1. Carillo vs.
People of the Philippines In the case at bar, we consider that the chain of circumstances above noted, namely:
G.R. No. 86890, January 21, 1994
Facts: Petitioner filed a petition for review on certiorari on the decision of the Court of Appeals
affirming his conviction by the RTC of the crime of simple negligence resulting in homicide, for
the death of his 13 year old patient Catherine Acosta after an appendectomy procedure
conducted on the patient. Catherine Acosta, a 13 year old girl, daughter of spouses
Domingo and Yolanda Acosta, complained to her father at about 10:30 o'clock in the
morning of May 31, 1981 of pains in the lower part of her abdomen. Catherine was then
brought to Dr. Elva Pea. Dra. Pea called for Dr. Emilio Madrid and the latter examined
Catherine Acosta.
According to Dr. Madrid, his findings might be appendicitis. The appellant Dr. Emilio
Madrid, a surgeon, operated on Catherine. He was assisted by appellant, Dr. Leandro
Carillo, anesthesiologists. After operation, Catherine remained unconscious until noontime the
next day, a neurologist examined her and she was diagnosed as comatose. Three (3)
days later, Catherine died without regaining consciousness.
The Court of Appeals held that Catherine had suffered from an overdose of, or an adverse
reaction to, anesthesia, particularly the arbitrary administration of Nubain, a pain killer,
without benefit of prior weighing of the patient's body mass, which weight determines the
dosage of Nubain which can safely be given to a patient.
The Court of Appeals held that this condition triggered off a heart attack as a post-operative
complication, depriving Catherine's brain of oxygen, leading to the brain's hemorrhage.
The Court of Appeals identified such cardiac arrest as the immediate cause of Catherine's
death. The Court of Appeals found criminal negligence on the part of petitioner Dr. Carillo
and his co-accused Dr. Madrid, holding that both had failed to observe the required
standard of diligence in the examination of Catherine prior to the actual administration of
anesthesia; that it was "a bit rash" on the part of the accused Dr. Carillo "to have administered
Nubain without first weighing Catherine"; and that it was an act of negligence on the part
of both doctors when, (a) they failed to monitor Catherine's heartbeat after the operation
and (b) they left the hospital immediately after reviving Catherine's heartbeat, depriving
the latter of immediate and expert medical assistance when she suffered a heart attack
approximately fifteen (15) to thirty (30) minutes later.
Issue: Whether or not Dr. Carillo is guilty of the crime of simple negligence resulting in
homicide.
Held: Simple negligence, penalized under what is now Article 365 of the Revised Penal Code,
is defined as "a mere lack of prevision in a situation where either the threatened harm is not
immediate or the danger not openly visible." Put in a slightly different way, the gravamen
of the offense of simple negligence is the failure to exercise the diligence necessitated or
called for the situation which was not immediately life-destructive but which culminated in the
present case, in the death of a human being three (3) days later.
(1)the failure of petitioner and Dr. Madrid to appreciate the serious post-surgery condition
of their patient and to monitor her condition and provide close patient care to her; (2)
the summons of petitioner by Dr. Madrid and the cardiologist after the patient's heart
attack on the very evening that the surgery was completed; (3) the low level of care
and diligence exhibited by petitioner in failing to correct Dr. Madrid's prescription of
Nubain for post-operative pain; (4) the extraordinary failure or refusal of petitioner and
Dr. Madrid to inform the parents of Catherine Acosta of her true condition after surgery, in
disregard of the requirements of the Code of Medical Ethics; and (5) the failure of petitioner
and Dr. Madrid to prove that they had in fact exercised the necessary and appropriate
degree of care and diligence to prevent the sudden decline in the condition of Catherine
Acosta and her death three (3) days later, leads the Court to the conclusion, with moral
certainty, that petitioner and Dr. Madrid were guilty of simple negligence resulting in homicide.
2. DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN, petitioners, vs. COURT OF
APPEALS, SPOUSES QUEDO D. ACOGIDO and FLOTILDE G. VILLEGAS, respondents.
G.R. No. 118231. July 5, 1996
Facts: The petitioner Dr. Batiquin was a Resident Physician at the Negros Oriental
Provincial Hospital, Dumaguete City from January 9, 1978 to September 1989. And Mrs.
Villegas is a married woman who submitted to Dr. Batiquin for prenatal care as the
latter's private patient sometime before September 21, 1988. The latter was submitted
to a simple cesarean operation by herein petitioner to deliver her first child. Soon after
leaving the Hospital Mrs. Villegas began to suffer abdominal pains and complained of being
feverish. She also gradually lost her appetite, so she consulted Dr. Batiquin at the
latter's polyclinic who prescribed for her certain medicines. In the meantime, Mrs. Villegas was
given a Medical Certificate by Dr. Batiquin certifying to her physical fitness to return to her
work and indeed soon after she returned back to her work. But still the abdominal
pains and fever kept on recurring and bothered Mrs. Villegas no end and despite the
medications administered by Dr. Batiquin. When the pains become unbearable and
she was rapidly losing weight she consulted Dr. Ma. Salud Kho at the Holy Child's Hospital in
Dumaguete City on January 20, 1989. Dr. Kho found whitish-yellow discharge inside, an
ovarian cyst on each of the left and right ovaries which gave out pus, dirt and pus behind
the uterus, and a piece of rubber materials on the right side of the uterus embedded on the
ovarian cyst, 2 inches by 3/4 inch in size. This piece of rubber material which Dr.
Kho described as a "foreign body" looked like a piece of a "rubber glove" . . . and
which is also "rubber-drain like . . . . It could have been a torn section of a surgeon's
gloves or could have come from other sources. And this foreign body was the cause of the
infection of the ovaries and
consequently of all the discomfort suffered by Mrs. Villegas after her delivery. And this
prompted Mrs. Villegas to file this present case against Dr. Batiquin. The CA ruled
against the petitioner, hence, this petition.
Issue: Whether or not petitioner, Dr. Batiquin should be held liable for her negligence
in leaving behind the piece of rubber from Mrs. Villegas abdomen.
Held: Yes. Dr. Batiquin is liable for negligently leaving behind a piece of rubber in
private respondent Villegas' abdomen and for all the adverse effects thereof. As such, the rule
of res ipsa loquitur comes to fore. This Court has had occasion to delve into the nature and
operation of this doctrine: This doctrine [res ipsa loquitur] 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." Or as Black's
Law Dictionary puts it:
Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption or inference that
defendant was negligent, which arises upon proof that [the] instrumentality causing injury was
in defendant's exclusive control, and that the accident was one which ordinary does not
happen in absence of negligence. Res ipsa loquitur is [a] rule of evidence whereby negligence
of [the] alleged wrongdoer may be inferred from [the] mere fact that [the] accident happened
provided [the] character of [the] accident and circumstances attending it lead reasonably
to belief that in [the] absence of negligence it would not have occurred and that thing
which caused injury is shown to have been under [the] management and control of [the] alleged
wrongdoer . . . . Under [this] doctrine . . . the happening of an injury permits an inference of
negligence where plaintiff produces substantial evidence that [the] injury was caused by an
agency or instrumentality under [the] exclusive control and management of defendant,
and that the occurrence [sic] was such that in the ordinary course of things would not happen
if reasonable care had been used.
xxx xxx xxx
The doctrine of [r]es 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 is
not a rule of substantive law, but merely a mode of proof or a mere procedural
convenience. The rule, when applicable to the facts and circumstances of a particular
case, is not intended to and does not dispense with the requirement of proof of culpable
negligence on the party charged. It merely determines and regulates what shall be
prima facie evidence thereof and facilitates the burden of plaintiff of proving a breach of the
duty of due care. The doctrine can be invoked when and only when, under the
circumstances involved, direct evidence is absent and not readily available.
In the instant case, all the requisites for recourse to the doctrine are present. First, the
entire proceedings of the cesarean section were under the exclusive control of Dr. Batiquin. In
this light, the private respondents were bereft of direct evidence as to the actual culprit
or the exact cause of the foreign object finding its way into private respondent Villegas'
body, which, needless to say, does not occur unless through the intervention of negligence.
Second, since aside from the cesarean section, private respondent Villegas underwent
no other operation which could have caused the offending piece of rubber to appear in
her uterus, it stands to reason that such could only have been a by-product of the
cesarean section performed by Dr. Batiquin. The petitioners, in this regard, failed to
overcome the presumption of negligence arising from resort to the doctrine of res ipsa loquitur.
As a final word, this Court reiterates its recognition of the vital role the medical profession plays
in the lives of the people, and State's compelling interest to enact measures to protect
the public from "the potentially deadly effects of incompetence and ignorance in those
who would undertake to treat our bodies and minds for disease or trauma." Indeed, a
physician is bound to serve the interest of his patients "with the greatest of solicitude,
giving them always his best talent and skill." Through her tortious conduct, the petitioner
endangered the life of Flotilde Villegas, in violation of her profession's rigid ethical code
and in contravention of the legal standards set forth for professionals, in the general, and
members of the medical profession, in particular.
3. LEONILA GARCIA-RUEDA, petitioner, vs. WILFREDO L. PASCASIO, RAUL R.
ARNAU, ABELARDO L. APORTADERA JR., Honorable CONDRADO M. VASQUEZ, all of
the Office of the Ombudsman; JESUS F. GUERRERO, PORFIRIO MACARAEG, and
GREGORIO A. ARIZALA, all of the Office of the City Prosecutor,
Manila, respondents. G.R. No. 118141. September 5, 1997
Facts: Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent
surgical operation at the UST hospital for the removal of a stone blocking his ureter. He was
attended by Dr. Domingo Antonio, Jr. who was the surgeon, while Dr. Erlinda Balatbat-Reyes
was the anaesthesiologist. Six hours after the surgery, however, Florencio died of
complications of unknown cause, according to officials of the UST Hospital. Not satisfied with
the findings of the hospital, petitioner requested the National Bureau of Investigation (NBI) to
conduct an autopsy on her husbands body. Consequently, the NBI ruled that Florencios death
was due to lack of care by the attending physician in administering anaesthesia. Pursuant to
its findings, the NBI recommended that Dr. Domingo Antonio and Dr. Erlinda Balatbat-
Reyes be charged for Homicide through Reckless Imprudence before the Office of the City
Prosecutor.
Issue: (1) Whether or not Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes should
be charged for Homicide through Reckless Imprudence before the Office of the City
Prosecutor.
(2) Whether or not a medical malpractice committed by Dr. Domingo Antonio and Dr.
Erlinda Balatbat-Reyes indeed transpired.
Held: (1) No. In this instant case, no less than the NBI pronounced after conducting an autopsy
that there was indeed negligence on the part of the attending physicians in administering the
anaesthesia. The fact of want of competence or diligence is evidentiary in nature, the veracity
of which can best be passed upon after a full-blown trial for it is virtually impossible to
ascertain the merits of a medical negligence case without extensive investigation,
research, evaluation and consultations with medical experts. Clearly, the City Prosecutors
are not in a competent position to pass judgment on such a technical matter, especially
when there are conflicting evidence and findings. The bases of a partys accusation
and defenses are better ventilated at the trial proper than at the preliminary investigation.
(2) Yes. In its simplest terms, the type of lawsuit which has been called 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 must prove that a health care 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 that failure or action caused injury to the patient. Hence, there are
four elements involved in medical negligence cases: duty, breach, injury and proximate
causation.
Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes, a
physician-patient relationship was created. In accepting the case, Dr. Antonio and Dr. Reyes
in effect represented that, having the needed training and skill possessed by physicians and
surgeons practicing in the same field, they will employ such training, care and skill in the
treatment of their patients. They have 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. The breach of these professional duties of skill and care, or their improper
performance, by a physician surgeon whereby the patient is injured in body or in health,
constitutes actionable malpractice. Consequently, in the event that any injury results to
the patient from want of due care or skill during the operation, the surgeons may be held
answerable in damages for negligence.
Moreover, in malpractice or negligence cases involving the administration of anaesthesia, the
necessity of expert testimony and the availability of the charge of res ipsa loquitur to
the plaintiff, have been applied in actions against anaesthesiologists to hold the defendant
liable for the death or injury of a patient under excessive or improper anaesthesia.
Essentially, it requires two-pronged evidence: evidence as to the recognized standards of
the medical community in the particular kind of case, and a showing that the physician in
question negligently departed from this standard in his treatment.
Another element in medical negligence cases is causation which is divided into two
inquiries: whether the doctors actions in fact caused the harm to the patient and whether these
were the proximate cause of the patients injury. Indeed here, a causal connection is
discernible from the occurrence of the victims death after the negligent act of the
anaesthesiologist in administering the anesthesia, a fact which, if confirmed, should warrant
the filing of the appropriate criminal case. To be sure, the allegation of negligence is not entirely
baseless. Moreover, the NBI deduced that the attending surgeons did not conduct the
necessary interview of the patient prior to the operation. It appears that the cause of the death
of the victim could have been averted had the proper drug been applied to cope with
the symptoms of malignant hyperthermia. Also, we cannot ignore the fact that an
antidote was readily available to counteract whatever deleterious effect the anaesthesia
might produce. Why these precautionary measures were disregarded must be sufficiently
explained. Absent otherwise, the attending medical expert should have been held liable
therein.
4. DR. NINEVETCH CRUZ, petitioner, vs. COURT OF APPEALS and LYDIA UMALI,
respondents. G.R. No. 122445. November 18, 1997
Facts: On March 22, 1991, prosecution witness, Rowena Umali De Ocampo,
accompanied her mother to the Perpetual Help Clinic and General Hospital situated in
Balagtas Street, San Pablo City, Laguna. They arrived at the said hospital at around
4:30 in the afternoon of the same day. Prior to March 22, 1991, Lydia was examined
by the petitioner who found a "myoma" in her uterus, and scheduled her for a
hysterectomy operation on March 23, 1991. According to Rowena, she noticed that the
clinic was untidy and the window and the floor were very dusty prompting her to ask the
attendant for a rag to wipe the window and the floor with. Because of the untidy state of the
clinic, Rowena tried to persuade her mother not to proceed with the operation. The following
day, before her mother was wheeled into the operating room, Rowena asked the
petitioner if the operation could be postponed. The petitioner called Lydia into her office
and the two had a conversation. Lydia then informed Rowena that the petitioner told her that
she must be operated on as scheduled. The operation nevertheless happened with these
circumstances attending:
a. The relatives of Umali were asked to buy tagamet ampules by Dr. Ercillo.
b. They were asked to buy blood for Umali, Type A.
c. When asked again to buy blood, nowhere blodd available at the Blood Bank of the
Hospital.
d. The condition of Umali became worse that she has to be transferred to
another Hospital, San Pablo District hospital.
Upon Lydia's arrival at the San Pablo District Hospital, she was wheeled into the operating
room and the petitioner and Dr. Ercillo re-operated on her because there was blood
oozing from the abdominal incision. While petitioner was closing the abdominal wall, the
patient died.
Thus, on March 24, 1991, Lydia Umali was pronounced dead. Her death certificate states
"shock" as the immediate cause of death and "Disseminated Intravascular Coagulation (DIC)"
as the antecedent cause. In convicting the petitioner, the MTCC found her to be negligent in
the performance of the operation.
The RTC reiterated the abovementioned findings of the MTCC and upheld the latter's
declaration of "incompetency, negligence and lack of foresight and skill of appellant (herein
petitioner) in handling the subject patient before and after the operation." And likewise
affirming the petitioner's conviction, the Court of Appeals echoed similar observations, thus:
"x x x. While we may grant that the untidiness and filthiness of the clinic may not by
itself indicate negligence, it nevertheless shows the absence of due care and supervision
over her subordinate employees. Did this unsanitary condition permeate the operating room?
Were the surgical instruments properly sterilized? Could the conditions in the OR have
contributed to the infection of the patient? Only the petitioner could answer these, but she
opted not to testify. This could only give rise to the presumption that she has nothing
good to testify on her defense. Anyway, the alleged "unverified statement of the
prosecution witness" remains unchallenged and unrebutted.
Issue: Whether or not a physician has committed an "inexcusable lack of precaution"
in the treatment of his patient is to be determined according to the standard of care
observed by other members of the profession in good standing under similar
circumstances bearing in mind the advanced state of the profession at the time of treatment
or the present state of medical science.
Held: The attending physician may have committed the lack of precaution if duly proven
with concrete evidence supporting such claim. But absence of the same will lead such
allegations as mere hearsay. In the recent case of Leonila Garcia-Rueda v. Wilfred L. Pacasio,
et. al., this Court stated that in accepting a case, a doctor in effect represents that, having
the needed training and skill possessed by physicians and surgeons practicing in the same
field, he will employ such training, care and skill in the treatment of his patients. 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 causation. Immediately
apparent from a review of the records of this case is the absence of any expert testimony on
the matter of the standard of care employed by other physicians of good standing in the conduct
of similar operations. The prosecution's expert witnesses in the persons of Dr. Floresto
Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of Investigation (NBI) only testified
as to the possible cause of death but did not venture to illuminate the court on the matter
of the standard of care that petitioner should have exercised.
All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness; the
lack of provisions such as blood, oxygen, and certain medicines; the failure to subject
the patient to a cardio-pulmonary test prior to the operation; the omission of any form of
blood typing before transfusion; and even the subsequent transfer of Lydia to the San Pablo
Hospital and the reoperation performed on her by the petitioner. But while it may be true
that the circumstances pointed out by the courts below seemed beyond cavil to constitute
reckless imprudence on the part of the surgeon, this conclusion is still best arrived at not
through the educated surmises nor conjectures of laymen, including judges, but by the
unquestionable knowledge of expert witnesses. For whether a physician or surgeon has
exercised the requisite degree of skill and care in the treatment of his patient is, in the
generality of cases, a matter of expert opinion. The deference of courts to the expert
opinion of qualified physicians stems from its realization that the latter possess unusual
technical skills which laymen in most instances are incapable of intelligently evaluating.
Expert testimony should have been offered to prove that the circumstances cited by the
courts below are constitutive of conduct falling below the standard of care employed by other
physicians in good standing when performing the same operation. It must be remembered
that when the qualifications of a physician are admitted, as in the instant case, there is an
inevitable presumption that in proper cases he takes the necessary precaution and
employs the best of his knowledge and skill in attending to his clients, unless the
contrary is sufficiently established. This presumption is rebuttable by expert opinion which
is so sadly lacking in the case at bench.
Even granting arguendo that the inadequacy of the facilities and untidiness of the clinic;
the lack of provisions; the failure to conduct pre-operation tests on the patient; and the
subsequent transfer of Lydia to the San Pablo Hospital and the reoperation performed
on her by the petitioner do indicate, even without expert testimony, that petitioner was
recklessly imprudent in the exercise of her duties as a surgeon, no cogent proof exists that any
of these circumstances caused petitioner's death. Thus, the absence of the fourth element of
reckless imprudence: that the injury to the person or property was a consequence of the
reckless imprudence.
In litigations involving medical negligence, the plaintiff has the burden of establishing
appellant's negligence and for a reasonable conclusion of negligence, there must be proof of
breach of duty on the part of the surgeon as well as a casual connection of such breach and
the resulting death of his patient. In Chan Lugay v. St Luke's Hospital, Inc., where the attending
physician was absolved of liability for the death of the complainant's wife and newborn baby,
this court held that: "In order that there may be a recovery for an injury, however, it
must be shown that the 'injury for which recovery is sought must be the legitimate
consequence of the wrong done; the connection between the negligence and the injury
must be a direct and natural sequence of events, unbroken by intervening efficient
causes.'
In other words, 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, unbroken by any efficient intervening cause, produces the injury, and
without which the result would not have occurred.''' (Underscoring supplied.)
The petitioner is a doctor in whose hands a patient puts his life and limb. For insufficiency of
evidence this Court was not able to render a sentence of conviction but it is not blind
to the reckless and imprudent manner in which the petitioner carried out her duties. A
precious life has been lost and the circumstances leading thereto exacerbated the grief of
those left behind. The heirs of the deceased continue to feel the loss of their mother up to
the present time and this Court is aware that no amount of compassion and commiseration nor
words of bereavement can suffice to assuage the sorrow felt for the loss of a loved one.
Certainly, the award of moral and exemplary damages in favor of the heirs of Lydia
Umali are proper in the instant case.
Hence, petitioner DR. NINEVETCH CRUZ is hereby ACQUITTED of the crime of
reckless imprudence resulting in homicide but is ordered to pay the heirs of the deceased
Lydia Umali the amount of FIFTY THOUSAND PESOS (P50,000.00) as civil liability,
ONE HUNDRED THOUSAND PESOS (P100,000.00) as moral damages, and FIFTY
THOUSAND PESOS (P50,000.00) as exemplary damages.
5. ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural
guardians of the minors, ROMMEL RAMOS, ROY RODERICK RAMOS and RON
RAYMOND RAMOS, petitioners, vs. COURT OF APPEALS, DELOS SANTOS
MEDICAL CENTER, DR. ORLINO HOSAKA and DRA. PERFECTA GUTIERREZ,
respondents. G.R. No. 124354 December 29, 1999
Facts: Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a 47-year old
was a robust woman. Except for occasional complaints of discomfort due to pains allegedly
caused by the presence of a stone in her gall bladder, she was as normal as any other woman.
Married to Rogelio E. Ramos, an executive of Philippine Long Distance Telephone Company,
she has three children whose names are Rommel Ramos, Roy Roderick Ramos and Ron
Raymond Ramos. Because the discomforts somehow interfered with her normal ways, she
sought professional advice. She was advised to undergo an operation for the removal of
a stone in her gall bladder. She underwent a series of examinations which included blood
and urine tests indicated she was fit for surgery.
Through the intercession of a mutual friend, Dr. Buenviaje, she and her husband Rogelio met
for the first time Dr. Orlino Hozaka, one of the defendants in this case, on June 10, 1985. They
agreed that their date at the operating table at the DLSMC (another defendant), would be on
June 17, 1985 at 9:00 A.M.. Dr. Hosaka decided that she should undergo a "cholecystectomy"
operation after examining the documents presented to him. Rogelio E. Ramos, however, asked
Dr. Hosaka to look for a good anesthesiologist.
After the operation, unfortunately, she suffered brain damage as a result of the absence
of oxygen in her brain for four to five minutes. After being discharged from the hospital, she
has been staying in their residence, still needing constant medical attention, with her
husband Rogelio incurring a monthly expense ranging from P8,000.00 to P10,000.00.
She was also diagnosed to be suffering from "diffuse cerebral parenchymal damage".
Thus, on 8 January 1986, petitioners filed a civil case for damages with the Regional
Trial Court of Quezon City against herein private respondents alleging negligence in the
management and care of Erlinda Ramos. After considering the evidence from both sides, the
Regional Trial Court rendered judgment in favor of petitioners. Private respondents seasonably
interposed an appeal to the Court of Appeals. The appellate court rendered a Decision, dated
29 May 1995, reversing the findings of the trial court.
Issue: Whether a surgeon, an anesthesiologist and a hospital should be made liable
for the unfortunate comatose condition of a patient scheduled for cholecystectomy.
Held: Yes. We hold that private respondents were unable to disprove the presumption of
negligence on their part in the care of Erlinda and their negligence was the proximate cause of
her piteous condition.
We do not agree with the reasoning of the appellate court. Although witness Cruz is
not an anesthesiologist, she can very well testify upon matters on which she is capable
of observing such as, the statements and acts of the physician and surgeon, external
appearances, and manifest conditions which are observable by any one. This is
precisely allowed under the doctrine of res ipsa loquitur where the testimony of expert
witnesses is not required. It is the accepted rule that expert testimony is not necessary for
the proof of negligence in non-technical matters or those of which an ordinary person
may be expected to have knowledge, or where the lack of skill or want of care is so obvious as
to render expert testimony unnecessary. We take judicial notice of the fact that
anesthesia procedures have become so common, that even an ordinary person can tell
if it was administered properly. As such, it would not be too difficult to tell if the tube
was properly inserted.
This kind of observation, we believe, does not require a medical degree to be acceptable. The
doctrine of res ipsa loquitur is simply a recognition of the postulate that, as a matter
of common knowledge and experience, the very nature of certain types of occurrences may
justify an inference of negligence on the part of the person who controls the instrumentality
causing the injury in the absence of some explanation by the defendant who is charged
with negligence. 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. Hence, res ipsa loquitur is applied in conjunction
with the doctrine of common knowledge.
Established medical procedures and practices, though in constant flux are devised for
the purpose of preventing complications. A physician's experience with his patients would
sometimes tempt him to deviate from established community practices, and he may end a
distinguished career using unorthodox methods without incident. However, when failure to
follow established procedure results in the evil precisely sought to be averted by
observance of the procedure and a nexus is made between the deviation and the injury
or damage, the physician would necessarily be called to account for it.
In the case at bar, the failure to observe pre-operative assessment protocol which would have
influenced the intubation in a salutary way was fatal to private respondents' case.
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.
6. Reyes v Sisters of Mercy Hospital
G.R. 130547 October 3, 2000
Facts: Petitioner Leah Alesna Reyes is the wife of the late Jorge Reyes. The other
petitioners, namely, Rose Nahdja, Johnny, Lloyd, and Kristine, all surnamed Reyes, were
their children. Five days before his death on January 8, 1987, Jorge had been suffering
from are curring fever with chills. After he failed to get relief from some home medication
he was taking, which consisted of analgesic, antipyretic, and antibiotics, he decided to
see the doctor. On January 8, 1987, he was taken to the Mercy Community Clinic by
his wife. He was attended to by respondent Dr. Marlyn Rico, resident physician and admitting
physician on duty, who gave Jorge a physical examination and took his medical history. She
noted that at the time of his admission, Jorge was conscious, ambulatory, oriented,
coherent, and with respiratory distress. Typhoid fever was then prevalent in the locality,
as the clinic had been getting from 15 to 20 cases of typhoid per month Suspecting that
Jorge could be suffering from this disease, Dr. Rico ordered a Widal Test, a standard test for
typhoid fever, to be performed on Jorge. Blood count, routine urinalysis, stool examination,
and malarial smear were also made after about an hour, the medical technician
submitted the results of the test from which Dr. Rico concluded that Jorge was positive
for typhoid fever. As her shift was only up to 5:00 p.m., Dr. Rico indorsed Jorge to respondent
Dr. Marvie Blanes.Dr. Marvie Blanes attended to Jorge at around six in the evening. She also
took Jorges history and gave him a physical examination. Like Dr. Rico, her impression was
that Jorge had typhoid fever. Antibiotics being the accepted treatment for typhoid fever, she
ordered that a compatibility test with the antibiotic chloromycetin be done on Jorge. Said
test was administered by nurse Josephine Pagente who also gave the patient a dose of
triglobe.
As she did not observe any adverse reaction by the patient to chloromycetin,Dr. Blanes ordered
the first five hundred milligrams of said antibiotic to be administered on Jorge at around
9:00 p.m. A second dose was administered on Jorge about three hours later just before
midnight. At around 1:00 a.m. of January 9, 1987, Dr. Blanes was called as Jorges
temperature roseto 41C. The patient also experienced chills and exhibited respiratory
distress, nausea, vomiting, and convulsions. Dr. Blanes put him under oxygen, used a
suction machine, and administered hydrocortisone, temporarily easing the patients
convulsions. When here gained consciousness, the patient was asked by Dr. Blanes
whether he had a previous heart ailment or had suffered from chest pains in the past. Jorge
replied he did not After about 15 minutes, however, Jorge again started to vomit, showed
restlessness, and his convulsions returned. Dr. Blanes re-applied the emergency measures
taken before and, in addition, valium was administered. Jorge, however, did not respond to
the treatment and slipped into cyanosis, a bluish or purplish discoloration of the skin or
mucous membrane due to deficient oxygenation of the blood. At around 2:00 a.m.,
Jorge died. He was forty years old. The cause of his death was Ventricular Arrythemia
Secondary to Hyperpyrexia and typhoid fever.
Issue: Whether or not petitioner is entitled to damage applying res ipsa loquitur?
Held: There is a case when expert testimony may be dispensed with, and that is under the
doctrine of res ipsa loquitur. Thus, courts of other jurisdictions have applied the doctrine in the
following situations: leaving of a foreign object in the body of the patient after an operation,
injuries sustained on a healthy part of the body which was not under, or in the area, of
treatment, removal of the wrong part of the body when another part was intended, knocking
out a tooth while a patients jaw was under anesthetic for the removal of his tonsils, and
loss of an eye while the patient was under the influence of anesthetic, during or following an
operation for appendicitis, among others. Petitioners now contend that all requisites for the
application of res ipsa loquitur were present, namely: (1) the accident was of a kind which does
not ordinarily occur unless someone is negligent; (2) the instrumentality or agency which
caused the injury was under the exclusive control of the person in charge; and (3) the injury
suffered must not have been due to any voluntary action or contribution of the person injured.
The contention is without merit. We agree with the ruling of the Court of Appeals. In the Ramos
case, the question was whether a surgeon, an anesthesiologist, and a hospital should be
made liable for the comatose condition of a patient scheduled for cholecystectomy. In
that case, the patient was given anesthesia prior to her operation.
Noting that the patient was neurologically sound at the time of her operation, the
Courtapplied the doctrine of res ipsa loquitur as mental brain damage does not normally
occurin a gall blader operation in the absence of negligence of the anesthesiologist.
Taking judicial notice that anesthesia procedures had become so common that even an
ordinary person could tell if it was administered properly, we allowed the testimony of a witness
who was not an expert.
In this case, while it is true that the patient died just a few hours after professional medical
assistance was rendered, there is really nothing unusual or extraordinary about his
death. Prior to his admission, the patient already had recurring fevers and chills for five days
unrelieved by the analgesic, antipyretic, and antibiotics given him by his wife. This shows
that he had been suffering from a serious illness and professional medical help came
too late for him. Respondents alleged failure to observe due care was not immediately
apparent to a layman so as to justify application of res ipsa loquitur. The question
required expert opinion on the alleged breach by respondents of the standard of care
required by the circumstances. Furthermore, on the issue of the correctness of her
diagnosis, no presumption of negligence can be applied to Dr. Marlyn Rico.
7. Ramos vs. CA;
GR No. 124354 ; April 11, 2001
Facts: After seeking professional help, Erlinda Ramos was advised to undergo an operation
for the removal of a stone in her gallbladder. She was referred to Dr. Hosaka who agreed
to do the operation and was further recommended to an anaesthesiologist, Dr. Gutierrez.
On the day of the scheduled operation at De Los Santos Medical Center, around 9:30 in the
morning Dr. Hosaka had not yet arrived so Dr. Gutierres tried to get in touch with him
by phone and informed Hermina Cruz, sister-in-law of Erlina who accompanied Erlinda to the
operating room, that the operation might be delayed. Dr. Hosaka arrived around 12:20 in the
afternoon, or more than three hours after the scheduled operation.
Cruz, who was then still inside the operation room while still holding the hand of
Erlinda saw Dr. Gutierrez trying to intubate the patient and heard Dr. Gutierrez utter and hirap
ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan. Cruz then noticed
bluish discoloration of Erlindas nailbeds on her left hand. She then hear Osaka instructed
someone to call another anestheologist in the name of Dr. Calderon. Dr. Calderon then
attempted
to intubate the patient but still the nailbeds of the patient remained bluish thus she was placed
in a trendelenburg position.
At almost 3:00 in the afternoon, Cruz saw Erlinda being wheeled to the ICU and the doctors
explained to Rogelio that Erlinda his wife had bronchospasm. Erlinda stayed in the ICU
for a month. She was then released from the hospital after four months and since then she
remained in a comatose condition and died on August 1999.
Petitioner then filed with the RTC a civil case for damages against private respondents.
After due trial, RTC rendered judgment in favor of petitioners and found the respondent
negiligent in the performance of their duties to Erlinda. On appeal, the CA reversed the RTCs
decision and directed the petitioners to pay their unpaid medical bills.
Issue: Whether Dr. Hosaka and Gutierrez were liable for negligence.
Held: Dr. Hosaka's irresponsible conduct of arriving very late for the scheduled operation of
petitioner Erlinda is violative, not only of his duty as a physician "to serve the interest
of his patients with the greatest solicitude, giving them always his best talent and skill,"
but also of Article 19 of the Civil Code which requires a person, in the performance of
his duties, to act with justice and give everyone his due. Dr. Gutierrez claim of lack of
negligence on her part is belied by the records of the case. It has been sufficiently
established that she failed to exercise the standards of care in the administration of
anesthesia on a patient. Dr. Gutierrez omitted to perform a thorough preoperative
evaluation on Erlinda. Further, there is no cogent reason for the Court to reverse its
finding that it was the faulty intubation on Erlinda that caused her comatose condition.
There is no question that Erlinda became comatose after Dr. Gutierrez performed a medical
procedure on her.
9. ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER
ANTHONY, ANGELICA,NANCY, and MICHAEL CHRISTOPHER, all surnamed
NOGALES, petitioners, vs. CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA,
DR. ELY VILLAFLOR, DR. ROSA UY, DR. JOELENRIQUEZ, DR. PERPETUA LACSON,
DR. NOE ESPINOLA, and NURSE J. DUMLAO, respondents. G.R. No. 142625 December
19, 2006
Facts: Corazon Nogales ("Corazon"), 37 years old pregnant with her fourth child, under the
exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada"). The Doctor noted an increase
in her blood pressure and development of leg edema indicating preeclampsia. Corazon
started to experience mild labor pains Dr. Estrada advised her immediate admission to
the Capitol Medical Center ("CMC"). The staff nurse noted the written admission request
of Dr. Estrada. Due to the "Consent on Admission and Agreement" and "Admission
Agreement" signed by Corazons husband she was then brought to the labor room of
the CMC. Corazon manifest moderate vaginal bleeding which rapidly became profusely,
Dr. Espinola ordered immediate hysterectomy. Rogelio was made to sign. Consent to
Operation."Due to the inclement weather, Dr. Espinola arrived an hour late. He examined
the patient and ordered some resuscitative measures to be administered. Despite Dr.
Espinola's efforts, Corazon died the cause of death was "hemorrhage, post
partum."Petitioners filed a complaint for damages with the Regional Trial Court of Manila
contending that defendant physicians and CMC personnel were negligent in the treatment
and management of Corazon's condition also in the selection and supervision of
defendant physicians and hospital staff. The defendant fail to file their answer to the
complaint the trial court declared Dr. Estrada, Dr. Enriquez, and Nurse Dumlao in default.
CMC, Dr. Villaflor, Dr. Uy, Dr. Espinola, and Dr. Lacson filed their respective answers denying
and opposing the allegations in the complaint. The trial court rendered judgment finding Dr.
Estrada solely liable for damages.
Petitioners appealed the trial court's decision, The Court of Appeals affirmed the decision
of the trial court. Petitioners filed a motion for reconsideration which was denied in its
Resolution. Hence, petitioners filed a Manifestation that respondents "need no longer be
notified of the petition because they are not involved in the issue raised before the [Court],
regarding the liability of [CMC]." The Court of Appeals concluded that since Rogelio engaged
Dr.Estrada as the attending physician of his wife, any liability for malpractice must be Dr.
Estrada's sole responsibility. While it found the amount of damages fair and reasonable, the
Court of Appeals held that no interest could be imposed on unliquidated claims or damages.
Hence this petition.
Issue: Whether or not CMC is vicariously liable for the negligence?
Held:
On the Liability of CMC
CMC is vicariously liable for Dr. Estrada's negligence based on Article 2180 in relation to
Article2176 of the Civil Code. Art. 2180. The obligation imposed by article 2176 is demandable
not only for one's own acts or omissions, but also for those of persons for whom one is
responsible. Employers shall be liable for the damages caused by their employees. The
records show that Rogelio testified that he and his wife specifically chose Dr. Estrada to
handle Corazon's delivery not only because of their friend's recommendation, but more
importantly because of Dr.Estrada's "connection with a reputable hospital, to provide the best
medical care and support services for Corazon's delivery.
On the Liability of the other Respondents
There was no evidence showing that the other respondents are liable for negligent act.
The records show that all are acting with good faith.
On the Award of interest on Damages
The award of interest on damages is proper and allowed under Article 2211 of the Civil
Code, which states that in crimes and quasi-delicts, interest as a part of the damages
may, in a proper case, be adjudicated in the discretion of the court. The Court partly grants
the petition finds respondent Capitol Medical Center vicariously liable for the negligence of Dr.
Oscar Estrada. The actual damages and moral damages should each earn legal interest at
the rate of six percent (6%) per annum computed from the date of the judgment of the trial
court.
10. PROFESSIONAL SERVICES, INC. VS. NATIVIDAD and ENRIQUE AGANA
G.R. no. 126297 January 31, 2007
NATIVIDAD and ENRIQUE AGANAVS JUAN FUENTES
G.R. no. 127590 January 31, 2007
Facts: Natividad Agana was rushed to the Medical City Hospital Dr. Miguel Ampil diagnosed
her to be suffering from cancer of the sigmoid . Dr. Ampil performed the surgery and
found the malignancy in her sigmoid necessitating the removal. Dr. Juan Fuentes
performs hysterectomy Dr. Ampil took over, completed the operation and closed the
incision. The attending nurse entered the remarks that the sponge count lacking 2. Since
nowhere to be found the surgeon avail to continue closure. After a couple of days, Natividad
complained of excruciating pain she consulted both the doctors about it but they told that it
was natural consequence of the surgery. Dr. Ampil. Natividad, went to the United States
after four months of consultation and laboratory examinations, she was free of cancer.
Natividad flew back to the Philippines, still suffering from pains, her daughter found gauze
protruding from her Vagina. Then after the pain intensified, prompting Natividad to seek
treatment. Dr. Ramon Gutierez detected the presence of another foreign object in her vagina
a foul-smelling gauze which badly infected her vaginal vault. Natividad underwent another
surgery to remedy the damage.
Natividad and her husband filed with the RTC, Quezon City a complaint for damages
against the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil,
and Dr. Fuentes. Enrique Agana also filed with the Professional Regulation Commission
(PRC) an administrative complaint for gross negligence and malpractice against Dr. Ampil
and Dr. Fuentes. The PRC Board of Medicine heard the case but it failed to acquire
jurisdiction over Dr. Ampil who was then in the United States. The case was pending; Natividad
died and was duly substituted by her above-named children (the Aganas).
RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr.
Fuentes liable for negligence and malpractice, ordering the defendants PROFESSIONAL
SERVICES, INC., Dr Miguel Ampil and Dr. Juan Fuentes to pay to the plaintiffs, jointly
and severally, except in respect of the award for exemplary damages and the interest
thereon which are the liabilities of defendants Dr. Ampil and Dr. Fuentes. Aggrieved, PSI, Dr.
Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals, Aganas filed with the
RTC a motion for a partial execution of its Decision. Aganas again filed a motion for an alias
writ of execution against the properties of PSI and Dr. Fuentes. RTC granted the motion and
issued the corresponding writ, prompting Dr. Fuentes to file with the Court of Appeals a petition
for certiorari and prohibition, with prayer for preliminary injunction. During its pendency,
the Court of Appeals issued a Resolution granting Dr. Fuentes prayer for injunctive
relief. PRC Board of Medicine rendered its Decision in Administrative Case dismissing the
case against Dr. Fuentes. The prosecution failed to show that Dr. Fuentes was the one who
left the two pieces of gauze inside Natividads body. The Court of Appeals rendered its
Decision Dr.Miguel Ampil is liable to reimburse defendant-appellant Professional Services,
Inc., whatever amount the latter will pay or had paid to the plaintiffs-appellees. Dr. Ampil filed
a motion for reconsideration, but it was denied in a Resolution Aganas maintain that
the Court of Appeals erred in finding that Dr. Fuentes is not guilty of negligence or medical
malpractice, invoking the doctrine of res ipsa loquitur. Dr. Ampilasserts that the Court of
Appeals erred in finding him liable for negligence and malpractice.
Issues: (1) Whether the Court of Appeals erred in holding Dr. Ampil liable for negligence and
malpractice
(2) Whether the Court of Appeals erred in absolving Dr. Fuentes of any liability
(3) Whether PSI may be held solidarily liable for the negligence of Dr. Ampil.
Held:
(1) Dr. Ampil is liable for Negligence and Malpractice, an attempt to absolve himself,
gears the Courts attention to other possible causes of Natividads detriment. His
arguments are purely conjectural and without basis. He did not present any
evidence to prove that the American doctors were the ones who put or left the
gauzes in
(2) Natividads body. Neither submit evidence to rebut the correctness of the record
of operation, particularly the
(3) number of gauzes used. As to the alleged negligence of Dr. Fuentes, we are mindful
that Dr. Ampil examined his (Dr.Fuentes) work and found it in order.
(2) The court is not convinced, that the Court of Appeals Erred in Absolving Dr. Fuentes of any
Liability. It was duly established that Dr. Ampil was the lead surgeon during the operation
of Natividad. He requested the assistance of Dr. Fuentes only to perform hysterectomy
when he(Dr. Ampil) found that the malignancy in her sigmoid area had spread to her left
ovary. Dr. Fuentes performed the surgery and thereafter reported and showed his work to Dr.
Ampil. The latter examined it and finding everything to be in order, allowed Dr. Fuentes to
leave the operating room. Dr. Ampil then resumed operating on Natividad. He was about
to finish the procedure when the attending nurses informed him that two pieces of gauze
were missing. A"diligent search" was conducted, but the misplaced gauzes were not
found. Dr. Ampil then directed that the incision be closed. During this entire period, Dr. Fuentes
was no longer in the operating room and had, in fact, left the hospital.
(3) The issue of whether PSI is solidarily liable with Dr. Ampil for damages, that PSI,
failed to adduce evidence showing that it exercised the diligence of a good father of a
family in the accreditation and supervision of the latter. Moreover PSI is also directly
liable to the Aganas. When a doctor practices medicine in a hospital setting, the hospital
and its employees are deemed to sub serve him in his ministrations to the patient and
his actions are of his own responsibility. The nature of the relationship between the hospital
and the physicians is an employer-employee relationship the hospitals exercise significant
control in the hiring and firing of consultants and in the conduct of their work within
the hospital premises. Doctors who apply for consultant slots, are required to submit proof of
completion of residency, their educational qualifications, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in most cases, and references.
These requirements in other words, private hospitals, hire, fire and exercise real control
over their attending and visiting consultant staff.
The hiring, and the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of wages. PSI publicly
displays in the lobby of the Medical City Hospital the names and specializations of the
physicians associated or accredited by it, including those of Dr. Ampil and Dr. Fuentes. PSI
failed to discharge its burden under the last paragraph of Article 2180 cited must be adjudged
solidarily liable with Dr. Ampil.
11. DR. MILAGROS L. CANTRE, Petitioner, vs. SPS. JOHN DAVID Z. GO and NORA S.
GO, Respondents.
Facts: At 1:30 a.m. of April 20, 1992, Nora gave birth to her fourth child, a baby boy. However,
at around 3:30 a.m., Nora suffered profuse bleeding inside her womb due to some parts of the
placenta which were not completely expelled from her womb after delivery. Consequently,
Nora suffered hypovolemic shock, resulting in a drop in her blood pressure to "40" over "0."
Petitioner and the assisting resident physician performed various medical procedures to
stop the bleeding and to restore Noras blood pressure. Her blood pressure was frequently
monitored with the use of a sphygmomanometer. While petitioner was massaging Noras
uterus for it to contract and stop bleeding, she ordered a droplight to warm Nora and her baby.
Nora remained unconscious until she recovered. While in the recovery room, her husband,
respondent John David Z. 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, close to the armpit.
He asked the nurses what caused the injury. He was informed it was a burn.
Respondent spouses filed a complaint for damages against petitioner, Dr. Abad, and the
hospital.
Issue: Is petitioner liable for the injury suffered by respondent Nora Go??
Held: The Court ruled In cases involving medical negligence, 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. The accident is of a kind which ordinarily does not occur in the absence of
someones 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.
As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary
occurrence in the act of delivering a baby, far removed as the arm is from the organs involved
in the process of giving birth. Such injury could not have happened unless negligence had set
in somewhere. Second, whether the injury was caused by the droplight or by the blood pressure
cuff is of no moment. Both instruments are deemed within the exclusive control of the physician
in charge under the "captain of the ship" doctrine. 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.
Use of the droplight and the blood pressure cuff is also within petitioners exclusive control.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition,
could only be caused by something external to her and outside her control as she was
unconscious while in hypovolemic shock. Hence, Nora could not, by any stretch of the
imagination, have contributed to her own injury.
12. ILAO-ORETA vs. RONQUILLOGR
G.R. No. 172406 October 17, 2007
Facts: Despite several years of marriage, Spouses Ronquillo is still childless. They consulted
Dr. Concepcion Ilao-Oreta, an obstetrician gynecologist-consultant at St. Lukes and Chief of
the Reproductive Endocrinology and Infertility Section. Eva Marie agreed to undergo
alaparoscopic procedure where a laparoscope would be inserted through her abdominal wall
to get a direct view of her internal reproductive organ in order to determine the real cause of
her infertility.
The procedure was scheduled on April 5, 1999 at 2 pm. Dr. Ilao-Oreta did not arrive at the
schedules time and no prior notice of its cancellation was received by the Ronquillos. Dr. Ilao-
Oreta was on her honeymoon in Hawaii.
She estimated that she would arrive in Manila in the early morning of April5. However, she
failed to consider the time difference between Hawaii and Philippines. Ronquillos filed a
complaint against Dr. Ilao-Oreta and St. Lukes for breach of professional and service contract
and for damages.
RTC: awarded Eva Marie only actual damages upon finding that the doctors failure to arrive
on time was not intentional
CA: found Dr. Ilao-Oreta grossly negligent
Issue: WON Dr. Ilao-Oreta was grossly negligent in not arriving on time for the scheduled
laparoscopy
Held: Records show that Dr- Ilao-Oreta left an admitting order with her secretary for one of the
spouses to pick up, apprised Eva Marie of the necessary preparations for the procedure and
instructed the hospital staff to perform pre-operative treatments before leaving for Hawaii.
These acts reflect an earnest intention to perform the procedure on the day and time scheduled.
On realizing that she missed the scheduled procedure, Dr. Ilao Oreta, upon arrival in Manila,
immediately called the hospital and asked the nurses about Eva Marie. She also wanted to call
the Ronquillos but she didnt have their number at that time. So the next morning, she went to
her office to get the Ronquillos contact number, which is written on Eva Maries chart, and
called them right away.
Noel admitted that indeed Dr. Ilao-Oreta called him up after she arrived in Manila. Although Dr.
Ilao-Oretas act is not grossly negligent, she was negligent when she scheduled to perform
professional service at 2 pm without considering the time difference between Philippines and
Hawaii. Having travelled to the US, where she obtained a fellowship in Reproductive
Endocrinology and Infertility, more than twice, she should have been mindful of said difference.
The procedure to be conducted on Eva Marie was only elective in nature thus the situation did
not present any clear and apparent harm or injury that even a careless person may perceive.
According to the SC, it bears noting that when Dr. Ilao-Oreta was scheduling the date of her
performance of the procedure, she had just gotten married and was preparing for her
honeymoon. It is common knowledge that excitement attends its preparations. Her negligence
could then be
partly attributed to human frailty which rules out its characterization as gross.
13. SPOUSES FREDELICTO FLORES (deceased) and FELICISIMA FLORES,
petitioners, vs. SPOUSES DOMINADOR PINEDA and VIRGINIA SACLOLO, and
FLORENCIO, CANDIDA, MARTA, GODOFREDO, BALTAZAR and LUCENA, all
surnamed PINEDA, as heirs of the deceased TERESITA S. PINEDA, and UNITED
DOCTORS MEDICAL CENTER, INC., respondents.
Facts:
Teresita was a 51-year old unmarried woman living in Sto. Domingo, Nueva Ecija. She
consulted on April 17, 1987 her townmate, Dr. Fredelicto Flores, regarding her medical
condition. She complained of general body weakness, loss of appetite, frequent urination and
thirst, and on-and-off vaginal bleeding. He advised her to return the following week or to go
to the United Doctors Medical Center (UDMC) in Quezon City for a general check-up. As
for her other symptoms, he suspected that Teresita might be suffering from diabetes and
told her to continue her medications.
They went to United Doctors Medical Center (UDMC) in Quezon City. Teresita was
taken to the operating room. It was only then that she met Dr. Felicisima, an obstetrician and
gynecologist. Upon Teresita's complete laboratory examination results came only on that
day . Teresita's urinalysis showed a three plus sign (+++) indicating that the sugar in her
urine was very high. She was then placed under the care of Dr. Amado Jorge, an internist.
Teresita's condition had worsened. She experienced difficulty in breathing and was
rushed to the intensive care unit. Further tests confirmed that she was suffering from
Diabetes Mellitus Type II. Insulin was administered on the patient, but the medication
might have arrived too late. Due to complications induced by diabetes, Teresita died.
Believing that Teresita's death resulted from the negligent handling of her medical
needs, her family (respondents) instituted an action for damages against Dr. Fredelicto
Flores and Dr. Felicisima Flores (collectively referred to as the petitioner spouses) before
the RTC of Nueva Ecija.
Issue:
Whether the said doctors can be held liable for negligence?
Held:
A medical negligence case is a type of claim to redress a wrong committed by a
medical professional, that has caused bodily harm to or the death of a patient. There are four
elements involved in a medical negligence case, namely: duty, breach, injury, and proximate
causation.
We clarify that Dr. Fredelicto's negligence is not solely the act of ordering an "on call"
D&C operation when he was mainly ananaesthesiologist who had made a very cursory
examination of the patient's vaginal bleeding complaint. Rather, it was his failure from the
very start to identify and confirm, despite the patient's complaints and his own suspicions, that
diabetes was a risk factor that should be guarded against, and his participation in the imprudent
decision to proceed with the D&C operation despite his early suspicion and the confirmatory
early laboratory results.
If Dr. Fredelicto believed himself to be incompetent to treat the diabetes, not being an
internist or a diabetologist (for which reason he referred Teresita to Dr. Jorge), he should have
likewise refrained from making a decision to proceed with the D&C operation since he
was niether an obstetrician nor a gynecologist.
These findings lead us to the conclusion that the decision to proceed with the D&C
operation, notwithstanding Teresita's hyperglycemia and without adequately preparing her for
the procedure, was contrary to the standards observed by the medical profession.
Deviation from this standard amounted to a breach of duty which resulted in the patient's
death. Due to this negligent conduct, liability must attach to the petitioner spouses.
RUEZ JR VS JURADO
It is unfortunate that this administrative case involves co-workers in this Court.
Complainant, Samuel R. Ruez, Jr. (Ruez, Jr.), is Chief of the Clearance Section, Checks
Disbursement Division of the FMO-OCA and is the son of the aggrieved party, Samuel V. Ruez,
Sr. (Ruez, Sr.), Driver I for the Motorpool, Property Division of the OCA. Respondent is Dr.
Marybeth V. Jurado (Dr. Jurado), Medical Officer IV of the Medical and Dental Services. All
three were working for the Court at the time of the incident in issue.
The parties agree that on January 12, 2005, at around 4:20 p.m., Ruez, Sr. arrived by
himself at this Courts clinic complaining of dizziness. His blood pressure and pulse rate were
taken by the reception nurse and were registered at 210/100 mmHg and 112 beats a minute,
respectively. What transpired next is disputed. Ruez, Jr. alleged that despite his fathers medical
condition, he was merely advised to go to a hospital and then allowed to walk out of the clinic
on his own. Dr. Jurado, on the other hand, maintained that after being informed of Ruez, Sr.s
blood pressure and heart rate, she instructed the nurse to administer one tablet of Capoten
25mg, an emergency drug that quickly lowers a patients blood pressure. She then informed
Ruez, Sr. that he will be taken to the hospital, after which she immediately instructed the
ambulance driver, Mr. Jacinto, to stand by for hospital conduction. Minutes later, after having
taken Capoten and being given a chance to rest, Ruez, Sr. stood up and walked out
saying, Doktora, hanap lang ho ako ng kasama. Dr. Jurado said she waited for him to return
but he failed to show up. She asked Mr. Almarza, a nurse at the clinic, to look for Ruez, Sr. but
he was unable to locate him.
According to Ruez, Jr., after being informed of his fathers condition, he rushed him to
the Manila Doctors Hospital. There, Ruez, Sr. was treated in the emergency room for
approximately four hours before he was discharged at around 8:30 p.m. and allowed to go
home. However, prior to reaching their house in Balintawak, Caloocan City, Ruez, Sr. began
experiencing nausea, abnormal palpitation and uneasiness and had to be brought back to the
hospital.
Ruez, Sr. and Ruez, Jr.[1] arrived at the emergency room of the Manila Doctors Hospital
at around 10:00 p.m. after which Ruez, Sr. underwent a C.T. Scan. The C.T. Scan revealed a
blood clot necessitating him to be admitted for treatment and observation. The following
morning he suffered a stroke and for a moment was on flat line. The doctors were able to revive
him and thereafter he was transferred to the intensive care unit. Unfortunately, Ruez Sr. never
recovered from his ailment and, on September 12, 2005, he passed away due to medical
complications.[2]
On February 15, 2005, Ruez, Jr. filed a letter-complaint with the Office of the Chief
Justice regarding the alleged lack of attention given to his father by Dr. Jurado. Specifically, he
claims that Dr. Jurado merely advised his father to go to the hospital and then allowed him to
travel to Manila Doctors Hospital despite the availability of an ambulance at the disposal of the
clinic. Ruez, Jr. submits that his father would not have suffered a stroke if not for the neglect of
Dr. Jurado.
The letter-complaint was referred to Atty. Eden T. Candelaria, Deputy Clerk of Court and Chief
of Administrative Services, for investigation. Atty. Candelaria required Dr. Jurado to submit her
comment to the letter-complaint. The comment was submitted on March 18, 2005, together
with supporting affidavits from respondents witnesses. This was followed by Ruez, Jr.s reply
to the comment on April 12, 2005 and Dr. Jurados rejoinder on April 22, 2005.[3]
Atty. Candelaria submitted her report on June 17, 2005. The report gave credence to the
account of Dr. Jurado that Ruez, Sr. was given Capoten, informed that he should be
hospitalized and that the ambulance was placed on standby to take him there. These factual
findings of Atty. Candelaria appear to be supported by the affidavits of the clinics personnel,
including the ambulance driver, who witnessed the events that happened between Ruez, Sr.
and Dr. Jurado.
The issue now for the Court to resolve is whether, given the accepted facts, there is cause to
hold Dr. Jurado administratively liable. Atty. Candelaria is satisfied that Dr. Jurado provided
Ruez, Sr. proper treatment inside the clinic. However, in her opinion, Dr. Jurados actions after
Ruez, Sr. had left were less than the required diligence of a good father of a family. We quote
below the analysis of Atty. Candelaria:
. . . Records will clearly show that minutes after Mr. Ruez, Sr. left the
clinic, Dr. Jurado also left the clinic to go home. This is shown by her time out
registered in the Chronolog Machine on the said date which was 4:31 p.m. and
her inclusion in the list of passengers of Shuttle Bus No. 6. As an efficient and
intelligent doctor, Dr. Jurado should have at least personally exerted all her
efforts to determine the whereabouts of Mr. Ruez, Sr. because of his condition
and again at the very least informed his relatives in the Court in order that they
too take the necessary action that very moment. Or in the alternative, if indeed,
Dr. Jurado may have been in a hurry at that time to do some errands, she
should have at least[,] again, turned Mr. Ruez over the a [d]octor who was
willing to be left behind after office hours. These however never happened. All
that she relied on was the fact that there was an emergency treatment and an
order for hospital conduction but [the same] didnt materialize and [she] put
[the] blame on Mr. Ruez, Sr. As admitted by complainant, Mr. Ruez, Sr., is a
mere driver and perhaps may have no knowledge at all of the consequences
of his 210/100 blood pressure and since he sought refuge from the [c]linic, the
clinic, particularly Dr. Jurado[,] should have made him feel safe and secure in
the said place. . . .
Atty. Candelaria recommends that Dr. Jurado be held liable for simple neglect of duty and
suspended for one (1) month and (1) day. She further recommends that, in light of what
happened, Dr. Prudencio Banzon, SC Senior Staff Officer, Medical and Dental Services, be
directed to prepare a flexi-time schedule (until 5:30 p.m.) for all doctors and nurses in the clinic
to enable it to provide immediate and proper attention in case of any emergency medical
situation.
The Court does not agree that the acts or omission of Dr. Jurado amount to simple neglect of
duty. Simple neglect of duty is defined as failure to give proper attention to a task expected of
an employee resulting from either carelessness or indifference[4] or signifies a disregard of duty
resulting from carelessness or indifference.[5] In Philippine Retirement Authority,[6] it was
stated, The Court has decided the following, inter alia, as constituting the less grave offense of
Simple Neglect of Duty: delay in the transmittal of court records, delay in responding to written
queries, and delay of more than one (1) year and seven (7) months in furnishing a party with a
copy of the courts decision. In all the instances cited by the Court, respondents had the duty
or were expected to do certain acts which they failed to do. How do we determine what acts
are expected of Dr. Jurado? Atty. Candelarias report cites the applicable yardstick: a physician
or surgeon is expected to apply in his practice of medicine that degree of care and skill which
is ordinarily employed by the profession, generally, and under similar conditions. [7] Therefore,
to find Dr. Jurado liable for simple neglect of duty the Court has to be convinced that those in
the medical profession were also expected to act in the manner illustrated by Atty.
Candelaria, i.e., to exert all efforts to determine the whereabouts of Ruez, Sr., inform his
relatives or turn his case over to a doctor who was available after office hours.
Article II, Section 1 of the Code of Medical Ethics of the Medical Profession in the
Philippines states:
A physician should attend to his patients faithfully and conscientiously.
He should secure for them all possible benefits that may depend upon his
professional skill and care. As the sole tribunal to adjudge the physicians
failure to fulfill his obligation to his patients is, in most cases, his own
conscience, violation of this rule on his part is discreditable and inexcusable.
A doctors duty to his patient is not required to be extraordinary. [8] The standard
contemplated for doctors is simply the reasonable average merit among ordinarily good
physicians, i.e. reasonable skill and competence.[9] We are persuaded that Dr. Jurado fulfilled
such a standard when she treated Ruez, Sr. inside the clinic. But what of Dr. Jurados conduct
after Ruez, Sr. left the clinic and failed to return?
It has been held that a patient cannot attribute to a physician damages resulting from
his own failure to follow his advice, even though he was ignorant of the consequences which
would result from his failure.[10] If a patient leaves the hospital contrary to instructions, the
physician is not liable for subsequent events.[11] There is no expectation from doctors that they
track down each patient who apparently missed their appointments or force them to comply
with their directives. After all, a person is still the master of his own body. [12]
Dr. Jurado may have allowed Ruez, Sr. to walk out of the clinic despite her earlier
diagnosis of his condition. By that time Ruez, Sr.s condition had temporarily stabilized and she
did not have the authority to stop him just as other doctors have no power, save in certain
instances (such as when the law makes treatment compulsory due to some communicable
disease[13] or when consent is withheld by a minor but non-treatment would be detrimental or
when the court of competent jurisdiction orders the treatment), to force patients into staying
under their care. Dr. Jurado relied on Ruez, Sr.s representation that he would return in order
to be brought to the hospital but made no undertaking to wait for him beyond the clinic hours
or to look for him if he did not return. Thus, when Ruez, Sr. failed to show up as of closing time,
and could not be found by the male nurse who looked for him at her instructions, Dr. Jurado
had reason to think that he had decided to disregard her medical advice, which he in fact did
when he and Ruez, Jr. decided to go to the hospital on their own. Ruez, Sr., still of sound mind,
had the right to accept or ignore his doctors recommendation. Dr. Jurado was obligated to care
for Ruez, Sr. when the latter asked for medical treatment, which she did, but when he left on
his own accord Dr. Jurado was not expected, much less duty-bound, to seek out her patient
and continue being his doctor.

Some people may interpret Dr. Jurados inaction as indifference, while others may view
the same as just proper. Some would applaud Dr. Jurados dedication had she done all the
things mentioned by Atty. Candelaria and yet others would see them as still insufficient. There
will always be a divergence of opinions as to how Dr. Jurado should have conducted herself
but the Court must distinguish between acts that deserve to be emulated or disdained and
those that deserve sanctions. The former is largely a matter of opinion while the latter can only
be imposed if there was a failure to perform a clear duty, expectation or obligation. People may
frown upon certain behaviors and chastise others for having less compassion, but it does not
necessarily follow that those acts translate to neglect of duty, misconduct or negligence.

Dr. Jurado could have exerted greater efforts by searching all over the compound for
Ruez, Sr. but the fact remains that these were not part of her duties nor were they expected
from her. Simple neglect of duty presupposes a task expected of an employee. Thus, it cannot
be present if there was no expected task on her part. That said, the Court wishes to exhort Dr.
Jurado, and all personnel in its clinic, not to be satisfied with merely fulfilling the minimum, but
to go for the magis, the best service they can render by way of being exemplars for their fellow
workers in the Court.

WHEREFORE, the Court finds no reason to hold Dr. Jurado liable for simple neglect of duty,
and, therefore, DISMISSES the complaint for lack of merit. As recommended by Atty. Eden T.
Candelaria, Deputy Clerk of Court and Chief of Administrative Services, Dr. Prudencio Banzon,
Senior Staff Officer, Medical and Dental Services, is DIRECTED to prepare a flexi-time
schedule for all doctors and nurses in the clinic to further develop its capability to provide
immediate and proper attention in emergency medical situations, and to submit the same to
Atty. Candelaria in 30 days from receipt of a copy of this decision which should be served upon
him forthwith.
SO ORDERED.