. Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora S. At 1:30 a. in Civil Case No. Go. While petitioner was massaging Noras uterus for 1[1] Rollo. pp. at 40-41.m. which affirmed with modification the Decision3[3] dated March 3.R. Cantre is a specialist in Obstetrics and Gynecology at the Dr. 1997 of the Regional Trial Court of Quezon City. However. 1992. . Her blood pressure was frequently monitored with the use of a sphygmomanometer. CV No. Branch 98.m. pp. Nora suffered hypovolemic shock.. For review on certiorari are the Decision1[1] dated October 3. Petitioner and the assisting resident physician performed various medical procedures to stop the bleeding and to restore Noras blood pressure. 1992. Nora suffered profuse bleeding inside her womb due to some parts of the placenta which were not completely expelled from her womb after delivery. 2[2] Id.

which was conducted by medico-legal officer Dr. . 1. Petitioner said the blood pressure cuff caused the injury. Jr. 1992. Forthwith. p. 54-55. p. John David filed a request for investigation. folder of exhibits. called petitioner and the assisting resident physician to explain what happened. 1995. on April 22.6[6] In response.5[5] He asked the nurses what caused the injury. Rainerio S. pp. pp. Floresto Arizala. 8[8] TSN. December 5. 1995. 1992. 1994.8[8] He dismissed the likelihood that 4[4] TSN. John David brought Nora to the National Bureau of Investigation for a physical examination. she ordered a droplight to warm Nora and her baby. 5[5] TSN. 13-16. close to the armpit. On May 7. September 12.4[4] Nora remained unconscious until she recovered. Dr. 9. September 16. While in the recovery room. the medical director of the hospital. Abad. her husband. folder of exhibits. Exhibit D.7[7] The medico-legal officer later testified that Noras injury appeared to be a burn and that a droplight when placed near the skin for about 10 minutes could cause such burn. He was informed it was a burn. Go noticed a fresh gaping wound two and a half (2 ) by three and a half (3 ) inches in the inner portion of her left arm. June 25. respondent John David Z. 6[6] Exhibit A. 7.it to contract and stop bleeding. p. 7[7] TSN. p. 1996. 6.

1992. 1994. 1996. When sleeping. 1994. Jesus Delgado Memorial Hospital for skin grafting. the pain in her left arm remains. at 23. which consequently bore a scar as well. p. About a year after. The costs of the skin grafting and the scar revision were shouldered by the hospital. 12[12] TSN. 11[11] TSN. which aches at the slightest touch. 16. Noras arm would never be the same. Her movements now are also restricted.10[10] Her wound was covered with skin sourced from her abdomen. 23. the thickest portion rising about one-fourth (1/4) of an inch from the surface of the skin. but just on one side of the arm. . pp. June 25. April 29. January 31. scar revision had to be performed at the same hospital. TSN. 42. 9[9] Id. folder of exhibits. Aside from the unsightly mark. p. 35-36.11[11] The surgical operation left a healed linear scar in Noras left arm about three inches in length. 1993.9[9] On May 22.the wound was caused by a blood pressure cuff as the scar was not around the arm. Her children cannot play with the left side of her body as they might accidentally bump the injured arm. p. 10[10] Exhibit L. Noras injury was referred to a plastic surgeon at the Dr. on April 30.12[12] Unfortunately. she has to cradle her wounded arm.

in view of all the foregoing.00) for and as attorneys fees.000. the same is hereby AFFIRMED. Thus. thus: WHEREFORE. Go the sum of P200.00) nominal damages. (d) to pay Fifty Thousand Pesos (P50. Deleting the award [of] exemplary damages. at 227. judgment is hereby rendered in favor of the plaintiffs and against the defendants.00 as moral damages. . which affirmed with modification the trial court decision.000. directing the latters. Finding in favor of respondent spouses.00) litigation expenses. (sic) jointly and severally (a) to pay the sum of Five Hundred Thousand Pesos (P500. attorneys fees and expenses of litigation. Abad. Milagros [L. on June 21. Q-93-16562. (c) to pay the sum of Eighty Thousand Pesos (P80.00) exemplary damages. and finding no reversible error in the appealed Decision dated March 3.] Cantre only to pay plaintiffs-appellees John David Go and Nora S. and the hospital all appealed to the Court of Appeals.000. 1-6. Dr. (b) to pay the sum of One Hundred Fifty Thousand Pesos (P150. respondent spouses filed a complaint13[13] for damages against petitioner.14[14] Petitioner.000. 13[13] Records.000.00) in moral damages. 14[14] Id. Ordering defendant-appellant Dra. Dr. 1993. SO ORDERED. and (e) to pay Six Thousand Pesos (P6. with the following MODIFICATIONS: 1. 1997 of Branch 98 of the Regional Trial Court of Quezon City in Civil Case No. pp. Abad. 2. and the hospital. the trial court decreed: In view of the foregoing consideration.000.

CONTRARY TO PREPONDERANCE OF EVIDENCE PRESENTED BY THE PETITIONER.] Cantre only to pay the costs. p. WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS DISCRETION WHEN. 4. AND THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF THEIR DISCRETION WHEN. THE LOWER COURT. WHETHER OR NOT. Hence. 67. and 5. Milagros [L. III.15[15] Petitioners motion for reconsideration was denied by the Court of Appeals. IT RULED THAT 15[15] Rollo. Abad and Delgado Clinic. Dismissing the counterclaims of defendants-appellants for lack of merit. SO ORDERED. Ordering defendant-appellant Dra. Dismissing the complaint with respect to defendants-appellants Dr. the instant petition assigning the following as errors and issues: I. NOTWITHSTANDING THAT BOTH PARTIES HAVE RESTED THEIR RESPECTIVE CASES. AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION. CONTRARY TO PREPONDERANCE OF EVIDENCE PRESENTED BY THE PETITIONER. II. .. THE LOWER COURT ADMITTED THE ADDITIONAL EXHIBITS FURTHER OFFERED BY RESPONDENTS NOT TESTIFIED TO BY ANY WITNESS AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION. Rainerio S. IT RULED THAT THE PETITIONER HAS NOT AMPLY SHOWED THAT THE DROPLIGHT DID NOT TOUCH THE BODY OF MRS. WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS DISCRETION WHEN. NORA GO. 3. Inc.

GO. at 169-171. WHETHER OR NOT THE LOWER COURT AND THE COURT [OF] APPEALS COMMITTED GRAVE ABUSE OF DISCRETION WHEN. WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF DISCRETION WHEN. WHETHER OR NOT THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF ITS DISCRETION WHEN IT MADE A RULING ON THE RESPONDENTS INJURY QUOTING THE TESTIMONY OF SOMEONE WHO WAS NOT PRESENT AND HAS NOT SEEN THE ORIGINAL. IV. CONTRARY TO THE DETAILED PROCEDURES DONE BY PETITIONER. FRESH INJURY OF RESPONDENT MRS. WHETHER OR NOT THE COURT OF APPEALS GRAVELY ABUSING ITS DISCRETION RULED THAT PETITIONER DRA. NORA GO.16[16] 16[16] Id. V. BOTH RULED THAT THE RESPONDENT WAS LEFT TO THE CARE OF THE NURSING STAFF. WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE OF (SIC) DISCRETION WHEN. GO CAME ABOUT. VI. ALTHOUGH MODIFIED. CANTRE SHOULD HAVE INTENDED TO INFLICT THE INJURY TO SAVE THE LIFE OF RESPONDENT MRS. BY THE COURT OF APPEALS LIKEWISE ABUSING ITS DISCRETION. CANTRE WAS NOT ABLE TO AMPLY EXPLAIN HOW THE INJURY (BLISTERS) IN THE LEFT INNER ARM OF RESPONDENT MRS. CONTRARY TO THE MEDICAL PURPOSES OF COSMETIC SURGERY. . IT RULED THAT THEY ARE ENTITLED TO DAMAGES AND WHICH WAS UPHELD. IT RULED THAT THE COSMETIC SURGERY MADE THE SCARS EVEN MORE UGLY AND DECLARED THE COSMETIC SURGERY A FAILURE. VII. PETITIONER DRA. VIII. CONTRARY TO RESPONDENTS CONTRARY TESTIMONIES AND THE ABSENCE OF ANY TESTIMONY.

Respondents point out that petitioners blood pressure cuff theory is highly improbable. Petitioner contends that additional documentary exhibits not testified to by any witness are inadmissible in evidence because they deprived her of her constitutional right to confront the witnesses against her. . Finally. petitioner stresses that plastic surgery was not intended to restore respondents injury to its original state but rather to prevent further complication. however. even if the injury was brought about by the blood pressure cuff. Petitioner also insinuates the Court of Appeals was misled by the testimony of the medico-legal officer who never saw the original injury before plastic surgery was performed. being unprecedented in medical history and that the injury was definitely caused by the droplight. Petitioner insists the droplight could not have touched Noras body. petitioner was still negligent in her duties as Noras attending physician. the inquiry is whether the appellate court committed grave abuse of discretion in its assailed issuances. At any rate. Simply put. She maintains the injury was due to the constant taking of Noras blood pressure. counter that the genuineness and due execution of the additional documentary exhibits were duly admitted by petitioners counsel. Respondents. they argue. the threshold issues for resolution are: (1) Are the questioned additional exhibits admissible in evidence? (2) Is petitioner liable for the injury suffered by respondent Nora Go? Thereafter.

while the skin grafting and the scar revision were performed on Nora on May 22. is petitioner liable for the injury suffered by respondent Nora Go? The Hippocratic Oath mandates physicians to give primordial consideration to the well-being of their patients. respectively. 1992. Records show that the medico-legal officer conducted the physical examination on May 7. a ruling on the negligence of petitioner may be made based on the res ipsa loquitur doctrine even in the absence of such additional exhibits. we agree with the Court of Appeals that said exhibits are admissible in evidence. 1993. courts face a unique restraint in . This notwithstanding. Petitioners contention that the medico-legal officer who conducted Noras physical examination never saw her original injury before plastic surgery was performed is without basis and contradicted by the records. given the particular circumstances of this case. If a doctor fails to live up to this precept. Coming now to the substantive matter. We note that the questioned exhibits consist mostly of Noras medical records. As to the first issue. In any case. 1992 and April 30. which were produced by the hospital during trial pursuant to a subpoena duces tecum. Petitioners counsel admitted the existence of the same when they were formally offered for admission by the trial court. he is accountable for his acts.

18[18] As to the first requirement. intent is immaterial in negligence cases because where negligence exists and is proven. far removed as the arm is 17[17] Ramos v. it automatically gives the injured a right to reparation for the damage caused. It is caused by an instrumentality within the exclusive control of the defendant or defendants. 321 SCRA 584. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.R. December 29. 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. 628. at 600. 18[18] Id. 2.adjudicating medical negligence cases because physicians are not guarantors of care and. 124354.17[17] In cases involving medical negligence. G. However. . Court of Appeals. 1999. The accident is of a kind which ordinarily does not occur in the absence of someones negligence. the gaping wound on Noras arm is certainly not an ordinary occurrence in the act of delivering a baby. and 3. No. provided that the following requisites concur: 1. they never set out to intentionally cause injury to their patients.

it can be logically inferred that petitioner. Hence. Both instruments are deemed within the exclusive control of the physician in charge under the captain of the ship doctrine. whether the injury was caused by the droplight or by the blood pressure cuff is of no moment. by any stretch of the imagination. could only be caused by something external to her and outside her control as she was unconscious while in hypovolemic shock. Hence. the senior consultant in charge during the delivery of Noras baby. by its very nature and considering her condition. (5th ed. This doctrine holds the surgeon in charge of an operation liable for the negligence of his assistants during the time when those assistants are under the surgeons control.19[19] In this particular case. 19[19] BLACKS LAW DICTIONARY 192. the use of the droplight and the blood pressure cuff is also within petitioners exclusive control. 1979).. the gaping wound on Noras left arm. . Second. Third. Nora could not.from the organs involved in the process of giving birth. exercised control over the assistants assigned to both the use of the droplight and the taking of Noras blood pressure. Such injury could not have happened unless negligence had set in somewhere. have contributed to her own injury.

Thus. 2217. there being fault or negligence. does not absolve her from liability. is obliged to pay for the damage done. . In this connection. Dr. then the taking of Noras blood pressure must have been done so negligently as to have inflicted a gaping wound on her arm. 1994. the presumption that petitioner was negligent in the exercise of her profession stands unrebutted. serious anxiety. Though incapable of pecuniary 20[20] TSN. and similar injury. Jr. Arizala. fright. besmirched reputation. moral shock. September 16. Moral damages include physical suffering. Otherwise. Based on the foregoing. petitioners argument that the failed plastic surgery was not intended as a cosmetic procedure. even if the latter was necessary given her condition. the medical practice is to deflate the blood pressure cuff immediately after each use. wounded feelings. if Noras wound was caused by the blood pressure cuff. 27-28. the inflated band can cause injury to the patient similar to what could have happened in this case. but rather as a measure to prevent complication does not help her case. pp. mental anguish. Further. ART..20[20] for which petitioner cannot escape liability under the captain of the ship doctrine. Whoever by act or omission causes damage to another. 2176. Petitioners defense that Noras wound was caused not by the droplight but by the constant taking of her blood pressure. the Civil Code provides: ART. It does not negate negligence on her part. As testified to by the medico-legal officer. social humiliation.

such that saving her life became petitioners elemental concern. No. we find no grave abuse of discretion in the assailed decision and resolution of the Court of Appeals. it should be stressed that all these could not justify negligence on the part of petitioner. This is the first time petitioner is being held liable for damages due to negligence in the practice of her profession. 240. 150920. The fact that petitioner promptly took care of Noras wound before infection and other complications set in is also indicative of petitioners good intentions. Inc. under the law. We also take note of the fact that Nora was suffering from a critical condition when the injury happened. computation. Tagorio. v. moral damages may be recovered if they are the proximate result of the defendants wrongful act or omission. November 25. 476 SCRA 236. petitioner is obliged to pay Nora for moral damages suffered by the latter as a proximate result of petitioners negligence. Further. . Hence. Clearly. we rule that the Court of Appeals award of Two Hundred Thousand Pesos (P200. 2005.000) as moral damages in favor of respondents and against petitioner is just and equitable. however.R.21[21] 21[21] See Child Learning Center. that petitioner has served well as Noras obstetrician for her past three successful deliveries. Nonetheless. G. considering the specific circumstances in the instant case. We note.

The Decision dated October 3. TINGA Associate Justice Associate Justice PRESBITERO J. JR. WHEREFORE.R. QUISUMBING Associate Justice WE CONCUR: ANTONIO T. Associate Justice . CV No. SO ORDERED. the petition is DENIED. No pronouncement as to costs. 2003 of the Court of Appeals in CA- G. 58184 are AFFIRMED. CARPIO Associate Justice CONCHITA CARPIO MORALES DANTE O. LEONARDO A. VELASCO. 2002 and Resolution dated November 19.

I certify that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division. and the Division Chairpersons Attestation. PUNO Chief Justice . REYNATO S. QUISUMBING Associate Justice Chairperson CERTIFICATION Pursuant to Section 13. LEONARDO A. ATTESTATION I attest that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division. Article VIII of the Constitution.