11. Atienza v.
Board (CASE REGARDING Petitioner filed his comments/objections to
KIDNEY)
NOTES: Admissibility of evidence refers to the
question of whether or not the circumstance (or
evidence) is to be considered at all.
Probative value of evidence refers to the question
of whether or not it proves an issue.
The rules of evidence are merely the means for
ascertaining the truth respecting a matter of fact.
Thus, they likewise provide for some facts which
are established and need not be proved, such as
those covered by judicial notice, both mandatory
and discretionary.
Facts of the case:
Due to her lumbar pains, private respondent
Editha Sioson went to Rizal Medical Center (RMC)
for checkup, was referred to Dr. Pedro Lantin III of
RMC who, accordingly, ordered several diagnostic
laboratory tests wherein it was noticed that right
kidney was normal but her left kidney is
nonfunctioning and nonvisualizing. Thus, she
underwent kidney operation in September,
1999.
Private respondents husband, Romeo Sioson (as
complainant), filed a complaint for gross
negligence and/or incompetence before the [BOM]
against the doctors who allegedly participated in
the fateful kidney operation, namely: Dr. Judd dela
Vega, Dr. Pedro Lantin, III, Dr. Gerardo Antonio
Florendo and petitioner Rico Rommel Atienza. It
was alleged in the complaint that the gross
negligence and/or incompetence committed by
the said doctors, including petitioner, consists
of
the removal of private respondents fully
functional right kidney, instead of the left
nonfunctioning and nonvisualizing kidney.
Submitted evidence by the complainant were
certified photocopy of the x-ray requests.
without or in excess of jurisdiction or with grave
private respondents [Editha Siosons] formal offer
of exhibits. He alleged that said exhibits are
inadmissible because the same are mere
photocopies, not properly identified and
authenticated, and intended to establish
matters which are hearsay. He added that the
exhibits are incompetent to prove the purpose for
which they are offered.
Disposition of the BOM: The formal offer of
documentary exhibits of private respondent
[Editha Sioson] was admitted. The petitioners
moved for motion for reconsideration, but was
denied. It concluded that it should first admit
the evidence being offered so that it can
determine its probative value when it decides
the case. According to the Board, it can
determine whether the evidence is relevant or
not if it will take a look at it through the
process of admission. Thus, a petition for
certiorari was filed with the CA which the court
dismissed due to lack of merit. Hence, this
petition.
ISSUES:
1. Whether the petitioner availed proper remedy
when he filed a petition for certiorari with the
CA under RULE 65
SC: Petitioner is correct when he asserts that a
petition for certiorari is the proper remedy to
assail the Orders of the BOM, admitting in
evidence the exhibits of Editha. As the assailed
Orders were interlocutory, these cannot be the
subject of an appeal separate from
the judgment that completely or finally disposes of
the case. At that stage, where there is no appeal, or
any plain, speedy, and adequate remedy in the
ordinary course of law, the only and remaining
remedy left to petitioner is a petition for certiorari
under Rule 65 of
the Rules of Court on the ground of grave abuse of
discretion amounting to lack or excess of
jurisdiction. However, the writ of certiorari will
not issue absent a showing that the BOM has acted
abuse of discretion. Embedded in the CAs finding
that the BOM did not exceed its jurisdiction or act
in grave abuse of discretion is the issue of whether
the exhibits of Editha contained in
her Formal Offer of Documentary Evidence are
inadmissible.
2. Whether CA committed grave reversible error
and decided a question of substance in a way
not in accordance with law and the applicable
decisions when it upheld the admission of
incompetent and inadmissible evidence by the
respondent board, which can result to
deprivation of Professional License.
SC: No. It is well-settled that the rules of evidence
are not strictly applied in proceedings before
administrative bodies such as the BOM. [I]t is the
safest policy to be liberal, not rejecting them
on doubtful or technical grounds, but
admitting them unless plainly irrelevant,
immaterial or incompetent, for the reason that
their rejection places them beyond the
consideration of the court, if they are
thereafter found relevant or competent on the
other hand, their admission, if they turn out
later to be irrelevant or incompetent, can
easily be remedied by completely discarding
them or ignoring them.
Petitioners insistence that the admission of
Edithas exhibits violated his substantive rights
leading to the loss of his medical license is
misplaced.
Best evidence rule is inapplicable.
Sec. 3. Original document must be produced
exceptions.When the subject of inquiry is the
contents of a document, no evidence shall be
admissible other than the original document itself,
except in the following
cases:
(a) When the original has been lost or destroyed,
or cannot be produced in court, without bad faith
on the part of the offeror
(b) When the original is in the custody or under
the control of the party against whom the
evidence is offered, and the latter fails to produce
it after reasonable notice
(c) When the original consists of numerous
accounts or other documents which cannot be
examined in court without great loss of time and
the fact sought to be established from them is only
the general result of the whole and
(d) When the original is a public record in the
custody of a public officer or is recorded in a
public office.
The introduction of secondary evidence, such as
copies of the exhibits, is allowed. Witness Dr.
Nancy Aquino testified that the Records Office of
RMC no longer had the originals of the exhibits
because [it] transferred from the previous
building, x x x to the new building. Ultimately,
since the originals cannot be produced, the BOM
properly admitted Edithas formal offer of
evidence and, thereafter, the BOM shall determine
the probative value thereof when it decides the
case.
WHEREFORE, the petition is DENIED. The
Decision of the Court of Appeals in CAG. R. SP No.
87755 is AFFIRMED.
12. G.R. No. 192973 (CASE REGARDING
SPECIALIZATION OF THE EXPERT)
PEDRITO DELA TORRE, Petitioner,
DR. ARTURO IMBUIDO, DRA. NORMA IMBUIDO
in their capacity as owners and operators of
DIVINE SPIRIT GENERAL HOSPITAL and/or DR.
NESTOR PASAMBA, Respondents.
Facts of the case:
The case stemmed from a complaint 4 for damages
filed by Pedrito against herein respondents Dr.
Arturo Imbuido and Dr. Norma Imbuido (Dr.
Norma), in their capacity as the owners and
operators of the Divine Spirit General Hospital in
Olongapo City, and Dr. Nestor Pasamba (Dr.
Nestor) (respondents).
Pedrito alleged in his complaint that he was
married to one Carmen Castillo Dela
Torre(Carmen), who died while admitted at the
Divine Spirit General Hospital on February 13,
1992. Carmen was due to give birth on February
2,1992 and was brought at around 11:30 p.m. on
that day by Pedrito to the Divine Spirit General
Hospital. When Carmen still had not delivered
her baby at the expected time, Dr. Norma
discussed with Pedrito the possibility of a
caesarean section operation.5
At around 3:00 p.m. on February 3, 1992, Carmen
was brought to the hospitals operating room for
her caesarian section operation, which was to be
performed by Dr. Nestor. By 5:30 p.m. of the same
day, Pedrito was informed of his wifes delivery of
a baby boy. In the early morning of February 4,
1992, Carmen experienced abdominal pain and
difficulty in urinating. She was diagnosed to be
suffering from urinary tract infection (UTI),
and was prescribed medications by Dr. Norma.
On February 10, 1992, Pedrito noticed that
Carmens stomach was getting bigger, but Dr.
Norma dismissed the patients condition as
mere flatulence (kabag).6
When Carmens stomach still grew bigger despite
medications, Dr. Norma advised Pedrito of the
possibility of a second operation on Carmen. Dr.
Norma, however, provided no details on its
purpose and the doctor who would perform it. At
around 3:00 p.m. on February 12, 1992, Carmen
had her second operation. Later in the evening, Dr.
Norma informed Pedrito that "everything was
going on fine with [his] wife."7
The condition of Carmen, however, did not
improve. It instead worsened that on February 13,
1992, she vomited dark red blood. At 9:30 p.m. on
the same day, Carmen died.8 Per her certificate of
death upon information provided by the
hospital,the immediate cause of Carmens death
was "cardio-respiratory arrest secondary to
cerebro vascular accident, hypertension and
chronic nephritis induced by pregnancy."9 An
autopsy Report10prepared by Dr. Richard
Patilano(Dr. Patilano), Medico-Legal Officer-
Designate of Olongapo City, however, provided
that the cause of Carmens death was "shock due
to peritonitis, severe, with multiple intestinal
adhesions; Status post C[a]esarian Section and
Exploratory Laparotomy."
Pedrito claimed in his complaint that the
respondents "failed to exercise the degree of
diligence required of them" as members of the
medical profession, and were "negligent for
practicing surgery on [Carmen] in the most
unskilled, ignorant and cruel manner, x x x[.]"11
In their answer12 to the complaint, the
respondents argued that they "observed the
required standard of medical care in attending to
the needs of Carmen."13 The respondents
explained that Carmen was admitted in Divine
Spirit General Hospital for "pregnancy in labor and
pre-eclampsia." Her condition was closely
monitored during her confinement. A caesarian
section operation became necessary, as she
manifested no significant progress for the
spontaneous delivery of her baby.14 No unusual
events were observed during the course of
Carmens caesarian section operation. The second
surgery, however, became necessary due to
suspected intestinal obstruction and adhesions.
This procedure was fully explained to Carmen and
Pedrito prior to its conduct. During the second
operation, the diagnosis of intestinal obstruction
and adhesion was confirmed but resolved by her
doctors. Despite the observance of due care by the
doctors, however, Carmen died on February 13,
1992.15
After the pre-trial conference, trial proper ensued.
To support his claim, Pedrito presented the
testimony of Dr. Patilano, the medicolegal officer
who conducted an autopsy on the body of Carmen
upon a telephone request made by the City Health
Officer of Olongapo City, Dr. Generoso Espinosa.
Among Dr. Patilanos observations, as narrated in
the lower courts decision, were as follows:
In the intestines, [Dr. Patilano] found out that it
was more reddish than the normal condition
which is supposed to be pinkish. There was
presence of adhesions, meaning, it sticks to each
other and these areas were dilated. There were
constricted areas. He concluded that there might
have been foreign organic matters in the
intestines. He did not see any swelling but
assuming that there was, it would be concomitant
to the enlargement. x x x He came to the
conclusion that the cause of death was peritonitis,
with the multiple adhesions status in the post
caesarian section. In connection with peritonitis,
this is the inflammation of the abdomen. This
peritonitis in the abdominal cavity may be caused
by several conditions which are supposed to be
infections, entrance of foreign bodies in the
intestines in connection with ruptured peptic
ulcer or [may be] somewhere in the spleen. The
entrance of foreign object in the abdominal
cavities may cause severe infections of the intra-
abdominal cavities resulting [in] multiple
adhesions of the intestines. In cases of surgical
operation, it [may be] due to the conditions of the
instruments used, the materials used in the
operating room being not aseptic and the ladies
assisting the operation were not in uniform. x x x. 17
Dr. Patilano claimed that peritonitis could have
been prevented through proper medical
procedures and medicines. He also stated that if
the cause of Carmens death was actually cerebro-
vascular accident, there would have been ruptured
blood vessels and blood clot in her head; but there
were none in Carmens case.18
Among those who testified to refutePedritos claim
was Dr. Nestor. He claimed that when Carmen was
referred to him on February 3, 1992, she was in
full term uterine pregnancy, with pre-eclampsia,
fetal distress and active labor pains. A caesarian
section operation became necessary to terminate
the pregnancy for her safety. Carmen was ready to
go home four days after giving birth, but was
advised by the doctors to stay more because of her
persistent hypertension.19
The second surgery performed on Carmen was
necessary after she showed symptoms of
intestinal obstruction, which happens as the
intestines get twisted due to adhesions and the
normal flow of intestinal contents are obstructed.
For Dr. Nestor, this occurrence was not
preventable since any interference of the
abdominal cavity would irritate the serosa of the
intestines, inviting adhesions that could cause
obstruction. Surgery could remedy the adhesions
and obstruction.20 Both Carmen and Pedrito gave
their written consent to this second procedure.21
RTC: RTC rendered its Decision24 in favor of
Pedrito. The trial court gave greater weight to
the testimony of Dr. Patilano
Dissatisfied with the RTC ruling, the respondents
appealed to the CA.
CA: The CA rendered its Decision reversing and
setting aside the decision of the RTC. For the
appellate court, it was not established that the
respondents failed to exercise the degree of
diligence required of them by their profession as
doctors.
Hence, this petition for review on certiorariin
which Pedrito insists that the respondents should
be held liable for the death of Carmen.
SC: The petition is denied.
"[M]edical 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 professionalwhich
has caused bodily harm." In order to successfully
pursue such a claim, a patient, or his or her family
as in this case, "must prove that 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 failure or action
caused injury to the patient."27
The Court emphasized in Lucas, et al. v.
Tuan o28 that in medical negligence cases, there is a
physician-patient relationship between the doctor
and the victim, but just like in any other
proceeding for damages, four essential elements
must be established by the plaintiff, namely: (1)
duty; (2) breach; (3) injury; and (4) proximate
causation. All four elements must be present in
order to find the physician negligent and, thus,
liable for damages.29
It is settled that a physicians duty to his patient
relates to his exercise of the degree of care, skill
and diligence which physicians in the same
general neighborhood, and in the same general
line of practice, ordinarily possess and exercise in
like cases. There is breach of this duty when the
patient is injured in body or in health. Proof of this
breach rests upon the testimony of an expert
witness that the treatment accorded to the patient
failed to meet the standard level of care, skill and
diligence. To justify an award of damages, the
negligence of the doctor must be established to be
the proximate cause of the injury.30
Through the instant petition, Pedritoseeks the
reinstatement of the decision of the RTC whose
finding of the respondents medical negligence
depended mainly on the testimony of Dr. Patilano.
Upon review, however, the Court agrees with
the CA that the report and testimony of Dr.
Patilano failed to justify Pedritos entitlement
to the damages awarded by the RTC.
For the trial court to give weightto Dr.
Patilanos report, it was necessary to show first
Dr. Patilanos specialization and competence to
testify on the degree of care, skill and diligence
needed for the treatment of Carmens case.
Considering that it was not duly established
that Dr. Patilano practiced and was an expert
inthe fields that involved Carmens condition, he
could not have accurately identified the said
degree of care, skill, diligence and the medical
procedures that should have been applied by
her attending physicians.
Similarly, such duty, degree of care, skill and
diligence were not sufficiently established in this
case because the testimony of Dr. Patilano was
based solely on the results of his autopsy on the
cadaver of Carmen. His study and assessment
were restrictedby limitations that denied his full
evaluation of Carmens case. He could have only
deduced from the injuries apparent in Carmens
body, and in the condition when the body was
examined. Judging from his testimony, Dr. Patilano
did not even take full consideration of the medical
history of Carmen, her actual health condition at
the time of hospital admission, and her condition
as it progressed while she was being monitored
and treated by the respondents. There was also no
reference to the respondents defense that the
emergency caesarian section operation had to be
performed in order to protect the lives and safety
of Carmen and her then unborn child. For lack of
sufficient information on Carmens health
condition while still alive, Dr. Patilano could not
have fully evaluated the suitability of the
respondents decisions in handling Carmens
medical condition as it turned critical.
On the other hand, the CA pointed out that Dr.
Nestor, a surgeon, possessed the reasonable
degree of learning, skill and experience required
by his profession for the treatment ofCarmen. The
respondents also emphasized in their pleadings
beforethe RTC that Dr. Nestor had his training and
experience in surgery and obstetrics since 1970.
Without sufficient proof from the claimant on a
different degree of care, skill and diligence that
should be expected from the respondents, it could
not be said with certainty that a breachwas
actually committed.
Moreover, while Dr. Patilano opined that Carmen
died of peritonitis which could be due to the poor
state of the hospital equipment and medical
supplies used during her operation, there was no
sufficient proof that any such fault actually
attended the surgery of Carmen, caused her illness
and resulted in her death. It is also significant that
the Chief of the Medico-Legal Division of the PNP
Crime Laboratory Service, Dr. Torres, testified
before the trial court that based on the autopsy
report issued by Dr. Patilano, the latter did not
comply with the basic autopsy procedure when he
examined the cadaver of Carmen. Dr. Patilano did
not appear to have thoroughly examined Carmens
vital organs such as her heart, lungs, uterus and
brain during the autopsy. His findings were then
inconclusive on the issue of the actual cause of
Carmen's death, and the claim of negligence
allegedly committed by the respondents.
As the Court held in Spouses Flores v. Spouses
Pineda, et al.,31 the critical and clinching factor in a
medical negligence case is proof of the causal
connection between the negligence and the
injuries. The claimant must prove not only the
injury but also the defendant's fault, and that such
fault caused the injury. A verdict in a malpractice
action cannot be based on speculation or
conjecture. Causation must be proven within a
reasonable medical probability based upon
competent expert testimony,32 which the Court
finds absent in the case at bar.
WHEREFORE, the petition is DENIED. The
Decision dated December 15, 2009 and Resolution
dated July 27, 2010 of the Court of Appeals in CA-
G.R. CV No. 78534 are AFFIRMED.
13. G.R. No. 175540 (Case regarding lack of
consent for transplant)
DR. FILOTEO A. ALANO, Petitioner,
ZENAIDA MAGUD-LOGMAO, Respondent.
FACTS OF THE CASE:
Plaintiff-appellee Zenaida Magud-Logmao is the
mother of deceased Arnelito Logmao. Defendant-
appellant Dr. Filoteo Alano is the Executive
Director of the National Kidney Institute (NKI).
At around 9:50 in the evening of March 1, 1988,
Arnelito Logmao, then eighteen (18) years old,
was brought to the East Avenue Medical Center
(EAMC) in Quezon City by two sidewalk vendors,
who allegedly saw the former fall from the
overpass near the Farmers Market in Cubao,
Quezon City. The patients data sheet identified
the patient as Angelito Lugmoso of Boni Avenue,
Mandaluyong.
However, the clinical abstract prepared by Dr.
Paterno F. Cabrera, the surgical resident on-duty at
the Emergency Room of EAMC, stated that the
patient is Angelito [Logmao].
Dr. Cabrera reported that [Logmao] was drowsy
with alcoholic breath, was conscious and
coherent; that the skull x-ray showed no fracture;
that at around 4:00 oclock in the morning of
March 2, 1988, [Logmao] developed generalized
seizures and was managed by the neuro-surgery
resident on-duty; that the condition of [Logmao]
progressively deteriorated and he was intubated
and ambu-bagging support was provided; that
admission to the Intensive Care Unit (ICU) and
mechanical ventilator support became necessary,
but there was no vacancy at the ICU and all the
ventilator units were being used by other patients;
that a resident physician of NKI, who was rotating
at EAMC, suggested that [Logmao] be transferred
to NKI; and that after arrangements were made,
[Logmao] was transferred to NKI at 10:10 in the
morning.
At the NKI, the name Angelito [Logmao] was
recorded as Angelito Lugmoso. Lugmoso was
immediately attended to and given the necessary
medical treatment. As Lugmoso had no relatives
around, Jennifer B. Misa, Transplant
Coordinator, was asked to locate his family by
enlisting police and media assistance. Dr.
Enrique T. Ona, Chairman of the Department of
Surgery, observed that the severity of the brain
injury of Lugmoso manifested symptoms of
brain death. He requested the Laboratory Section
to conduct a tissue typing and tissue cross-
matching examination, so that should Lugmoso
expire despite the necessary medical care and
management and he would be found to be a
suitable organ donor and his family would consent
to organ donation, the organs thus donated could
be detached and transplanted promptly to any
compatible beneficiary.
Jennifer Misa verified on the same day, March 2,
1988, from EAMC the identity of Lugmoso and,
upon her request, she was furnished by EAMC a
copy of the patients date sheet which bears the
name Angelito Lugmoso, with address at Boni
Avenue, Mandaluyong. She then contacted several
radio and television stations to request for air time
for the purpose of locating the family of Angelito
Lugmoso of Boni Avenue, Mandaluyong, who was
confined at NKI for severe head injury after
allegedly falling from the Cubao overpass, as well
as Police Station No. 5, Eastern Police District,
whose area of jurisdiction includes Boni Avenue,
Mandaluyong, for assistance in locating the
relatives of Angelito Lugmoso. Certifications were
issued by Channel 4, ABS-CBN and GMA attesting
that the request made by the NKI on March 2,
1988 to air its appeal to locate the family and
relatives of Angelito Lugmoso of Boni Avenue,
Mandaluyong was accommodated. A Certification
was likewise issued by Police Station No. 5,
Eastern Police District, Mandaluyong attesting to
the fact that on March 2, 1988, at about 6:00 p.m.,
Jennifer Misa requested for assistance to
immediately locate the family and relatives of
Angelito Lugmoso and that she followed up her
request until March 9, 1988.
On March 3, 1988, at about 7:00 oclock in the
morning, Dr. Ona was informed that Lugmoso
had been pronounced brain dead by Dr. Abdias
V. Aquino, a neurologist, and by Dr. Antonio Rafael,
a neurosurgeon and attending physician of
Lugmoso, and that a repeat electroencephalogram
(EEG) was in progress to confirm the diagnosis of
brain death. Two hours later, Dr. Ona was informed
that the EEG recording exhibited a flat tracing,
thereby confirming that Lugmoso was brain dead.
Upon learning that Lugmoso was a suitable organ
donor and that some NKI patients awaiting organ
donation had blood and tissue types compatible
with Lugmoso, Dr. Ona inquired from Jennifer Misa
whether the relatives of Lugmoso had been
located so that the necessary consent for organ
donation could be obtained. As the extensive
search for the relatives of Lugmoso yielded no
positive result and time being of the essence in
the success of organ transplantation, Dr. Ona
requested Dr. Filoteo A. Alano, Executive Director
of NKI, to authorize the removal of specific organs
from the body of Lugmoso for transplantation
purposes. Dr. Ona likewise instructed Dr. Rose
Marie Rosete-Liquete to secure permission for the
planned organ retrieval and transplantation from
the Medico-Legal Office of the National Bureau of
Investigation (NBI), on the assumption that the
incident which lead to the brain injury and death
of Lugmoso was a medico legal case.
On March 3, 1988, Dr. Alano issued to Dr. Ona a
Memorandum, in connection with the use of the
human organs or any portion or portions of the
human body of the deceased patient, identified as
a certain Mr. Angelito Lugmoso who was brought
to the National Kidney Institute on March 2, 1988
from the East Avenue Medical Center.
As shown by the medical records, the said patient
died on March 3, 1988 at 9:10 in the morning due
to craniocerebral injury. The memo requires to
make certain that the Department has exerted all
reasonable efforts to locate the relatives or next of
kin of the said deceased patient such as appeal
through the radios and television as well as
through police and other government agencies
and that the NBI [Medico-Legal] Section has been
notified and is aware of the case.
In accordance with the provisions of Republic Act
No. 349 as amended and P.D. 856, the department
was given permission and/or authority to retrieve
and remove the kidneys, pancreas, liver and heart
of the said deceased patient and to transplant the
said organs to any compatible patient who maybe
in need of said organs to live and survive.
A Certification dated March 10, 1988 was issued
by Dr. Maximo Reyes, Medico-Legal Officer of the
NBI, stating that he received a telephone call from
Dr. Liquete on March 3, 1988 at 9:15 a.m.
regarding the case of Lugmoso, who was declared
brain dead; that despite efforts to locate the
latters relatives, no one responded; that Dr.
Liquete sought from him a second opinion for
organ retrieval for donation purposes even in the
absence of consent from the family of the
deceased; and that he verbally agreed to organ
retrieval.
At 3:45 in the afternoon of March 3, 1988, a
medical team, composed of Dr. Enrique Ona, as
principal surgeon, Drs. Manuel Chua-Chiaco, Jr.,
Rose Marie Rosete-Liquete, Aurea Ambrosio,
Ludivino de Guzman, Mary Litonjua, Jaime
Velasquez, Ricardo Fernando, and Myrna
Mendoza, removed the heart, kidneys, pancreas,
liver and spleen of Lugmoso. The medical team
then transplanted a kidney and the pancreas of
Lugmoso to Lee Tan Hoc and the other kidney of
Lugmoso to Alexis Ambustan. The transplant
operation was completed at around 11:00 oclock
in the evening of March 3, 1988.
On March 4, 1988, Dr. Antonio R. Paraiso, Head of
the Cadaver Organ Retrieval Effort (CORE)
program of NKI, made arrangements with La
Funeraria Oro for the embalmment of the cadaver
of Lugmoso good for a period of fifteen (15) days
to afford NKI more time to continue searching for
the relatives of the latter. On the same day, Roberto
Ortega, Funeral Consultant of La Funeraria Oro,
sent a request for autopsy to the NBI. The Autopsy
Report and Certification of Post-Mortem
Examination issued by the NBI stated that the
cause of death of Lugmoso was intracranial
hemorrhage secondary to skull fracture.
On March 11, 1988, the NKI issued a press release
announcing its successful double organ
transplantation. Aida Doromal, a cousin of
plaintiff, heard the news aired on television that
the donor was an eighteen (18) year old boy
whose remains were at La Funeraria Oro in
Quezon City. As the name of the donor sounded
like Arnelito Logmao, Aida informed plaintiff of
the news report.
It appears that on March 3, 1988, Arlen Logmao, a
brother of Arnelito, who was then a resident of 17-
C San Pedro Street, Mandaluyong, reported to
Police Station No. 5, Eastern Police District,
Mandaluyong that the latter did not return home
after seeing a movie in Cubao, Quezon City, as
evidenced by a Certification issued by said Station;
and that the relatives of Arnelito were likewise
informed that the latter was missing. Upon
receiving the news from Aida, plaintiff and her
other children went to La Funeraria Oro, where
they saw Arnelito inside a cheap casket.
On April 29, 1988, plaintiff filed with the court a
quo a complaint for damages. Plaintiff alleged that
defendants conspired to remove the organs of
Arnelito while the latter was still alive and that
they concealed his true identity.
RTC: On January 17, 2000, the court a quo
rendered judgment finding only Dr. Filoteo Alano
liable for damages to plaintiff and dismissing the
complaint against the other defendants for lack of
legal basis.3
Petitioner appealed to the CA.
CA: Affirmed the decision with modification on the
reward for damages.
Petitioner then elevated the matter to this Court
via a petition for review on certiorari, where the
following issues are presented for resolution:
ISSUES: WHETHER THE COURT OF APPEALS
DISREGARDED EXISTING JURISPRUDENCE
PRONOUNCED BY THIS HONORABLE SUPREME
COURT IN HOLDING PETITIONER DR. FILOTEO
ALANO LIABLE FOR MORAL AND EXEMPLARY
DAMAGES AND ATTORNEY'S FEES DESPITE THE
FACT THAT THE ACT OF THE PETITIONER IS NOT
THE PROXIMATE CAUSE NOR IS THERE ANY
FINDING THAT THE ACT OF THE PETITIONER
WAS THE PROXIMATE CAUSE OF THE INJURY OR
DAMAGE ALLEGEDLY SUSTAINED BY
RESPONDENT ZENAIDA MAGUD-LOGMAO.
B. WHETHER THE COURT OF APPEALS GRAVELY
ERRED IN REFUSING AND/OR FAILING TO
DECLARE THAT PETITIONER DR. ALANO ACTED
IN GOOD FAITH AND PURSUANT TO LAW WHEN
HE ISSUED THE AUTHORIZATION TO REMOVE
AND RETRIEVE THE ORGANS OF ANGELITO
LUGMOSO (LATER IDENTIFIED TO BE IN FACT
ARNELITO LOGMAO) CONSIDERING THAT NO
NEGLIGENCE CAN BE ATTRIBUTED OR IMPUTED
ON HIM IN HIS PERFORMANCE OF AN ACT
MANDATED BY LAW.
C. WHETHER THE COURT OF APPEALS GRAVELY
ERRED IN AWARDING RESPONDENT ZENAIDA
MAGUD-LOGMAO MORAL AND EXEMPLARY
DAMAGES AND ATTORNEY'S FEES THAT ARE NOT
IN ACCORDANCE WITH AND ARE CONTRARY TO
ESTABLISHED JURISPRUDENCE.5
The first two issues boil down to the question of
whether respondent's sufferings were brought
about by petitioner's alleged negligence in
granting authorization for the removal or retrieval
of the internal organs of respondent's son who
had been declared brain dead.
Petitioner maintains that when he gave
authorization for the removal of some of the
internal organs to be transplanted to other
patients, he did so in accordance with the letter of
the law, Republic Act (R.A.) No. 349, as amended
by Presidential Decree (P.D.) 856, i.e., giving his
subordinates instructions to exert all reasonable
efforts to locate the relatives or next of kin of
respondent's son. In fact, announcements were
made through radio and television, the assistance of
police authorities was sought, and the NBI Medico-
Legal Section was notified. Thus, petitioner insists
that he should not be held responsible for any
damage allegedly suffered by respondent due to the
death of her son and the removal of her sons
internal organs for transplant purposes.
The appellate court affirmed the trial court's
finding that there was negligence on petitioner's
part when he failed to ensure that reasonable time
had elapsed to locate the relatives of the deceased
before giving the authorization to remove said
deceased's internal organs for transplant
purposes.
However, a close examination of the records of this
case would reveal that this case falls under one of
the exceptions to the general rule that factual
findings of the trial court, when affirmed by the
appellate court, are binding on this Court. There
are some important circumstances that the lower
courts failed to consider in ascertaining whether it
was the actions of petitioner that brought about
the sufferings of respondent.6
A careful reading shows that petitioner instructed
his subordinates to "make certain" that "all
reasonable efforts" are exerted to locate the
patient's next of kin, even enumerating ways in
which to ensure that notices of the death of the
patient would reach said relatives. It also clearly
stated that permission or authorization to
retrieve and remove the internal organs of the
deceased was being given ONLY IF the
provisions of the applicable law had been
complied with. Such instructions reveal that
petitioner acted prudently by directing his
subordinates to exhaust all reasonable means
of locating the relatives of the deceased. He
could not have made his directives any clearer.
He even specifically mentioned that
permission is only being granted IF the
Department of Surgery has complied with all
the requirements of the law. Verily, petitioner
could not have been faulted for having full
confidence in the ability of the doctors in the
Department of Surgery to comprehend the
instructions, obeying all his directives, and acting
only in accordance with the requirements of the
law.
Furthermore, as found by the lower courts from
the records of the case, the doctors and personnel
of NKI disseminated notices of the death of
respondent's son to the media and sought the
assistance of the appropriate police authorities as
early as March 2, 1988, even before petitioner
issued the Memorandum. Prior to performing the
procedure for retrieval of the deceased's internal
organs, the doctors concerned also the sought the
opinion and approval of the Medico-Legal Officer
of the NBI.
Thus, there can be no cavil that petitioner
employed reasonable means to disseminate
notifications intended to reach the relatives of the
deceased. The only question that remains
pertains to the sufficiency of time allowed for
notices to reach the relatives of the deceased.
If respondent failed to immediately receive notice
of her son's death because the notices did not
properly state the name or identity of the
deceased, fault cannot be laid at petitioner's door.
The trial and appellate courts found that it was the
EAMC, who had the opportunity to ascertain the
name of the deceased, who recorded the wrong
information regarding the deceased's identity to
NKI. The NKI could not have obtained the
information about his name from the patient,
because as found by the lower courts, the
deceased was already unconscious by the time he
was brought to the NKI.
Ultimately, it is respondent's failure to adduce
adequate evidence that doomed this case. As
stated in Otero v. Tan,8 "[i]n civil cases, it is a basic
rule that the party making allegations has the
burden of proving them by a preponderance of
evidence. The parties must rely on the strength of
their own evidence and not upon the weakness of
the defense offered by their opponent." 9 Here,
there is to proof that, indeed, the period of around
24 hours from the time notices were
disseminated, cannot be considered as reasonable
under the circumstances. They failed to present
any expert witness to prove that given the medical
technology and knowledge at that time in the
1980's, the doctors could or should have waited
longer before harvesting the internal organs for
transplantation.
Verily, the Court cannot, in conscience, agree with
the lower court. Finding petitioner liable for
damages is improper. It should be emphasized
that the internal organs of the deceased were
removed only after he had been declared brain
dead; thus, the emotional pain suffered by
respondent due to the death of her son cannot
in any way be attributed to petitioner. Neither
can the Court find evidence on record to show that
respondent's emotional suffering at the sight of
the pitiful state in which she found her son's
lifeless body be categorically attributed to
petitioner's conduct.
WHEREFORE, the petition is GRANTED. The
Decision of the Court of Appeals, dated March 31,
2006, is REVERSED and SET ASIDE. The complaint
against petitioner is hereby DISMISSED.
14. G.R. No. 203080 cesarean section but this was not done. The
midwife arrived and berated her for not yet
DR. IDOL L. BONDOC, Petitioner, v. MARILOU R. sleeping and holding on to the steel bar. The
MANTALA, Respondent. midwife and the younger assistants again pressed
down on her abdomen causing excruciating pain
Facts of the case:
on her ribs and made her very weak. They
On November 6, 2009, Marilou R. Mantala
repeatedly did this pressing until the baby and
(respondent) filed a complaint for grave
placenta came out. When she regained
misconduct against Dr. Idol L. Bondoc (petitioner),
consciousness, she was already at the recovery
Medical Officer III at the Oriental Mindoro
room. She learned that an operation was
Provincial Hospital (OMPH).
performed on her by petitioner to remove her
ruptured uterus but what depressed her most
Respondent was admitted at the OMPH on April 3,
was her stillborn baby and the loss of her
2009, at around 11:00 in the morning, with
reproductive capacity. The next day, she was
referral5 from the Bansud Municipal Health Office
transferred to a ward. She noticed her very
(BMHO). She was due to deliver her fifth child and
swollen vulva and her surgical wound open with
was advised by the BMHO for a cesarean
liquid squirting from it. Her wound was regularly
section because her baby was big and there
cleaned by a nurse. On April 9, 2009, she was
was excessive amniotic fluid in her womb. She
discharged notwithstanding that the suture on her
started to labor at 7:00 in the morning and was
wound needs to be fixed and she still has a cough.
initially brought to the Bongabon Health Center.
At home, she took the antibiotics, cough medicine
However, said health center also told her to
and multivitamins prescribed by petitioner.
proceed directly to the hospital.
After two days, the opening in her wound
In her complaint-affidavit,6 respondent alleged
widened. Her husband brought her to the
that inside the delivery room of OMPH, she was
Bongabon Community Hospital but they were
attended to by petitioner who instructed the
advised to have her wound re-stitched by the same
midwife and two younger assistants to press down
surgeon (petitioner) who operated on her. Thus,
on respondent's abdomen and even demonstrated
on April 14, 2009, they went back to OMPH. She
to them how to insert their fingers into her vagina.
was attended to by a certain Dr. Gonzales who
Thereafter, petitioner went out of the delivery
cleaned her wound which now has a lot of pus,
room and later, his assistants also left. As she
and the said doctor commented that "problema ito
labored in pain, she felt the movement of her baby
ni Bondoc." On April 18, 2009, after she was given
inside her womb and the intermittent stiffening of
blood transfusion, petitioner re-stitched her
her abdomen.
wound. Thereafter, it was Dr. Gonzales who
regularly checked on her condition.
At about 4:00 in the afternoon, petitioner returned
to the delivery room and asked her, "Hindi ka pa
On April 27, 2009, petitioner removed the sutures
nanganganak?" Since she could no longer bear the
but still left open three of them. She wondered
pain, she requested petitioner to perform a
then why petitioner suddenly showed kindness
towards her. In the evening of April 28, 2009,
petitioner talked to her and said in a threatening
tone "Ikaw ang sadyang ayaw magpa-cs" and also
told her that he just came from Pinamalayan and
Bansud and already talked to Dr. Atienza and Dr.
Sales. Petitioner then told the nurse on
duty, "Papirmahin mo si Mantala, pauuwiin ko na
'yan bukas. Tanggalin mo na rin ang tahi." He
further said, "huwag sana akong idemanda ni
Mantala kasi kaya ko siyang baligtarin" The
following day, she was discharged after the nurse
had removed the remaining sutures. At home, it
was her sister who cleaned the still open wound.
Joel F. Mantala, respondent's husband, and her
sisters Mylen R. Amistad and Lucia Rala, executed
their respective affidavits7 to corroborate her
story. In addition, respondent submitted the
affidavit of Dr. Rosinico F. Fabon, the
anesthesiologist on duty during the operation
performed by petitioner on April 3, 2009.
Joel Mantala claimed that at the OMPH at around
2:30 in the afternoon when her wife was still
laboring, petitioner talked to him and told her that
the baby is too big and if it comes out alive it will
probably be abnormal so that it would be better if
the baby is stillborn. He further averred that
despite the pleas of her wife for a cesarean
operation, petitioner insisted on a normal delivery
during which she almost died. 8
On the other hand, Dr. Fabon narrated that in the
afternoon of April 3, 2009, he was attending to a
patient being operated on by petitioner when he
heard the latter saying that "meron pa nga kami sa
DR macrosomia, polyhydramnios pa, pero paanakin
na lang 'yon, abnormal din naman ang bata kahit
mabuhay, kawawa lang siya" After the operation,
petitioner went out of the Operating Room (OR)
and proceeded towards the direction of the OB
ward. At 5:35 in the afternoon, a Request for
Surgery[9was forwarded to the OR for Emergency
Pelvic Laparotomy of respondent with a diagnosis
of T/C Ruptured Uterus.
When respondent was brought to the OR at 8:15
p.m., Dr. Fabon found her conscious but very weak
and pale, with abdominal pain and tenderness on
very slight palpation. He then heard from
petitioner himself that it was the same patient he
was referring to earlier with a diagnosis of
macrosomia, polyhydramnios. Petitioner
volunteered that respondent had just delivered
her baby but that her uterus probably ruptured in
the process of childbirth. "Pinilit no 'ng tatlong
ungas, ayon lumusot pero patay ang bata, tapos Ho,
mukhang pumutok" petitioner said.
Dr. Fabon immediately prepared respondent for
General Anesthesia; respondent was inducted at
8:35 p.m. while surgery began at 8:45 p.m. He
continued to narrate what transpired next and his
observations, as
That right after induction - when patient was
asleep already and don't feel any pain at all - her
blood pressure suddenly dropped to 70/40
That after opening the abdomen, I saw massive
hemoperitonium and the ruptured uterus with
bleeding from various directions. I immediately
requested for additional blood to be used intra-
operatively while at the same time I established
another intravenous line so as to cope with on-
going surgical blood loss. I had now three big-bore
fast-dripping IV lines.
That in spite of this measure, blood pressure
dropped to 50/30 mmHg. There was an instance
wherein I cannot even appreciate the blood
pressure of the patient, her pulse hardly
noticeable on palpation and she was very pale that
necessitates turning the anesthetic gas off so as to
keep her alive. She was given a dose of Atropine
after patient did not respond to two l0mg doses of
Ephedrine. I prescribed Dobutamine and
Dopamine drips to help improve her blood
pressure and maintain adequate urine output.
Unfortunately, only Dopamine was available. I had
to use 100% Oxygen at 3L/minute without
mixture of volatile gas for several minutes. She
was maintained using muscle relaxants alone on
controlled ventilation.
That Dr. Bondoc operated on the patient all by
himself without the help of a consultant or an
assistant surgeon. Nowhere in the patient chart
will show that he referred this case to his
consultant; one thing that I was wondering why he
was doing the surgery alone. He utilized the scrub
nurse to assist him making a delicate and bloody
surgery more bloody and difficult.
That after Dr. Bondoc had removed the ruptured
uterus and the bleeding was controlled, he made
intra-operative referral to Dr. Ariel Tria, a resident
surgeon, to check on the urinary bladder and the
ureters.
That the operation performed was Subtotal
Hysterectomy with Unilateral
Salpingooophorectomy. I noticed that the
operation technique was different from that which
Dr. Bondoc had written in the Surgical Memo and
that the patient did not tolerate the procedure
well.
That the patient was very pale after the procedure
with low blood pressure due to massive blood
loss. That her blood pressure started to improve at
the Recovery Room but the pulse rate remained
considerably high for several hours. Her urine
output was inadequate and that it had to be
maintained using Dopamine.
That when Leo Reyes, the Recovery Room nurse,
referred the patient to me and I checked the
urinary catheter, I noticed her vagina to be
massively swollen with hematomas all over.
That the patient had to be referred to Internal
Medicine for co-management[.]
That Marilou Mantala stayed in the Recovery
Room for almost eleven (11) hours. She was
transferred to Gyne Ward at 9:20 AM the following
day.10
In his counter-affidavit,11 petitioner averred that
when respondent was brought to OMPH with
referral form from BMHO, she had been in labor
for more than twelve (12) hours at home. He
submitted his admitting diagnosis of the patient,
"Gravida 5 Parity 4 (4004) Pregnancy Uterine 38
to 39 Weeks Age of Gestation by Last Menstrual
Period Cephalic in Labor; Macrosomia; Fetal Death
in Utero."
Petitioner alleged that during his interview with
respondent, the latter admitted to him that she
doesn't want to be confined at any hospital
because she was afraid to be handled by medical
doctors. Instead, she went to a traditional birth
attendant (TBA) or "hilot which she voluntarily
named as Apolonia Salcedo, residing at Dalapian,
Labasan, Bongabon, Oriental Mindoro.
Respondent clearly defied the advice of Drs.
Theresa Atienza and Mario Sales not to give birth
at home. As to her swollen vulvar hematoma
which was noticed by Dr. Fabon, it was the result
of prolonged labor.
As to the charge that he abandoned the
respondent to his assistants, petitioner claimed
that between 12 noon and 2:00 o'clock in the
afternoon, he was busy checking on pregnant
patients at the out-patient department (OPD) of
OMPH until he was called for his first cesarean
section (CS). Later at 4:00 o'clock, without resting
and having lunch, he visited respondent and other
admitted patients at the delivery room. Together
with the nurse on duty, Mrs. Evelyn D. Morales,
petitioner said he explained to respondent her and
her baby's condition based on the referral from
BMHO (polyhydramnios) and initial findings that
her abdomen and baby were big and the baby's
heartbeat is not appreciated. He presented the
respondent with two options: have a normal
delivery or undergo cesarean section, and the
consequences of each choice. Respondent chose
the former believing that she can handle this
childbirth at home, and petitioner respected her
decision.
After seeing other patients at the delivery room,
petitioner was called for his second CS that day.
Thus, he was obliged to proceed to the OR and left
the respondent under the care of three assistants,
one of whom is an experienced midwife. That he
was not the one who attended to the, respondent
during her delivery is confirmed by the statements
of respondent herself, Dr. Fabon and Mrs. Morales.
Further, petitioner claimed it has been a long-time
practice at OMPH that whenever the doctor is at
the OR, the experienced midwives will take over
the delivery of laboring patients.
Petitioner blamed respondent for risking her own
life in not seeking immediately a higher level of
medical care and instead preferring a TBA who is
prohibited under a 2006 provincial circular to
handle deliveries at home. He emphasized that
upon admission the fetal heart tone is no longer
appreciated and maintained that diligent care was
extended to respondent during her stay at OMPH.
As to the complications like cough and wound
dehiscence, he explained that these were the
effects of anesthesia and surgery (loss of blood,
massive blood transfusion and intravenous fluid
infusion), and also poor compliance with
prescribed medication. He further asserted that he
had referred the patient to other co-doctors on
duty like Dr. Romy Lomio (Internal Medicine) for
co-management.
On April 23, 2010, petitioner submitted a
manifestation that he had resigned as Medical
Officer of OMPH effective March 5, 2010. He
thus posited that the administrative case is
now rendered moot and academic.
On August 12, 2010, the Office of the Deputy
Ombudsman for Luzon rendered a Decision
finding the petitioner administratively liable. It
held that by fully entrusting to his subordinates
the task of handling respondent's complicated
delivery, petitioner exhibited an improper or
wrongful conduct and dereliction of duty as
medical practitioner. Being the most competent
person who should have rendered the appropriate
medical service to respondent, petitioner should
have personally attended to the latter. Such action
or inaction of his part amounts to intentional or
willful neglect in discharging his sworn duty as a
government physician which is also equivalent to
misconduct in office. The administrative case filed
against the respondent is also not rendered moot
by his subsequent resignation in office.

The Decision of the OMB:
Medical Officer Idol L. Bondoc of Oriental
Mindoro Provincial Hospital (OMPH) - guilty of
Grave Misconduct with penalty of DISMISSAL in
the Government Service pursuant to Section 10,
Rule III, Administrative Order No. 07, as amended
by Administrative Order No. 17, in relation to
Section 25 of Republic Act No. 6770. The penalty
of dismissal shall carry with it that of cancellation
of eligibility, forfeiture of the retirement benefits,
and the perpetual disqualification for
reemployment in the government service
pursuant to Section 58, Rule IV of the Uniform
Rules on Administrative Cases in the Civil Service.
The foregoing ruling was affirmed by the CA
and petitioner's motion for reconsideration
was denied.
The CA concurred that petitioner should have
chosen to stay in the delivery room and
personally attend to the patient as he is the
most competent person to render medical
service in view of respondent's critical condition.
It likewise faulted the petitioner for deliberately
leaving the laboring and unstable respondent to
the care of his inexperienced subordinates at the
time she was about to give birth. As to petitioner's
excuse that he had to attend to an equally
important cesarean operation, the CA said there
was no sufficient showing of the latter's urgency
and assuming it to be true, still, petitioner should
have exerted efforts to refer respondent's case to
another competent doctor or one of his
consultants.
Petitioner is now before this Court arguing that
the CA erred in affirming the Ombudsman's ruling
that he is guilty of grave misconduct and imposing
on him the penalty of dismissal from the service.
SC: The petition has no merit.
Misconduct is defined as a transgression of some
established and definite rule of action, more
particularly, unlawful behavior or gross negligence
by a public officer,13 a forbidden act, a dereliction
of duty, willful in character, and implies wrongful
intent and not mere error in judgment. 14 It
generally means wrongful, improper or unlawful
conduct motivated by a premeditated, obstinate or
intentional purpose. The term, however, does
not necessarily imply corruption or criminal
intent. To constitute an administrative offense,
misconduct should relate to or be connected with
the performance of the official functions and
duties of a public officer. On the other hand, when
the elements of corruption, clear intent to violate
the law or flagrant disregard of established rule
are manifest, the public officer shall be liable for
grave misconduct.15
In this case, both the Ombudsman and CA found
the petitioner guilty of grave misconduct in
failing to attend to respondent when she was
having prolonged difficult labor and vaginal
delivery after being diagnosed with macrosamia
and polyhydramnios.
Polyhydramnios is an abnormal condition
occurring in pregnancy, characterized by excessive
amniotic fluid (the fluid surrounding the baby in
the uterus). Apart from protecting the baby from
any external impact by providing a cushioning
effect, the clear or slightly yellowish fluid plays a
vital role in proper fetal development as well.
However, increased levels of the fluid can cause
various complications during different stages of
pregnancy and childbirth.16 Intra-amniotic
pressure is markedly elevated in most patients
with severe hydramnios. The incidence of
cesarean section is also increased as a result of
unstable lie and placental abruption, which may
occur with the rapid decrease in intrauterine
pressure that accompanies membrane rupture. 17
One of the known causes and risk factors
of polyhydramnios is fetal macrosomia (having a
baby too large for the gestational age).18
According to medical authorities, a macrosomic
infant poses a different set of complications. The
incidences of shoulder dystocia,19 birth injuries,
perinatal death, and low Apgar scores are
increased in macrosomic infants.20 In these cases,
careful attention to the patient, potential risk
factors, clinical progress, and fetal size should
allow obstetricians to reduce the occurrence of
maternal and neonatal morbidity.21 Vaginal
delivery of the macrosomic infant is associated
with an increased incidence of birth trauma. The
question whether to perform cesarean section
thus arises.22
If the estimated fetal weight is 4000 to 4500 g by
ultrasonography and the patient has a clinically
adequate pelvis, labor may be allowed. If labor is
protracted or the second stage is prolonged, a
cesarean section would avoid the possible trauma
of a difficult vaginal delivery. Because of the
greater morbidity associated with infants who
weigh more than 4500 g, elective cesarean section
is warranted. On the other hand, prolonged labor
may culminate in obstructed labor, and is
associated with maternal infection, uterine
rupture and postpartum hemorrhage.24
As per the admitting diagnosis [25 submitted by
petitioner, the latter was aware of macrosomia and
the fetal heartbeat not appreciated. He also
maintains that respondent's baby was already
dead due to prolonged labor but she had insisted
on having a normal delivery. However, this claim is
belied by the sworn statements of respondent, her
husband and her sisters, all of whom averred that
they requested for a cesarean section as per the
advice given by Dr. Atienza who examined her in
March 2009, and as confirmed at the Bansud
Health Center where she was told that it would be
risky for her to have a normal delivery. Moreover,
Joel Mantala asserted that what petitioner said to
him was that the baby was too big and if born alive
it would probably have abnormalities so it would
be better that the baby is stillborn.
The Court is more inclined to believe respondent's
version which was duly corroborated by Dr. Fabon
who heard petitioner saying that: "Meron pa nga
kami sa DR macrosomnia, polyhydramnios pa, pero
paanakin na long 'yon. Abnormal din naman ang
bata kahit mabuhay." This puts into doubt
petitioner's supposed finding that the baby was
already dead upon respondent's admission at
OMPH and that it was respondent who insisted on
a normal delivery. Even assuming that petitioner
had actually confirmed intrauterine fetal death,
this only aggravates the patient's condition and it
was incumbent upon petitioner as the obstetrician
on duty to personally attend to her and render
appropriate management or treatment.
In deliberately leaving the respondent to a
midwife and two inexperienced assistants despite
knowing that she was under prolonged painful
labor and about to give birth to a macrosomic
baby by vaginal delivery, petitioner clearly
committed a dereliction of duty and a breach
of his professional obligations. The gravity of
respondent's condition is highlighted by the
expected complications she suffered - her stillborn
baby, a ruptured uterus that necessitated
immediate surgery and blood transfusion, and
vulvar hematomas.
Article II, Section 1 of the Code of Medical Ethics of
the Medical Profession in the Philippinesstates:
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 physician's 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.26
A doctor's duty to his patient is not required to be
extraordinary. The standard contemplated for
doctors is simply the reasonable average merit
among ordinarily good physicians, i.e. reasonable
skill and competence.27 Even by this standard,
petitioner fell short when he routinely delegated
an important task that requires his professional
skill and competence to his subordinates who
have no requisite training and capability to make
crucial decisions in difficult childbirths.
Petitioner's proffered excuse that it was the
practice in OMPH to allow midwives to administer
to patients during deliveries, is unacceptable. No
proof of such alleged hospital practice such as an
official written directive was presented. Besides, it
is doubtful whether hospital administrators would
remedy personnel shortage by permitting
inexperienced staff, by themselves, to handle
laboring patients with high-risk pregnancies and
maternal/fetal complications.
As to the two other scheduled CS performed by
petitioner on the same day, this will not exculpate
him from administrative liability. As correctly
pointed out by the CA, there was no showing of
similar urgency in the said operations, and
petitioner could have referred respondent to
another competent physician. He could have
likewise arranged for adjustment in the operation
schedules considering that his personal attention
and management is urgently needed in
respondent's difficult and complicated delivery.
But there is no indication in the records that
petitioner duly informed or referred the matter to
the other doctors or the administrators of OMPH.
We therefore hold that the CA correctly
affirmed the Ombudsman in finding the
petitioner guilty of grave misconduct. His
violation of the sworn duty to attend to his
patients faithfully and conscientiously is
inexcusable. Such flagrant disregard of
established rule and improper conduct were
proven by substantial evidence.
Not only did petitioner routinely delegate his
responsibility to his subordinates, he casually
instructed them to press down repeatedly on
respondent's abdomen, unmindful of her critical
condition as borne out by his very own findings.
Worse, petitioner haughtily and callously spoke of
respondent's case to the other doctors and
medical staff while performing a CS after he had
briefly attended to her at the delivery room
"...paanakin na long 'yon, abnormal din naman ang
bata kahit mabuhay, kawawa lang siya." Such
insensitive and derisive language was again heard
from the petitioner when he referred for the
second time to respondent's traumatic delivery,
saying that: "Pinilit no 'ng tatlong ungas, ayon
lumusot pero patay ang bata, tapos ito, mukhang
pumutok" As a government physician, petitioner's
demeanor is unbecoming and bespeaks of his
indifference to the well-being of his patients.
Petitioner thus not only committed a dereliction of
duty, but also transgressed the ethical norms of his
profession when he failed to render competent
medical care with compassion and respect for his
patient's dignity.
A physician should be dedicated to provide
competent medical care with full professional skill
in accordance with the current standards of care,
compassion, independence and respect for human
dignity.28 (Italics supplied.)
Finally, we find no merit in petitioner's argument
that the CA should have at least considered as
mitigating circumstances his being a first
offender,29 his 16 years in government service, and
that he had not acted in bad faith and with clear
intent to violate the law and established rules.
Jurisprudence is replete with cases declaring that
a grave offense cannot be mitigated by the fact
that the accused is a first time offender or by
the length of service of the accused.30
While in most cases, length of service is
considered in favor of the respondent, it is not
considered where the offense committed is found
to be serious or grave.31 In Medina v. Commission
on Audit,32 the Court stressed that dishonesty and
grave misconduct have always been and should
remain anathema in the civil service. They
inevitably reflect on the fitness of a civil servant to
continue in office. When an officer or employee is
disciplined, the object sought is not the
punishment of such officer or employee but the
improvement of the public service and the
preservation of the public's faith and confidence in
the government.
WHEREFORE, the petition is DENIED for lack of
merit. The Decision dated May 24, 2012 and
Resolution dated August 14, 2012 of the Court of
Appeals in CA-G.R. SP No. 120563 are AFFIRMED
and UPHELD.
15. SPS. ALFREDO BONTILAO AND SHERLINA
BONTILAO, petitioners, vs. DR. CARLOS GERONA,
respondent.
Notes: It is a rule of evidence whereby negligence
of the alleged wrongdoer may be inferred from the
mere fact that the accident happened, provided
that the character of the accident and
circumstances attending it lead reasonably to the
belief that in the absence of negligence it would
not have occurred and that the thing which caused
injury is shown to have been under the
management and control of the alleged
wrongdoer.
Res ipsa loquitur is a rebuttable presumption or
inference that the defendant was negligent. The
presumption only arises upon proof that the
instrumentality causing injury was in the
defendants exclusive control, and that the
accident was one (1) which ordinarily does not
happen in the absence of negligence.
Res ipsa loquitur is not a rigid or ordinary
doctrine to be perfunctorily used but a rule to be
cautiously applied, depending upon the
circumstances of each case. In malpractice cases,
the doctrine is generally restricted to situations
where a layman is able to say, as a matter of
common knowledge and observation, that the
consequences of professional care were not as
such as would ordinarily have followed if due care
had been exercised.
Facts of the case:
Allen Key, 8-year old son of Alfredo and Sherlina,
was treated by Dr. Carlos for a fractured right
wrist. He administered a U-splint on Allen Key
then sent him home. On June 4, 1992, Allen
refracted the same wrist, where x-ray examination
showed a complete fracture and displacement of
the bone. Dr. Carlos then performed a closed
reduction procedure with Dr. Vicente as
anaesthesiologist. After the post-reduction x-ray
showed that the bones were properly aligned,
Allen was sent home with instruction to bring him
for re-tightening not later than June 15, 1992. It
was later that Allen was brought to the hospital.
Because no retightening happened, a rotational
deformity had developed in Allens arm, caused by
a re-displacement of the bone fragments,
necessitating an open reduction surgery which
was set on June 24, 1992 by Dr. Carlos as surgeon
and again Dr. Vicente as anaesthesiologist.
Sherlina was allowed to observe the procedure.
After five attempts, Dr. Vicente failed to intubate
Allen Key, so anaesthesia was administered
through a gas mask. When Dr. Carlos asked if the
operation should continue with the failure to
intubate, Dr. Vicente gave the go-ahead. Dr. Carlos
checked if Allen Key was breathing properly
before proceeding with the surgery. Sherlina
went out temporarily to make a telephone call
when she saw Dr. Carlos about to finish the
suturing, but was informed that her son died at
the operating table due to asphyxia due to
congestion and edema of the epiglottis.
Allen Keys parents then filed criminal and
administrative charges against Dr. Carlos and Dr.
Vicente, as well as instituted a civil case for
damages against both doctors, alleging
incompetence and negligence in the performance
of their duty.
RTC: Applying the doctrine of res ipsa loquitor,
found Dr. Carlos and Dr. Vicente solidarily liable
and ordered them to pay damages.
Out of this decision, only Dr. Carlos appealed to the
Court of Appeals, as Dr. Vicente opted not to file
his appeal.
CA: Reversed the RTC ruling, holding that Dr.
Carlos is not liable under the doctrine of res ipsa
loquitor, and in applying the captain of the ship
doctrine in the case. Here, the anaesthesiologist
was chosen by the spouses, and no negligence was
attributable to Dr. Carlos.
The spouses then elevated their case against Dr.
Carlos to the Supreme Court:
SC: The trial court erred in applying the
doctrine of res ipsa loquitur to pin liability on
respondent for Allens death. Res ipsa loquitur
is a rebuttable presumption or inference that the
defendant was negligent. The presumption only
arises upon proof that the instrumentality causing
injury was in the defendants exclusive control,
and that the accident was one (1) which ordinarily
does not happen in the absence of negligence. It is
a rule of evidence whereby negligence of the
alleged wrongdoer may be inferred from the mere
fact that the accident happened, provided that the
character of the accident and circumstances
attending it lead reasonably to the belief that in
the absence of negligence it would not have
occurred and that the 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 the
plaintiff produces substantial evidence that the
injury was caused by an agency or instrumentality
under the exclusive control and management of
the defendant, and that the injury was such that in
the ordinary course of things would not happen if
reasonable care had been used.
However, res ipsa loquitur is not a rigid or
ordinary doctrine to be perfunctorily used but a
rule to be cautiously applied, depending upon the
circumstances of each case. In malpractice cases,
the doctrine is generally restricted to situations
where a layman is able to say, as a matter of
common knowledge and observation, that the
consequences of professional care were not as
such as would ordinarily have followed if due care
had been exercised. In other words, as held in
Ramos v. Court of Appeals,[14] the real question
is whether or not in the process of the
operation, any extraordinary incident or
unusual event outside of the routine
performance occurred which is beyond the
regular scope of professional activity in such
operations, and which, if unexplained, would
themselves reasonably speak to the average
man as the negligent cause or causes of the
untoward consequence.
Here, we find that the CA correctly found that
petitioners failed to present substantial evidence
of any specific act of negligence on respondents
part or of the surrounding facts and circumstances
which would lead to the reasonable inference that
the untoward consequence was caused by
respondents negligence. In fact, under the
established facts, respondent appears to have
observed the proper amount of care required
under the circumstances. Having seen that Dr.
Jabagat failed in the intubation, respondent
inquired from the latter, who was the expert on
the matter of administering anesthesia, whether
the surgery should be postponed considering the
failure to intubate. X X X
xxx
Respondent further verified that Allen was still
breathing by looking at his chest to check that
there was excursion before proceeding with the
surgery. That respondent decided to continue
with the surgery even though there was a failure
to intubate also does not tend to establish liability,
contrary to the trial courts ruling. Petitioners
failed to present substantial proof that intubation
was an indispensable prerequisite for the
operation and that it would be grave error for any
surgeon to continue with the operation under
such circumstances. In fact, the testimony of the
expert witness presented by the prosecution in
the criminal proceedings and admitted into
evidence at the RTC, was even to the effect that the
anesthesia could be administered by alternative
means such as a mask and that the operation
could proceed even without intubation.
There was also no indication in the records that
respondent saw or should have seen that
something was wrong as to prompt him to act
differently than he did in this case. The anesthesia
used in the operation was the same anesthesia
used in the previous closed reduction procedure,
and Allen did not register any adverse reaction to
it. In fact, respondent knows the anesthesia
Ketalar to be safe for children. Dr. Jabagat was also
a specialist and more competent than respondent
to determine whether the patient has been
properly anesthetized for the operation, all things
considered. Lastly, it appears that Allen started
experiencing difficulty in breathing only after the
operation, when respondent was already about to
jot down his post-operation notes in the adjacent
room. Respondent was called back to the
operating room after Dr. Jabagat failed to
appreciate a heartbeat on the patient. He acted
promptly and called for other doctors to assist and
revive Allen, but to no avail.
Moreover, we note that in the instant case, the
instrument which caused the damage or injury
was not even within respondents exclusive
management and control as Dr. Jabagat was
exclusively in control and management of the
anesthesia and the endotracheal tube. 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.

Here, the respondent could only supervise Dr.

Jabagat to make sure that he was performing his
duties. But respondent could not dictate upon Dr.
Jabagat the particular anesthesia to administer,
the dosage thereof, or that it be administered in
any particular way not deemed appropriate by Dr.
Jabagat. Respondents specialization not being in
the field of anesthesiology, it would be dangerous
for him to substitute his judgment for Dr. Jabagats
decisions in matters that fall appropriately within
the scope of Dr. Jabagats expertise.

Under the above circumstances, although the

Court commiserates with the petitioners on their
infinitely sorrowful loss, the Court cannot properly
declare that respondent failed to exercise the
required standard of care as lead surgeon as to
hold him liable for damages for Allens death.

In civil cases, the burden of proof to be established

by preponderance of evidence is on the plaintiff
who is asserting the affirmative of an issue. Unless
the party asserting the affirmative of an issue
sustains the burden of proof, his or her cause will
not succeed.