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E. M.

WRIGHT, plaintiff-appellant, While both parties appealed from the decision, the defendant on the ground that it
vs. was not liable and the plaintiff on the ground that the damages were insufficient
MANILA ELECTRIC R.R. & LIGHT CO., defendant-appellant. according to the evidence, and while the plaintiff made a motion for a new trial upon
the statutory grounds and took proper exception to the denial thereof, thus conferring
MORELAND, J.: upon this court jurisdiction to determine the question of fact, nevertheless, not all of
the testimony taken on the trial, so far as can be gathered from the record, has been
brought to this court. There seems to have been two hearings, one on the 31st of
This is an action brought to recover damages for injuries sustained in an August and the other on the 28th of September. The evidence taken on the first
accident which occurred in Caloocan on the night of August 8, 1909. hearing is here; that taken on the second is not. Not all the evidence taken on the
The defendant is a corporation engaged in operating an electric street hearings being before the court, we must refuse, under our rules, to consider even
railway in the city of Manila and its suburbs, including the municipality of that evidence which is here; and, in the decision of this case, we are, therefore,
Caloocan. The plaintiff's residence in Caloocan fronts on the street along relegated to the facts stated in the opinion of the court and the pleadings filed.
which defendant's tracks run, so that to enter his premises from the street
plaintiff is obliged to cross defendant's tracks. On the night mentioned
A careful reading of the decision of the trial court leads us to the conclusion that there
plaintiff drove home in a calesa and in crossing the tracks to enter his
is nothing in the opinion which sustains the conclusion of the court that the plaintiff
premises the horse stumbled, leaped forward, and fell, causing the vehicle
was negligent with reference to the accident which is the basis of this action. Mere
with the rails, resulting in a sudden stop, threw plaintiff from the vehicle and
intoxication establish a want of ordinary care. It is but a circumstance to be
caused the injuries complained of.
considered with the other evidence tending to prove negligence. It is the general rule
It is undisputed that at the point where plaintiff crossed the tracks on the
that it is immaterial whether a man is drunk or sober if no want of ordinary care or
night in question not only the rails were above-ground, but that the ties upon
prudence can be imputed to him, and no greater degree of care is required than by a
which the rails rested projected from one-third to one-half of their depth out
sober one. If one's conduct is characterized by a proper degree of care and prudence,
of the ground, thus making the tops of the rails some 5 or 6 inches or more
it is immaterial whether he is drunk or sober.
above the level of the street.
It is admitted that the defendant was negligent in maintaining its tracks as
described, but it is contended that the plaintiff was also negligent in that he If intoxication is not in itself negligence, what are the facts found by the trial court and
was intoxicated to such an extent at the time of the accident that he was stated in its opinion upon which may be predicated the finding that the plaintiff did not
unable to take care of himself properly and that such intoxication was the use ordinary care and prudence and that the intoxication contributed to the injury
primary cause of the accident. complained of? After showing clearly and forcibly the negligence of the defendant in
leaving its tracks in the condition in which they were on the night of the injury, the
court has the following to say, and it is all that can be found in its opinion, with
TRIAL COURT held that both parties were negligent, but that the plaintiff's negligence
reference to the negligence of the plaintiff: "With respect to the condition in which Mr.
was not as great as defendant's and under the authority of the case of Rakes vs. A. Wright was on returning to his house on the night in question, the testimony of Doctor
G. & P. Co. apportioned the damages and awarded plaintiff a judgment of P1,000. Kneedler, who was the physician who attended him an hour after the accident,
demonstrates that he was intoxicated. . . . .
Whether the negligence of plaintiff contributed t the 'principal occurrence' or 'only to
his own injury.' If the former, he cannot recover; if the latter, the trial court was correct If the defendant or its employees were negligent by reason of having left the rails and
in apportioning the damages." a part of the ties uncovered in a street where there is a large amount of travel, the
plaintiff was no less negligent, he not having abstained from his custom of taking
Whether or not the plaintiff was negligent, and, if so, to what extent. If the negligence more wine than he could carry without disturbing his judgment and his self-control, he
of the plaintiff was the primary cause of the accident then, of course, he cannot knowing that he had to drive a horse and wagon and to cross railroad tracks which
recover; if his negligence had nothing to do with the accident but contributed to his were to a certain extent dangerous by reason of the rails being elevated above the
injury, then the court was right in apportioning the damages, but if there was no level of the street.
negligence on the part of the plaintiff, then he should be awarded damages
adequates to the injury sustained." If the plaintiff had been prudent on the night in question and had not attempted to
drive his conveyance while in a drunken condition, he would certainly have avoided
In support of the defendant's contention counsel says: "Defendant's negligence was the damages which he received, although the company, on its part, was negligent in
its failure properly to maintain the track; plaintiff's negligence was his intoxication; the maintaining its tracks in a bad condition for travel.
'principal occurrence' was plaintiff's fall from his calesa. It seems clear that plaintiff's
intoxication contributed to the fall; if he had been sober, it can hardly be doubted that Both parties, therefore, were negligent and both contributed to the damages resulting
he would have crossed the track safely, as he had done a hundred times before." to the plaintiff, although the plaintiff, in the judgment of the court, contributed in
greater proportion to the damages that did the defendant.
As is clear from reading the opinion, no facts are stated therein which warrant the which he arrived at such findings. Neither evidence, argument, nor comment has any
conclusion that the plaintiff was negligent. The conclusion that if he had been sober legitimate place in findings of facts. (Conlan vs. Grace, 36 Minn., 276, 282.)
he would not have been injured is not warranted by the facts as found. It is impossible
to say that a sober man would not have fallen from the vehicle under the conditions BUTARO YAMADA, Plaintiff-Appellee, vs. THE MANILA RAILROAD CO.,
described. A horse crossing the railroad tracks with not only the rails but a portion of defendant, and BACHRACH GARAGE & TAXICAB CO., Defendant-Appellant.
the ties themselves aboveground, stumbling by reason of the unsure footing and
falling, the vehicle crashing against the rails with such force as to break a wheel, this
might be sufficient to throw a person from the vehicle no matter what his condition; The three cases dealt with in this decision differ in their facts only with respect to the
and to conclude that, under such circumstances, a sober man would not have fallen injury suffered by the respective plaintiffs. The law applicable to them is the same
while a drunken man did, is to draw a conclusion which enters the realm of and, at the request of counsel, they will be decided at the same time. Plaintiffs claim
speculation and guesswork. damages against both the railroad and the garage company because of injuries
suffered by them in a collision between a train owned by and operated over tracks
belonging to the railroad company and an automobile the property of the Bachrach
It having been found that the plaintiff was not negligent, it is unnecessary to discuss Garage & Taxicab Co.
the question presented by the appellant company with reference to the applicability of
the case of Rakes vs. A. G. & P. Co., above; and we do not find facts in the opinion of
the court below which justify a larger verdict than the one found. On January 2, 1913, the plaintiffs, together with three companions, hired an
automobile from the defendant taxicab company for a trip to Cavite Viejo. The
automobile was secured at a certain price hour and was driven and controlled by a
Separate Opinions chauffeur supplied by the taxicab company. The journey to Cavite Viejo was made
without incident but, on the return trip, while crossing the tracks of defendant railroad
CARSON, J., dissenting: company in the barrio of San Juan, municipality of Cavite Viejo, the automobile was
struck by a train and the plaintiffs injured.
I dissent. I think, in the first place, that before pronouncing judgment the parties
should have an opportunity, if they so desire, to correct the manifestly accidental The trial court dismissed the complaint on the merits as to the Manila Railroad
omission from the record of a part of the transcript of the record. It is very clear that Company and held the defendant taxicab company liable for damages to the plaintiffs
when the case was submitted, and the brief filed, both parties were under the in various amounts. The taxicab company appealed.
mistaken impression that all the evidence was in the record.
It appears from the record, and was found by the trial court, that the driver of the
I think, furthermore, that if the case is to be decided on the findings of fact by the trial automobile drove his machine upon the railroad tracks without observing the
judge, these findings sufficiently establish the negligence of the plaintiff.1awphil.net precautions which ordinary care and prudence would require, without reducing speed
and without taking any precaution looking to determining whether there was danger
The trail judge expressly found that If the plaintiff had been prudent on the night in from a train or locomotive. The trial court accordingly found that the driver was guilty
question and had not attempted to drive his conveyance while in a drunken condition, of gross negligence and that said negligence was the proximate cause of the
he would certainly have avoided the damages which he received, although the accident. It also found that the driver had been, in effect, instructed by the taxicab
company, on its part was negligent in maintaining its tracks in a bad condition for company to approach and pass over railroad tracks in the manner and form followed
travel. and observed on the occasion in question, and that, for that reason, the taxicab
company was liable for the damages caused.
This is a finding of fact the fact of negligence and I know of no rule which
requires the trial court to set forth not only the ultimate facts found by it, but also all Several errors are assigned by the appellant. The first one relates to the finding of
the evidentiary facts on which such conclusions are based. The finding is not in the trial court: "That the driver of the automobile did not slacken speed, which was
conflict with the other facts found by the trial judge, and though it is not fully sustained fast, upon approaching the railroad crossing, which was clearly visible and had to be
thereby, we must assume, if we decline to examine the record, that there were approached on an upward grade, or take any other precaution to avert accident. ...
evidentiary facts disclosed at the trial which were sufficient to sustain the finding if and I can but conclude that the driver of the automobile was grossly negligent and
negligence. "The statement of facts must contain only those facts which are essential careless in not taking such precaution as would have notified him of the coming of the
to a clear understanding of the issues presented and the facts involved." (Act No. train. On the contrary, he proceeded with reckless speed and regardless of possible
190, sec. 133.) or threatened danger. If he had been driving the automobile at a proper rate of speed
for going over railroad crossing he could easily have stopped before going over the
The facts required to be found are the ultimate facts forming the issues presented by railroad crossing after seeing the train."
the pleadings, and which constitute the fundation for a judgment, and not those that
are merely evidentiary facts, or to set forth and explain the means or processes by
The argument of the appellant which is devoted to this findings seems to admit prove that custom counsel presents the evidence of the president of the defendant
impliedly at least that the driver of the automobile maintained his rate of speed as he company, Mr. Bachrach, who testified on the trial that all of his drivers, including the
approached and went upon the railroad crossing; and that he took no precaution to one in charge of the car on the night of the accident, operated cars in that manner
ascertain the approach of a train. and that it was the custom among automobile drivers generally. Counsel also cites
the testimony of the witness Palido, living near the scene of the accident, who testified
The appellant contended on the trial and offered evidence to prove that, on that, as a general rule, automobiles passed over the railroad crossing without
approaching the railroad crossing from the direction in which the automobile was changing speed. This testimony was corroborated by the defendant company's driver
travelling at the time, the view of the railroad tracks in both directions was obstructed who had the automobile in charge at the time of the occurrence. Basing himself on
by bushes and trees growing alongside thereof, and that it was impossible for a this alleged custom counsel contends that "When a person does what is usual and
person approaching the crossing even though on guard, to detect by sight the customary, i. e., proceeds as he and others engaged in a like occupation have been
approach of a train. If that were the case, it was clearly the duty of the driver to reduce accustomed to proceed, the action cannot be characterized as reckless, nor, strictly
the speed of his car and the noise thereof to such an extent that he would be able to speaking as negligent." To this the obvious reply may be made, for the moment
determine from the unrestricted and uninterrupted use of all his faculties whether or admitting the existence of the custom, that a practice which is dangerous to human
not a train was near. It is the law that a person must use ordinary care and prudence life cannot ripen into a custom which will protect anyone who follows it. To go upon a
in passing over a railroad crossing. While we are not prepared to lay down any railroad crossing without making any effort to ascertain the approach of a train is so
absolute rule as to what precise acts of precaution are necessary to be done or left hazardous an act and one so dangerous to life, that no one may be permitted to
undone by a person who may have need to pass over a railroad crossing, we may excuse himself who does it, provided injury result. One who performs an act so
say that it is always incumbent on him to use ordinary care and diligence. What acts inherently dangerous cannot, when an accident occurs, take refuge behind the plea
are necessary to constitute such care and diligence must depend on the that others have performed the same act safely.
circumstances of each particular case. The degree of care differs in different cases.
Greater care is necessary in crossing a road where the cars are running at a high rate Under the second error assigned, the appellant contends with much vigor that the
of speed and close together than where they are running at less speed and remote plaintiffs cannot recover for the reason that the negligence of the driver of the
from one another. But in every case due care should be exercised. It is very possible automobile, if any, was imputable to them, they having permitted the driver to
that where, on approaching a crossing, the view of the tracks in both directions is approach and pass over the railroad crossing without the use of ordinary care and
unobstructed for such a distance as to render it perfectly safe to pass over without the diligence to determine the proximity of a train or locomotive, and having made no
use of any other faculty than sight, such use alone is sufficient and it is not necessary effort to caution or instruct him or compel him to take reasonable care in making the
to stop or even to slacken speed or listen. On the other hand, where the view of the crossing. With this contention we cannot agree. We think the better rule, and one
tracks is obstructed, them it is driver's duty to slacken speed, to reduce the noise, if more consonant with the weight of authority, is that a person who hires a public
any, of the vehicle, to look and to listen, if necessary, or do any other act necessary to automobile and gives the driver direction as to the place to which he wishes to be
determine that a train is not in dangerous proximity to the crossing. conveyed, but exercise no other control over the conduct of the driver, is not
responsible for acts of negligence of the latter or prevented from recovering for
In the case at bar the appellant's own showing is to the effect that the view of the injuries suffered from a collision between the automobile and a train, caused by the
track in the direction from which the train was coming was obstructed in such manner negligence either of the locomotive engineer or the automobile driver. (Little vs.
that neither the track nor a train could be seen as a traveler approached the crossing; Hackett, 116 U.S., 366.) The theory on which the negligence of the driver has in some
and yet, in spite of that fact, the chauffeur drove upon the tracks without investigation instances been imputed to the occupant of the vehicle is that, having trusted the
or precaution of any kind. The very fact that a train was approaching and was so near driver by selecting the particular conveyance, the plaintiff so far identified himself with
as to collide with the automobile is strong evidence of the fact that no precautions the owner and his servants that, in case of injury resulting from their negligence, he
were taken to determine that fact. It is undoubted that if the driver had taken the was considered a party thereto. This was the theory upon which the case of
simplest means of permitting his own faculties to exercise themselves fairly, there Thorogood vs. Bryan (8 C.B., 115) was decided, which is the leading case in favor of
would have been no accident, as the presence of the train would have been the principle contended for by appellant. The Supreme Court of the United States,
discovered in an instant; but he chose, rather, to give his senses no opportunity to however, in Little vs. Hackett (116 U.S., 366), had this to say concerning the ground
protect him or his passengers and drove on the track at full speed with all the noise on which the Thorogood case was decided: "The truth is, the decision in
which an automobile produces at such speed on an upgrade and the sense of hearing Thorogood vs. Bryan rests upon indefensible ground. The identification of the
impaired by the rush of the wind. Railroad trains rarely pass over tracks without noise passenger with the negligent driver or the owner, without his personal cooperation or
and their presence, generally speaking, is easily detected by persons who take encouragement, is a gratuitous assumption. There is no such identity. The parties are
ordinary precautions. not in the same position. The owner of public conveyance is a carrier, and the driver
or the servant of the passenger, and his asserted identity with them is contradicted by
the daily experience of the world."
Under this assignment the appellant's main effort is being to the demonstration of the
fact that there was a custom established among automobile drivers of Manila by
which they habitually drove their cars over railroad crossings in the manner in which Further discussing the same question the court said: "There is no distinction in
the automobile was driven by defendant's servant on the occasion in controversy. To principle whether the passenger be on public conveyance like a railroad train or an
omnibus, or be on a hack hired from a public stand in the street for a drive. Those on that, therefore, the railroad company in nowise contributed to the accident. We do not
a hack do not become responsible for the negligence of the driver if they exercise no believe that the record will justify us in a reversal of this finding. There is abundant
control over him further than to indicate the route they wish to travel or the places to evidence to support it and we have nothing before us by which that evidence may be
which they wish to go. If he is their agent so that his negligence can be imputed to impeached. That the bell was rung and the whistle was blown on nearing the
them to prevent their recovery against a third party, he must be their agent in all other crossing, giving due and timely warning to all persons approaching, was testified to
respects, so far as the management of the carriage is concerned, and responsibility to not only by servants of the corporation but by passengers on the train. We find
third parties would attach to them for injuries caused by his negligence in the course nothing in the record which materially impairs the credibility of these witnesses or to
of his employment. But, as we have already stated, responsibility cannot, within any show that their evidence is improbable or unreasonable; and we would be going far
recognized rules of law, be fastened upon one who has in no way interfered with and under such circumstances in discarding it and reversing a judgment based thereon.
the with and controlled in the matter causing the injury. From the simple fact of hiring
the carriage or riding in it no such liability can arise. The party hiring or riding must in The appellant under this assignment of error presents other facts which he claims
some way have cooperated in producing the injury complained of before he incur any show necessarily that the company was negligent. He asserts: "(1) That this accident
liability for it. 'If the law were otherwise,' as said by Mr. Justice Depue in his elaborate occurred in the heart of the barrio of San Juan (Cavite Viejo), within approximately
opinion in the latest case in New Jersey, 'not only the hirer of the coach but also all one hundred meters of the railroad station, that is, in a populous community; (2) that
the passengers in it would be under a constraint to mount the box and superintend the railroad company did not maintain either a flagman or protecting gates at the
the conduct of the driver in the management and control of his team, or be put for grade crossing where the accident occurred, while the sign "Railroad Crossing" was
remedy exclusively to an action against the irresponsible driver or equally broken on the side toward the road; (3) that trees and undergrowth had been
irresponsible owner of a coach taken, it may be, from a coach stand, for the permitted to grow on and adjoining the right of way and houses were constructed
consequences of an injury which was the product of the cooperating wrongful acts of thereon, in such manner as to obstruct the view of persons approaching the railroad
the driver and of a third person, and that too, though the passengers were ignorant of track until within a few meters thereof; and (4) that the approach to the crossing is
the character of the driver, and of the responsibility of the owner of the team, and twisting, and on either side thereof are ditches about two meters deep."
strangers to the route over which they were to be carried.' (New York, Lake Erie &
Western Railroad vs. Steinbrenner, 47 N.J.L. [18 Vroom], 161, 171.)"
With respect to the existence of trees and undergrowth on the railroad company's
right of way, the evidence is conflicting, plaintiff maintaining and attempting to prove
We are of the opinion, therefore, that the rule is as we have stated it. Ordinarily where that such trees and undergrowth existed, while defendant company contended and
one rides in public vehicle with the driver thereof and is injured by the negligence of a offered evidence to show that no such growth existed at the time of the accident. On
third person, to which negligence that of the driver contributes his contributory this conflict of evidence the trial court found: "Evidence on the part of the defendant
negligence is not imputable to the passenger unless said passenger has or is in the Bachrach Garage & Taxicab Co. is to the effect that the view from the crossing along
position to have and exercise some control over the driver with reference to the the track towards Manila was obstructed by bushes growing on the railroad right to
matter wherein he was negligent. Whether the person injured exercises any control way along the track, while the preponderance of the evidence discloses that for a
over the conduct of the driver further than to indicate the place to which he wishes to distance of twelve or fifteen meters from the a view of the track for a considerable
drive is a question of fact to be determined by the trial court on all of the evidence in distance is wholly unobstructed, and I can but conclude that the driver of the
the case. (Duval vs. Railroad Co., 134 N. C., 331; Hampel vs. Detroit etc. R. R. Co., unobstructed, and I can but conclude that the driver of the automobile was grossly
110 Am. St. Rep., 275; Cotton vs. Willmar etc. R. R. Co., 99 Minn., 366; Shultz vs. negligent and careless in not taking such precaution as would have notified him of the
Old Colony Street Ry. Co., 193 Mass., 309; Wilson vs. Puget Sound Elec. Ry. Co., 52 coming of the train. On the contrary, he proceeded with reckless speed and
Wash., 522; Johnson vs. Coey, 237 Ill., 88; Hinduvs. Steere, 209 Mass. 442.) regardless of possible or threatened danger."

The appellant assigns as the third error the finding of the trial court "that the Here again we are met with a contradiction in the evidence of witnesses who, so far
defendant Manila Railroad Company was not guilty of negligence which contributed to as appears, are equally entitled to credit, which conflict has been resolved by the trial
the causing of the accident complained of." court in favor of the witnesses for the defendant railroad company. Counsel for
appellant has failed to give any reason why we should we should accept the
In this connection it appears that, prior to the beginning of the action now before us, testimony of appellant's witnesses rather than those of the railroad company and he
two actions were instituted, both growing out of the accident which forms the basis of has also neglected to point out any error committed by the trial court in making its
the actions before us: (1) A criminal action against the engineer of the train, in which finding in this regard. A careful examination of the record discloses no reason why the
the engineer was acquitted; and (2) a civil action for damages by the garage and judgment of the trial court on this point should be disturbed, there appearing nothing
taxicab company, the appellant herein, against the defendant railroad company, for on which we could base a judgment declaring that the trial court erred in making its
damages to the automobile which was destroyed as a result of the accident, in which decision.
judgment was for defendant. There is evidence in the record showing that the
locomotive engineer gave due and timely signals on approaching the crossing in As to the other facts set forth on which appellant predicates negligence on the part of
question. The trial court found that the employees of the railroad company fully the railroad company, we find them, even if admitted, to be insufficient to establish
performed their duty as the train approached the crossing on the night in question and
negligence. It is not negligence on the part of the railroad company to maintain grade 1902. A person who by an act or omission causes damage to another when there is
crossing, even in populous district; nor is it negligence not to maintain a flagman at fault or negligence shall be obliged to repair the damage so done.
such crossing. It is true that a railroad company is held to greater caution in the more
thronged streets of the densely populated portions of the city than in the less ART. 1903. The obligation imposed by the preceding article is demandable, not only
frequented streets in suburban parts or in towns; but this does not mean that it is for personal acts and omissions, but also for the persons for whom they should be
negligence to maintain grade crossing in such densely populated portions or that it is responsible.
negligence not to maintain a flagman at crossings located in such districts. It simply
means that the company in operating its trains over such crossings must exercise
care commensurate with the use of crossings in any given The father, and on his death or incapacity the mother is liable for the damages
locality.chanroblesvirtualawlibrary chanrobles virtual law library caused by the minors who live with them.

The main contention of the appellant is based on the claim that, even admitting as Guardians are liable for the damages caused by minors or incapacitated persons who
proved all of the facts alleged by the plaintiffs, the appellant is not liable. It is are under their authority and live with them.
maintained that up to the time the accident occurred the defendant taxicab company
had fully performed its duty to the public, it being undisputed in the record that the Owners or directors of an establishment or enterprise are equally liable for the
driver was competent and had a long and satisfactory record, having driven cars for damages caused by their employees in the service of the branches in which the latter
the defendant for 5 or 6 years without accident or misadventure, and that his may be employed or on account of their duties.
negligence, if any, in attempting to pass over the crossing on the occasion before us,
cannot legally be imputed to the taxicab company so as to make it liable for the The State is liable in this sense when it acts through a special agent, but not when the
damages resulting therefrom. In supporting of this argument the case of Johnson vs. damage should have been caused by the official to whom properly it pertained to do
David (5 Phil., Rep., 663), is cited as determinative of the question under the act performed, in which case the provisions of the proceeding article shall be
consideration. The appellant, however, having denied the fact of negligence, we applicable.
might, before entering on a discussion of the applicability of the principles enunciated
in Johnson vs. David to the facts before us, repeat what we have already said, that it
appears from the record, and was found by the trial court, that the driver of the Finally, master or directors of arts and trades are liable for the damages caused by
automobile drove his machine upon the railroad tracks without observing the their pupils or apprentices while they are under their custody.
precautions which ordinary care and prudence would have required. He made
substantially no effort toward ascertaining whether there was danger from a train or The liability referred to in this articles shall cease when the persons mentioned therein
locomotive. The trial court found, as was quite necessary under the facts, that the prove that they employed all the diligence of a good father of a family to avoid the
driver was guilty of gross negligence and that such negligence was the proximate damage.
cause of the accident. It also found that the taxicab company had permitted its drivers
to approach and pass over railroad tracks in the manner and form followed and
These two articles are found under chapter 2, title 16, of the Civil Code, dealing with
observed on the occasion in question until it had become a custom among its drivers,
"obligations which arise from fault or negligence;" and set out the cases, generally
known and sanctioned by the company; and that, for that reason, the taxicab
speaking, in which the master is liable for the acts of his servant. That chapter also
company was liable for the damages caused. We are of the opinion that the trial court
contains articles providing for liability for negligent acts of servants in special cases,
is fully supported in the finding that the conduct of the officials of the taxicab
among them 1905, which provides that "the possessor of an animal, or the one who
company, and notably the president thereof, amounted, in law, to a sanction of the
uses it, is liable for the damages it may cause even when said animal escapes from
custom established among its automobile drivers in passing over railroad crossings.
him or strays," but that this liability shall cease "in the case the damage should arise
Counsel is met, therefore, at the opening of his discussion on this branch of the case,
from force majeure or from the fault of the person who may have suffered it;" 1906,
with the question: Did the defendant taxicab company fully discharge its duty when it
which declares that "the owner of a game preserve shall be liable for damages
furnished a suitable and proper car and selected driver who had been with the
caused by the game to neighboring estates, should he not have done what may have
company for 5 or 6 years and who had not had an accident or misadventure before?
been necessary to avoid increase of the same or should he have hindered the efforts
We think not. It was the duty of the company not only to furnish a suitable and proper
of the owners of said estates to hunt;" 1907, which provides for the liability of the
car and select a competent operator, but also to supervise and, where necessary,
owner of a building "for damages which may result from the collapse of the whole or a
instruct him properly.
part thereof, if it should occur through the absence of necessary repairs;" 1908, which
states that "owners shall be liable for damages caused by the explosion of machines
Returning now to the applicability of the case of Johnson vs. David to the facts before which may not have been cared for with due diligence, and been placed in a safe and
us: The Civil Code, in dealing with the liability of a master for the negligent acts of his proper place;" "by excessive smoke, which may be noxious to persons of property;"
servant, makes a distinction between private individuals and public enterprises. (Art. "by the fall of trees, located in places of transit, when not caused by force majeure;"
1903, Civil Code.) That article, together with the preceding article, is as follows: ART "by the emanations of sewers or deposits of infectious matters, when constructed
without precautions proper for the place where they are located;" and "the head of a
family who dwells in a house, or in a part of the same, is liable for the damages by the owner is present, unless the negligent acts of the driver are continued for such a
things which may be thrown or which may fall therefrom."chanrobles virtual law library length of time as to give the owner a reasonable opportunity to observe them and to
direct his driver to desist therefrom. An owner who sits in his automobile, or other
These are the only cases under the Civil Code in which damages may be recovered vehicle, and permits his driver to continue in a violation of the law by the performance
from the master for the negligent of his servant. As is seen from a reading of article of negligent acts, after he has had a reasonable opportunity to observe them and to
1903, a person being driven about by his servant's negligent acts except under direct that the driver, becomes himself responsible for such acts. The owner of an
certain circumstances. (Chapman vs. Underwood, 27 Phil., Rep., 374; Johnson vs. automobile who permits his chauffeur to drive up the Escolta, for example, at a speed
David, supra.) On the other hand, the master is liable for the negligent acts of his of 60 miles an hour, without any effort to stop him, although he has had a reasonable
servant where he is the owner or director of a business or enterprise and the opportunity to do so, becomes himself responsible, both criminally and civilly, for the
negligent acts are committed while the servant is engaged in his master's results produced by the acts of his chauffeur. On the other hand, if the driver, by a
employment as such owner. sudden act of negligence, and without the owner having a reasonable opportunity to
prevent the act or its continuance, injures a person or violates the criminal law, the
owner of the automobile, although present therein at the time the act was committed,
The distinction made in the Code has been observed, as would naturally be expected, is not responsible, either civilly or criminally, therefor. The act complained of must be
by the decisions of this court. In the case of Johnson vs. David, supra, we held that continued in the presence of the owner for such a length of time that the owner, by his
the defendant was not liable for the acts of his servant in negligently driving a horse acquiescence, makes his driver's act his own.
and carriage against plaintiff, who was at the time riding a bicycle in the streets of
Manila, throwing him to the ground and injuring him and his bicycle. It appeared in
that case that the vehicle was owned by the defendant, that it was being driven by the In the case before us it does not appear from the record that, from the time the
defendant's coachman on the private affairs of the owner, that it was not a public automobile took the wrong side of the road to the commission of the injury, sufficient
conveyance driven for hire or as a part of a business or enterprise. In that case we time intervened to afford the defendant an opportunity correct the act of his driver.
said: "It would seem, from an examination of these various provisions, that the Instead, it appears with fair clearness that the interval between the turning out to meet
obligation to respond for the negligent acts of another was limited to the particular and pass the street car and the happening of the accident was so short as not to be
cases mentioned; in other words, we are of the opinion and so hold that it was the sufficient to charge defendant with the negligence of the driver.
intention of the legislature in enacting said chapter 2 to enumerate all the persons for
whose negligent acts third persons are responsible. Article 1902 provides when a The case of Bahia vs. Litonjua and Leynes (30 Phil., Rep., 624), was a case of a
person himself is liable for negligence. Articles 1903, 1904, 1905, 1906, 1907, 1908, different character. There an automobile was being operated by the defendant as a
and 1910 provide when a person shall be liable for injuries caused, not by his own public vehicle carrying passengers from Balayan to Tuy (Province of Batangas) and
negligence but by the negligence of other persons or things. return for hire. On one to the trips, the machine, by reason of a defect in the steering
gear, refused to respond to the guidance of the driver and, as a result a child was run
These sections do not include a liability on the part of the plaintiff for injuries resulting over and killed. That case, as is seem at a glance, is quite different from the case of
from acts of negligence such as are complained of in the present cause . . . ." Johnson vs. David and that of Chapman vs. Underwood, in that the automobile was
operated as a business or enterprise on which the defendant had entered for gain;
and this is the particular distinction which is made in article 1903 of the Civil Code
These case of Chapman vs. Underwood, (27 Phil., Rep., 374) was similar in its facts which holds the masters responsible for the negligent acts of the servant when the
and the principles governing it, to that of Johnson vs. David. In that case the plaintiff, master is the owner "of an establishment or enterprise," and the acts complained of
while about to board a street car, was struck by an automobile which, at the time, was are committed within the scope of the servant's employment in such business. In the
being driven on the wrong side of the street. The automobile was in charge of the case under discussion we held that, in addition to the requirement to furnish and use
servant of the owner, who was present in the automobile at the time the accident proper and safe machines, it was the duty of a person or corporation operating
occurred. The automobile was not a part of defendant's business nor was it being automobiles for hire to exercise ordinary care and diligence in the selection of the
used at the time as a part or adjunct of any business or enterprise owned or drivers of his or its automobiles and in supervision over them while in his or its
conducted by him. Although the act of the driver was negligent, and was so declared employ, including the promulgation of proper rules and regulations and the
by this court, it was, nevertheless, held that the master was not liable for the results of formulation and due publication of proper instructions for their guidance in cases
the act. We said: where such rules, regulations and the formulation and due publication of proper
instructions for their guidance in cases where such rules, regulations and instruction
The defendant, however, is not responsible for the negligence of his driver, under the are necessary. Discussion article 1903 of the Civil Code, which, as we have seen, not
facts and circumstances of this case. As we have said in the case of Johnsonvs. only established liability in case of negligence but also provides when that liability
David (5 Phil., Rep., 663), the driver does not fall within the list of person in article ceases, the court in that case said:
1903 of the Civil Code for whose acts the defendant would be responsible.
From this article two things are apparent: (1) That when an injury is caused by the
Although in the David case the owner of the vehicle was not present at the time the negligence of a servant or employee there instantly arises a presumption of law that
alleged negligent acts were committed by the driver, the same rule applies where the there was negligence on the part of the master or employer either in the selection of
the selection of the servant or employee or in supervision over him after the selection, governed by Johnson vs. David. Not only has the defendant taxicab company failed to
or both; and (2) that that presumption is juris tantum and not juris et de jure and rebut the presumption of negligence arising from the carelessness of its servant, but it
consequently may be rebutted. It follows necessarily that if the employer shows to the has, in effect, made those negligent acts its own by having observed and known the
satisfaction of the court that in selection and supervision he has exercised the care custom of its drivers without disapproving it and without issuing instructions designed
and diligence of a good father of a family, the presumption is overcome and he is to supersede it.
relieved from liability.
We are of the opinion that the trial court erred in fixing the amount of damages which
This theory bases the responsibility of the master ultimately on his ownnegligence the plaintiffs suffered. Under the law, each of the plaintiffs, is entitled to recover the
and not on that of his servant. This is the notable peculiarity of the Spanish law of time, doctors' bills and hospital bills and hospital bills and medicines, and any other
negligence. It is, of course, in striking contrast to the American doctrine that, in item of expense which it was found necessary to undergo by reason of the damages
relations with strangers, the negligence of the servant is conclusively the negligence sustained.
of the master.
The plaintiff Butaro Yamada is entitled to be reimbursed for his hospital bill of P49, for
In the case before us the death of the child caused by a defect in the steering gear of the P50 which he paid to Dr. Strahan, and for the loss of time which he suffered at the
the automobile immediately raised the presumption that Leynes was negligent in rate of P100 a month. The trial court allowed him for certain alleged fees of doctors
selecting a defective automobile or in his failure to maintain it in good condition after and expenses in hospitals and at hot springs in Japan. He was also allowed P150
selection and the burden of proof was on him to show that he had exercised the care alleged by him to have been paid to a Japanese doctor in Manila. We do not believe
of a good father of a family. that the record warrants these allowances. As to the expenses in Japan, we may say
that the injury occurred to plaintiff on the 2nd of January and he remained in Manila
In that case we further said: "From the commencement of the use of the machine until for nearly 6 months before going to Japan. According to the testimony of Dr. Strahan
the accident occurred sufficient time had not elapsed to require an examination of the the plaintiff was in good physical condition long before he left this country for Japan.
machine by the defendant as a part of his duty of inspection and supervision. While it His testimony is to the effect that the plaintiff suffered no permanent injuries, the
does not appear that the defendant formulated rules and regulations for the guidance damage being limited to temporary shocks and bruises, and that he would be ready
of the drivers and gave them proper instructions, designed for the protection of the for his usual occupation in about 3 months. According to plaintiff's own testimony he
public and the passengers, the evidence shows, as we have seen, that the death of went back to work 2 months after the injury, but, claiming he still felt pains, went to
the child was not caused by a failure to promulgate rules and regulations. It was Japan. We do not believe that we ought to accept the plaintiff's bare statement as to
caused by a defect in the machine as to which the defendant has shown himself free his physical condition after leaving the Philippine Islands in defiance of the testimony
from responsibility." of Dr. Strahan as to his physical condition 3 months after the injury was received and
particularly in view of the fact that he returned to work at the end of 2 months. As to
the P150 alleged to have been paid to a Japanese doctor in Manila, we have grave
We, therefore, see that taxicab company did not perform its full duty when it furnished doubts whether he had sufficiently proved that item of expenditure. He does not give
a safe and proper car and a driver with a long and satisfactory record. It failed to the name of the physician to whom he paid the money and he presents no receipt or
comply with one of the essential requirements of the law of negligence in this voucher from the person whom he paid. He made no memorandum of the payment at
jurisdiction, that of supervision and instruction, including the promulgation of proper the time or of the person to whom he paid it or of the date on which it was paid. All of
rules and regulations and the formulation and publication of proper instructions for his testimony relating to the items which constitute his damage was based on a
their guidance in cases where such rules and regulations and instructions are memorandum made from memory on the morning of the trial. It seems to us that
necessary. To repeat, it was found by the trial court, and that finding is fully sustained where the sources of knowledge are to so large an extent within the knowledge and
by the record, that it was the custom of the driver who operated the machine on the control of the person who presents the evidence, he should be held rather strictly to
night of the accident, to approach and pass over railroad crossings without adequate presenting the best evidence that the circumstances permit. If he had offered the
precautions, and that such custom was known to and had been sanctioned by the Japanese doctor as a witness or if he had even produced receipts from him, the
officials of the taxicab company, the president of the company testifying that none of matter would have borne quite a different aspect.
its drivers, especially the one who operated the car on the night of the accident, were
accustomed to stop or even reduce speed or take any other precaution in
approaching and passing over railroad crossings, no matter of what nature, unless We are accordingly of the opinion that the judgment in favor of this plaintiff should
they heard "the signal of a car." He testified that he himself had ridden behind several consist simply of the loss of time, amounting to 2 months at P100 a month, his
of his drivers, among them the one who handled the automobile on the night of the hospital bill of P49 and his doctor's bill of P50, in all P299, with costs.
accident, and that it was settled practice, to which he made no objection and as to
which he gave no instructions, to approach and pass over railroad crossings without With respect to the plaintiff Takutaru Uyehara, the judgment in his favor must be also
any effort to ascertain the proximity of a train. These facts and circumstances bring modified. Concerning his condition we have substantially the same testimony by the
the case within the doctrine enunciated in the Litonjua case to which reference has same doctor that we had in the case of Yamada. There were no permanent injuries.
already been made, and, at the same time, remove it from that class of cases The plaintiff suffered merely from shock and bruises. He was quite recovered in 3
months. It appears that he was earning P200 a month at the time of his injury and that credibility of witnesses except where it appears that the court overlooked or
his hospital expense, including attendance of a physician, was P350. We are satisfied misapplied facts or circumstances of weight and influence appearing in the case.
from the record that he is entitled to P600 for 3 months' loss of wages and to P350 for Here the trial court seems to have overlooked those facts and circumstances top
hospital expenses and medical attendance. As to the claim for P150 paid to a which we have adverted and which we have made the basis of the modification. It
Japanese doctor, we have in substance the same circumstances found in connection nowhere appears in the decision of the trial court or elsewhere in the record that it
with the claim of the plaintiff Yamada, - no name, no date, no memorandum, no took any of those facts and circumstances into consideration. So ordered.
receipt; nothing but the testimony of the plaintiff himself based upon date prepared
from memory. It is worthy of note also that both this plaintiff and plaintiff Yamada NATIVIDAD V. ANDAMO and EMMANUEL R. ANDAMO, petitioners, vs.
claim to have paid exactly the same amount to Japanese doctors in Manila. INTERMEDIATE APPELLATE COURT (First Civil Cases Division) and
MISSIONARIES OF OUR LADY OF LA SALETTE, INC., respondents.
Judgment is hereby rendered in favor of the plaintiff Takutaru Uyehara for the sum of
P950, and costs. Petitioner spouses Emmanuel and Natividad Andamo are the owners of a
parcel of land situated in Biga (Biluso) Silang, Cavite which is adjacent to
With respect to the judgment in favor of the plaintiff Kenjiro Karabayashi, we are clear that of private respondent, Missionaries of Our Lady of La Salette, Inc., a
that it must be reduced in amount. This plaintiff was able, immediately after the religious corporation.
accident occurred, to move about readily an to assist his injured companions. He did Within the land of respondent corporation, waterpaths and contrivances,
not go to a hospital, or, so far as appeared, consult a physician until some time after including an artificial lake, were constructed, which allegedly inundated and
the accident. He alleges that he paid to Japanese doctors P310 and to massage eroded petitioners' land, caused a young man to drown, damaged
doctors P130, and that he paid P365 for medicines. The injury was received on the 2d petitioners' crops and plants, washed away costly fences, endangered the
of January, 1913, and this caution was commenced in October of the same year. It lives of petitioners and their laborers during rainy and stormy seasons, and
seem to us incredible that the plaintiff, who suffered and suffers from no physical exposed plants and other improvements to destruction.
injury testified to by any physician, should have paid out during that time more than In July 1982, petitioners instituted a criminal action, docketed as Criminal
P800 for medicines and doctors. That sum exceeds the sums claimed to have been Case No. TG-907-82, before the Regional Trial Court of Cavite, Branch 4
paid out by the other plaintiffs, who were so badly injured that they were carried in a (Tagaytay City), against Efren Musngi, Orlando Sapuay and Rutillo Mallillin,
semiconscious condition to the hospital and were unable to move without assistance officers and directors of herein respondent corporation, for destruction by
for some days.chanroblesvirtualawlibrary chanrobles virtual law library means of inundation under Article 324 of the Revised Penal Code.
Subsequently, petitioners filed another action against respondent
This plaintiff complains of loss of memory as the only result of his injuries and claims corporation, this time a civil case, docketed as Civil Case No. TG-748, for
that he is unable to obtain a salary equivalent to that which he was receiving before damages with prayer for the issuance of a writ of preliminary injunction
the accident. He presents no evidence of such loss of memory except his own before the same court. 1
statement, his physical condition at the time of the trial being apparently perfect and respondent corporation filed its answer to the complaint and opposition to
there being at that time no evidence, as he himself admitted, of loss of memory. He the issuance of a writ of preliminary injunction. Hearings were conducted
presented no doctor to testify as to services rendered, indeed, he does not even including ocular inspections on the land. However, on April 26, 1984, the trial
furnish the name of the person to whom the money was paid, and he shows no court, acting on respondent corporation's motion to dismiss or suspend the
receipts and produces no evidence except his own statement with respect to the civil action, issued an order suspending further hearings in Civil Case No,
amount paid out for medicines. We believe that, under this testimony, no damages TG-748 until after judgment in the related Criminal Case No. TG-907-82.
should be allowed to this plaintiff except possibly salary for the short period during Resolving respondent corporation's motion to dismiss filed on June 22,
which, by reason of shock, he may have been unable to render active service. He 1984, the trial court issued on August 27, 1984 the disputed
testified that he lost two and one-half months' time, during which he did not work at order dismissing Civil Case No. TG-748 for lack of jurisdiction, as the
all, and that his services were worth P160 a month. criminal case which was instituted ahead of the civil case was still
unresolved. Said order was anchored on the provision of Section 3 (a), Rule
The judgment of the Court of First Instance with respect to this plaintiff, Kenjiro III of the Rules of Court which provides that "criminal and civil actions arising
Karabayashi, is modified and judgment in his favor and against the Bachrach Garage from the same offense may be instituted separately, but after the criminal
& Taxicab Co. for P400 is hereby decreed, with costs. action has been commenced the civil action cannot be instituted until final
judgment has been rendered in the criminal action." 2
Petitioners appealed from that order to the Intermediate Appellate Court. 3
It may be urged that the reductions in the amounts allowed the several plaintiffs by respondent Appellate Court, First Civil Cases Division, promulgated a
the trial court are arbitrary, the evidence as to the damages sustained being decision 4 affirming the questioned order of the trial court. 5 A motion for
uncontradicted and the trial court having based its judgment thereon. It is clear, reconsideration filed by petitioners was denied by the Appellate Court in its
however, that we are in no way interfering with the rule so many times laid down by resolution dated May 19, 1986. 6
this court that we will not interfere with the judgment of the trial court as to the
Directly at issue is the propriety of the dismissal of Civil Case No. TG-748 in b) Costly fences constructed by plaintiffs were, on several occasions, washed away.
accordance with Section 3 (a) of Rule 111 of the Rules of Court. Petitioners contend
that the trial court and the Appellate Court erred in dismissing Civil Case No. TG-748 c) During rainy and stormy seasons the lives of plaintiffs and their laborers are always
since it is predicated on a quasi-delict. Petitioners have raised a valid point. in danger.

It is axiomatic that the nature of an action filed in court is determined by the facts d) Plants and other improvements on other portions of the land of plaintiffs are
alleged in the complaint as constituting the cause of action. 7 The purpose of an exposed to destruction. ... 10
action or suit and the law to govern it, including the period of prescription, is to be
determined not by the claim of the party filing the action, made in his argument or
brief, but rather by the complaint itself, its allegations and prayer for relief. 8 The A careful examination of the aforequoted complaint shows that the civil action is one
nature of an action is not necessarily determined or controlled by its title or heading under Articles 2176 and 2177 of the Civil Code on quasi-delicts. All the elements of a
but the body of the pleading or complaint itself. To avoid possible denial of substantial quasi-delict are present, to wit: (a) damages suffered by the plaintiff, (b) fault or
justice due to legal technicalities, pleadings as well as remedial laws should be negligence of the defendant, or some other person for whose acts he must respond;
liberally construed so that the litigants may have ample opportunity to prove their and (c) the connection of cause and effect between the fault or negligence of the
respective claims. 9 defendant and the damages incurred by the plaintiff. 11

Quoted hereunder are the pertinent portions of petitioners' complaint in Civil Case No. Clearly, from petitioner's complaint, the waterpaths and contrivances built by
TG-748: respondent corporation are alleged to have inundated the land of petitioners. There is
therefore, an assertion of a causal connection between the act of building these
waterpaths and the damage sustained by petitioners. Such action if proven
4) That within defendant's land, likewise located at Biga (Biluso), Silang, Cavite, constitutes fault or negligence which may be the basis for the recovery of damages.
adjacent on the right side of the aforesaid land of plaintiffs, defendant constructed
waterpaths starting from the middle-right portion thereof leading to a big hole or
opening, also constructed by defendant, thru the lower portion of its concrete hollow- In the case of Samson vs. Dionisio, 12 the Court applied Article 1902, now Article
blocks fence situated on the right side of its cemented gate fronting the provincial 2176 of the Civil Code and held that "any person who without due authority constructs
highway, and connected by defendant to a man height inter-connected cement a bank or dike, stopping the flow or communication between a creek or a lake and a
culverts which were also constructed and lain by defendant cross-wise beneath the tip river, thereby causing loss and damages to a third party who, like the rest of the
of the said cemented gate, the left-end of the said inter-connected culverts again residents, is entitled to the use and enjoyment of the stream or lake, shall be liable to
connected by defendant to a big hole or opening thru the lower portion of the same the payment of an indemnity for loss and damages to the injured party.
concrete hollowblocks fence on the left side of the said cemented gate, which hole or
opening is likewise connected by defendant to the cemented mouth of a big canal, While the property involved in the cited case belonged to the public domain and the
also constructed by defendant, which runs northward towards a big hole or opening property subject of the instant case is privately owned, the fact remains that
which was also built by defendant thru the lower portion of its concrete hollow-blocks petitioners' complaint sufficiently alleges that petitioners have sustained and will
fence which separates the land of plaintiffs from that of defendant (and which serves continue to sustain damage due to the waterpaths and contrivances built by
as the exit-point of the floodwater coming from the land of defendant, and at the same respondent corporation. Indeed, the recitals of the complaint, the alleged presence of
time, the entrance-point of the same floodwater to the land of plaintiffs, year after damage to the petitioners, the act or omission of respondent corporation supposedly
year, during rainy or stormy seasons. constituting fault or negligence, and the causal connection between the act and the
damage, with no pre-existing contractual obligation between the parties make a clear
5) That moreover, on the middle-left portion of its land just beside the land of plaintiffs, case of a quasi delict or culpa aquiliana.
defendant also constructed an artificial lake, the base of which is soil, which utilizes
the water being channeled thereto from its water system thru inter-connected It must be stressed that the use of one's property is not without limitations. Article 431
galvanized iron pipes (No. 2) and complimented by rain water during rainy or stormy of the Civil Code provides that "the owner of a thing cannot make use thereof in such
seasons, so much so that the water below it seeps into, and the excess water above it a manner as to injure the rights of a third person." SIC UTERE TUO UT ALIENUM
inundates, portions of the adjoining land of plaintiffs. NON LAEDAS. Moreover, adjoining landowners have mutual and reciprocal duties
which require that each must use his own land in a reasonable manner so as not to
6) That as a result of the inundation brought about by defendant's aforementioned infringe upon the rights and interests of others. Although we recognize the right of an
water conductors, contrivances and manipulators, a young man was drowned to owner to build structures on his land, such structures must be so constructed and
death, while herein plaintiffs suffered and will continue to suffer, as follows: maintained using all reasonable care so that they cannot be dangerous to adjoining
landowners and can withstand the usual and expected forces of nature. If the
structures cause injury or damage to an adjoining landowner or a third person, the
a) Portions of the land of plaintiffs were eroded and converted to deep, wide and long latter can claim indemnification for the injury or damage suffered.
canals, such that the same can no longer be planted to any crop or plant.
Article 2176 of the Civil Code imposes a civil liability on a person for damage caused civil action contemplated in the said articles to the result of the criminal prosecution
by his act or omission constituting fault or negligence, thus: whether it be conviction or acquittal would render meaningless the independent
character of the civil action and the clear injunction in Article 31, that his action may
Article 2176. Whoever by act or omission causes damage to another, there being fault proceed independently of the criminal proceedings and regardless of the result of the
or negligence, is obliged to pay for the damage done. Such fault or negligence, if latter."
there is no pre-existing contractual relation between the parties, is called a quasi-
delict and is governed by the provisions of this chapter. WHEREFORE, the assailed decision dated February 17, 1986 of the then
Intermediate Appellate Court affirming the order of dismissal of the Regional Trial
Article 2176, whenever it refers to "fault or negligence", covers not only acts "not Court of Cavite, Branch 18 (Tagaytay City) dated August 17, 1984 is hereby
punishable by law" but also acts criminal in character, whether intentional and REVERSED and SET ASIDE. The trial court is ordered to reinstate Civil Case No.
voluntary or negligent. Consequently, a separate civil action lies against the offender TG-748 entitled "Natividad V. Andamo and Emmanuel R. Andamo vs. Missionaries of
in a criminal act, whether or not he is criminally prosecuted and found guilty or Our Lady of La Salette Inc." and to proceed with the hearing of the case with
acquitted, provided that the offended party is not allowed, (if the tortfeasor is actually dispatch. This decision is immediately executory. Costs against respondent
charged also criminally), to recover damages on both scores, and would be entitled in corporation.
such eventuality only to the bigger award of the two, assuming the awards made in
the two cases vary. 13 ORLANDO D. GARCIA, JR., doing business under the name and style
COMMUNITY DIAGNOSTIC CENTER and BU CASTRO,1 Petitioners,
The distinctness of quasi-delicta is shown in Article 2177 of the Civil Code, which vs.
states: RANIDA D. SALVADOR and RAMON SALVADOR, Respondents.

Article 2177. Responsibility for fault or negligence under the preceding article is This is a petition for review2 under Rule 45 of the Rules of Court assailing the
entirely separate and distinct from the civil liability arising from negligence under the February 27, 2004 Decision3 of the Court of Appeals in CA-G.R. CV No. 58668
Penal Code. But the plaintiff cannot recover damages twice for the same act or finding petitioner Orlando D. Garcia liable for gross negligence; and its June 16, 2005
omission of the defendant. Resolution4 denying petitioners motion for reconsideration.

According to the Report of the Code Commission "the foregoing provision though at respondent Ranida D. Salvador started working as a trainee in the
first sight startling, is not so novel or extraordinary when we consider the exact nature Accounting Department of Limay Bulk Handling Terminal, Inc. (the
of criminal and civil negligence. The former is a violation of the criminal law, while the Company). As a prerequisite for regular employment, she underwent a
latter is a distinct and independent negligence, which is a "culpa aquiliana" or quasi- medical examination at the Community Diagnostic Center (CDC). Garcia
delict, of ancient origin, having always had its own foundation and individuality, who is a medical technologist, conducted the HBs Ag (Hepatitis B Surface
separate from criminal negligence. Such distinction between criminal negligence and Antigen) test and CDC issued the test result5 indicating that Ranida was
"culpa extra-contractual" or "cuasi-delito" has been sustained by decisions of the "HBs Ag: Reactive." The result bore the name and signature of Garcia as
Supreme Court of Spain ... 14 examiner and the rubber stamp signature of Castro as pathologist.
When Ranida submitted the test result to Dr. Sto. Domingo, the Company
15 physician, the latter apprised her that the findings indicated that she is
In the case of Castillo vs. Court of Appeals, this Court held that a quasi-delict or suffering from Hepatitis B, a liver disease. Thus, based on the medical
culpa aquiliana is a separate legal institution under the Civil Code with a substantivity report6submitted by Sto. Domingo, the Company terminated Ranidas
all its own, and individuality that is entirely apart and independent from a delict or employment for failing the physical examination. 7
crime a distinction exists between the civil liability arising from a crime and the
When Ranida informed her father, Ramon, about her ailment, the latter
responsibility for quasi-delicts or culpa extra-contractual. The same negligence
suffered a heart attack and was confined at the Bataan Doctors Hospital.
causing damages may produce civil liability arising from a crime under the Penal
During Ramons confinement, Ranida underwent another HBs Ag test at the
Code, or create an action for quasi-delicts or culpa extra-contractual under the Civil
said hospital and the result8 indicated that she is non-reactive. She informed
Code. Therefore, the acquittal or conviction in the criminal case is entirely irrelevant in
Sto. Domingo of this development but was told that the test conducted by
the civil case, unless, of course, in the event of an acquittal where the court has
CDC was more reliable because it used the Micro-Elisa Method.
declared that the fact from which the civil action arose did not exist, in which case the
Thus, Ranida went back to CDC for confirmatory testing, and this time, the
extinction of the criminal liability would carry with it the extinction of the civil liability.
Anti-HBs test conducted on her indicated a "Negative" result.9
Ranida also underwent another HBs Ag test at the Bataan Doctors Hospital
In Azucena vs. Potenciano, 16 the Court declared that in quasi-delicts, "(t)he civil using the Micro-Elisa Method. The result indicated that she was non-
action is entirely independent of the criminal case according to Articles 33 and 2177 reactive.10
of the Civil Code. There can be no logical conclusion than this, for to subordinate the
Ranida submitted the test results from Bataan Doctors Hospital and CDC to Garcia maintains he is not negligent, thus not liable for damages, because he
the Executive Officer of the Company who requested her to undergo another followed the appropriate laboratory measures and procedures as dictated by his
similar test before her re-employment would be considered. Thus, CDC training and experience; and that he did everything within his professional
conducted another HBs Ag test on Ranida which indicated a "Negative" competence to arrive at an objective, impartial and impersonal result.
result.11 Ma. Ruby G. Calderon, Med-Tech Officer-in-Charge of CDC, issued
a Certification correcting the initial result and explaining that the examining At the outset, we note that the issues raised are factual in nature. Whether a person is
medical technologist (Garcia) interpreted the delayed reaction as positive or negligent or not is a question of fact which we cannot pass upon in a petition for
reactive.12 review on certiorari which is limited to reviewing errors of law.19
Thereafter, the Company rehired Ranida.
Ranida and Ramon filed a complaint13 for damages against petitioner Garcia
Negligence is the failure to observe for the protection of the interest of another person
and a purportedly unknown pathologist of CDC, claiming that, by reason of
that degree of care, precaution and vigilance which the circumstances justly
the erroneous interpretation of the results of Ranidas examination, she lost
demand,20 whereby such other person suffers injury. For health care providers, the
her job and suffered serious mental anxiety, trauma and sleepless nights,
test of the existence of negligence is: did the health care provider either fail to do
while Ramon was hospitalized and lost business opportunities.
something which a reasonably prudent health care provider would have done, or that
respondents amended their complaint14 by naming Castro as the "unknown
he or she did something that a reasonably prudent health care provider would not
pathologist."
have done; and that failure or action caused injury to the patient; 21 if yes, then he is
Garcia denied the allegations of gross negligence and incompetence and guilty of negligence.
reiterated the scientific explanation for the "false positive" result of the first
HBs Ag test in his December 7, 1993 letter to the respondents. 15
For his part, Castro claimed that as pathologist, he rarely went to CDC and Thus, the elements of an actionable conduct are: 1) duty, 2) breach, 3) injury, and 4)
only when a case was referred to him; that he did not examine Ranida; and proximate causation.
that the test results bore only his rubber-stamp signature.
All the elements are present in the case at bar.
TRIAL COURT dismissed the complaint for failure of the respondents to present
sufficient evidence to prove the liability of Garcia and Castro. It held that respondents Owners and operators of clinical laboratories have the duty to comply with statutes,
should have presented Sto. Domingo because he was the one who interpreted the as well as rules and regulations, purposely promulgated to protect and promote the
test result issued by CDC. Likewise, respondents should have presented a medical health of the people by preventing the operation of substandard, improperly managed
expert to refute the testimonies of Garcia and Castro regarding the medical and inadequately supported clinical laboratories and by improving the quality of
explanation behind the conflicting test results on Ranida. 17 performance of clinical laboratory examinations.22 Their business is impressed with
public interest, as such, high standards of performance are expected from them.
Respondents appealed to the Court of Appeals which reversed the trial courts
findings, the dispositive portion of which states: In F.F. Cruz and Co., Inc. v. Court of Appeals, we found the owner of a furniture shop
liable for the destruction of the plaintiffs house in a fire which started in his
WHEREFORE, the decision appealed from is REVERSED and SET ASIDE and establishment in view of his failure to comply with an ordinance which required the
another one entered ORDERING defendant-appellee Orlando D. Garcia, Jr. to pay construction of a firewall. In Teague v. Fernandez, we stated that where the very
plaintiff-appellant Ranida D. Salvador moral damages in the amount of P50,000.00, injury which was intended to be prevented by the ordinance has happened, non-
exemplary damages in the amount of P50,000.00 and attorneys fees in the amount of compliance with the ordinance was not only an act of negligence, but also the
P25,000.00. SO ORDERED.18 proximate cause of the death.23

The appellate court found Garcia liable for damages for negligently issuing an In fine, violation of a statutory duty is negligence. Where the law imposes upon a
erroneous HBs Ag result. On the other hand, it exonerated Castro for lack of person the duty to do something, his omission or non-performance will render him
participation in the issuance of the results. liable to whoever may be injured thereby.

After the denial of his motion for reconsideration, Garcia filed the instant petition. Section 2 of Republic Act (R.A.) No. 4688, otherwise known as The Clinical
Laboratory Law, provides:
The main issue for resolution is whether the Court of Appeals, in reversing the
decision of the trial court, correctly found petitioner liable for damages to the Sec. 2. It shall be unlawful for any person to be professionally in-charge of a
respondents for issuing an incorrect HBsAG test result. registered clinical laboratory unless he is a licensed physician duly qualified in
laboratory medicine and authorized by the Secretary of Health, such authorization to
be renewed annually.
No license shall be granted or renewed by the Secretary of Health for the operation Section 29. Penal Provisions.- Without prejudice to the provision of the Medical Act of
and maintenance of a clinical laboratory unless such laboratory is under the 1959, as amended relating to illegal practice of Medicine, the following shall be
administration, direction and supervision of an authorized physician, as provided for in punished by a fine of not less than two thousand pesos nor more than five thousand
the preceding paragraph. pesos, or imprisonment for not less than six months nor more than two years, or both,
in the discretion of the court:
Corollarily, Sections 9(9.1)(1), 11 and 25(25.1)(1) of the DOH Administrative Order
No. 49-B Series of 1988, otherwise known as the Revised Rules and Regulations (b) Any medical technologist, even if duly registered, who shall practice medical
Governing the Registration, Operation and Maintenance of Clinical Laboratories in the technology in the Philippines without the necessary supervision of a qualified
Philippines, read: pathologist or physician authorized by the Department of Health;

Sec. 9. Management of the Clinical Laboratory: From the foregoing laws and rules, it is clear that a clinical laboratory must be
administered, directed and supervised by a licensed physician authorized by the
9.1 Head of the Clinical Laboratory: The head is that person who assumes technical Secretary of Health, like a pathologist who is specially trained in methods of
and administrative supervision and control of the activities in the laboratory. laboratory medicine; that the medical technologist must be under the supervision of
the pathologist or a licensed physician; and that the results of any examination may
be released only to the requesting physician or his authorized representative upon the
For all categories of clinical laboratories, the head shall be a licensed physician direction of the laboratory pathologist.
certified by the Philippine Board of Pathology in either Anatomic or Clinical Pathology
or both provided that:
These rules are intended for the protection of the public by preventing performance of
substandard clinical examinations by laboratories whose personnel are not properly
(1) This shall be mandatory for all categories of free-standing clinical laboratories; all supervised. The public demands no less than an effective and efficient performance
tertiary category hospital laboratories and for all secondary category hospital of clinical laboratory examinations through compliance with the quality standards set
laboratories located in areas with sufficient available pathologist. by laws and regulations.

Sec. 11. Reporting: All laboratory requests shall be considered as consultations We find that petitioner Garcia failed to comply with these standards.
between the requesting physician and pathologist of the laboratory. As such all
laboratory reports on various examinations of human specimens shall be construed
as consultation report and shall bear the name of the pathologist or his associate. No First, CDC is not administered, directed and supervised by a licensed physician as
person in clinical laboratory shall issue a report, orally or in writing, whole portions required by law, but by Ma. Ruby C. Calderon, a licensed Medical Technologist. 24 In
thereof without a directive from the pathologist or his authorized associate and only to the License to Open and Operate a Clinical Laboratory for the years 1993 and 1996
the requesting physician or his authorized representative except in emergencies when issued by Dr. Juan R. Naagas, M.D., Undersecretary for Health Facilities, Standards
the results may be released as authorized by the pathologist. and Regulation, defendant-appellee Castro was named as the head of
CDC.25 However, in his Answer with Counterclaim, he stated:
Sec. 25. Violations:
3. By way of affirmative and special defenses, defendant pathologist further avers and
plead as follows:
25.1 The license to operate a clinical laboratory may be suspended or revoked by the
Undersecretary of Health for Standards and Regulation upon violation of R.A. 4688 or
the rules and regulations issued in pursuance thereto or the commission of the Defendant pathologist is not the owner of the Community Diagnostic Center nor an
following acts by the persons owning or operating a clinical laboratory and the employee of the same nor the employer of its employees. Defendant pathologist
persons under their authority. comes to the Community Diagnostic Center when and where a problem is referred to
him. Its employees are licensed under the Medical Technology Law (Republic Act No.
5527) and are certified by, and registered with, the Professional Regulation
(1) Operation of a Clinical Laboratory without a certified pathologist or qualified Commission after having passed their Board Examinations. They are competent
licensed physician authorized by the Undersecretary of Health or without employing a within the sphere of their own profession in so far as conducting laboratory
registered medical technologist or a person not registered as a medical technologist examinations and are allowed to sign for and in behalf of the clinical laboratory. The
in such a position. defendant pathologist, and all pathologists in general, are hired by laboratories for
purposes of complying with the rules and regulations and orders issued by the
And Section 29(b) of R.A. No. 5527, otherwise known as The Philippine Medical Department of Health through the Bureau of Research and Laboratories. Defendant
Technology Act of 1969, reads: pathologist does not stay that long period of time at the Community Diagnostic Center
but only periodically or whenever a case is referred to him by the laboratory.
Defendant pathologist does not appoint or select the employees of the laboratory nor employment."32 Having established her right to moral damages, we see no reason to
does he arrange or approve their schedules of duty.26 disturb the award of exemplary damages and attorneys fees. Exemplary damages
are imposed, by way of example or correction for the public good, in addition to moral,
Castros infrequent visit to the clinical laboratory barely qualifies as an effective temperate, liquidated or compensatory damages,33 and attorneys fees may be
administrative supervision and control over the activities in the laboratory. recovered when, as in the instant case, exemplary damages are awarded. 34
"Supervision and control" means the authority to act directly whenever a specific
function is entrusted by law or regulation to a subordinate; direct the performance of WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No. 58668 dated
duty; restrain the commission of acts; review, approve, revise or modify acts and February 27, 2004 finding petitioner Orlando D. Garcia, Jr. guilty of gross negligence
decisions of subordinate officials or units.27 and liable to pay to respondents 50,000.00 as moral damages, 50,000.00 as
exemplary damages, and 25,000.00 as attorneys fees, is AFFIRMED. SO
Second, Garcia conducted the HBsAG test of respondent Ranida without the ORDERED.
supervision of defendant-appellee Castro, who admitted that:
NOEL CASUMPANG, RUBY SANGA-MIRANDA AND SAN JUAN DE DIOS
[He] does not know, and has never known or met, the plaintiff-patient even up to this HOSPITAL, Petitioners, v.NELSON CORTEJO, Respondent.
time nor has he personally examined any specimen, blood, urine or any other tissue,
from the plaintiff-patient otherwise his own handwritten signature would have at about 11:30 in the morning, Mrs. Jesusa Cortejo brought her 11-year old
appeared in the result and not merely stamped as shown in Annex "B" of the son, Edmer Cortejo (Edmer), to the Emergency Room of the San Juan de
Amended Complaint.28 Dios Hospital (SJDH) because of difficulty in breathing, chest pain, stomach
pain, and fever.4
Last, the disputed HBsAG test result was released to respondent Ranida without the Dr. Ramoncito Livelo (Dr. Livelo) initially attended to and examined Edmer.
authorization of defendant-appellee Castro.29 In her testimony, Mrs. Cortejo narrated that in the morning of April 20, 1988,
Edmer had developed a slight fever that lasted for one day; a few hours
upon discovery, she brought Edmer to their family doctor; and two hours
Garcia may not have intended to cause the consequences which followed after the after administering medications, Edmer's fever had subsided. 5
release of the HBsAG test result. However, his failure to comply with the laws and
After taking Edmer's medical history, Dr. Livelo took his vital signs, body
rules promulgated and issued for the protection of public safety and interest is failure
temperature, and blood pressure.6 Based on these initial examinations and
to observe that care which a reasonably prudent health care provider would observe.
the chest x-ray test that followed, Dr. Livelo diagnosed Edmer with
Thus, his act or omission constitutes a breach of duty.
"bronchopneumonia."7 Edmer's blood was also taken for testing, typing, and
for purposes of administering antibiotics. Afterwards, Dr. Livelo gave Edmer
Indubitably, Ranida suffered injury as a direct consequence of Garcias failure to an antibiotic medication to lessen his fever and to loosen his phlegm.
comply with the mandate of the laws and rules aforequoted. She was terminated from Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune Care
the service for failing the physical examination; suffered anxiety because of the card and was referred to an accredited Fortune Care coordinator, who was
diagnosis; and was compelled to undergo several more tests. All these could have then out of town. She was thereafter assigned to Dr. Noel Casumpang (Dr.
been avoided had the proper safeguards been scrupulously followed in conducting Casumpang), a pediatrician also accredited with Fortune Care.8
the clinical examination and releasing the clinical report. At 5:30 in the afternoon of the same day, Dr. Casumpang for the first time
examined Edmer in his room. Using only a stethoscope, he confirmed the
Article 20 of the New Civil Code provides: initial diagnosis of "Bronchopneumonia."9
At that moment, Mrs. Cortejo recalled entertaining doubts on the doctor's
Art. 20. Every person who, contrary to law, willfully or negligently causes damage to diagnosis. She immediately advised Dr. Casumpang that Edmer had a high
another, shall indemnify the latter for the same. fever, and had no colds or cough10 but Dr. Casumpang merely told her that
her son's "bloodpressure is just being active,"11 and remarked that "that's the
usual bronchopneumonia, no colds, no phlegm."12
The foregoing provision provides the legal basis for the award of damages to a party Dr. Casumpang next visited and examined Edmer at 9:00 in the morning the
who suffers damage whenever one commits an act in violation of some legal following day.13 Still suspicious about his son's illness, Mrs. Cortejo again
provision.30 This was incorporated by the Code Commission to provide relief to a called Dr. Casumpang's attention and stated that Edmer had a fever, throat
person who suffers damage because another has violated some legal provision. 31 irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted Dr.
Casumpang about the traces of blood in Edmer's sputum. Despite these
We find the Court of Appeals award of moral damages reasonable under the pieces of information, however, Dr. Casumpang simply nodded, inquired if
circumstances bearing in mind the mental trauma suffered by respondent Ranida who Edmer has an asthma, and reassured Mrs. Cortejo that Edmer's illness is
thought she was afflicted by Hepatitis B, making her "unfit or unsafe for any type of
bronchopneumonia.14 Dr. Casumpang immediately gave the attending physician the patient's
clinical history and laboratory exam results. Upon examination, the attending
At around 11:30 in the morning of April 23, 1988, Edmer vomited "phlegm physician diagnosed "Dengue Fever Stage IV" that was already in its
with blood streak"15prompting the respondent (Edmer's father) to request for irreversible stage.
a doctor at the nurses' station.16 Edmer died at 4:00 in the morning of April 24, 1988. 24 His Death Certificate
Forty-five minutes later, Dr. Ruby Sanga-Miranda (Dr. Miranda), one of the indicated the cause of death as "Hypovolemic Shock/hemorrhagic shock;"
resident physicians of SJDH, arrived. She claimed that although aware that "Dengue Hemorrhagic Fever Stage IV."
Edmer had vomited "phlegm with blood streak," she failed to examine the Believing that Edmer's death was caused by the negligent and erroneous
blood specimen because the respondent washed it away. She then advised diagnosis of his doctors, the respondent instituted an action for damages
the respondent to preserve the specimen for examination. against SJDH, and its attending physicians: Dr. Casumpang and Dr. Miranda
Thereafter, Dr. Miranda conducted a physical check-up covering Edmer's (collectively referred to as the "petitioners") before the RTC of Makati City.
head, eyes, nose, throat, lungs, skin and abdomen; and found that Edmer
had a low-grade non-continuing fever, and rashes that were not typical of The Ruling of the Regional Trial Court
dengue fever.17 Her medical findings state: the patient's rapid breathing and
then the lung showed sibilant and the patient's nose is flaring which is a sign In a decision25 dated May 30, 1997, the RTC ruled in favor of the respondent, and
that the patient is in respiratory distress; the abdomen has negative finding; awarded actual and moral damages, plus attorney's fees and costs.
the patient has low grade fever and not continuing; and the rashes in the
patient's skin were not "Herman's Rash" and not typical of dengue fever. 18 In ruling that the petitioning doctors were negligent, the RTC found untenable the
At 3:00 in the afternoon, Edmer once again vomited blood. Upon seeing Dr. petitioning doctors' contention that Edmer's initial symptoms did not indicate dengue
Miranda, the respondent showed her Edmer's blood specimen, and reported fever. It faulted them for heavily relying on the chest x-ray result and for not
that Edmer had complained of severe stomach pain and difficulty in moving considering the other manifestations that Edmer's parents had relayed. It held that in
his right leg.19 diagnosing and treating an illness, the physician's conduct should be judged not only
Dr. Miranda then examined Edmer's "sputum with blood" and noted that he by what he/she saw and knew, but also by what he/she could have reasonably seen
was bleeding. Suspecting that he could be afflicted with dengue, she and known. It also observed that based on Edmer's signs and symptoms, his medical
inserted a plastic tube in his nose, drained the liquid from his stomach with history and physical examination, and also the information that the petitioning doctors
ice cold normal saline solution, and gave an instruction not to pull out the gathered from his family members, dengue fever was a reasonably foreseeable
tube, or give the patient any oral medication. illness; yet, the petitioning doctors failed to take a second look, much less, consider
Dr. Miranda thereafter conducted a tourniquet test, which turned out to be these indicators of dengue.
negative.20 She likewise ordered the monitoring of the patient's blood
pressure and some blood tests. Edmer's blood pressure was later found to The trial court also found that aside from their self-serving testimonies, the petitioning
be normal.21 doctors did not present other evidence to prove that they exercised the proper
At 4:40 in the afternoon, Dr. Miranda called up Dr. Casumpang at his clinic medical attention in diagnosing and treating the patient, leading it to conclude that
and told him about Edmer's condition.22 Upon being informed, Dr. they were guilty of negligence.
Casumpang ordered several procedures done including: hematocrit,
hemoglobin, blood typing, blood transfusion and tourniquet tests. The RTC also held SJDH solidarity liable with the petitioning doctors for damages
The blood test results came at about 6:00 in the evening. based on the following findings of facts: first, Dr. Casumpang, as consultant, is
Dr. Miranda advised Edmer's parents that the blood test results showed that an ostensible agent of SJDH because before the hospital engaged his medical
Edmer was suffering from "Dengue Hemorrhagic Fever." One hour later, Dr. services, it scrutinized and determined his fitness, qualifications, and competence as
Casumpang arrived at Edmer's room and he recommended his transfer to a medical practitioner; and second, Dr. Miranda, as resident physician, is
the Intensive Care Unit (ICU), to which the respondent consented. Since the an employee of SJDH because like Dr. Casumpang, the hospital, through its
ICU was then full, Dr. Casumpang suggested to the respondent that they screening committee, scrutinized and determined her qualifications, fitness, and
hire a private nurse. The respondent, however, insisted on transferring his competence before engaging her services; the hospital also exercised control over
son to Makati Medical Center. her work.
After the respondent had signed the waiver, Dr. Casumpang, for the last
time, checked Edmer's condition, found that his blood pressure was stable, The dispositive portion of the decision reads:
and noted that he was "comfortable." The respondent requested for an WHEREFORE, judgment is hereby rendered in favor of the plaintiff and against the
ambulance but he was informed that the driver was nowhere to be found. defendants, ordering the latter to pay solidarity and severally plaintiff the
This prompted him to hire a private ambulance that cost him P600.00. 23 following: (1) Moral damages in the amount of P500,000.00; (2) Costs of burial and
funeral in the amount of P45,000.00; (3) Attorney's fees of P50,000.00; and (4) Cost
At 12:00 midnight, Edmer, accompanied by his parents and by Dr.
of this suit. SO ORDERED.
Casumpang, was transferred to Makati Medical Center.
The petitioners appealed the decision to the CA. the necessary training, skills, and experience as a specialist in dengue fever cases.

The Ruling of the Court of Appeals II. Dr. Miranda's Position (G.R. No. 171217)

In its decision dated October 29, 2004, the CA affirmed en toto the RTC's ruling, In her petition, Dr. Miranda faults the CA for holding her responsible for Edmer's
finding that SJDH and its attending physicians failed to exercise the minimum medical wrong diagnosis, stressing that the function of making the diagnosis and undertaking
care, attention, and treatment expected of an ordinary doctor under like the medical treatment devolved upon Dr. Casumpang, the doctor assigned to Edmer,
circumstances. and who confirmed "bronchopneumonia."

The CA found the petitioning doctors' failure to read even the most basic signs of Dr. Miranda also alleged that she exercised prudence in performing her duties as a
"dengue fever" expected of an ordinary doctor as medical negligence. The CA also physician, underscoring that it was her professional intervention that led to the correct
considered the petitioning doctors' testimonies as self-serving, noting that they diagnosis of "Dengue Hemorrhagic Fever." Furthermore, Edmer's Complete Blood
presented no other evidence to prove that they exercised due diligence in diagnosing Count (CBC) showed leukopenia and an increase in balance as shown by the
Edmer's illness. differential count, demonstrating that Edmer's infection, more or less, is of bacterial
and not viral in nature.
The CA likewise found Dr. Rodolfo Jaudian's (Dr. Jaudian) testimony admissible. It
gave credence to his opinion26 that: (1) given the exhibited symptoms of the patient, Dr. Miranda as well argued that there is no causal relation between the alleged
dengue fever should definitely be considered, and bronchopneumonia could be erroneous diagnosis and medication for "Bronchopneumonia," and Edmer's death
reasonably ruled out; and (2) dengue fever could have been detected earlier than due to "Dengue Hemorrhagic Fever."
7:30 in the evening of April 23, 1988 because the symptoms were already evident;
and agreed with the RTC that the petitioning doctors should not have solely relied on Lastly, she claimed that Dr. Jaudian is not a qualified expert witness since he never
the chest-x-ray result, as it was not conclusive. presented any evidence of formal residency training and fellowship status in
Pediatrics.
On SJDH's solidary liability, the CA ruled that the hospital's liability is based on Article
2180 of the Civil Code. The CA opined that the control which the hospital exercises III. SJDH's Position (G.R. No. 171228)
over its consultants, the hospital's power to hire and terminate their services, all fulfill
the employer-employee relationship requirement under Article 2180. SJDH, on the other hand, disclaims liability by asserting that Dr. Casumpang and Dr.
Miranda are mere independent contractors and "consultants" (not employees) of the
Lastly, the CA held that SJDH failed to adduce evidence showing that it exercised the hospital. SJDH alleges that since it did not exercise control or supervision over the
diligence of a good father of a family in the hiring and the supervision of its consultants' exercise of medical profession, there is no employer-employee
physicians. relationship between them, and consequently, Article 2180 of the Civil Code does not
apply.
The petitioners separately moved to reconsider the CA decision, but the CA denied
their motion in its resolution of January 12, 2006; hence, the present consolidated SJDH likewise anchored the absence of, employer-employee relationship on the
petitions pursuant to Rule 45 of the Rules of Court. following circumstances: (1) SJDH does not hire consultants; it only grants them
privileges to admit patients in the hospital through accreditation; (2) SJDH does not
The Petitions pay the consultants wages similar to an ordinary employee; (3) the consultants earn
their own professional fees directly from their patients; SJDH does not fire or
I. Dr. Casumpang's Position (G.R. No. 171127) terminate their services; and (4) SJDH does not control or interfere with the manner
and the means the consultants use in the treatment of their patients. It merely
Dr. Casumpang contends that he gave his patient medical treatment and care to the provides them with adequate space in exchange for rental payment.
best of his abilities, and within the proper standard of care required from physicians
under similar circumstances. He claims that his initial diagnosis of bronchopneumonia Furthermore, SJDH claims that the CA erroneously applied the control test when it
was supported by the chest x-ray result. treated the hospital's practice of accrediting consultants as an exercise of control. It
explained that the control contemplated by law is that which the employer exercises
Dr. Casumpang also contends that dengue fever occurs only after several days of over the: (i) end result; and the (ii) manner and means to be used to reach this end,
confinement. He alleged that when he had suspected that Edmer might be suffering and not any kind of control, however significant, in accrediting the consultants.
from dengue fever, he immediately attended and treated him.
SJDH moreover contends that even if the petitioning doctors are considered
Dr. Casumpang likewise raised serious doubjs on Dr. Jaudian's credibility, arguing employees and not merely consultants of the hospital, SJDH cannot still be held
that the CA erred in appreciating his testimony as an expert witness since he lacked solidarity liable under Article 2180 of the Civil Code because it observed the diligence
of a good father of a family in their selection and supervision as shown by the
following: (1) the adequate measures that the hospital undertakes to ascertain the 3. Whether or not there is a causal connection between the petitioners'
petitioning doctors' qualifications and medical competence; and (2) the documentary negligent act/omission and the patient's resulting death; and
evidence that the petitioning doctors presented to prove their competence in the field
of pediatrics.27 4. Whether or not the lower courts erred in considering Dr. Rodolfo Tabangcora
Jaudian as an expert witness.
SJDH likewise faults the CA for ruling that the petitioning doctors are its agents,
claiming that this theory, aside from being inconsistent with the CA's finding of
Our Ruling
employment relationship, is unfounded because: first, the petitioning doctors are
independent contractors, not agents of SJDH; and second, as a medical institution,
We find the petition partly meritorious.
SJDH cannot practice medicine, much more, extend its personality to physicians to
practice medicine on its behalf.
A Petition for Review on Certiorari under Rule 45 of the Rules of Court is
Limited to Questions of Law.
Lastly, SJDH maintains that the petitioning doctors arrived at an intelligently deduced
and correct diagnosis. It claimed that based on Edmer's signs and symptoms at the
The settled rule is that the Court's jurisdiction in a petition for review
time of admission (i.e., one day fever,28bacterial infection,29 and lack of hemorrhagic
on certiorari under Rule 45 of the Rules of Court is limited only to the review of pure
manifestations30), there was no reasonable indication yet that he was suffering from
questions of law. It is not the Court's function to inquire on the veracity of the
dengue fever, and accordingly, their failure to diagnose dengue fever, does not
appellate court's factual findings and conclusions; this Court is not a trier of facts. 31
constitute negligence on their part.
A question of law arises when there is doubt as to what the law is on a certain state of
The Case for the Respondent facts, while there is a question of fact when the doubt arises as to the truth or falsity of
the alleged facts.32
In his comment, the respondent submits that the issues the petitioners raised are
mainly factual in nature, which a petition for review on certiorari under Rule 45 of the These consolidated petitions before us involve mixed questions of fact and law. As
Rules of Court does not allow. a rule, we do not resolve questions of fact. However, in determining the legal question
of whether the respondent is entitled to claim damages under Article 2176 of the Civil
In any case, he contends that the petitioning doctors were negligent in conducting Code for the petitioners' alleged medical malpractice, the determination of the factual
their medical examination and diagnosis based on the following: (1) the petitioning issues - i.e., whether the petitioning doctors were grossly negligent in diagnosing the
doctors failed to timely diagnose Edmer's correct illness due to their non-observance patient's illness, whether there is causal relation between the petitioners' act/omission
of the proper and acceptable standard of medical examination; (2) the petitioning and the patient's resulting death, and whether Dr. Jaudian is qualified as an expert
doctors' medical examination was not comprehensive, as they were always in a rush; witness - must necessarily be resolved. We resolve these factual questions solely for
and (3) the petitioning doctors employed a guessing game in diagnosing the purpose of determining the legal issues raised.
bronchopneumonia.
Medical Malpractice Suit as a Specialized Area of Tort Law
The respondent also alleges that there is a causal connection between the petitioning
doctors' negligence and Edmer's untimely death, warranting the claim for damages. The claim for damages is based on the petitioning doctors' negligence in diagnosing
and treating the deceased Edmer, the child of the respondent. It is a medical
The respondent, too, asserted that SJDH is also negligent because it was not malpractice suit, an action available to victims to redress a wrong committed by
equipped with proper paging system, has no bronchoscope, and its doctors are not medical professionals who caused bodily harm to, or the death of, a patient. 33 As the
proportionate to the number of its patients. He also pointed out that out of the seven term is used, the suit is brought whenever a medical practitioner or health care
resident physicians in the hospital, only two resident physicians were doing rounds at provider fails to meet the standards demanded by his profession, or deviates from this
the time of his son's confinement. standard, and causes injury to the patient.

The Issues To successfully pursue a medical malpractice suit, the plaintiff (in this case, the
deceased patient's heir) must prove that the doctor either failed to do what a
The case presents to us the following issues: reasonably prudent doctor would have done, or did what a reasonably prudent doctor
would not have done; and the act or omission had caused injury to the patient. 34 The
1. Whether or not the petitioning doctors had committed "inexcusable lack of patient's heir/s bears the burden of proving his/her cause of action.
precaution" in diagnosing and in treating the patient;
The Elements of a Medical Malpractice Suit
2. Whether or not the petitioner hospital is solidarity liable with the petitioning
doctors; The elements of medical negligence are: (1) duty; (2) breach; (3) injury; and (4)
proximate causation. hospital's assigned doctor without objections.

Duty refers to the standard of behavior that imposes restrictions on one's conduct. 35 It b. The Relationship Between Dr. Miranda and Edmer
requires proof of professional relationship between the physician and the patient.
Without the professional relationship, a physician owes no duty to the patient, and With respect to Dr. Miranda, her professional relationship with Edmer arose when she
cannot therefore incur any liability. assumed the obligation to provide resident supervision over the latter. As second year
resident doctor tasked to do rounds and assist other physicians, Dr. Miranda is
A physician-patient relationship is created when a patient engages the services of a deemed to have agreed to the creation of physician-patient relationship with the
physician,36 and the latter accepts or agrees to provide care to the patient.37 The hospital's patients when she participated in the diagnosis and prescribed a course of
establishment of this relationship is consensual,38 and the acceptance by the treatment for Edmer.
physician essential. The mere fact that an individual approaches a physician and
seeks diagnosis, advice or treatment does not create the duty of care unless the The undisputed evidence shows that Dr. Miranda examined Edmer twice (at around
physician agrees.39 12:00 and 3:30 in the afternoon of April 23, 1988), and in both instances, she
prescribed treatment and participated in the diagnosis of Edmer's medical condition.
The consent needed to create the relationship does not always need to be Her affirmative acts amounted to her acceptance of the physician-patient relationship,
express.40 In the absence of an express agreement, a physician-patient relationship and incidentally, the legal duty of care that went with it.
may be implied from the physician's affirmative action to diagnose and/or treat a
patient, or in his participation in such diagnosis and/or treatment.41 The usual In Jarcia, Jr. v. People of the Philippines,46 the Court found the doctors who merely
illustration would be the case of a patient who goes to a hospital or a clinic, and is passed by and were requested to attend to the patient, liable for medical malpractice.
examined and treated by the doctor. In this case, we can infer, based on the It held that a physician-patient relationship was established when they examined the
established and customary practice in the medical community that a patient-physician patient, and later assured the mother that everything was fine.
relationship exists.
In the US case of Mead v. Legacy Health System,47 the Court also considered the
Once a physician-patient relationship is established, the legal duty of care follows. rendering of an opinion in the course of the patient's care as the doctor's assent to the
The doctor accordingly becomes duty-bound to use at least the same standard of physician-patient relationship. It ruled that the relationship was formed because of the
care that a reasonably competent doctor would use to treat a medical condition under doctor's affirmative action.
similar circumstances.
Likewise, in Wax v. Johnson,48 the court found that a physician-patient relationship
Breach of duty occurs when the doctor fails to comply with, or improperly performs his was formed between a physician who "contracts, agrees, undertakes, or otherwise
duties under professional standards. This determination is both factual and legal, and assumes" the obligation to provide resident supervision at a teaching hospital, and
is specific to each individual case.42 the patient with whom the doctor had no direct or indirect contract.

If the patient, as a result of the breach of duty, is injured in body or in health, Standard of Care and Breach of Duty
actionable malpractice is committed, entitling the patient to damages.43
A determination of whether or not the petitioning doctors met the required standard of
To successfully claim damages, the patient must lastly prove the causal relation care involves a question of mixed fact and law; it is factual as medical negligence
between the negligence and the injury. This connection must be direct, natural, and cases are highly technical in nature, requiring the presentation of expert witnesses to
should be unbroken by any intervening efficient causes. In other words, the provide guidance to the court on matters clearly falling within the domain of medical
negligence must be the proximate cause of the injury.44 The injury or damage is science, and legal, insofar as the Court, after evaluating the expert testimonies, and
proximately caused by the physician's negligence when it appears, based on the guided by medical literature, learned treatises, and its fund of common knowledge,
evidence and the expert testimony, that the negligence played an integral part in ultimately determines whether breach of duty took place.
causing the injury or damage, and that the injury or damage was either a direct result,
or a reasonably probable consequence of the physician's negligence. 45 Whether or not Dr. Casumpang and Dr. Miranda committed a breach of duty is to be
measured by the yardstick of professional standards observed by the other members
a. The Relationship Between Dr. Casumpang and Edmer of the medical profession in good standing under similar circumstances. 49 It is in this
aspect of medical malpractice that expert testimony is essential to establish not only
In the present case, the physician-patient relationship between Dr. Casumpang and the professional standards observed in the medical community, but also that the
Edmer was created when the latter's parents sought the medical services of Dr. physician's conduct in the treatment of care falls below such standard. 50
Casumpang, and the latter knowingly accepted Edmer as a patient. Dr. Casumpang's
acceptance is implied from his affirmative examination, diagnosis and treatment of In the present case, expert testimony is crucial in determining first, the standard
Edmer. On the other hand, Edmer's parents, on their son's behalf, manifested their medical examinations, tests, and procedures that the attending physicians should
consent by availing of the benefits of their health care plan, and by accepting the have undertaken in the diagnosis and treatment of dengue fever; and second, the
dengue fever signs and symptoms that the attending physicians should have noticed Edmer. While he noted some of these symptoms in confirming bronchopneumonia, he
and considered. did not seem to have considered the patient's other manifestations in ruling out
dengue fever or dengue hemorrhagic fever.58 To our mind, Dr. Casumpang
Both the RTC and the CA relied largely on Dr. Jaudian's expert testimony on dengue selectively appreciated some, and not all of the symptoms; worse, he casually ignored
diagnosis and management to support their finding that the petitioning doctors were the pieces of information that could have been material in detecting dengue fever.
guilty of breach of duty of care. This is evident from the testimony of Mrs. Cortejo:

Dr. Jaudian testified that Edmer's rapid breathing, chest and stomach pain, fever, and TSN, Mrs. Cortejo, November 27, 1990
the presence of blood in his saliva are classic symptoms of dengue fever. According Q: Now, when Dr. Casumpang visited your son for the first time at 5:30 p.m., what
to him, if the patient was admitted for chest pain, abdominal pain, and difficulty in did he do, if any?
breathing coupled with fever, dengue fever should definitely be considered; 51 if the A: He examined my son by using stethoscope and after that, he confirmed to me
patient spits coffee ground with the presence of blood, and the patient's platelet count that my son was suffering from broncho pneumonia.
drops to 47,000, it becomes a clear case of dengue fever, and bronchopneumonia Q: After he confirmed that your son was suffering broncho pneumonia, what did
can be reasonably ruled out.52 you say if any?
A: Again, I told Dr. Casumpang, how come it was broncho pneumonia when
Furthermore, the standard of care according to Dr. Jaudian is to administer oxygen my son has no cough or colds.
inhalation, analgesic, and fluid infusion or dextrose.53 If the patient had twice vomited Q: What was the answer of Dr. Casumpang to your statement?
fresh blood and thrombocytopenia has already occurred, the doctor should A: And then, Dr. Casumpang answered "THAT'S THE USUAL BRONCHO
order blood transfusion, monitoring of the patient every 30 minutes, hemostatic to PNEUMONIA, NO COLDS, NO PHLEGM."
stop bleeding, and oxygen if there is difficulty in breathing.54 Q: How long did Dr. Casumpang stay in your son's room?
A: He stayed for a minute or 2.
We find that Dr. Casumpang, as Edmer's attending physician, did not act Q: Q: When Dr. Casumpang arrived at 9:00 o'clock a.m. on April 23, what did you
according to these standards and, hence, was guilty of breach of duty. We do tell him, if any?
not find Dr. Miranda liable for the reasons discussed below. A: I told Dr. Casumpang... After examining my son using stethoscope and
nothing more, I told Dr. Casumpang about the traces of blood in my son's
Dr. Casumpang's Negligence sputum and I told him what is all about and he has throat irritation.
Q: What did he tell you?
a. Negligence in the Diagnosis A: He just nodded his head but he did not take the initiative of looking at the
throat of my son.
At the trial, Dr. Casumpang declared that a doctor's impression regarding a patient's Q: So what happened after that?
illness is 90% based on the physical examination, the information given by the patient A: I also told Dr. Casumpang about his chest pain and also stomach pain.
or the latter's parents, and the patient's medical history. 55 He testified that he did not Q: So what did Dr. Casumpang do after you have narrated all these complaints
consider either dengue fever or dengue hemorrhagic fever because the patient's of your son?
history showed that Edmer had low breath and voluntary submission, and that he was A: Nothing. He also noticed the rapid breathing of my son and my son was
up and about playing basketball.56 He based his diagnosis of bronchopneumonia on almost moving because of rapid breathing and he is swaying in the bed.
the following observations: "difficulty in breathing, clearing run nostril, harsh breath Q: Do you know what action was taken by Dr. Casumpang when you told him
sound, tight air, and sivilant sound."57 that your son is experiencing a rapid breathing?
A: No action. He just asked me if my son has an asthma but I said none.
It will be recalled that during Dr. Casumpang's first and second visits to Edmer, he Q: So how long did Dr. Casumpang stay and attended your son on April 23?
already had knowledge of Edmer's laboratory test result (CBC), medical history, and A: More or less two (2) minutes then I followed him up to the door and I
symptoms (i.e., fever, rashes, rapid breathing, chest and stomach pain, throat repeated about the fever of my son.
irritation, difficulty in breathing, and traces of blood in the sputum). However, these Q: What did he tell you, if any, regarding that information you gave him that
information did not lead Dr. Casumpang to the possibility that Edmer could be your son had a fever?
suffering from either dengue fever, or dengue hemorrhagic fever, as he clung to A: He said, that is broncho pneumonia, It's only being active now. [Emphasis
his diagnosis of broncho pneumonia. This means that given the symptoms supplied]
exhibited, Dr. Casumpang already ruled out the possibility of other diseases like
dengue. We also find it strange why Dr. Casumpang did not even bother to check Edmer's
throat despite knowing that as early as 9:00 in the morning of April 23, 1988, Edmer
In other words, it was lost on Dr. Casumpang that the characteristic symptoms of had blood streaks in his sputum. Neither did Dr. Casumpang order confirmatory tests
dengue (as Dr. Jaudian testified) are: patient's rapid breathing; chest and stomach to confirm the source of bleeding. The Physician's Progress Notes 59 stated: "Blood
pain; fever; and the presence of blood in his saliva. All these manifestations were streaks on phlegm can be due to bronchial irritation or congestion" which clearly
present and known to Dr. Casumpang at the time of his first and second visits to showed that Dr. Casumpang merely assumed, without confirmatory physical
examination, that bronchopneumonia caused the bleeding.
Second, we clarify that a wrong diagnosis is not by itself medical
Dr. Jaudian likewise opined that Dr. Casumpang's medical examination was not malpractice.65 Physicians are generally not liable for damages resulting from a bona
comprehensive enough to reasonably lead to a correct diagnosis. 60 Dr. Casumpang fide error of judgment. Nonetheless, when the physician's erroneous diagnosis was
only used a stethoscope in coming up with the diagnosis that Edmer was suffering the result of negligent conduct (e.g., neglect of medical history, failure to order the
from bronchopneumonia; he never confirmed this finding with the use of a appropriate tests, failure to recognize symptoms), it becomes an evidence of medical
bronchoscope. Furthermore, Dr. Casumpang based his diagnosis largely on the chest malpractice.
x-ray result that is generally inconclusive.61
Third, we also note that medicine is not an exact science;66 and doctors, or even
Significantly, it was only at around 5:00 in the afternoon of April 23, 1988 (after specialists, are not expected to give a 100% accurate diagnosis in treating patients
Edmer's third episode of bleeding) that Dr. Casumpang ordered the conduct who come to their clinic for consultations. Error is possible as the exercise of
of hematocrit, hemoglobin, blood typing, blood transfusion and tourniquet tests. These judgment is called for in considering and reading the exhibited symptoms, the results
tests came too late, as proven by: (1) the blood test results that came at about 6:00 in of tests, and in arriving at definitive conclusions. But in doing all these, the doctor
the evening, confirming that Edmer's illness had developed to "Dengue Hemorrhagic must have acted according to acceptable medical practice standards.
Fever" and (2) Dr. Jaudian's testimony that "dengue fever could have been detected
earlier than 7:30 in the evening of April 23, 1988 because the symptoms were already In the present case, evidence on record established that in confirming the diagnosis
evident."62 of bronchopneumonia, Dr. Casumpang selectively appreciated some and not all of the
symptoms presented, and failed to promptly conduct the appropriate tests to confirm
In Spouses Flores v. Spouses Pineda,63 a case involving a medical malpractice suit, his findings. In sum, Dr. Casumpang failed to timely detect dengue fever, which
the Court ruled that the petitioner doctors were negligent because they failed to failure, especially when reasonable prudence would have shown that indications of
immediately order tests to confirm the patient's illness. Despite the doctors' suspicion dengue were evident and/or foreseeable, constitutes negligence.
that the patient could be suffering from diabetes, the former still proceeded to the
D&C operation. In that case, expert testimony showed that tests should have been a. Negligence in the Treatment and Management of Dengue
ordered immediately on admission to the hospital in view of the symptoms presented.
The Court held: Apart from failing to promptly detect dengue fever, Dr. Casumpang also failed to
When a patient exhibits symptoms typical of a particular disease, these symptoms promptly undertake the proper medical management needed for this disease.
should, at the very least, alert the physician of the possibility that the patient may be
afflicted with the suspected disease. As Dr. Jaudian opined, the standard medical procedure once the patient had
The Court also ruled that reasonable prudence would have shown that diabetes and exhibited the classic symptoms of dengue fever should have been: oxygen inhalation,
its complications were foreseeable harm. However, the petitioner doctors failed to use of analgesic, and infusion of fluids or dextrose;67 and once the patient had twice
take this into consideration and proceeded with the D&C operation. Thus, the Court vomited fresh blood, the doctor should have ordered: blood transfusion, monitoring of
ruled that they failed to comply with their duty to observe the standard of care to be the patient every 30 minutes, hemostatic to stop bleeding, and oxygen if there is
given to hyperglycemic/diabetic patients. difficulty in breathing.68

Similarly, in Jarcia,64 involving the negligence of the doctors in failing to exercise Dr. Casumpang failed to measure up to these standards. The evidence strongly
reasonable prudence in ascertaining the extent of the patient's injuries, this Court suggests that he ordered a transfusion of platelet concentrate instead of blood
declared that: transfusion. The tourniquet test was only conducted after Edmer's second episode of
In failing to perform an extensive medical examination to determine the extent bleeding, and the medical management (as reflected in the records) did not include
of Roy Jr.'s injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as antibiotic therapy and complete physical examination.
members of the medical profession. Assuming for the sake of argument that they
did not have the capacity to make such thorough evaluation at that stage, they should Dr. Casumpang's testimony states:
have referred the patient to another doctor with sufficient training and experience Q: Now, after entertaining - After considering that the patient Edmer Cortero was
instead of assuring him and his mother that everything was all right. [Emphasis already suffering from dengue hemorrhagic fever, what did you do, if any?
supplied] A: We ordered close monitoring of the blood pressure, the cardiac rate and
Even assuming that Edmer's symptoms completely coincided with the diagnosis of respiratory rate of the patient.
bronchopneumonia (so that this diagnosis could not be considered "wrong"), we still Q: Now, was your instructions carried on?
find Dr. Casumpang guilty of negligence. A: Yes, sir.
Q: What was the blood pressure of the patient?
First, we emphasize that we do not decide the correctness of a doctor's A: During those times, the blood pressure of the patient was even normal during
diagnosis, or the accuracy of the medical findings and treatment. Our duty in those times.
medical malpractice cases is to decide - based on the evidence adduced and expert Q: How about the respiratory rate?
opinion presented - whether a breach of duty took place. A: The respiratory rate was fast because the patient in the beginning since
admission had difficulty in breathing. decision to be made and on the action to be taken.
Q: Then, after that, what did you do with the patient? Doctor?
A: We transfused platelet concentrate and at the same time, we monitor [sic] The attending physician, on the other hand, is primarily responsible for managing the
the patient. resident's exercise of duties. While attending and resident physicians share the
Q: Then, who monitor [sic] the patient? collective responsibility to deliver safe and appropriate care to the patients, 74 it is the
A: The pediatric resident on duty at that time. attending physician who assumes the principal responsibility of patient
Q: Now, what happened after that? care.75 Because he/she exercises a supervisory role over the resident, and is
Q: While monitoring the patient, all his vital signs were ________; his blood pressure ultimately responsible for the diagnosis and treatment of the patient, the standards
was normal so we continued with the supportive management at that time. applicable to and the liability of the resident for medical malpractice is theoretically
Q: Now, after that? less than that of the attending physician. These relative burdens and distinctions,
A: In the evening of April 23, 1988,1 stayed in the hospital and I was informed by the however, do not translate to immunity from the legal duty of care for residents, 76 or
pediatric resident on duty at around 11:15 in the evening that the blood pressure from the responsibility arising from their own negligent act.
of the patient went down to .60 palpatory.
Q: What did you do upon receipt of that information? In Jenkins v. Clark,77 the Ohio Court of Appeals held that the applicable standard of
A: I immediately went up to the room of the patient and we changed the IV care in medical malpractice cases involving first-year residents was that of a
fluid from the present fluid which was D5 0.3 sodium chloride to lactated reasonably prudent physician and not that of interns. According to Jenkins:
ringers solution. It is clear that the standard of care required of physicians is not an individualized one
Q: You mean to say you increased the dengue [sic] of the intervenus [sic] but of physicians in general in the community. In order to establish medical
fluid? malpractice, it must be shown by a preponderance of the evidence that a physician
A: We changed the IV fluid because lactated ringers was necessary to resume did some particular thing or things that a physician or surgeon of ordinary skill, care
the volume and to bring back the blood pressure, to increase the blood and diligence would not have done under like or similar conditions or circumstances,
pressure. [Emphasis supplied] or that he failed or omitted to do some particular thing or things that a physician or
Although Dr. Casumpang presented the testimonies of Dr. Rodolfo Jagonap and Dr. surgeon of ordinary skill, care and diligence would have done under like or similar
Ellewelyn Pasion (Dr. Pasion), Personnel Officer and Medical Director of SJDH, conditions or circumstances, and that the inquiry complained of was the direct result
respectively as well as the testimonies of Dr. Livelo and Dr. Reyes (the radiologist of such doing or failing to do such thing or things.
who read Edmer's chest x-ray result), these witnesses failed to dispute the standard
of action that Dr. Jaudian established in his expert opinion. We cannot consider them We note that the standard of instruction given by the court was indeed a proper
expert witnesses either for the sole reason that they did not testify on the standard of one. It clearly informed the jury that the medical care required is that of
care in dengue cases.69 reasonably careful physicians or hospital emergency room operators, not of
interns or residents. [Emphasis supplied]
On the whole, after examining the totality of the adduced evidence, we find that the A decade later, Centman v. Cobb,78 affirmed the Jenkins ruling and held that interns
lower courts correctly did not rely on Dr. Casumpang's claim that he exercised and first-year residents are "practitioners of medicine required to exercise the same
prudence and due diligence in handling Edmer's case. Aside from being self-serving, standard of care applicable to physicians with unlimited licenses to practice." The
his claim is not supported by competent evidence. As the lower courts did, we rely on Indiana Court held that although a first-year resident practices under a temporary
the uncontroverted fact that he failed, as a medical professional, to observe the most medical permit, he/she impliedly contracts that he/she has the reasonable and
prudent medical procedure under the circumstances in diagnosing and treating ordinary qualifications of her profession and that he/she will exercise reasonable skill,
Edmer. diligence, and care in treating the patient.

Dr. Miranda is Not Liable for Negligence We find that Dr. Miranda was not independently negligent. Although she had
greater patient exposure, and was' subject to the same standard of care applicable to
In considering the case of Dr. Miranda, the junior resident physician who was on-duty attending physicians, we believe that a finding of negligence should also depend on
at the time of Edmer's confinement, we see the need to draw distinctions between the several competing factors, among them, her authority to make her own diagnosis, the
responsibilities and corresponding liability of Dr. Casumpang, as the attending degree of supervision of the attending physician over her, and the shared
physician, and that of Dr. Miranda. responsibility between her and the attending physicians.

In his testimony, Dr. Pasion declared that resident applicants are generally doctors of In this case, before Dr. Miranda attended to Edmer, both Dr. Livelo and Dr.
medicine licensed to practice in the Philippines and who would like to pursue a Casumpang had diagnosed Edmer with bronchopneumonia. In her testimony, Dr.
particular specialty.70 They are usually the front line doctors responsible for the first Miranda admitted that she had been briefed about Edmer's condition, his medical
contact with the patient. During the scope of the residency program,71 resident history, and initial diagnosis;79 and based on these pieces of information,
physicians (or "residents")72 function under the supervision of attending she confirmed the, finding of bronchopneumonia.
physicians73 or of the hospital's teaching staff. Under this arrangement, residents
operate merely as subordinates who usually defer to the attending physician on the Dr. Miranda likewise duly reported to Dr. Casumpang, who admitted receiving
updates regarding Edmer's condition.80 There is also evidence supporting Dr. Criteria in Qualifying as an Expert Witness
Miranda's claim that she extended diligent care to Edmer. In fact, when she
suspected - during Edmer's second episode of bleeding - that Edmer could be The competence of an expert witness is a matter for the trial court to decide upon in
suffering from dengue fever, she wasted no time in conducting the necessary tests, the exercise of its discretion. The test of qualification is necessarily a relative one,
and promptly notified Dr. Casumpang about the incident. Indubitably, her medical depending upon the subject matter of the investigation, and the fitness of the expert
assistance led to the finding of dengue fever. witness.84 In our jurisdiction, the criterion remains to be the expert witness' special
knowledge experience and practical training that qualify him/her to explain
We note however, that during Edmer's second episode of bleeding, 81 Dr. Miranda highly technical medical matters to the Court.
failed to immediately examine and note the cause of the blood specimen. Like Dr.
Casumpang, she merely assumed that the blood in Edmer's phlegm was caused by In Ramos v. Court of Appeals,85 the Court found the expert witness, who is a
bronchopneumonia. Her testimony states: pulmonologist, not qualified to testify on the field of anesthesiology. Similarly,
TSN, June 8, 1993: in Cereno v. Court of Appeals,86 a 2012 case involving medical negligence, the Court
Q: Let us get this clear, you said that the father told you the patient cocked [sic] out excluded the testimony of an expert witness whose specialty was anesthesiology, and
phlegm. concluded that an anesthesiologist cannot be considered an expert in the field of
A: With blood streak. surgery or even in surgical practices and diagnosis.
Q: Now, you stated specimen, were you not able to examine the specimen?
A: No, sir, I did not because according to the father he wash [sic] his hands. Interestingly in this case, Dr. Jaudian, the expert witness was admittedly not a
xxxx pediatrician but a practicing physician who specializes in pathology. 87 He likewise
Q: Now, from you knowledge, what does that indicate if the patient expels a phlegm does not possess any formal residency training in pediatrics. Nonetheless, both the
and blood streak? lower courts found his knowledge acquired through study and practical experience
A: If a patient cocked [sic] out phlegm then the specimen could have come from the sufficient to advance an expert opinion on dengue-related cases.
lung alone.82 [Emphasis supplied]
xxxx We agree with the lower courts.
TSN, June 17, 1993:
Q: Now, in the first meeting you had, when that was relayed to you by the father that A close scrutiny of Ramos and Cereno reveals that the Court primarily based the
Edmer Cortejo had coughed out blood, what medical action did you take? witnesses' disqualification to testify as an expert on their incapacity to shed light on
A: I examined the patient and I thought that, that coughed out phlegm was a product the standard of care that must be observed by the defendant-physicians. That the
of broncho pneumonia. expert witnesses' specialties do not match the physicians' practice area only
xxxx constituted, at most, one of the considerations that should not be taken out of context.
Q: So what examination did you specifically conduct to see that there was no After all, the sole function of a medical expert witness, regardless of his/her specialty,
internal bleeding? is to afford assistance to the courts on medical matters, and to explain the medical
A: At that time I did not do anything to determine the cause of coughing of the facts in issue.
blood because I presumed that it was a mucous (sic) produced by broncho
pneumonia, And besides the patient did not even show any signs of any Furthermore, there was no reasonable indication in Ramos and Cereno that the
other illness at that time.[83 expert witnesses possess a sufficient familiarity with the standard of care applicable
Based on her statements we find that Dr. Miranda was not entirely to the physicians' specialties.
faultless. Nevertheless, her failure to discern the import of Edmer's second
bleeding does not necessarily amount to negligence as the respondent himself US jurisprudence on medical malpractice demonstrated the trial courts' wide latitude
admitted that Dr. Miranda failed to examine the blood specimen because he washed it of discretion in allowing a specialist from another field to testify against a defendant
away. In addition, considering the diagnosis previously made by two doctors, and the specialist.
uncontroverted fact that the burden of final diagnosis pertains to the attending
physician (in this case, Dr. Casumpang), we believe that Dr. Miranda's error was In Brown v. Sims,88 a neurosurgeon was found competent to give expert testimony
merely an honest mistake of judgment influenced in no small measure by her status in regarding a gynecologist's standard of pre-surgical care. In that case, the court held
the hospital hierarchy; hence, she should not be held liable for medical negligence. that since negligence was not predicated on the gynecologist's negligent performance
of the operation, but primarily on the claim that the pre-operative histories and
Dr. Jaudian 's Professional Competence and Credibility physicals were inadequate, the neurosurgeon was competent to testify as an expert.

One of the critical issues the petitioners raised in the proceedings before the lower Frost v. Mayo Clinic89 also allowed an orthopedic surgeon to testify against a
court and before this Court was Dr. Jaudian's competence and credibility as an expert neurologist in a medical malpractice action. The court considered that the orthopedic
witness. The petitioners tried to discredit his expert testimony on the ground that he surgeon's opinion on the "immediate need for decompression" need not come from a
lacked the proper training and fellowship status in pediatrics. specialist in neurosurgery. The court held that:
It is well established that "the testimony of a qualified medical doctor cannot be
excluded simply because he is not a specialist x x x." The matter of "x x x training and As a licensed medical practitioner specializing in pathology, who had practical and
specialization of the witness goes to the weight rather than admissibility x x x." relevant exposure in pediatrics and dengue related cases, we are convinced that Dr.
Jaudian demonstrated sufficient familiarity with the standard of care to be applied in
dengue fever cases. Furthermore, we agree that he possesses knowledge and
It did not appear to the court that a medical doctor had to be a specialist in experience sufficient to qualify him to speak with authority on the subject.
neurosurgery to express the opinions permitted to be expressed by plaintiffs'
doctors, e.g., the immediate need for a decompression in the light of certain The Causation Between Dr. Casumpang's Negligent Act/Omission, and the
neurological deficits in a post-laminectomy patient. As stated above, there was no Patient's Resulting Death was Adequately Proven
issue as to the proper execution of the neurosurgery. The medical testimony
supported plaintiffs' theory of negligence and causation. (Citations omitted) Dr. Jaudian's testimony strongly suggests that due to Dr. Casumpang's failure to
In another case,90 the court declared that it is the specialist's knowledge of the timely diagnose Edmer with dengue, the latter was not immediately given the proper
requisite subject matter, rather than his/her specialty that determines his/her treatment. In fact, even after Dr. Casumpang had discovered Edmer's real illness, he
qualification to testify. still failed to promptly perform the standard medical procedure. We agree with these
findings.
Also in Evans v. Ohanesian,91 the court set a guideline in qualifying an expert
witness: As the respondent had pointed out, dengue fever, if left untreated, could be a life
To qualify a witness as a medical expert, it must be shown that the witness (1) has threatening disease. As in any fatal diseases, it requires immediate medical
the required professional knowledge, learning and skill of the subject under attention.93 With the correct and timely diagnosis, coupled with the proper medical
inquiry sufficient to qualify him to speak with authority on the subject; and (2) management, dengue fever is not a life-threatening disease and could easily be
is familiar with the standard required of a physician under similar cured.94
circumstances; where a witness has disclosed sufficient knowledge of the subject to
entitle his opinion to go to the jury, the question of the degree of his knowledge goes Furthermore, as Dr. Jaudian testified, with adequate intensive care, the mortality rate
more to the weight of the evidence than to its admissibility. of dengue fever should fall to less than 2%. Hence, the survival of the patient is
directly related to early and proper management of the illness. 95

Nor is it critical whether a medical expert is a general practitioner or a specialist so To reiterate, Dr. Casumpang failed to timely diagnose Edmer with dengue fever
long as he exhibits knowledge of the subject. Where a duly licensed and despite the presence of its characteristic symptoms; and as a consequence of the
practicing physician has gained knowledge of the standard of care applicable delayed diagnosis, he also failed to promptly manage Edmer's illness. Had he
to a specialty in which he is not directly engaged but as to which he has an immediately conducted confirmatory tests, (i.e., tourniquet tests and series of blood
opinion based on education, experience, observation, or association wit that tests) and promptly administered the proper care and management needed for
specialty, his opinion is competent. (Emphasis supplied) dengue fever, the risk of complications or even death, could have been substantially
reduced.
Finally, Brown v. Mladineo92 adhered to the principle that the witness' familiarity, and
Furthermore, medical literature on dengue shows that early diagnosis and
not the classification by title or specialty, which should control issues regarding the
management of dengue is critical in reducing the risk of complications and avoiding
expert witness' qualifications:
further spread of the virus.96 That Edmer later died of "Hypovolemic
The general rule as to expert testimony in medical malpractice actions is that "a
Shock/hemorrhagic shock," "Dengue Hemorrhagic Fever Stage IV," a severe and
specialist in a particular branch within a profession will not be required." Most courts
fatal form of dengue fever, established the causal link between Dr. Casumpang's
allow a doctor to testify if they are satisfied of his familiarity with the standards of a
negligence and the injury.
specialty, though he may not practice the specialty himself. One court explained that
"it is the scope of the witness' knowledge and not the artificial classification by title
Based on these considerations, we rule that the respondent successfully proved the
that should govern the threshold question of admissibility. (Citations omitted)
element of causation.
Application to the Present Case
Liability of SJDH
In the case and the facts before us, we find that Dr. Jaudian is competent to testify on
the standard of care in dengue fever cases.
We now discuss the liability of the hospital.
Although he specializes in pathology, it was established during trial that he had
The respondent submits that SJDH should not only be held vicariously liable for the
attended not less than 30 seminars held by the Pediatric Society, had exposure in
petitioning doctors' negligence but also for its own negligence. He claims that SJDH
pediatrics, had been practicing medicine for 16 years, and had handled not less than
fell short of its duty of providing its patients with the necessary facilities and
50 dengue related cases.
equipment as shown by the following circumstances:
(a) SJDH was not equipped with proper paging system; patient knows, or should have known, that the physician is an independent contractor.
(b) the number of its doctors is not proportionate to the number of patients; The elements of the action have been set out as follows:
(c) SJDH was not equipped with a bronchoscope; For a hospital to be liable under the doctrine of apparent authority, a plaintiff must
(d) when Edmer's oxygen was removed, the medical staff did not immediately show that: (1) the hospital, or its agent, acted in a manner that would lead a
provide him with portable oxygen; reasonable person to conclude that the individual who was alleged to be
(e) when Edmer was about to be transferred to another hospital, SJDH's was not negligent was an employee or agent of the hospital; (2) where the acts of the
ready and had no driver; and agent create the appearance of authority, the plaintiff must also prove that the
(f) despite Edmer's critical condition, there was no doctor attending to him from 5:30 hospital had knowledge of and acquiesced in them; and (3) the plaintiff acted in
p.m. of April 22, to 9:00 a.m. of April 23, 1988. reliance upon the conduct of the hospital or its agent, consistent with ordinary
SJDH on the other hand disclaims liability by claiming that the petitioning doctors are care and prudence. (Emphasis supplied)
not its employees but are mere consultants and independent contractors. The doctrine was applied in Nogales v. Capitol Medical Center101 where this Court,
through the ponenciaof Associate Justice Antonio T. Carpio, discussed the two
We affirm the hospital's liability not on the basis of Article 2180 of the Civil Code, but factors in determining hospital liability as follows:
on the basis of the doctrine of apparent authority or agency by estoppel. The first factor focuses on the hospital's manifestations and is sometimes described
as an inquiry whether the hospital acted in a manner which would lead a reasonable
There is No Employer-Employee Relationship Between SJDH and the person to conclude that the individual who was alleged to be negligent was an
Petitioning Doctors employee or agent of the hospital. In this regard, the hospital need not make express
representations to the patient that the treating physician is an employee of the
In determining whether an employer-employee relationship exists between the hospital; rather a representation may be general and implied.
parties, the following elements must be present: (1) selection and engagement of
services; (2) payment of wages; (3) the power to hire and fire; and (4) the power to
control not only the end to be achieved, but the means to be used in reaching such an The second factor focuses on the patient's reliance. It is sometimes characterized as
end.97 an inquiry on whether the plaintiff acted in reliance upon the conduct of the hospital or
its agent, consistent with ordinary care and prudence. (Citation omitted)
Control, which is the most crucial among the elements, is not present in this case. In sum, a hospital can be held vicariously liable for the negligent acts of a physician
(or an independent contractor) providing care at the hospital if the plaintiff can prove
Based on the records, no evidence exists showing that SJDH exercised any degree of these two factors: first, the hospital's manifestations; and second, the patient's
control over the means, methods of procedure and manner by which the petitioning reliance.
doctors conducted and performed their medical profession. SJDH did not control their
diagnosis and treatment. Likewise, no evidence was presented to show that SJDH a. Hospital's manifestations
monitored, supervised, or directed the petitioning doctors in the treatment and
management of Edmer's case. In these lights, the petitioning doctors were not It involves an inquiry on whether the hospital acted in a manner that would lead a
employees of SJDH, but were mere independent contractors. reasonable person to conclude that the individual alleged to be negligent was an
employee or agent of the hospital. As pointed out in Nogales, the hospital need not
SJDH is Solidarity Liable Based on The Principle of Agency or Doctrine of make express representations to the patient that the physician or independent
Apparent Authority contractor is an employee of the hospital; representation may be general and
implied.102
Despite the absence of employer-employee relationship between SJDH and the
petitioning doctors, SJDH is not free from liability.98 In Pamperin v. Trinity Memorial Hospital,103 questions were raised on "what acts by
the hospital or its agent are sufficient to lead a reasonable person to conclude that the
As a rule, hospitals are not liable for the negligence of its independent contractors. individual was an agent of the hospital." In ruling that the hospital's manifestations can
However, it may be found liable if the physician or independent contractor acts as an be proven without the express representation by the hospital, the court relied on
ostensible agent of the hospital. This exception is also known as the "doctrine of several cases from other jurisdictions, and held that:
apparent authority."99 (1) the hospital, by providing emergency room care and by failing to advise patients
that they were being treated by the hospital's agent and not its employee, has
The US case of Gilbert v. Sycamore Municipal Hospital100 abrogated the hospitals' created the appearance of agency; and
immunity to vicarious liability of independent contractor physicians. In that case, the (2) patients entering the hospital through the emergency room, could properly
Illinois Supreme Court held that under the doctrine of apparent authority, hospitals assume that the treating doctors and staff of the hospital were acting on its
could be found vicariously liable for the negligence of an independent contractor: behalf.
Therefore, we hold that, under the doctrine of apparent authority, a hospital can be In this case, the court considered the act of the hospital of holding itself out as
held vicariously liable for the negligent acts of a physician providing care at the provider of complete medical care, and considered the hospital to have impliedly
hospital, regardless of whether the physician is an independent contractor, unless the created the appearance of authority.
petitions. The Court finds Dr. Noel Casumpang and San Juan de Dios Hospital
b. Patient's reliance solidarity liable for negligent medical practice. We SET ASIDE the finding of liability
as to Dr. Ruby Sanga-Miranda. The amounts of P45,000.00 as actual damages and
It involves an inquiry on whether the plaintiff acted in reliance on the conduct of the P500,000.00 as moral damages should each earn legal interest at the rate of six
hospital or its agent, consistent with ordinary care and prudence.104 percent (6%) per annum computed from the date of the judgment of the trial court.
The Court AFFIRMSthe rest of the Decision dated October 29, 2004 and the
In Pamperin, the court held that the important consideration in determining the Resolution dated January 12, 2006 in CA-G.R. CV No. 56400.
patient's reliance is: whether the plaintiff is seeking care from the hospital itself or
whether the plaintiff is looking to the hospital merely as a place for his/her personal CARLOS BORROMEO, Petitioner, v. FAMILY CARE HOSPITAL, INC. AND
physician to provide medical care.105 RAMON S. INSO, M.D., Respondents.

Thus, this requirement is deemed satisfied if the plaintiff can prove that he/she relied The petitioner, Carlos Borromeo, was the husband of the late Lilian V. Borromeo
upon the hospital to provide care and treatment, rather than upon a specific physician. (Lilian). Lilian was a patient of the respondent Family Care Hospital, Inc. (Family
In this case, we shall limit the determination of the hospital's apparent authority to Dr. Care) under the care of respondent Dr. Ramon Inso (Dr. Inso).
Casumpang, in view of our finding that Dr. Miranda is not liable for negligence.
On July 13, 1999, the petitioner brought his wife to the Family Care Hospital because
SJDH Clothed Dr. Casumpang With Apparent Authority she had been complaining of acute pain at the lower stomach area and fever for two
days. She was admitted at the hospital and placed under the care of Dr. Inso.
SJDH impliedly held out and clothed Dr. Casumpang with apparent authority leading
the respondent to believe that he is an employee or agent of the hospital. Dr. Inso suspected that Lilian might be suffering from acute appendicitis. However,
there was insufficient data to rule out other possible causes and to proceed with an
Based on the records, the respondent relied on SJDH rather than upon Dr. appendectomy. Thus, he ordered Lilian's confinement for testing and evaluation.
Casumpang, to care and treat his son Edmer. His testimony during trial showed that
he and his wife did not know any doctors at SJDH; they also did not know that Dr. Over the next 48 hours, Lilian underwent multiple tests such as complete blood count,
Casumpang was an independent contractor. They brought their son to SJDH for urinalysis, stool exam, pelvic ultrasound, and a pregnancy test. However, the tests
diagnosis because of their family doctor's referral. The referral did not specifically were not conclusive enough to confirm that she had appendicitis.
point to Dr. Casumpang or even to Dr. Miranda, but to SJDH.
Meanwhile, Lilian's condition did not improve. She suffered from spiking fever and her
Significantly, the respondent had relied on SJDH's representation of Dr. Casumpang's abdominal pain worsened. The increasing tenderness of her stomach, which was
authority. To recall, when Mrs. Cortejo presented her Fortune Care card, she was previously confined to her lower right side, had also extended to her lower left side.
initially referred to the Fortune Care coordinator, who was then out of town. She was Lilian abruptly developed an acute surgical abdomen.
thereafter referred to Dr. Casumpang, who is also accredited with Fortune Care. In
both instances, SJDH through its agent failed to advise Mrs. Cortejo that Dr. On July 15, 1999, Dr. Inso decided to conduct an exploratory laparotomy on Lilian
Casumpang is an independent contractor. because of the findings on her abdomen and his fear that she might have a ruptured
appendix. Exploratory laparotomy is a surgical procedure involving a large incision on
Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such the abdominal wall that would enable Dr. Inso to examine the abdominal cavity and
were being provided by SJDH or its employees, agents, or servants. By referring Dr. identify the cause of Lilian's symptoms. After explaining the situation, Dr. Inso
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. obtained the patient's consent to the laparotomy.
Casumpang, not only as an accredited member of Fortune Care, but also as a
member of its medical staff. SJDH cannot now disclaim liability since there is no At around 3:45 P.M., Lilian was brought to the operating room where Dr. Inso
showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr. conducted the surgery. During the operation, Dr. Inso confirmed that Lilian was
Casumpang is only an independent contractor of the hospital. In this case, estoppel suffering from acute appendicitis. He proceeded to remove her appendix which was
has already set in. already infected and congested with pus.

We also stress that Mrs. Cortejo's use of health care plan (Fortune Care) did not The operation was successful. Lilian's appearance and vital signs improved. At
affect SJDH's liability. The only effect of the availment of her Fortune Care card around 7:30 P.M., Lilian was brought back to her private room from the recovery
benefits is that her choice of physician is limited only to physicians who are accredited room.
with Fortune Care. Thus, her use of health care plan in this case only limited the
choice of doctors (or coverage of services, amount etc.) and not the liability of doctors At around 1:30 A.M. on July 16, 1999, roughly six hours after Lilian was brought back
or the hospital. to her room, Dr. Inso was informed that her blood pressure was low. After assessing
her condition, he ordered the infusion of more intravenous (IV) fluids which somehow
WHEREFORE, premises considered, this Court PARTLY GRANTS the consolidated raised her blood pressure.
hemorrhages from the surface and it was normal. The valvular leaflets were soft and
Despite the late hour, Dr. Inso remained in the hospital to monitor Lilian's condition. pliable, and of course, the normal color is reddish brown as noted. And the coronary
Subsequently, a nurse informed him that Lilian was becoming restless. Dr. Inso arteries which supply the heart were normal and unremarkable. Next, the lungs
immediately went to Lilian and saw that she was quite pale. He immediately appears [sic] hemorrhagic. That was the right lung while the left lung was collapsed
requested a blood transfusion. and paled. For the intestines, I noted throughout the entire lengths of the small and
large intestine were hemorrhagic areas. Noted absent is the appendix at the ileo-colic
Lilian did not respond to the blood transfusion even after receiving two 500 cc-units of area but there were continuous suture repair done thereat. However, there was a 0.5
blood. Various drugs, such as adrenaline or epinephrine, were administered. x 0.5 cm opening or left unrepaired at that time. There was an opening on that repair
site. Meaning it was not repaired. There were also at that time clot and unclot blood
Eventually, an endotracheal tube connected to an oxygen tank was inserted into Lilian found adherent thereon. The liver and the rest of the visceral organs were noted
to ensure her airway was clear and to compensate for the lack of circulating oxygen in exhibit [sic] some degree of pallor but were otherwise normal. The stomach contains
her body from the loss of red blood cells. Nevertheless, her condition continued to one glassful about 400 to 500 ml.3ChanRoblesVirtualawlibrary
deteriorate. Dr. Reyes concluded that the cause of Lilian's death was hemorrhage due to bleeding
petechial blood vessels: internal bleeding. He further concluded that the internal
Dr. Inso observed that Lilian was developing petechiae in various parts of her bleeding was caused by the 0.5 x 0.5 cm opening in the repair site. He opined that the
body. Petechiae are small bruises caused by bleeding under the skin whose presence bleeding could have been avoided if the site was repaired with double suturing
indicates a blood-coagulation problem - a defect in the ability of blood to clot. At this instead of the single continuous suture repair that he found.
point, Dr. Inso suspected that Lilian had Disseminated Intravascular
Coagulation (DIC), a blood disorder characterized by bleeding in many parts of her Based on the autopsy, the petitioner filed a complaint for damages against Family
body caused by the consumption or the loss of the clotting factors in the blood. Care and against Dr. Inso for medical negligence.
However, Dr. Inso did not have the luxury to conduct further tests because the
immediate need was to resuscitate Lilian. During the trial, the petitioner presented Dr. Reyes as his expert witness. Dr. Reyes
testified as to his findings during the autopsy and his opinion that Lilian's death could
Dr. Inso and the nurses performed cardiopulmonary resuscitation (CPR) on Lilian. Dr. have been avoided if Dr. Inso had repaired the site with double suture rather than a
Inso also informed her family that there may be a need to re-operate on her, but she single suture.
would have to be put in an Intensive Care Unit (ICU). Unfortunately, Family Care did
not have an ICU because it was only a secondary hospital and was not required by However, Dr. Reyes admitted that he had very little experience in the field of
the Department of Health to have one. Dr. Inso informed the petitioner that Lilian pathology and his only experience was an on-the-job training at the V. Luna Hospital
would have to be transferred to another hospital. where he was only on observer status. He further admitted that he had no experience
in appendicitis or appendectomy and that Lilian's case was his first autopsy involving
At around 3:30 A.M., Dr. Inso personally called the Perpetual Help Medical Center to a death from appendectomy.
arrange Lilian's transfer, but the latter had no available bed in its ICU. Dr. Inso then
personally coordinated with the Muntinlupa Medical Center (MMC) which had an Moreover, Dr. Reyes admitted that he was not intelligently guided during the autopsy
available bed. because he was not furnished with clinical, physical, gross, histopath, and laboratory
information that were important for an accurate conclusion. Dr. Reyes also admitted
At around 4:00 A.M., Lilian was taken to the MMC by ambulance accompanied by the that an appendical stump is initially swollen when sutured and that the stitches may
resident doctor on duty and a nurse. Dr. Inso followed closely behind in his own loosen during the healing process when the initial swelling subside.
vehicle.
In their defense, Dr. Inso and Family Care presented Dr. Inso, and expert witnesses
Upon reaching the MMC, a medical team was on hand to resuscitate Lilian. A Dr. Celso Ramos (Dr. Ramos) and Dr. Herminio Hernandez (Dr. Hernandez).
nasogastric tube (NGT) was inserted and IV fluids were immediately administered to
her. Dr. Inso asked for a plasma expander. Unfortunately, at around 10:00 A.M., Lilian Dr. Ramos is a practicing pathologist with over 20 years of experience. He is an
passed away despite efforts to resuscitate her. associate professor at the Department of Surgery of the Fatima Medical Center, the
Manila Central University, and the Perpetual Help Medical Center. He is a Fellow of
At the request of the petitioner, Lilian's body was autopsied at the Philippine National the Philippine College of Surgeons, a Diplomate of the Philippine Board of Surgery,
Police (PNP) Camp Crame Crime Laboratory. Dr. Emmanuel Reyes (Dr. Reyes), the and a Fellow of the Philippine Society of General Surgeons.
medico-legal assigned to the laboratory, conducted the autopsy. Dr. Reyes
summarized his notable findings as: Dr. Ramos discredited Dr. Reyes' theory that the 0.5 x 0.5 cm opening at the repair
x x x I opened up the body and inside the abdominal cavity which you call peritoneal site caused Lilian's internal bleeding. According to Dr. Ramos, appendical vessels
cavity there were 3,000 ml of clot and unclot blood accumulated thereat. The measure only 0.1 to 0.15 cm, a claim that was not refuted by the petitioner. If the 0.5 x
peritoneal cavity was also free from any adhesion. Then, I opened up the head and 0.5 cm opening had caused Lilian's hemorrhage, she would not have survived for
the brain revealed paper white in color and the heart revealed abundant petechial over 16 hours; she would have died immediately, within 20 to 30 minutes, after
surgery. a pathologist of equal or of greater expertise than Dr. Ramos or Dr. Hernandez.

Dr. Ramos submitted that the cause of Lilian's death was hemorrhage due to DIC, a The CA held that there was no causal connection between the alleged omission of Dr.
blood disorder that leads to the failure of the blood to coagulate; Dr. Ramos Inso to use a double suture and the cause of Lilian's death. It also found that Dr. Inso
considered the abundant petechial hemorrhage in the myocardic sections and the did, in fact, use a double suture ligation with a third silk reinforcement ligation on the
hemorrhagic right lung; the multiple bleeding points indicate that Lilian was afflicted repair site which, as Dr. Reyes admitted on cross-examination, loosened up after the
with DIC. initial swelling of the stump subsided.

Meanwhile, Dr. Hernandez is a general surgeon and a hospital administrator who had The CA denied the applicability of the doctrine of res ipsa loquitur because the
been practicing surgery for twenty years as of the date of his testimony. element of causation between the instrumentality under the control and management
of Dr. Inso and the injury that caused Lilian's death was absent; the respondents
Dr. Hernandez testified that Lilian's death could not be attributed to the alleged wrong sufficiently established that the cause of Lilian's death was DIC.
suturing. He submitted that the presence of blood in the lungs, in the stomach, and in
the entire length of the bowels cannot be reconciled with Dr. Reyes' theory that the On March 18, 2010, the petitioner filed the present petition for review on certiorari.
hemorrhage resulted from a single-sutured appendix.
THE PETITION
Dr., Hernandez testified that Lilian had uncontrollable bleeding in the microcirculation
as a result of DIC. In DIC, blood oozes from very small blood vessels because of a The petitioner argues: (1) that Dr. Inso and Family Care were negligent in caring for
problem in the clotting factors of the blood vessels. The microcirculation is too small Lilian before, during, and after her appendectomy and were responsible for her death;
to be seen by the naked eye; the red cell is even smaller than the tip of a needle. and (2) that the doctrine of res ipsa loquitur is applicable to this case.
Therefore, the alleged wrong suturing could not have caused the amount of
hemorrhaging that caused Lilian's death. In their Comment, the respondents counter: (1) that the issues raised by the petitioner
are not pure questions of law; (2) that they exercised utmost care and diligence in the
Dr. Hernandez further testified that the procedure that Dr. Inso performed was treatment of Lilian; (3) that Dr. Inso did not deviate from the standard of care
consistent with the usual surgical procedure and he would not have done anything observed under similar circumstances by other members of the profession in good
differently.4 standing; (4) that res ipsa loquitur is not applicable because direct evidence as to the
cause of Lilian's death and the presence/absence of negligence is available; and (5)
The petitioner presented Dr. Rudyard Avila III (Dr. Avila) as a rebuttal witness. Dr. that doctors are not guarantors of care and cannot be held liable for the death of their
Avila, also a lawyer, was presented as an expert in medical jurisprudence. Dr. Avila patients when they exercised diligence and did everything to save the patient.
testified that between Dr. Reyes who autopsied the patient and Dr. Ramos whose
findings were based on medical records, greater weight should be given to Dr. Reyes' OUR RULING
testimony.
The petition involves factual questions.
On April 10, 2007, the RTC rendered its decision awarding the petitioner P88,077.50
as compensatory damages; P50,000.00 as death indemnity; P3,607,910.30 as loss of Under Section 1 of Rule 45, a petition for review on certiorari shall only raise
earnings; P50,000.00 as moral damages; P30,000.00 as exemplary damages; questions of law. The Supreme Court is not a trier of facts and it is not our function to
P50,000.00 as attorney's fees, and the costs of the suit. analyze and weigh evidence that the lower courts had already passed upon.
The RTC relied on Dr. Avila's opinion and gave more weight to Dr. Reyes' findings The factual findings of the Court of Appeals are, as a general rule, conclusive upon
regarding the cause of Lilian's death. It held that Dr. Inso was negligent in using a this Court. However, jurisprudence has also carved out recognized exceptions 5 to this
single suture on the repair site causing Lilian's death by internal hemorrhage. It rule, to wit: (1) when the findings are grounded entirely on speculation, surmises, or
applied the doctrine of res ipsa loquitur, holding that a patient's death does not conjectures;6 (2) when the inference made is manifestly mistaken, absurd, or
ordinarily occur during an appendectomy. impossible;7 (3) when there is grave abuse of discretion;8 (4) when the judgment is
based on a misapprehension of facts;9 (5) when the findings of facts are
The respondents elevated the case to the CA and the appeal was docketed as CA- conflicting;10 (6) when in making its findings the Court of Appeals went beyond the
G.R. CV No. 89096. issues of the case, or its findings are contrary to the admissions of both the appellant
and the appellee;11(7) when the findings are contrary to those of the trial
On January 22, 2010, the CA reversed the RTC's decision and dismissed the court's;12 (8) when the findings are conclusions without citation of specific evidence
complaint. The CA gave greater weight to the testimonies of Dr. Hernandez and Dr. on which they are based;13 (9) when the facts set forth in the petition as well as in the
Ramos over the findings of Dr. Reyes because the latter was not an expert in petitioner's main and reply briefs are not disputed by the respondent; 14 (10) when the
pathology, appendectomy, nor in surgery. It disregarded Dr. Avila's opinion because findings of fact are premised on the supposed absence of evidence and contradicted
the basic premise of his testimony was that the doctor who conducted the autopsy is
by the evidence on record;15 and (11) when the Court of Appeals manifestly
overlooked certain relevant facts not disputed by the parties, which, if properly Witness: Well, if I remember right during my residency in my extensive
considered, would justify a different conclusion.16 training, during the operation of the appendix, your Honor, it should really
be sutured twice which we call double.
Considering that the CA's findings with respect to the cause of Lilian's death
contradict those of the RTC, this case falls under one of the exceptions. The Court will
thus give due course to the petition to dispel any perception that we denied the Court: What would be the result if there is only single?
petitioner justice.

The requisites of establishing medical malpractice Witness: We cannot guarranty [sic] the bleeding of the sutured blood vessels, your
Honor.
Whoever alleges a fact has the burden of proving it. This is a basic legal principle that
equally applies to civil and criminal cases. In a medical malpractice case, the plaintiff
has the duty of proving its elements, namely: (1) a duty of the defendant to his patient; Court: So, the bleeding of the patient was caused by the single suture?
(2) the defendant's breach of this duty; (3) injury to the patient; and (4) proximate
causation between the breach and the injury suffered.17 In civil cases, the plaintiff
must prove these elements by a preponderance of evidence. Witness: It is possible.24
A medical professional has the duty to observe the standard of care and exercise the Dr. Reyes testified that he graduated from the Manila Central University (MCU)
degree of skill, knowledge, and training ordinarily expected of other similarly trained College of Medicine and passed the medical board exams in 1994.25 He established
medical professionals acting under the same circumstances.18 A breach of the his personal practice at his house clinic before being accepted as an on-the-job
accepted standard of care constitutes negligence or malpractice and renders the trainee in the Department of Pathology at the V. Luna Hospital in 1994. In January
defendant liable for the resulting injury to his patient.19 1996, he joined the PNP Medico-Legal Division and was assigned to the Crime
Laboratory in Camp Crame. He currently heads the Southern Police District Medico-
The standard is based on the norm observed by other reasonably competent Legal division.26 His primary duties are to examine victims of violent crimes and to
members of the profession practicing the same field of medicine.20 Because conduct traumatic autopsies to determine the cause of death.
medical malpractice cases are often highly technical, expert testimony is usually
essential to establish: (1) the standard of care that the defendant was bound to After having conducted over a thousand traumatic autopsies, Dr. Reyes can be
observe under the circumstances; (2) that the defendant's conduct fell below the considered an expert in traumatic autopsies or autopsies involving violent deaths.
acceptable standard; and (3) that the defendant's failure to observe the industry However, his expertise in traumatic autopsies does not necessarily make him an
standard caused injury to his patient.21 expert in clinical and pathological autopsies or in surgery.

The expert witness must be a similarly trained and experienced physician. Thus, a Moreover, Dr. Reyes' cross-examination reveals that he was less than candid about
pulmonologist is not qualified to testify as to the standard of care required of an his qualifications during his initial testimony:
anesthesiologist22 and an autopsy expert is not qualified to testify as a specialist in
infectious diseases.23 Atty. Dr. Reyes, you mentioned during your direct testimony last March 5, 2002 that you
Castro: graduated in March of 1994, is that correct?
The petitioner failed to present an expert witness.

In ruling against the respondents, the RTC relied on the findings of Dr. Reyes in the Witness: Yes, sir.
light of Dr. Avila's opinion that the former's testimony should be given greater weight
than the findings of Dr. Ramos and Dr. Hernandez. On the other hand, the CA did not
consider Dr. Reyes or Dr. Avila as expert witnesses and disregarded their testimonies Atty. You were asked by Atty. Fajardo, the counsel for the plaintiff, when did you finish
Castro: your medical works, and you answered the following year of your graduation which
in favor of Dr. Ramos and Dr. Hernandez. The basic issue, therefore, is whose
was in 1994?
testimonies should carry greater weight?

We join and affirm the ruling of the CA.


Witness: Not in 1994, it was in 1984, sir.
Other than their conclusion on the culpability of the respondents, the CA and the RTC
have similar factual findings. The RTC ruled against the respondents based primarily
Atty. And after you graduated Mr. Witness, were there further study that you undergo after
on the following testimony of Dr. Reyes.
Castro: graduation? [sic]
Witness: Yes, sir.
Witness: It was during my service only at the police organization that I was given the chance
to attend the training, one year course.
Atty. After you took the board examination, did you pursue any study?
Castro:
Atty. Did you call that what you call a post graduate internship?
Castro:
Witness: During that time, no sir.

Witness: Residency.
Atty. You also testified during the last hearing that "page 6 of March 5, 2002, answer of
Castro: the witness: then I was accepted as on the job training at the V. Luna Hospital at the
Atty. Since you call that a post graduate, you were not undergo post graduate? [sic] Department of Pathologist in 1994", could you explain briefly all of this Mr. witness?
Castro:

Witness: I was given an order that I could attend the training only as a civilian not as a
Witness: I did. member of the AFP because at that time they were already in the process of
discharging civilian from undergoing training.

Atty. Where did you undergo a post graduate internship?


Castro: Atty. So in the Department of Pathology, what were you assigned to?
Castro:

Witness: Before I took the board examination in the year 1984, sir.
Witness: Only as an observer status.

Atty. That was where?


Castro: Atty. So you only observed.
Castro:

Witness: MCU Hospital, sir.


Witness: Yes, sir.

Atty. After the post graduate internship that was the time you took the board examination?
Castro: Atty. And on the same date during your direct testimony on March 5, 2002, part of which
Castro: reads "well if I remember right during my residency in my extensive training during
the operation of the appendix," what do you mean by that Mr. witness?
Witness: Yes, sir.

Witness: I was referring to my internship, sir.


Atty. And I supposed that you did it for the first take?
Castro:
Atty. So this is not a residency training?
Castro:
Witness: Yes, sir.

Witness: No, sir.


Atty. Are you sure of that?
Castro:
Atty. This is not a specialty training?
Castro:
Perhaps nothing is more telling about Dr. Reyes' lack of expertise in the subject
Witness: No, sir.
matter than the petitioner's counsel's own admission during Dr. Reyes' cross
examination.
Atty. This was the time the year before you took the board examination? Atty. How long were you assigned to observe with the Department of
Castro: Castro: Pathology?

Witness: That's right, sir. Yes, sir. Witness: Only 6 months, sir.

Atty. You were not then a license[d] doctor?


Castro:
Atty. During your studies in the medical school, Mr. Witness, do you recall
Castro: attending or having participated or [sic] what you call motivity mortality
complex?
Witness: No, sir.

Atty. Your honor, what is the materiality?


Atty. And you also mentioned during the last hearing shown by page 8 of the same Fajardo:
Castro: transcript of the stenographic notes, dated March 5,2002 and I quote "and that is
your residence assignment?", and you answered "yes, sir." What was the meaning
of your answer? What do you mean when you say yes, sir? Atty. That is according to his background, your honor. This is a procedure
Castro: which could more or less measure his knowledge in autopsy proceedings
when he was in medical school and compared to what he is actually doing
now.

Witness: Okay, I stayed at the barracks of the Southern Police District Fort Bonifacio.
Atty. The witness is not an expert witness, your honor.
Fajardo:
Atty. So this is not referring to any kind of training?
Castro:
Atty. He is being presented as an expert witness, your honor. 29
Castro:
Witness: No, sir.
When Atty. Castro attempted to probe Dr. Reyes about his knowledge on the subject
of medical or pathological autopsies, Dr. Fajardo objected on the ground that Dr.
Atty. This is not in anyway related to appendicitis? Reyes was not an expert in the field. His testimony was offered to prove that Dr. Inso
Castro: was negligent during the surgery without necessarily offering him as an expert
witness.

Witness: No, sir.27 Atty. x x x The purpose of this witness is to establish that there was negligence
Fajardo: on the surgical operation of the appendix or in the conduct of the
Atty. Reyes appears to have inflated his qualifications during his direct testimony. appendectomy by the defendant doctor on the deceased Lilian Villaran
First, his "extensive training during [his] residency" was neither extensive actual Borromeo.30
training, nor part of medical residency. His assignment to the V. Luna Hospital was
not as an on-the-job trainee but as a mere observer. This assignment was Dr. Reyes is not an expert witness who could prove Dr. Inso's alleged negligence. His
also before he was actually licensed as a doctor. Dr. Reyes also loosely used the testimony could not have established the standard of care that Dr. Inso was expected
terms "residence" and "residency" - terms that carry a technical meaning with respect to observe nor assessed Dr. Inso's failure to observe this standard. His testimony
to medical practice -during his initial testimony28 to refer to (1) his physical place of cannot be relied upon to determine if Dr. Inso committed errors during the operation,
dwelling and (2) his internship before taking the medical board exams. This misled the the severity of these errors, their impact on Lilian's probability of survival, and the
trial court into believing that he was more qualified to give his opinion on the matter existence of other diseases/conditions that might or might not have caused or
than he actually was. contributed to Lilian's death.
Res ipsa loquitur is not applicable when the failure to observe due care is not
The testimony of Dr. Avila also has no probative value in determining whether Dr. immediately apparent to the layman.
Inso was at fault. Dr. Avila testified in his capacity as an expert in medical
jurisprudence, not as an expert in medicine, surgery, or pathology. His testimony fails The petitioner cannot invoke the doctrine of res ipsa loquitur to shift the burden of
to shed any light on the actual cause of Lilian's death. evidence onto the respondent. Res ipsa loquitur, literally, "the thing speaks for itself;"
is a rule of evidence that presumes negligence from the very nature of the accident
On the other hand, the respondents presented testimonies from Dr. Inso himself and itself using common human knowledge or experience.
from two expert witnesses in pathology and surgery.
The application of this rule requires: (1) that the accident was of a kind which does not
Dr. Ramos graduated from the Far Eastern University, Nicanor Reyes Medical ordinarily occur unless someone is negligent; (2) that the instrumentality or agency
Foundation, in 1975. He took up his post-graduate internship at the Quezon Memorial which caused the injury was under the exclusive: control of the person charged with
Hospital in Lucena City, before taking the board exams. After obtaining his negligence; and (3) that the injury suffered must not have been due to any voluntary
professional license, he underwent residency training in pathology at the Jose R. action or contribution from the injured person.38 The concurrence of these elements
Reyes Memorial Center from 1977 to 1980. He passed the examination in Anatomic, creates a presumption of negligence that, if unrebutted, overcomes the plaintiffs
Clinical, and Physical Pathology in 1980 and was inducted in 1981. He also took the burden of proof.
examination in anatomic pathology in 1981 and was inducted in 1982. 31
This doctrine is used in conjunction with the doctrine of common knowledge. We have
At the time of his testimony, Dr. Ramos was an associate professor in pathology at applied this doctrine in the following cases involving medical practitioners:
the Perpetual Help Medical School in Bian, Laguna, and at the De La Salle
University in Dasmarias, Cavite. He was the head of the Batangas General Hospital a. Where a patient who was scheduled for a cholecystectomy (removal of gall
Teaching and Training Hospital where he also headed the Pathology Department. He stones) but was otherwise healthy suffered irreparable brain damage after
also headed the Perpetual Help General Hospital Pathology department. 32 being administered anesthesia prior to the operation.39
Meanwhile, Dr. Hernandez at that time was a General Surgeon with 27 years of
b. Where after giving birth, a woman woke up with a gaping burn wound close
experience as a General Practitioner and 20 years of experience as a General
to her left armpit;40
Surgeon. He obtained his medical degree from the University of Santo Tomas before
undergoing five years of residency training as a surgeon at the Veterans Memorial
Center hospital. He was certified as a surgeon in 1985. He also holds a master's c. The removal of the wrong body part during the operation; and
degree in Hospital Administration from the Ateneo de Manila University. 33
d. Where an operating surgeon left a foreign object (i.e., rubber gloves) inside
He was a practicing surgeon at the: St. Luke's Medical Center, Fatima Medical the body of the patient.41
Center, Unciano Medical Center in Antipolo, Manila East Medical Center of Taytay,
and Perpetual Help Medical Center in Bian.34He was also an associate professor at The rule is not applicable in cases such as the present one where the defendant's
the Department of Surgery at the Fatima Medical Center, the Manila Central alleged failure to observe due care is not immediately apparent to a layman. 42 These
University, and the Perpetual Help Medical Center. He also chaired the Department of instances require expert opinion to establish the culpability of the defendant doctor. It
Surgery at the Fatima Medical Center.35 is also not applicable to cases where the actual cause of the injury had been identified
or established.43
Dr. Hernandez is a Fellow of the American College of Surgeons, the Philippine
College of Surgeons, and the Philippine Society of General Surgeons. He is a While this Court sympathizes with the petitioner's loss, the petitioner failed to present
Diplomate of the Philippine Board of Surgery and a member of the Philippine Medical sufficient convincing evidence to establish: (1) the standard of care expected of the
Association and the Antipolo City Medical Society.36 respondent and (2) the fact that Dr. Inso fell short of this expected standard.
Considering further that the respondents established that the cause of Lilian's
Dr. Hernandez affirmed that Dr. Inso did not deviate from the usual surgical uncontrollable bleeding (and, ultimately, her death) was a medical disorder -
procedure.37 Both experts agreed that Lilian could not have died from bleeding of the Disseminated Intravascular Coagulation we find no reversible errors in the CA's
appendical vessel. They identified Lilian's cause of death as massive blood loss dismissal of the complaint on appeal.
resulting from DIC.
WHEREFORE, we hereby DENY the petition for lack of merit. No costs.
To our mind, the testimonies of expert witnesses Dr. Hernandez and Dr. Ramos carry
far greater weight than that of Dr. Reyes. The petitioner's failure to present expert SO ORDERED.
witnesses resulted in his failure to prove the respondents' negligence. The
preponderance of evidence clearly tilts in favor of the respondents.