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Francisco:ThirdDivision

THIRDDIVISION

[G.R.No.122445.November18,1997]

DR. NINEVETCH CRUZ, petitioner, vs. COURT OF APPEALS and LYDIA UMALI,
respondents.

DECISION
FRANCISCO,J.:

"Doctorsareprotectedbyaspeciallaw.Theyarenotguarantorsofcare.Theydonotevenwarrantagoodresult.
Theyarenotinsurersagainstmishaporunusualconsequences.Furthermoretheyarenotliableforhonest
mistakeofjudgment"[1]

The present case against petitioner is in the nature of a medical malpractice suit, which in
simplest term is the type of claim which a victim has available to him or her to redress a wrong
committed by a medical professional which has cause bodily harm.[2] In this jurisdiction, however,
suchclaimsaremostoftenbroughtasacivilactionfordamagesunderArticle2176oftheCivilCode,
[3]
and in some instances, as a criminal case under Article 365 of the Revised Penal Code[4] with
whichthecivilactionfordamagesisimpliedlyinstituted.Itisviathelattertypeofactionthattheheirs
ofthedeceasedsoughtredressforthepetitioner'sallegedimprudenceandnegligenceintreatingthe
deceasedthereby causing her death.The petitioner and one Dr. Lina Ercillowhowastheattending
anaesthesiologistduringtheoperationofthedeceasedwerechargedwith"recklessimprudenceand
negligenceresultingto(sic)homicide"inaninformationwhichreads:

"ThatonoraboutMarch23,1991,intheCityofSanPablo,RepublicofthePhilippinesandwithinthe
jurisdictionofthisHonorableCourt,theaccusedabovenamed,beingthentheattendinganaesthesiologistand
surgeon,respectively,didthenandthere,inanegligence(sic),careless,imprudent,andincompetentmanner,
andfailingtosupplyorstoresufficientprovisionsandfacilitiesnecessarytomeetanyandallexigenciesaptto
arisebefore,duringand/orafterasurgicaloperationcausingbysuchnegligence,carelessness,imprudence,and
incompetence,andcausingbysuchfailure,includingthelackofpreparationandforesightneededtoaverta
tragedy,theuntimelydeathofsaidLydiaUmalionthedayfollowingsaidsurgicaloperation."[5]

Trial ensued after both the petitioner and Dr. Lina Ercillo pleaded not guilty to the above
mentionedcharge.On March 4, 1994, the Municipal Trial Court in Cities (MTCC) of San Pablo City
renderedadecision,thedispositiveportionofwhichishereunderquotedasfollows:

"WHEREFORE,thecourtfindstheaccusedDr.LinaErcillonotguiltyoftheoffensechargedforinsufficiency
ofevidencewhilehercoaccusedDra.NinevetchCruzisherebyheldresponsibleforthedeathofLydiaUmali
onMarch24,1991,andthereforeguiltyunderArt.365oftheRevisedPenalCode,andsheisherebysentenced
tosufferthepenaltyof2monthsand1dayimprisonmentofarrestomayorwithcosts."[6]

The petitioner appealed her conviction to the Regional Trial Court (RTC) which affirmed in toto the
decisionoftheMTCC[7]promptingthepetitionertofileapetitionforreviewwiththeCourtofAppeals
buttonoavail.Hencethispetitionforreviewoncertiorariassailingthedecisionpromulgatedbythe
Court of Appeals on October 24, 1995 affirming petitioner's conviction with modification that she is
furtherdirectedtopaytheheirsofLydiaUmaliP50,000.00asindemnityforherdeath.[8]

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Insubstance,thepetitionbroughtbeforethisCourtraisestheissueofwhetherornotpetitioner's
convictionofthecrimeofrecklessimprudenceresultinginhomicide,arisingfromanallegedmedical
malpractice,issupportedbytheevidenceonrecord.
Firsttheantecedentfacts.
OnMarch22,1991,prosecutionwitness,RowenaUmaliDeOcampo,accompaniedhermotherto
thePerpetualHelpClinicandGeneralHospitalsituatedinBalagtasStreet,SanPabloCity,Laguna.
Theyarrivedatthesaidhospitalataround4:30intheafternoonofthesameday.[9]PriortoMarch22,
1991,Lydiawasexaminedbythepetitionerwhofounda"myoma"[10]inheruterus,andscheduledher
forahysterectomyoperationonMarch23,1991.[11]Rowenaandhermothersleptinthecliniconthe
evening of March 22, 1991 as the latter was to be operated on the next day at 1:00 o'clock in the
afternoon.[12]According to Rowena, she noticed that the clinic was untidy and the window and the
floorwereverydustypromptinghertoasktheattendantforaragtowipethewindowandthefloor
with.[13]Becauseoftheuntidystateoftheclinic,Rowenatriedtopersuadehermothernottoproceed
with the operation.[14] The following day, before her mother was wheeled into the operating room,
Rowenaaskedthepetitioneriftheoperationcouldbepostponed.ThepetitionercalledLydiaintoher
office and the two had a conversation. Lydia then informed Rowena that the petitioner told her that
shemustbeoperatedonasscheduled.[15]
Rowenaandherotherrelatives,namelyherhusband,hersisterandtwoauntswaitedoutsidethe
operatingroomwhileLydiaunderwentoperation.Whiletheywerewaiting,Dr.Ercillowentoutofthe
operating room and instructed them to buy tagamet ampules which Rowena's sister immediately
bought. About one hour had passed when Dr. Ercillo came out again this time to ask them to buy
blood for Lydia. They bought type "A" blood from the St. Gerald Blood Bank and the same was
brought by the attendant into the operating room. After the lapse of a few hours, the petitioner
informed them that the operation was finished. The operating staff then went inside the petitioner's
clinictotaketheirsnacks.Somethirtyminutesafter,Lydiawasbroughtoutoftheoperatingroomina
stretcher and the petitioner asked Rowena and the other relatives to buy additional blood for Lydia.
Unfortunately, they were not able to comply with petitioner's order as there was no more type "A"
blood available in the blood bank. Thereafter, a person arrived to donate blood which was later
transfusedtoLydia.Rowenathennoticedhermother,whowasattachedtoanoxygentank,gasping
forbreath.ApparentlytheoxygensupplyhadrunoutandRowena'shusbandtogetherwiththedriver
oftheaccusedhadtogototheSanPabloDistrictHospitaltogetoxygen.Lydiawasgiventhefresh
supplyofoxygenassoonasitarrived.[16]Butataround10:00o'clockP.M.shewentintoshockand
herbloodpressuredroppedto60/50.Lydia'sunstableconditionnecessitatedhertransfertotheSan
PabloDistrictHospitalsoshecouldbeconnectedtoarespiratorandfurtherexamined.[17]Thetransfer
to the San Pablo City District Hospital was without the prior consent of Rowena nor of the other
relativespresentwhofoundoutabouttheintendedtransferonlywhenanambulancearrivedtotake
LydiatotheSanPabloDistrictHospital.Rowenaandherotherrelativesthenboardedatricycleand
followedtheambulance.[18]
UponLydia'sarrivalattheSanPabloDistrictHospital,shewaswheeledintotheoperatingroom
and the petitioner and Dr. Ercillo reoperated on her because there was blood oozing from the
abdominal incision.[19] The attending physicians summoned Dr. Bartolome Angeles, head of the
ObstetricsandGynecologyDepartmentoftheSanPabloDistrictHospital.However,whenDr.Angeles
arrived, Lydia was already in shock and possibly dead as her blood pressure was already 0/0. Dr.
AngelestheninformedpetitionerandDr.Ercillothattherewasnothinghecoulddotohelpsavethe
patient.[20] While petitioner was closing the abdominal wall, the patient died.[21] Thus, on March 24,
1991,at3:00o'clockinthemorning,LydiaUmaliwaspronounceddead.Herdeathcertificatestates
"shock"astheimmediatecauseofdeathand"DisseminatedIntravascularCoagulation(DIC)"asthe
antecedentcause.[22]
In convicting the petitioner, the MTCC found the following circumstances as sufficient basis to
concludethatshewasindeednegligentintheperformanceoftheoperation:
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"xxx,theclinicwasuntidy,therewaslackofprovisionlikebloodandoxygentoprepareforanycontingency
thatmighthappenduringtheoperation.ThemannerandthefactthatthepatientwasbroughttotheSanPablo
DistrictHospitalforreoperationindicatesthattherewassomethingwronginthemannerinwhichDra.Cruz
conductedtheoperation.Therewasnoshowingthatbeforetheoperation,accusedDr.Cruzhadconducteda
cardiopulmonaryclearanceoranytypingofthebloodofthepatient.Itwas(sic)saidinmedicalparlancethat
the"abdomenofthepersonisatempleofsurprises"becauseyoudonotknowthewholethingthemomentit
wasopen(sic)andsurgeonmustbepreparedforanyeventualitythereof.Thepatient(sic)chartwhichisa
publicdocumentwasnotpresentedbecauseitisonlytherethatwecoulddeterminetheconditionofthepatient
beforethesurgery.ThecourtalsonoticedinExh."F1"thatthesisterofthedeceasedwishedtopostponethe
operationbutthepatientwasprevaileduponbyDra.Cruztoproceedwiththesurgery.Thecourtfindsthat
LydiaUmalidiedbecauseofthenegligenceandcarelessnessofthesurgeonDra.NinevetchCruzbecauseofloss
ofbloodduringtheoperationofthedeceasedforevidentunpreparednessandforlackofskill,thereasonwhy
thepatientwasbroughtforoperationattheSanPabloCityDistrictHospital.Assuch,thesurgeonshould
answerforsuchnegligence.WithrespecttoDra.LinaErcillo,theanaesthesiologist,thereisnoevidenceto
indicatethatsheshouldbeheldjointlyliablewithDra.Cruzwhoactuallydidtheoperation."[23]

TheRTCreiteratedtheabovementionedfindingsoftheMTCCandupheldthelatter'sdeclaration
of"incompetency,negligenceandlackofforesightandskillofappellant(hereinpetitioner)inhandling
thesubjectpatientbeforeandaftertheoperation."[24]Andlikewiseaffirmingthepetitioner'sconviction,
theCourtofAppealsechoedsimilarobservations,thus:

"xxx.Whilewemaygrantthattheuntidinessandfilthinessoftheclinicmaynotbyitselfindicatenegligence,
itneverthelessshowstheabsenceofduecareandsupervisionoverhersubordinateemployees.Didthis
unsanitaryconditionpermeatetheoperatingroom?Werethesurgicalinstrumentsproperlysterilized?Couldthe
conditionsintheORhavecontributedtotheinfectionofthepatient?Onlythepetitionercouldanswerthese,but
sheoptednottotestify.Thiscouldonlygiverisetothepresumptionthatshehasnothinggoodtotestifyonher
defense.Anyway,thealleged"unverifiedstatementoftheprosecutionwitness"remainsunchallengedand
unrebutted.

Likewiseundisputedistheprosecution'sversionindicatingthefollowingfacts:thattheaccusedaskedthe
patient'srelativestobuyTagametcapsuleswhiletheoperationwasalreadyinprogressthatafteranhour,they
werealsoaskedtobuytype"A"bloodforthepatientthatafterthesurgery,theywereagainaskedtoprocure
moretype"A"blood,butsuchwasnotanymoreavailablefromthesourcethattheoxygengiventothepatient
wasemptyandthatthesoninlawofthepatient,togetherwithadriverofthepetitioner,hadtorushtotheSan
PabloCityDistrictHospitaltogetthemuchneededoxygen.Alltheseconclusivelyshowthatthepetitionerhad
notpreparedforanyunforeseencircumstancesbeforegoingintothefirstsurgery,whichwasnotemergencyin
nature,butwaselectiveorprescheduledshehadnoreadyantibiotics,nopreparedblood,properlytypedand
crossmatched,andnosufficientoxygensupply.

Moreover,therearealotofquestionsthatkeepnaggingUs.Wasthepatientgivenanycardiopulmonary
clearance,oratleastaclearancebyaninternist,whicharestandardrequirementsbeforeapatientissubjectedto
surgery.Didthepetitionerdetermineaspartofthepreoperativeevaluation,thebleedingparametersofthe
patient,suchasbleedingtimeandclottingtime?Thereisnoshowingthattheseweredone.Thepetitionerjust
appearstohavebeeninahurrytoperformtheoperation,evenasthefamilywantedthepostponementtoApril6,
1991.Obviously,shedidnotpreparethepatientneitherdidshegetthefamily'sconsenttotheoperation.
Moreover,shedidnotprepareamedicalchartwithinstructionsforthepatient'scare.Ifshedidallthese,proof
thereofshouldhavebeenoffered.Butthereisnone.Indeed,theseareoverwhelmingevidenceofrecklessness
andimprudence."[25]

Thiscourt,however,holdsdifferentlyandfindstheforegoingcircumstancesinsufficienttosustain
a judgment of conviction against the petitioner for the crime of reckless imprudence resulting in
homicide.Theelementsofrecklessimprudenceare:(1)thattheoffenderdoesorfailstodoanact(2)
thatthedoingorthefailuretodothatactisvoluntary(3)thatitbewithoutmalice(4)thatmaterial
damageresultsfromtherecklessimprudenceand(5)thatthereisinexcusablelackofprecautionon
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the part of the offender, taking into consideration his employment or occupation, degree of
intelligence,physicalcondition,andothercircumstancesregardingpersons,timeandplace.
Whetherornotaphysicianhascommittedan"inexcusablelackofprecaution"inthetreatmentof
hispatientistobedeterminedaccordingtothestandardofcareobservedbyothermembersofthe
profession in good standing under similar circumstances bearing in mind the advanced state of the
profession at the time of treatment or the present state of medical science.[26]In therecentcase of
Leonila GarciaRueda v. Wilfred L. Pacasio, et. al.,[27] this Court stated that in accepting a case, a
doctor in effect represents that, having the needed training and skill possessed by physicians and
surgeonspracticinginthesamefield,hewillemploysuchtraining,careandskillinthetreatmentof
hispatients.Hethereforehasadutytouseatleastthesamelevelofcarethatanyotherreasonably
competentdoctorwouldusetotreataconditionunderthesamecircumstances.Itisinthisaspectof
medicalmalpracticethatexperttestimonyisessentialtoestablishnotonlythestandardofcareofthe
professionbutalsothatthephysician'sconductinthetreatmentandcarefallsbelowsuchstandard.
[28]
Further, inasmuch as the causes of the injuries involved in malpractice actions are determinable
only in the light of scientific knowledge, it has been recognized that expert testimony is usually
necessarytosupporttheconclusionastocausation.[29]
Immediately apparent from a review of the records of this case is the absence of any expert
testimonyonthematterofthestandardofcareemployedbyotherphysiciansofgoodstandinginthe
conduct of similar operations. The prosecution's expert witnesses in the persons of Dr. Floresto
ArizalaandDr.NietoSalvador,Jr.oftheNationalBureauofInvestigation(NBI)onlytestifiedastothe
possible cause of death but did not venture to illuminate the court on the matter of the standard of
carethatpetitionershouldhaveexercised.
All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness the
lackofprovisionssuchasblood,oxygen,andcertainmedicinesthefailuretosubjectthepatienttoa
cardiopulmonary test prior to the operation the omission of any form of blood typing before
transfusionandeventhesubsequenttransferofLydiatotheSanPabloHospitalandthereoperation
performedonherbythepetitioner.Butwhileitmaybetruethatthecircumstancespointedoutbythe
courtsbelowseemedbeyondcaviltoconstituterecklessimprudenceonthepartofthesurgeon,this
conclusion is still best arrived at not through the educated surmises nor conjectures of laymen,
includingjudges,butbytheunquestionableknowledgeofexpertwitnesses.Forwhetheraphysician
orsurgeonhasexercisedtherequisitedegreeofskillandcareinthetreatmentofhispatientis,inthe
generality of cases, a matter of expert opinion.[30] The deference of courts to the expert opinion of
qualified physicians stems from its realization that the latter possess unusual technical skills which
laymen in most instances are incapable of intelligently evaluating.[31] Expert testimony should have
been offered to prove that the circumstances cited by the courts below are constitutive of conduct
fallingbelowthestandardofcareemployedbyotherphysiciansingoodstandingwhenperformingthe
sameoperation.Itmustberememberedthatwhenthequalificationsofaphysicianareadmitted,asin
the instant case, there is an inevitable presumption that in proper cases he takes the necessary
precaution and employs the best of his knowledge and skill in attending to his clients, unless the
contrary is sufficiently established.[32] This presumption is rebuttable by expert opinion which is so
sadlylackinginthecaseatbench.
Evengrantingarguendothattheinadequacyofthefacilitiesanduntidinessoftheclinicthelack
ofprovisionsthefailuretoconductpreoperationtestsonthepatientandthesubsequenttransferof
LydiatotheSanPabloHospitalandthereoperationperformedonherbythepetitionerdoindicate,
evenwithoutexperttestimony,thatpetitionerwasrecklesslyimprudentintheexerciseofherdutiesas
a surgeon, no cogent proof exists that any of these circumstances caused petitioner's death. Thus,
the absence of the fourth element of reckless imprudence: that the injury to the person or property
wasaconsequenceoftherecklessimprudence.
Inlitigationsinvolvingmedicalnegligence,theplaintiffhastheburdenofestablishingappellant's
negligenceandforareasonableconclusionofnegligence,theremustbeproofofbreachofdutyon

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thepartofthesurgeonaswellasacasualconnectionofsuchbreachandtheresultingdeathofhis
patient.[33]InChanLugayv.StLuke'sHospital,Inc.,[34]wheretheattendingphysicianwasabsolvedof
liabilityforthedeathofthecomplainant'swifeandnewbornbaby,thiscourtheldthat:

"Inorderthattheremaybearecoveryforaninjury,however,itmustbeshownthatthe'injuryforwhich
recoveryissoughtmustbethelegitimateconsequenceofthewrongdonetheconnectionbetweenthe
negligenceandtheinjurymustbeadirectandnaturalsequenceofevents,unbrokenbyinterveningefficient
causes.'Inotherwords,thenegligencemustbetheproximatecauseoftheinjury.For,'negligence,nomatterin
whatitconsists,cannotcreatearightofactionunlessitistheproximatecauseoftheinjurycomplainedof.'And
'theproximatecauseofaninjuryisthatcause,which,innaturalandcontinuoussequence,unbrokenbyany
efficientinterveningcause,producestheinjury,andwithoutwhichtheresultwouldnothaveoccurred.'''[35]
(Underscoringsupplied.)

Dr.Arizalawhoconductedanautopsyonthebodyofthedeceasedsummarizedhisfindingsas
follows:
"Atty.Cachero:
Q.YoumentionedaboutyourAutopsyReportwhichhasbeenmarkedasExh."A1b".Thereappears
hereasignatureabovethetypewrittennameFlorestoArizala,Jr.,whosesignatureisthat?
A.Thatismysignature,sir.
Q.DoyouaffirmthetruthofallthecontentsofExh."A1b"?
A.Onlyastotheautopsyreportno.9109,thetimeandplaceandeverythingafterthepostmortem
findings,sir.
Q.Youmentionedonyour"PostMortemFindings"aboutsurgicalincision,14:0cm.,infraumbilicalarea,
anteriorabdominalarea,midline,willyoupleaseexplainthatinyourownlanguage?
A.Therewasincisionwound(sic)theareajustbelowthenavel,sir.
Q.AndthelastparagraphofthepostmortemfindingswhichIread:Uterus,pearshapedandpale
measuring7.5x5.5x5.0cm,withsomesurfacenodulationofthefundicareaposteriorly.Cut
sectionshowsdiffuselypalemyometriumwithareasofstreakinduration.Theovariesandadnexal
structuresaremissingwiththerawsurfacespatchedwithclottedblood.Surgicalsutureswere
notedontheoperativesite.
Intestinesandmesenteriesarepalewithbloodclotsnotedbetweenthemesentricfolds.
Hemoperitonium:300s.s.,
rightparacolicgutter,
50c.c.,leftparacolicgutter
200c.c.,mesentricarea,
100c.c.,rightpelvicgutter
stomachempty.
Othervisceralorgans,pale.',
willyoupleaseexplainthaton(sic)yourownlanguageorinordinary
A.Therewasauteruswhichwasnotattachedtotheadnexalstructuresnamelyovarieswhichwerenot
presentandalsosignofprevioussurgicaloperationandtherewere(sic)clottedblood,sir.
Q.Howabouttheovariesandadnexalstructures?
A.Theyaremissing,sir.
Q.Youmeantosaytherearenoovaries?
A.Duringthattimetherearenoovaries,sir.

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Q.Andtherewerelikewisesignofsurgicalsutures?
A.Yes,sir.
Q.Howabouttheintestinesandmesenteriesareplace(sic)withbloodclotsnotedbetweenthe
mesentericfolds,willyoupleaseexplainon(sic)this?
A.Intheperitonealcavity,theyaremostlyperritonialblood.
Q.Andwhatcouldhavecausedthisblood?
A.Well,ordinarilybloodisfoundinsidethebloodvessel.Bloodwere(sic)outsideasaresultofthe
injurieswhichdestroyedtheintegrityofthevesselallowingbloodtosip(sic)out,sir.
Q.BythenatureofthepostmortemfindingsindicatedinExh.A1B,canyoutellthecourtthecauseof
death?
A.Yes,sir.Thecauseofdeathis:Grossfindingsarecompatiblewithhemorrhagicshock.
Q.Canyoutelltheuswhatcouldhavecausedthishemorrhagicshock?
A.Wellhemorrhagicshockistheresultofbloodloss.
Q.Whatcouldhavetheeffectofthatlossofblood?
A.Unattendedhemorrhage,sir.[36](Underscoringsupplied.)
TheforegoingwascorroboratedbyDr.NietoSalvador:
"Q.Andwereyouabletodeterminethecauseofdeathbyvirtueoftheexaminationofthespecimen
submittedbyDr.Arizala?
A.Withoutknowledgeoftheautopsyfindingsitwouldbedifficultformetodeterminethecauseofdeath,
sir.
Q.HaveyouexaminedthepostmortemofDr.Arizala?
A.Yes,sir,andbyvirtueoftheautopsyreportinconnectionwithyourpathologyreport.
Q.Whatcouldhavecausedthedeathofthevictim?
A.Thispathologicexaminationare(sic)compatiblewiththepersonwhodied,sir.
Q.Willyouexplaintousthemeaningofhemorrhagiccompatible?
A.Itmeansthatapersondiedofbloodloss.Meaningapersondiedofnonreplacementofbloodandso
thevictimbeforeshediedtherewasshockofdiminishofbloodofthecirculation.Shediedmost
probablybeforetheactualcompletebloodloss,sir.
Court:Isitpossibledoctorthatthelossofthebloodwasdueon(sic)operation?
A.Basedonmypathologyfindings,sir.
Q.Whatcouldhavecausedthislossofblood?
A.Many,sir.Apatientwhohaveundergonesurgery.Anothermaybeabloodvesselmaybecutwhileon
operationandthiscause(sic)bleeding,ormaybesetinthecourseoftheoperation,ormaybe(sic)
hediedaftertheoperation.Ofcoursethereareothercause(sic).
Atty.Cachero:
Q.Especiallysodoctorwhentherewasnobloodreplacement?
A.Yes,sir."[37](Underscoringsupplied.)
The testimonies of both doctors establish hemorrhage or hemorrhagic shock as the cause of
death. However, as likewise testified to by the expert witnesses in open court, hemorrhage or
hemorrhagic shock during surgery may be caused by several different factors. Thus, Dr. Salvador's
elaborationonthematter:
"Atty.Pascual:

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Q.Doctor,amongthecausesofhemorrhagethatyoumentionedyousaidthatitcouldbeatthemoment
ofoperationwhenonelosses(sic)controlofthepresence,isthatcorrect?Duringtheoperation
thereislost(sic)ofcontrolofthecutvessel?
A.Yes,sir.
Q.Orthereisafailuretoligateavesselofconsiderablesize?
A.Yes,sir.
Q.Orevenifthevesselwereligatedtheknotmayhaveslippedlateron?
A.Yes,sir.
Q.Andyoualsomentionedthatitmaybepossiblealsotosomeclottingdefect,isthatcorrect?
A.Maybe(sic)."[38](Underscoringsupplied).
Defensewitness,Dr.BuC.Castroalsogavethefollowingexpertopinion:
"Q.Doctorevenapatientafteranoperations(sic)wouldsufferhemorragewhatwouldbethepossible
causesofsuchhemorrage(sic)?
A.AmongthosewouldbewhatwecallIntravascularCoagulationandthisisthereasonforthebleeding,
sir,whichcannotbepreventedbyanyone,itwillhappentoanyone,anytimeandtoanypersons
(sic),sir.
COURT:
Whatdoyouthinkofthecauseofthebleeding,thecuttingortheoperationsdoneinthebody?
A.Notrelatedtothisone,thebleedinghereisnotrelatedtoanycuttingoroperationthatI(sic)have
done.
Q.AsidefromtheDICwhatcouldanothercauses(sic)thatcouldbethecauseforthehemorrhageor
bleedinginapatientbyanoperations(sic)?
A.Ingeneralsir,iftherewasanoperations(sic)anditispossiblethattheligatureinthesuturewas(sic)
become(sic)loose,itis(sic)becomeslooseifproven.
xxxxxxxxx
Q.Ifthepersonwhoperformedanautopsydoesnotfindanyuntight(sic)clot(sic)bloodvesselorany
suturethatbecome(sic)loosethecauseofthebleedingcouldnotbeattributedtothefaultofthe
subject?
A.Definitely,sir."[39](Underscoringsupplied.)
According to both doctors, the possible causes of hemorrhage during an operation are: (1) the
failureofthesurgeontotieorsutureacutbloodvessel(2)allowingacutbloodvesseltogetoutof
control(3)thesubsequentlooseningofthetieorsutureappliedtoacutbloodvesseland(4)anda
clottingdefectknownasDIC.ItissignificanttostateatthisjuncturethattheautopsyconductedbyDr.
ArizalaonthebodyofLydiadidnotrevealanyuntiedorunsuturedcutbloodvesselnorwasthereany
indication that the tie or suture of a cut blood vessel had become loose thereby causing the
hemorrhage.[40]HencethefollowingpertinentportionofDr.Arizala'stestimony:
"Q:Doctor,inexaminingthesestructuresdidyouknowwhethertheseweresuturedligatureorplain
ligature
A:Ligature,sir.
Q:Wewillexplainthatlateron.Didyourecallifthecutstructuresweretiedbyfirstsuturingitandthen
tyingaknotorthetiewasmerelyplacedaroundthecutstructureandtied?
A:Icannotrecall,sir.
Q:Asamatteroffact,youcannotrecallbecauseyoudidnotevenbothered(sic)toexamine,isthat
correct?

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A:Well,Ibotheredenoughtoknowthattheyweresutured,sir.
Q:So,therefore,Doctor,youwouldnotknowwhetheranyofthecutstructureswerenotsuturedortied
neitherwereyouabletodeterminewhetheranyloosesuturewasfoundintheperitonealcavity?
A:Icouldnotrecallanyloosesutured(sic),sir."[41]
Ontheotherhand,thefindingsofallthreedoctorsdonotprecludetheprobabilitythatDICcaused
the hemorrhage and consequently, Lydia's death. DIC which is a clotting defect creates a serious
bleedingtendencyandwhenmassiveDICoccursasacomplicationofsurgeryleavingrawsurface,
majorhemorrhageoccurs.[42]And as testified to by defense witness, Dr. Bu C. Castro, hemorrhage
duetoDIC"cannotbeprevented,itwillhappentoanyone,anytime."[43]Hetestifiedfurther:
"Q.Now,underthecircumstanceoneofthepossibilityasyoumentionedin(sic)DIC?
A.Yes,sir.
Q.Andyoumentionedthatitcannotbeprevented?
A.Yes,sir.
Q.Canyouevenpredictifitreallyhappen(sic)?
A.Possible,sir.
Q.Arethereanyspecificfindingsofautopsythatwilltellyouwhetherthispatientsufferedamongsuch
thingsasDIC?
A.Well,Ididreservebecauseoftheconditionofthepatient.
Q.Now,DoctoryousaidthatyouwentthroughtherecordofthedeceasedLydiaUmalilookingforthe
chart,theoperated(sic)records,thepostmortemfindingsonthehistophanic(sic)examination
basedonyourexaminationofrecord,doctor,canyoumoreorlesssays(sic)whatpartare(sic)
concernedcouldhavebeenthecaused(sic)ofdeathofthisLydiaUmali?
A.Asfarasthemedicalrecordisconcern(sic)thecaused(sic)ofdeathisdessimulated(sic)Intra
VascularCoagulationortheDICwhichresultedtohemorrhageorbleedings,sir.
Q.Doctorbasedonyourfindingsthenthereisknowing(sic)thedoctorwouldsaywhetherthedoctor
her(sic)hasbeen(sic)fault?
ATTY.MALVEDA:
Wewillmoved(sic)tostrikeoutthe(sic)basedonfindingtheyjustreadthechartaswellastheother
record.
ATTY.PASCUAL:
Preciselybasedonthisexamination.
ATTY.MALVEDA:
Notfinding,therewasnofindingmade.
COURT:
Heisonlyreadingtherecord.
ATTY.PASCUAL:
Yes,sir.
A.No,sir,thereisnofaultonthepartofthesurgeon,sir."[44]
Thiscourthasnorecoursebuttorelyontheexperttestimoniesrenderedbybothprosecutionand
defense witnesses that substantiate rather than contradict petitioner's allegation that the cause of
Lydia's death was DIC which, as attested to by an expert witness, cannot be attributed to the
petitioner'sfaultornegligence.TheprobabilitythatLydia'sdeathwascausedbyDICwasunrebutted
during trial and has engendered in the mind of this Court a reasonable doubt as to the petitioner's
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guilt.Thus,heracquittalofthecrimeofrecklessimprudenceresultinginhomicide.Whilewecondole
withthefamilyofLydiaUmali,ourhandsareboundbythedictatesofjusticeandfairdealingwhich
holdinviolabletherightofanaccusedtobepresumedinnocentuntilprovenguiltybeyondreasonable
doubt.Nevertheless,thisCourtfindsthepetitionercivillyliableforthedeathofLydiaUmali,forwhilea
conviction of a crime requires proof beyond reasonable doubt, only a preponderance of evidence is
requiredtoestablishcivilliability.[45]
The petitioner is a doctor in whose hands a patient puts his life and limb. For insufficiency of
evidencethisCourtwasnotabletorenderasentenceofconvictionbutitisnotblindtothereckless
andimprudentmannerinwhichthepetitionercarriedoutherduties.Apreciouslifehasbeenlostand
the circumstances leading thereto exacerbated the grief of those left behind. The heirs of the
deceasedcontinuetofeelthelossoftheirmotheruptothepresenttime[46]andthisCourtis aware
thatnoamountofcompassionandcommiserationnorwordsofbereavementcansufficetoassuage
thesorrowfeltforthelossofalovedone.Certainly,theawardofmoralandexemplarydamagesin
favoroftheheirsofLydiaUmaliareproperintheinstantcase.
WHEREFORE,premisesconsidered,petitionerDR.NINEVETCHCRUZisherebyACQUITTED
of the crime of reckless imprudence resulting in homicide but is ordered to pay the heirs of the
deceasedLydiaUmalitheamountofFIFTYTHOUSANDPESOS(P50,000.00)ascivilliability,ONE
HUNDREDTHOUSANDPESOS(P100,000.00)asmoraldamages,andFIFTYTHOUSANDPESOS
(P50,000.00)asexemplarydamages.
LetthecopyofthisdecisionbefurnishedtotheProfessionalRegulationCommission(PRC)for
appropriateaction.
SOORDERED.
Romero,Melo,andPanganiban,JJ.,concur.
Narvasa,C.J.,(Chairman),onleave.

[1]"THE PHYSICIAN'S LIABILITY AND THE LAW OF NEGLIGENCE" by Constantino Nuez, p.1 citing Louis Nizer, My
Life in Court, New York: Double Day & Co., 1961 in Tolentino, Jr., MEDICINE and LAW, Proceedings of the
SymposiumonCurrentIssuesCommontoMedicineandLawU.P.LawCenter,1980.
[2]LeonilaGarciaRuedavs.WilfredL.Pascasio,et.al.,G.R.No.118141,September5,1997.

[3]ART.2176.Whoeverbyactoromissioncausesdamagetoanother,therebeingfaultornegligence,isobligedtopayfor
the damage done.Such fault or negligence, if there is no preexisting contractual relation between the parties, is
calledaquasidelictandisgovernedbytheprovisionsofthisChapter.
[4]Art.365.ImprudenceandNegligence.Anypersonwho,byrecklessimprudence,shallcommitanyactwhich,haditbeen
intentional,wouldconstituteagravefelony,shallsufferthepenaltyofarrestomayorinitsmaximumperiodtoprision
correccionalinitsmediumperiodifitwouldhaveconstitutedalessgravefelony,thepenaltyofarrestomayorinits
minimum and medium periods shall be imposed if it would have constituted a light felony, the penalty, of arresto
menorinitsmaximumperiodshallbeimposed.
Anypersonwho,bysimpleimprudenceornegligence,shallcommitanactwhichwouldotherwiseconstituteagravefelony,
shall suffer the penalty of arrestomayor in its medium and maximum periods if it would have constituted a less
seriousfelony,thepenaltyofarrestomayorinitsminimumperiodshallbeimposed.
When the execution of the act covered by this article shall have only resulted in damage to the property of another, the
offendershallbepunishedbyafinerangingfromanamountequaltothevalueofsaiddamagestothreetimessuch
value,butwhichshallinnocasebelessthantwentyfivepesos.
A fine not exceeding two hundred pesos and censure shall be imposed upon any person who, by simple imprudence or
negligence,shallcausesomewrongwhich,ifdonemaliciously,wouldhaveconstitutedalightfelony.
In the imposition of this penalties, the court shall exercise their sound discretion, without regard to the rules prescribed in
articlesixtyfour.
Theprovisionscontainedinthisarticleshallnotbeapplicable:

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1.When the penalty provided for the offense is equal to or lower than those provided in the first two paragraphs of this
article,inwhichcasethecourtsshallimposethepenaltynextlowerindegreethanthatwhichshouldbeimposed,in
theperiodwhichtheymaydeempropertoapply.
2.When,byimprudenceornegligenceandwithviolationoftheAutomobileLaw,thedeathofapersonshallbecaused,in
whichcasethedefendantshallbepunishedbyprisioncorreccionalinitsmediumandthemaximumperiods.
Reckless imprudence consists in voluntarily, but without malice, doing or failing to do an act from which material damage
results by reason of inexcusable lack of precaution on the part of the person performing or failing to perform such
act, taking into consideration his employment or occupation, degree of intelligence, physical condition and other
circumstancesregardingpersons,timeandplace.
Simpleimprudenceconsistsinthelackofprecautiondisplayedinthosecasesinwhichthedamageimpendingtobecaused
isnotimmediatenorthedangerclearlymanifest.
Thepenaltynexthigherindegreetothoseprovidedforinthisarticleshallbeimposedupontheoffenderwhofailstolendon
thespottotheinjuredpartiessuchhelpasmaybeinhishandstogive.
[5]INFORMATION,

[6]DECISIONinCriminalCaseNo.25534,March4,1994,p.12Rollo,p.65.

[7]DECISIONinCriminalCaseNo.9273SP,July26,1994,p.4Rollo,p.53.

[8]DECISIONinCAG.R.CRNo.16388,October25,1995,p.10Rollo,p.49.

[9]TSN,RowenaUmaliDeOcampo,November10,1992,pp.56.

[10]TSN,EdnaPujanes,September30,1992,p.5.

[11]RecordofExhibits,p.15.

[12]TSN,supra,p.8.

[13]Ibid.,p.6.

[14]Ibid.,p.8.

[15]Ibid.,pp.2728.

[16]Ibid.,pp.1014

[17]RecordsofExhibits,supra.

[18]TSN,supra,pp.1516.

[19]RecordofExhibits,supra.

[20]TSN,Dr.BartolomeAngeles,October7,1992,pp.1012.

[21]RecordofExhibits,supra.

[22]RecordofExhibits,p.5.

[23]DECISION,supra,pp.1112Rollo,pp.6465.

[24]DECISION,supra,p.4Rollo,p.53.

[25]DECISION,supra,p.7Rollo,pp.47.

[26]MEDICINEandLAW,supra,p.24.

[27]Supra.

[28]MEDICINEandLAW,supra,p.25Willardvs.Hutson,1ALR3d1092,1102[1963]Snydervs.Pantaleo,122A.2d21,
23[1956].
[29]AmericanJurisprudence2d,Vol.61,p.510.

[30]Willardvs.Hutson,supra.

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[31]MEDICINEandLAW,supra.

[32]Abaya,et.al.vs.Favis,3CAReports450,454455[1963].

[33]Ibid.

[34]10CAReports415[1966].

[35]Ibid.,pp.427428.

[36]TSN,Dr.FlorestoArizala,Jr.January20,1993,pp.4346.

[37]TSN,Dr.NietoSalvador,Jr.,pp.1011.

[38]TSN,Dr.NietoSalvador,Ibid.,pp.2021.

[39]TSN,Dr.BuC.Castro,September28,1993,pp.1013.

[40]TSN,Dr.FlorestoArizala,supra.

[41]TSN,Dr.FlorestoArizala,supra,pp.2728.

[42]RobertBerkow,TheMerckManualofDiagnosisandTherapy,1987,p.1170.

[43]TSN,Dr.BuCastro,supra.

[44]TSN,Dr.BuC.Castro,supra,pp.1315.

[45]Padillavs.CourtofAppeals,129SCRA558,565[1984]Peoplevs.Jalandoni,131SCRA454[1984].

[46]
"Q.WhenyoucametoknowthatyourmotherwasalreadydeadthereintheoperatingroomoftheSanPabloDistrict
Hospital,howdidyoufeelbeingthedaughter?
A.Iwascryingandcryinghysterically.AndIaskedwhyithappenedtomymother,sir.
Q.Anduptothepresenttimedoyoustillfeelaboutthelossofyourmother?
A.Yes,sir.
Q.Howaboutyoursisterandbrother?
A.Samewithme,sir.
Q.Estimatedtomoneyvalue,howmuchIcostyouandyoursisterandbrotherthelostofyourmother?
A.Thereisnoequivalent,sir."(TSN,RowenaUmaliDeOcampo,supra,p.18.)

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