PART II

Culion Ice, Fish And Electric Co V. Phil Motors Corp. (1930)

G.R. No. L-32611 November 3, 1930

Lessons Applicable: Experts and Professionals (Torts and Damages)
FACTS:
January, 1925: Cranston decided, if practicable, to have the engine on the Gwendoline changed from a gasoline consumer to a crude
oil burner, expecting thereby to effect economy in the cost of running the boat
He made known his desire to McLeod & Co., a firm dealing in tractors, and was told by Mc Kellar that he might make inquiries of the
Philippine Motors Corporations
Cranston repaired to the office of the Philippine Motors Corporation and had a conference with C.E. Quest, its manager, who agreed
to do the job, with the understanding that payment should be made upon completion of the work.
The Philippine Motors Corporation was at this time engaged in business as an automobile agency, but, under its charter, it had
authority to deal in all sorts of machinery engines and motors, as well as to build, operate, buy and sell the same and the equipment
therof.
Quest, in company with Cranston, visited the Gwendoline while it lay at anchor in the Pasig River, and the work of effecting the
change in the engine was begun
Upon preliminary inspection of the engine, Quest came to the conclusion that the principal thing necessary to accomplish the end in
view was to install a new carburetor, and a Zenith carburetor was chosen as the one most adapted to the purpose.
After this appliance had been installed, the engine was tried with gasoline as a fuel, supplied from the tank already in use. The result
of this experiment was satisfactory.
The next problem was to introduce into the carburetor the baser fuel, consisting of a low grade of oil mixed with distillate.
In the course of the preliminary work upon the carburetor and its connections, it was observed that the carburetor was flooding,
and that the gasoline, or other fuel, was trickling freely from the lower part to the carburetor to the floor. This fact was called to
Quest's attention, but he appeared to think lightly of the matter and said that, when the engine had gotten to running well, the
flooding would disappear.
January 30,1925 5 pm: The first part of the course was covered without any untoward development, other than the fact that the
engine stopped a few times, owing no doubt to the use of an improper mixture of fuel. In the course of the trial Quest remained
outside of the engine compartment and occupied himself with making distillate, with a view to ascertaining what proportion of the
two elements would give best results in the engine.
7:30 pm: and when passing near Cavite, the engine stopped, and connection again had to be made with the gasoline line to get a
new start. After this had been done the mechanic, or engineer, switched to the tube connecting with the new mixture.
A moment later a back fire occurred in the cylinder chamber. This caused a flame to shoot back into the carburetor, and instantly
the carburetor and adjacent parts were covered with a mass of flames, which the members of the crew were unable to subdue.
They were therefore compelled, as the fire spread, to take to a boat, and their escape was safely effected, but the Gwendoline was
reduced to a mere hulk. The salvage from, the wreck, when sold, brought only the sum of P150. The value of the boat, before the
accident occurred, as the court found, was P10,000.

ISSUE: W/N the incident was due to the negligence of Phil. Motors as experts.

HELD: YES. It results that the judgment appealed from, awarding damages to the plaintiff in the amount of P9,850, with interest,
must be affirmed; and it is so ordered, with costs against the appellant.
Ordinarily a back fire from an engine would not be followed by any disaster, but in this case the leak along the pipe line and the
flooding of the carburetor had created a dangerous situation, which a prudent mechanic, versed in repairs of this nature, would
have taken precautions to avoid. The back fire may have been due either to the fact that the spark was too advanced or the fuel
improperly mixed.
In this connection it must be remembered that when a person holds himself out as being competent to do things requiring
professional skill, he will be held liable for negligence if he fails to exhibit the care and skill of one ordinarily skilled in the particular
work which he attempts to do.
Page 1 of 13
 PART II

The proof shows that Quest had had ample experience in fixing the engines of automobiles and tractors, but it does not appear that
he was experienced in the doing of similar work on boats.
Quest did not use the skill that would have been exhibited by one ordinarily expert in repairing gasoline engines on boats =
negligence.
The test of liability is not whether the injury was accidental in a sense, but whether Quest was free from blame
accident is chargeable to lack of skill or negligence in effecting the changes which Quest undertook to accomplish; and even
supposing that our theory as to the exact manner in which the accident occurred might appear to be in some respects incorrect, yet
the origin of the fire in not so inscrutable as to enable us to say that it was casus fortuitus.

US V. Pineda (1918)

G.R. No. L-12858 January 22, 1918

Lessons Applicable: Experts and Professionals (Torts and Damages)

FACTS:

Feliciano Santos, having some sick horses, presented a copy of a prescription obtained from Dr. Richardson, and which on other
occasions Santos had given to his horses with good results, at Pineda's drug store for filling. (Santiago Pineda, the defendant, is a
registered pharmacist)

Under the supervision of Pineda, the prescription was prepared and returned to Santos in the form of 6 papers marked Botica
Pineda

Santos, under the belief that he had purchased the potassium chlorate which he had asked for, put two of the packages in water the
doses to two of his sick horses.

Another package was mixed with water for another horse, but was not used. The two horses, to which had been given the
preparation, died shortly afterwards.

Santos, thereupon, took the three remaining packages to the Bureau of Science for examination. Drs. Pea and Darjuan, of the
Bureau of Science, on analysis found that the packages contained not potassium chlorate but barium chlorate.

At the instance of Santos, the two chemists also went to the drug store of the defendant and bought potassium chlorate, which
when analyzed was found to be barium chlorate. (Barium chlorate, it should be noted, is a poison; potassium chlorate is not.)

Dr. Buencamino, a veterinarian, performed an autopsy on the horses, and found that death was the result of poisoning

RTC: held Pineda liable

ISSUE: W/N Pineda should be liable for negligence

HELD: YES. The judgment of the lower court, sentencing the defendant to pay a fine of P100, with subsidiary imprisonment in case
of insolvency, and to pay the costs, is affirmed with the cost of this instance against the appellant, without prejudice to any civil
action which may be instituted

Every pharmacist shall be responsible for the quality of all drugs, chemicals, medicines, and poisons he may sell or keep for sale; and
it shall be unlawful for any person whomsoever to manufacture, prepare, sell, or administer any prescription, drug, chemical,
medicine, or poison under any fraudulent name, direction, or pretense, or to adulterate any drug, chemical, medicine, or poison so
used, sold or offered for sale. Any drug, chemical, medicine, or poison shall be held to be adulterated or deteriorated within the
meaning of this section if it differs from the standard of quality or purity given in the United States Pharmacopoeia.

The same section of the Pharmacy Law also contains the following penal provision: "Any person violating the provisions of this Act
shall, upon conviction, be punished by a fine of not more than five hundred dollar." The Administrative Code, section 2676, changes
the penalty somewhat by providing that: Any person engaging in the practice of pharmacy in the Philippine Islands contrary to any
provision of the Pharmacy Law or violating any provisions of said law for which no specific penalty s provided shall, for each offense,
be punished by a fine not to exceed two hundred pesos, or by imprisonment for not more than ninety days, or both, in the
discretion of the court.
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 PART II

As a pharmacist, he is made responsible for the quality of all drugs and poisons which he sells. And finally it is provided that it shall
be unlawful for him to sell any drug or poison under any "fraudulent name." It is the one word "fraudulent" which has given the
court trouble. What did the Legislature intend to convey by this restrictive adjective?

Were we to adhere to the technical definition of fraud, which the appellant vigorously insists upon, it would be difficult, if not
impossible, to convict any druggist of a violation of the law. The prosecution would have to prove to a reasonable degree of
certainty that the druggist made a material representation; that it was false; that when he made it he knew that it was false or made
it recklessly without any knowledge of its truth and as positive assertion; that he made it with the intention that it should be acted
upon by the purchaser; that the purchaser acted in reliance upon it, and that the purchased thereby suffered injury.

Under one conception, and it should not be forgotten that the case we consider are civil in nature, the question of negligence or
ignorance is irrelevant. The druggist is responsible as an absolute guarantor of what he sells. Instead of caveat emptor, it should be
caveat venditor.

Mercury vs De leon

Facts:Raul De leon consulted Dr. Milla about his irritated left eye.The latter prescribed the drugs Cortisporin Opthalmic and Ceftin to
relieve his eye problems.Before heading to work the following morning,

De leon went to the Betterliving, Paranaque, branch of Mercury Drug Store Corporation to buy the prescribed medicines.He showed
his prescription to petitioner Aurmela Ganzon, a pharmacist assistant.Subsequently, he paid for and took the medicine handed over
by Ganzon. at his chambers,

De leon requested his sheriff to assist him in using the eye drops. As instructed, the sheriff applied 2-3 drops on respondents left
eye.Instead of relieving his irritation, respondent felt searing pain. He immediately rinsed the affected eye with water, but the pain
did not subside.Only then did he discover that he was given the wrong medicine, Cortisporin Otic Solution. He returned to the same
Mercury Drug branch, with his left eye still red and teary. When he confronted Ganzon why he was given ear drops, instead of the
prescribed eye drops, she did not apologize and instead brazenly replied that she was unable to fully read the prescription. In fact, it
was her supervisor who apologized and informed De Leon that they do not have stock of the needed Cortisporin Opthalmic.He then
wrote a letter through the president of Mercury Drug, Ms. Vivian K. Askuna, about the days incident.It did not merit any
response.Instead, two sales persons went to his office and informed him that their supervisor was busy with other matters.Having
been denied his simple desire for a written apology and explanation, De Leon filed a complaint for damages against Mercury Drug.
Mercury claimed that De leon's injury was brought by his own negligence, he should have check the name of the medicine before
putting on his eyes. The RTC ruled in favor of De leon and the Ca affirmed the decision of the RTC, hence this petition for certiorari

Issue:

Whether Mercury and Guanzon was negligent.(Culpa Contractual).

Holding:

Yes

This Court once more reiterated that the profession of pharmacy demands great care and skill.It reminded druggists to exercise the
highest degree of care known to practical men.In cases where an injury is caused by the negligence of an employee, there instantly
arises a presumption of law that there has been negligence on the part of the employer, either in the selection or supervision of
ones employees.This presumption may be rebutted by a clear showing that the employer has exercised the care and diligence of a
good father of the family. Mercury Drug failed to overcome such presumption.

Petitioners Mercury Drug and Ganzon have similarly failed to live up to high standard of diligence expected of them as pharmacy
professionals.They were grossly negligent in dispensing ear drops instead of the prescribed eye drops to De Leon.Worse, they have
once again attempted to shift the blame to their victim by underscoring his own failure to read the label.As a buyer, De Leon relied
on the expertise and experience of Mercury Drug and its employees in dispensing to him the right medicine.This Court has ruled
that in the purchase and sale of drugs, the buyer and seller do not stand at arms length.There exists an imperative duty on the seller
or the pharmacist to take precaution to prevent death or injury to any person who relies on ones absolute honesty and peculiar
learning. Article 2229 allows the grant of exemplary damages by way of example or correction for the public good. As mentioned
earlier, the drugstore business is affected by public interest. Petitioner should have exerted utmost diligence in the selection and
supervision of its employees. On the part of the employee concerned, she should have been extremely cautious in dispensing
pharmaceutical products. Due to the sensitive nature of its business, petitioner must at all times maintain a high level of
meticulousness. Therefore, an award of exemplary damages in the amount of P25,000.00 is in order.
Page 3 of 13
 PART II

WHEREFORE, the petition is PARTIALLY GRANTED. The Decisions of the CA and the RTC in Paranaque City are AFFIRMED WITH
MODIFICATION, in that the award of moral and exemplary damages is reduced to P50,000.00 and P25,000.00, respectively.

CRUZ VS CA (GR NO. 122445 NOVEMBER 18, 1997)

Cruz vs Court of Appeals

GR No. 122445 November 18, 1997

Facts: On March 22, 1991, prosecution witness, Rowena Umali de Ocampo, accompanied her mother to the Perpetual Help Clinic
and General Hospital situated in Balagtas Street, San Pablo City, Laguna. They arrived at the said hospital at around 4:30 in the
afternoon of the same day. Prior to March 22, 1991, Lydia was examined by the petitioner who found a Myoma in her uterus, and
scheduled her for a hysterectomy operation on March 23, 1991. Rowena and her mother slept in the clinic on the evening of March
22, 1991 as the latter was to be operated on the next day at 1pm. According to Rowena, she noticed that the clinic was untidy and
the windows and the floor were very dusty prompting her to ask the attendant fora rag to wipe the window and floor with. Prior to
the operation, Rowena tried to convince her mother to not proceed with the operation and even asked petitioner for it to be
postponed, however it still pushed through after the petitioner told Lydia that operation must be done as scheduled. During the
operation, the assisting doctor of the petitioner, Dr. Ercillo went out of the operating room and asked that tagmet ampules be
bought which was followed by another instruction to buy a bag of blood. After the operation, when Lydia came out of the OR,
another bag of blood was requested to be bought, however, the same was not bought due to unavailability of type A from the blood
bank. Thereafter a person arrived to donate blood which was later transferred to Lydia. Rowena then noticed her mother, who was
attached to an oxygen tank, gasping for breathe apparently, the oxygen tank is empty, so her husband and petitioners driver
bought an oxygen. Later, without the knowledge of Lydias relatives,she was decided by the doctors to be transferred to San Pablo
District Hospital were she was supposed to be re-operated. After Lydia experienced shocks, she died.

Issue: Whether or not petitioner has been negligent which caused the death of Lydia Umali.

Held: Yes. Whether or not a physician has committed an inexcusable lack of precaution in the treatment of his patient to be
determined according to the standard of care observed by other members of the profession in good standing under similar
circumstances bearing in mind the advanced state of the profession at the time of treatment or the present state of medical
science. A doctor in effect represents that, having the needed training and skill possessed by physicians and surgeons practicing in
the same field, he will employ such training, care and skill in the treatment of his patients. He therefore has a duty to use at least
the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. It
is in this aspect of medical malpractice that expert testimony is essential to establish not only the standard of care of the profession
but also that the physicians conduct in the treatment and care falls below such standard. Further, in as much as the causes of the
injuries involved in malpractice actions are determinable only in the light of scientific knowledge, it has been recognized that expert
testimony is usually necessary to the conclusion as to causation.

In litigations involving medical negligence, the plaintiff has the burden of establishing appellants negligence and for a reasonable
conclusion of negligence, there must be proof of breach of duty on the part of the surgeon as well as causal connection of such
breach and the resulting death of his patient.

In order that there may be recovery for an injury, however, it must be shown that the injury for which recovery is sought must be
legitimate consequence of the wrong done; the connection between the negligence and the injury must be a direct and natural
reference of events, unbroken by intervening efficient causes. In other words, the negligence must be the proximate cause of the
injury. For negligence, no matter what it consists, cannot create a right of action unless it is the proximate cause of the injury
complained of and the proximate cause of an injury is that cause, which in natural and continuous sequence, unbroken by any
efficient intervening cause, produces the injury and without which the result would have occurred.

The elements of reckless imprudence are:

1. That the offender does or fails to do an act;
2. That the doing or the failure to do that act is voluntary;
3. That it be without malice;
4. That material damage results from the reckless imprudence; and
5. That there is inexcusable lack of precaution on the part of the offender, taking into consideration his employment or
occupation, degree of intelligence, physical condition, and other circumstances regarding persons, time, and place.

Page 4 of 13
 PART II

The possible causes of hemorrhage during an operation are: 1.) the failure of the surgeon to tie or suture a cut blood vessel; 2.)
allowing a cut blood vessel to get out of control; 3.) the subsequent loosening of the tie or suture applied to a cut blood vessel; and
4.)and a clotting defect known as DIC.

ALBERT TISON

vs.

SPS. GREGORIO POMASIN

PEREZ, J.:

FACTS: A tractor-trailer and a jitney collided along Maharlika Highway in Albay. LaarniPomasin was the driver of the jitney while the
tractor was driven by Claudio Jabon. Multiple death and injuries to those in the jitney resulted. Albert Tison, the owner of the truck,
extended financial assistance to respondents and P200,000.00 to Cynthia Pomasin, sister of Laarni. Cynthia, in turn, executed an
Affidavit of Desistance.

Still, respondents filed a complaint for damages before the RTC of Antipolo. They alleged that the proximate cause of the accident
was the negligence, imprudence and carelessness of petitioners. In their Answer, petitioners countered that it was Laarnis
negligence which proximately caused the accident. They further claimed that Cynthia was authorized by Spouses Pomasin to enter
into an amicable settlement by executing an Affidavit of Desistance.

Petitioners subsequently filed a motion to dismiss the complaint in view of the Affidavit of Desistance executed by
Cynthia. However, the motion was denied. The trial court ruled in favor Tison giving more credence to the testimony of Jabon. The
CA disagreed with the trial court and ruled that the reckless driving of Jabon caused the vehicular collision based on the gravity of
the damage caused to the jitney. Also, it was noted that the restriction in Jabons drivers license was violated, thus, giving rise to
the presumption that he was negligent at the time of the accident. Tison was also held liable for damages for his failure to prove
due diligence in supervising Jabon after he was hired as driver of the truck.

ISSUE: Whether CA is correct in its findings.

RULING: NO. Petitioners are not negligent. According to Article 2176 of the Civil Code, whoever by act or omission causes damage
to another, there being fault or negligence, is obliged to pay for the damage done. To sustain a claim based on quasi-delict, the
following requisites must concur: (a) damage suffered by the plaintiff; (b) fault or negligence of defendant; and (c) connection of
cause and effect between the fault or negligence of defendant and the damage incurred by the plaintiff. These requisites must be
proved by a preponderance of evidence. The claimants, respondents in this case, must, therefore, establish their claim or cause of
action by preponderance of evidence, evidence which is of greater weight, or more convincing than that which is offered in
opposition to it.

Driving without a proper license is a violation of traffic regulation. Under Article 2185 of the Civil Code, the legal presumption of
negligence arises if at the time of the mishap, a person was violating any traffic regulation. However, inSanitary Steam Laundry, Inc.
v. Court of Appeals, the court held that a causal connection must exist between the injury received and the violation of the traffic
regulation. It must be proven that the violation of the traffic regulation was the proximate or legal cause of the injury or that it
substantially contributed thereto. Negligence, consisting in whole or in part, of violation of law, like any other negligence, is without
legal consequence unless it is a contributing cause of the injury. Likewise controlling is our ruling in Aonuevo v. Court of
Appeals where we reiterated that negligence per se, arising from the mere violation of a traffic statute, need not be sufficient in
itself in establishing liability for damages. In said case, Aonuevo, who was driving a car, did not attempt to establish a causal
connection between the safety violations imputed to the injured cyclist, and the accident itself. Instead, he relied on a putative
presumption that these violations in themselves sufficiently established negligence appreciable against the cyclist. Since the onus
on Aonuevo is to conclusively prove the link between the violations and the accident, we can deem him as having failed to
discharge his necessary burden of proving the cyclists own liability.

The rule on negligence per se must admit qualifications that may arise from the logical consequences of the facts leading to the
mishap. The doctrine (and Article 2185, for that matter) is undeniably useful as a judicial guide in adjudging liability, for it seeks to
impute culpability arising from the failure of the actor to perform up to a standard established by a legal fiat. But the doctrine
should not be rendered inflexible so as to deny relief when in fact there is no causal relation between the statutory violation and the
injury sustained. Presumptions in law, while convenient, are not intractable so as to forbid rebuttal rooted in fact. After all, tort law
is remunerative in spirit, aiming to provide compensation for the harm suffered by those whose interests have been invaded owing
to the conduct of other.

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 PART II

In the instant case, no causal connection was established between the tractor-trailer drivers restrictions on his license to the
vehicular collision. Furthermore, Jabon was able to sufficiently explain that the Land Transportation Office merely erred in not
including restriction code 8 in his license.

JONAS AONUEVO, petitioner vs. HON. COURT OF APPEALS and JEROME VILLAGRACIA, respondent [G.R. No. 130003.
October 20, 2004]

Facts: At the intersection of Boni Avenue and Barangka Drive in Mandaluyong (now a city). Villagracia was traveling along Boni
Avenue on his bicycle, while Aonuevo, traversing the opposite lane was driving his Lancer car with plate number PJJ 359. The car
was owned by Procter and Gamble Inc., the employer of Aonuevos brother, Jonathan. Aonuevo was in the course of making a left
turn towards Libertad Street when the collision occurred. Villagracia sustained serious injuries as a result, which necessitated his
hospitalization several times in 1989, and forced him to undergo four (4) operations.
Villagracia instituted an action for damages against Procter and Gamble Phils., Inc. and Aonuevo before the RTC.. Trial on the civil
action ensued, and in a Decision dated 9 March 1990, the RTC rendered judgment against Procter and Gamble and Aonuevo,
ordering them to pay Villagracia.

The Court of Appeals Fourth Division affirmed the RTC Decision in toto. Aonuevo points out that Villagracias bicycle had no safety
gadgets such as a horn or bell, or headlights, as invoked by a 1948 municipal ordinance.[ Nor was it duly registered with the Office of
the Municipal Treasurer, as required by the same ordinance. Finally, as admitted by Villagracia, his bicycle did not have foot brakes.

Issue: Whether Article 2185 of the New Civil Code, which presumes the driver of a motor vehicle negligent if he was violating a
traffic regulation at the time of the mishap, should apply by analogy to non-motorized vehicles.

Ruling: A motorized vehicle operates by reason of a motor engine unlike a non-motorized vehicle, which runs as a result of a direct
exertion by man or beast of burden of direct physical force. A motorized vehicle, unimpeded by the limitations in physical exertion.is
capable of greater speeds and acceleration than non-motorized vehicles. At the same time, motorized vehicles are more capable in
inflicting greater injury or damage in the event of an accident or collision. This is due to a combination of factors peculiar to the
motor vehicle, such as the greater speed, its relative greater bulk of mass, and greater combustibility due to the fuels that they use.
There long has been judicial recognition of the peculiar dangers posed by the motor vehicle.
The Code Commission was cognizant of the difference in the natures and attached responsibilities of motorized and non-motorized
vehicles. Art. 2185 was not formulated to compel or ensure obeisance by all to traffic rules and regulations. If such were indeed the
evil sought to be remedied or guarded against, then the framers of the Code would have expanded the provision to include non-
motorized vehicles or for that matter, pedestrians. Yet, that was not the case; thus the need arises to ascertain the peculiarities
attaching to a motorized vehicle within the dynamics of road travel. The fact that there has long existed a higher degree of diligence
and care imposed on motorized vehicles, arising from the special nature of motor vehicle, leads to the inescapable conclusion that
the qualification under Article 2185 exists precisely to recognize such higher standard. Simply put, the standards applicable to motor
vehicle are not on equal footing with other types of vehicles.
Thus, we cannot sustain the contention that Art. 2185 should apply to non-motorized vehicles, even if by analogy.

PSI VS AGANA (GR NO. 126297 JANUARY 31, 2007)

Professional Services Inc. vs Agana
GR No. 126297 January 31, 2007

Facts: On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital because of difficulty of bowel movement
and bloody anal discharge. After a series of medical examinations, Dr. Miguel Ampil diagnosed her to be suffering from Cancer of
the sigmoid. On April 11, 1984, Dr. Ampil assisted by the medical staff of the Medical City Hospital performed an Anterior resection
surgery on Natividad. He found that the malignancy on her sigmoid area had spread on her left ovary, necessitating the removal of
certain portions of it. Thus, Dr. Ampil obtained the consent of Natividads husband, Enrique Agana, to permit Dr. Juan Fuentes to
perform hysterectomy on her. After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation
and closed the incision after searching for the missing 2 gauzes as indicated by the assisting nurses but failed to locate it. After a
couple of days, Natividad complained of excruciating pains in her anal region but Dr. Ampil said it is a natural consequence of the
operation/surgery and recommended that she consult an oncologist to examine the cancerous nodes which were not removed
during the operation. Natividad and her husband went to the US to seek further treatment and she was declared free from cancer.
A piece of gauze portruding from Natividads vagina was found by her daughter which was then removed by hand by Dr. Ampil and
assured that the pains will vanished. However, it didnt. The pains intensified prompting Natividad to seek treatment at the
Polymedic General Hospital. While confined there, Dr. Ramon Guttierez detected the presence of another foreign object in her
vagina a foul smelling gauze measuring 1.5 inches in width which badly infected her vagina. A recto-vaginal fistula had forced stool
to excrete through her vagina. Another surgical operation was needed to remedy the damage.

Issue: Whether or not Dr. Ampil and Fuentes are liable for medical malpractice and the PSI for damages due to the negligence of the
said doctors.

Held: Yes. No. Yes. An operation requiring the placing of sponges in the incision is not complete until the sponges are properly
removed and it is settled that the leaving of sponges or other foreign substances in the wound after the incision has been closed is
Page 6 of 13
 PART II

at least prima facie negligence by the operating surgeon. To put it simply, such act is considered so inconsistent with due care as to
raise inference of negligence. There are even legions of authorities to the effect that such act is negligence per se.

This is a clear case of medical malpractice or more appropriately, medical negligence. To successfully pursue this kind of case, a
patient must only prove that a health care provider either failed to do something which a reasonably prudent health care provider
would have done, or that he did something that a reasonably prudent provider would not have done; and that failure or action
caused injury to the patient. Simply puts the elements are duty, breach, injury, and proximate causation. Dr. Ampil, as the lead
surgeon, had the duty to remove all foreign objects, such as gauzes, from Natividads body before closure of the incision. When he
failed to do so, it was his duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused injury to Natividad,
necessitating her further examination by American doctors and another surgery. That Dr. Ampils negligence is the proximate cause
of Natividads injury could be traced from his act of closing the incision despite the information given by the attending nurses that 2
pieces of gauze were still missing. That they were later on extracted from Natividads vagina established the causal link between Dr.
Ampils negligence and the injury. And what further aggravated such injury was his deliberate concealment of this missing gauzes
from the knowledge of Natividad and her family.

The requisites for the applicability of the doctrine of res ipsa liquitor are:

1. Occurrence of an injury;
2. The thing which caused the injury was under the control and management of the defendant;
3. The occurrence was such that in the ordinary course of things would not have happened if those who had
control or management used proper care, and;
4. The absence of explanation by the defendant
5.
Of the foregoing, the most instrumental is the Control and management of the thing which caused the injury.

Under the Captain of the ship rule, the operating surgeon is the person in complete charge of the surgery room and all personnel
connected with the operation.

The knowledge of any of the staff of Medical City constitutes knowledge of PSI.

The doctrine of corporate responsibility has the duty to see that it meets the standards of responsibilities for the care of patients.
Such duty includes the proper supervision of the members of its medical staff. The hospital accordingly has the duty to make a
reasonable effort to monitor and over see the treatment prescribed and administered by the physician practicing in its premises.

PEDRO T. LAYUGAN, vs. INTERMEDIATE APPELLATE COURT, GODOFREDO ISIDRO, and TRAVELLERS MULTI-INDEMNITY
CORPORATION,
SARMIENTO, J.:
FACTS: on May 15, 1979 while at Baretbet, Bagabag, Nueva Vizcaya, the Plaintiff and a companion were repairing the tire of their
cargo truck with Plate No. SU-730 which was parked along the right side of the National Highway; that defendant's truckdriven
recklessly by Daniel Serrano bumped the plaintiff, that as a result, plaintiff was injured and hospitalized at Dr. Paulino J. Garcia
Research and Medical Center and the Our Lady of Lourdes Hospital; that he spent TEN THOUSAND PESOS (Pl0,000.00) and will incur
more expenses as he recuperates from said injuries; that because of said injuries he would be deprived of a lifetime income in the
sum of SEVENTY THOUSAND PESOS (P70,000.00); and that he agreed to pay his lawyer the sum of TEN THOUSAND PESOS
Defendant countered that the plaintiff was merely a bystander, not a truck helper being a brother-in-law law of the driver of said
truck; that the truck allegedly being repaired was parked, occupying almost half of the right lane towards Solano, Nueva Vizcaya,
right after the curve; that the proximate cause of the incident was the failure of the driver of the parked truck in installing the early
warning device, hence the driver of the parked car should be liable for damages sustained by the truck
On May 29, 1981, a third-party complaint was filed by the defendant against his insurer,
amply supported by the evidence on record, the trial court rendered its decision and ordered defendat to pay damages
Intermediate Appellate Court as earlier stated reversed the decision of the trial court and dismissed the complaint, the third-party
complaint, and the counter- claims of both appellants.

ISSUE: WON CA CORRECT? WHO WAS NEGLIGENT? CA wrong isidro was negligent

HELD: The test by which to determine the existence of negligence in a particular case may be stated as follows: Did the defendant in
doing the alleged negligent act use that reasonable care and caution which an ordinarily prudent person would have used in the
same situation? If not, then he is guilty of negligence. The law here in effect adopts the standard supposed to be supplied by the
imaginary conduct of the discreet paterfamilias of the Roman law

ISIDROS CLAIM: Respondent Isidro posits that any immobile object along the highway, like a parked truck, poses serious danger to a
moving vehicle which has the right to be on the highway. He argues that since the parked cargo truck in this case was a threat to life
and limb and property, it was incumbent upon the driver as well as the petitioner, who claims to be a helper of the truck driver, to
exercise extreme care so that the motorist negotiating the road would be properly forewarned of the peril of a parked vehicle. Isidro
submits that the burden of proving that care and diligence were observed is shifted to the petitioner, for, as previously claimed, his
(Isidro's) Isuzu truck had a right to be on the road, while the immobile cargo truck had no business, so to speak, to be there.
Likewise, Isidro proffers that the petitioner must show to the satisfaction of a reasonable mind that the driver and he (petitioner)
himself, provided an early warning device, like that required by law, or, by some other adequate means that would properly
Page 7 of 13
 PART II

forewarn vehicles of the impending danger that the parked vehicle posed considering the time, place, and other peculiar
circumstances of the occasion. Absent such proof of care, as in the case at bar, Isidro concludes, would, under the doctrine of Res
ipsa loquitur, evoke the presumption of negligence on the part of the driver of the parked cargo truck as well as his helper, the
petitioner herein, who was fixing the flat tire of the said truck.

COURTS ANSWER: The evidence on record discloses that three or four meters from the rear of the parked truck, a lighted kerosene
lamp was placed and Whether the cargo truck was parked along the road or on half the shoulder of the right side of the road would
be of no moment taking into account the warning device consisting of the lighted kerosene lamp placed three or four meters from
the back of the truck.

IAC WRONG:From its finding that the parked truck was loaded with ten (10) big round logs the Court of Appeals inferred that
because of its weight the truck could not have been driven to the shoulder of the road and concluded that the same was parked on
a portion of the road at the time of the accident. Consequently, the respondent court inferred that the mishap was due to the
negligence of the driver of the parked truck. The inference or conclusion is manifestly erroneous. In a large measure, it is grounded
on speculation, surmise, or conjecture. How the respondent court could have reversed the finding of the trial court that a warning
device was installed (res ipsaliquitor not applicable ca was applying it. It merely determines and regulates what shall be prima facie
evidence thereof and facilitates the burden of plaintiff of proving a breach of the duty of due care) once the actual cause of injury is
established beyond controversy, whether by the plaintiff or by the defendant, no presumptions will be involved and the doctrine
becomes inapplicable when the circumstances have been so completely eludicated that no inference of defendant's liability can
reasonably be made, whatever the source of the evidence,

ISIDROS drivers claim while driving Isuzu truck at Baretbet, Bagabag, Nueva Vizcaya and at KM 285, I met another vehicle who (sic)
did not dim his (sic) lights which cause (sic) me to be blinded with intense glare of the light that's why I did not notice a parked truck
who (sic) was repairing a front flat tire. When I was a few meters away, I saw the truck which was loaded with round logs. I step (sic)
on my foot brakes but it did not function with my many attempts. I have (sic) found out later that the fluid pipe on the rear right was
cut that's why the breaks did not function.

The private respondent or his mechanic, who must be competent, should have conducted a thorough inspection of his vehicle
before allowing his driver to drive it. In the light of the circumstances obtaining in the case, we hold that Isidro failed to prove that
the diligence of a good father of a family in the supervision of his employees which would exculpate him from solidary liability with
his driver to the petitioner. RTC reinstated

Luz Tan vs Jam Transit

Facts:Luz Palanca Tan (Tan) alleged that she was the owner of a passenger-type jitney with plate number DKF-168.On March 14,
1997, at around 5:00 a.m., the said jitney figured in an accident at an intersection along Maharlika Highway, Barangay Bangyas,
Calauan, Laguna, as it collided with a JAM Transit passenger bus bound for Manila, bearing plate number DVG-557 and body number
8030.The bus was driven by Eddie Dimayuga (Dimayuga).At the time of the collision, Tans jitney was loaded with quail eggs and duck
eggs (balot and salted eggs).It was driven by Alexander M. Ramirez (Ramirez).Tan alleged that Dimayuga was reckless, negligent,
imprudent, and not observing traffic rules and regulations, causing the bus to collide with the jitney which was then, with care and
proper light direction signals, about to negotiate a left turn towards the feeder or barangay road of Barangay Bangyas, Calauan,
Laguna going to the Poblacion.The jeepney turned turtle along the shoulder of the road and the cargo of eggs was
destroyed.Ramirez and his helper were injured and hospitalized, incurring expenses for medical treatment at thePagamutang
Pangmasain Bay, Laguna.Tan prayed for damages in the amount of P400,000.00 for the damaged jitney,P142,210.00 for the
destroyed shipment,P20,000.00 for moral damages, attorneys fees of P20,000.00 plus P1,000.00 per court appearance of counsel,
and other reliefs warranted under the premises.In its Answer with Counterclaim, respondent JAM Transit, Inc. (JAM) admitted
ownership of the subject passenger bus and that Dimayuga was under its employ.However, it denied the allegations in the
Complaint, and claimed that the accident occurred due to the gross negligence of Ramirez.As counterclaim, JAM sought payment of
P100,000.00 for the damages sustained by the bus,P100,000.00 for loss of income, and P50,000.00 as attorneys fees plusP3,000.00
per court appearance of counsel. The RTC ruled in favor of Tan and the CA ruled in favor of JAM Transit,There was no evidence as to
who between Ramirez and Dimayuga was negligent in connection with the vehicular accident.The CA held that the doctrine of res
ipsa loquitur can only be invoked when direct evidence is nonexistent or not accessible.

Issue:Whether direct evidence is needed to prove the omission or negligence of Jam Transit.

Holding:

No,Verily, although there was no direct evidence that the JAM passenger bus was overtaking the vehicles running along the right
lane of the highway from the left lane, the available evidence readily points to such fact.There were two continuous yellow lines at
the center of the highway, which meant that no vehicle in the said area should overtake another on either side of the road.The
double yellow center lines regulation, which this Court takes judicial notice of as an internationally recognized pavement regulation,
was precisely intended to avoid accidents along highways, such as what happened in this case. This prohibition finds support in
Republic Act (R.A.) No. 4136 (Land Transportation and Traffic Code), Section 41(e).Furthermore, it is observed that the area of
collision was an intersection.Section 41(c) of R.A. No. 4136, likewise, prohibits overtaking or passing any other vehicle proceeding in
the same direction at any intersection of highways, among others.Thus, by overtaking on the left lane, Dimayuga was not only
violating the double yellow center lines regulation, but also the prohibition on overtaking at highway intersections.Consequently,
negligence can be attributed only to him, which negligence was the proximate cause of the injury sustained by petitioner.This prima
Page 8 of 13
 PART II

facie finding of negligence was not sufficiently rebutted or contradicted by Dimayuga. Therefore, a finding that he is liable for
damages to petitioner is warranted.Whenever an employees negligence causes damage or injury to another, there instantly arises a
presumption juris tantum that the employer failed to exercise diligentissimi patris families in the section (culpa in eligiendo) or
supervision (culpa in vigilando)of its employees.To avoid liability for a quasi-delict committed by its employee, an employer must
overcome the presumption, by presenting convincing proof that he exercised the care and diligence of a good father of a family in
the selection and supervision of his employee. To warrant an award of actual or compensatory damages for repair to damage
sustained, the best evidence should be the receipts or other documentary proofs of the actual amount expended. However,
considering that it was duly proven that the jitney was damaged and had to be repaired, as it was repaired, and that the cargo of
eggs was indeed destroyed, but the actual amounts expended or lost were not proven, we deem it appropriate to award
P250,000.00 by way of temperate damages. Under Article 2224 of the Civil Code, temperate damages may be recovered when
pecuniary loss has been suffered but its amount cannot be proved with certainty. WHEREFORE, the petition is GRANTED. The
Decision dated June 2, 2008 of the Court of Appeals in CA-G.R. CV No. 89046 is REVERSED and SET ASIDE. The Decision dated
December 20, 2006 of the Regional Trial Court, Branch 27, Sta. Cruz, Laguna in Civil Case No. SC-3838 is REINSTATED with the
MODIFICATION.

COLLEGE ASSURANCE V. BELFRANIT CASE DIGEST

FACTS:Belfrant Development Inc. (BDI) was the owner of Belfrant building in Angeles City, Pampanga. It leased to College Assurance
Plan Phil and Comprehensive Annuity Plans and Pension Corporation (Petitioners) several units on the 2nd and 3rd floors of the
building. Fire destroyed portions of the building, including the 3rd floor units being occupied by the petitioners. A field investigation
report by an unnamed arson investigator assigned to the case disclosed:
Origin of the fire: store room occupied by the CAP located at the 3rd floor
Cause of fire: accidental (overheated coffee percolator)
These findings were reiterated in the certification, which the BFP City Fire Marshal, Insp. issued to petitioners as a supporting
document for the latters insurance claim. BDI sent to petitioners a Notice to Vacate the leased premises to make way for repairs
and to pay reparation estimated at 1.5million.
Petitioners vacated the premises including the units in the 2nd floor but they did not act on the demand for reparation. After
succeeding demands went unheeded, BDI filed a complaint for damages.Both trial and appellate court ruled against the petitioner

ISSUE:whether the petitioners are liable for damages

RULING: Yes. The Court applied the doctrine of res ipsaloquitor in this case, even if there were documents emanating from the BFP
that were presented as evidence as to the cause of fire.
The court ruled that The CA correctly applied the doctrine of res ipsa loquitur under which expert testimony may be dispensed
with[35] to sustain an allegation of negligence if the following requisites obtain: a) the accident is of a kind which does not ordinarily
occur unless someone is negligent; b) the cause of the injury was under the exclusive control of the person in charge and c) the
injury suffered must not have been due to any voluntary action or contribution on the part of the person injured.
The fire that damaged Belfranlt Building was not a spontaneous natural occurrence but the outcome of a human act or omission. It
originated in the store room which petitioners had possession and control of. Respondent had no hand in the incident. Hence, the
convergence of these facts and circumstances speaks for itself: petitioners alone having knowledge of the cause of the fire or the
best opportunity to ascertain it, and respondent having no means to find out for itself, it is sufficient for the latter to merely allege
that the cause of the fire was the negligence of the former and to rely on the occurrence of the fire as proof of such
negligence.[37] It was all up to petitioners to dispel such inference of negligence, but their bare denial only left the matter
unanswered.

Consunji vs. Court of Appeals

JUSTIFICATION FOR THE RULE (RES IPSA LOQUITUR)

FACTS: Jose Juego, a construction worker of D. M. Consunji, Inc., fell 14 floors from the Renaissance Tower, Pasig City to his death. .
Juego together with Jessie Jaluag and Delso Destajo [were] performing their work as carpenter[s] at the elevator core of the
14th floor of the Tower D, Renaissance Tower Building on board a [p]latform made of channel beam (steel) measuring 4.8 meters by
2 meters wide with pinulid plywood flooring and cable wires attached to its four corners and hooked at the 5 ton chain block, when
suddenly, the bolt or pin which was merely inserted to connect the chain block with the [p]latform, got loose xxx causing the whole
[p]latform assembly and the victim to fall down to the basement of the elevator core, Tower D of the building under construction
thereby crushing the victim of death, save his two (2) companions who luckily jumped out for safety. Juegos widow, Maria, filed in
the Regional Trial Court (RTC) of Pasig a complaint for damages against the deceaseds employer, D.M. Consunji, Inc.
Res ipsa loquitur became an issue in relation to DM Consunjis objection to PO3 Villanuevas testimony. What Consunji took
particular exception to is PO3 Villanuevas testimony that the cause of the fall of the platform was the loosening of the bolt from the
chain block. Petitioner claimed that such portion of the testimony is mere opinion. Subject to certain exceptions,18 the opinion of a
witness is generally not admissible.

Petitioner does not dispute the existence of the requisites for the application of res ipsa loquitur, but argues that the presumption
or inference that it was negligent did not arise since it "proved that it exercised due care to avoid the accident which befell
respondents husband."

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 PART II

ISSUE: WON CA erred in holding that the doctrine of res ipsa loquitor [sic] is applicable to prove negligence on the part of petitioner.

HELD: The concept of res ipsa loquitur has been explained in this wise:
While negligence is not ordinarily inferred or presumed, and while the mere happening of an accident or injury will not generally
give rise to an inference or presumption that it was due to negligence on defendants part, under the doctrine of res ipsa loquitur,
which means, literally, the thing or transaction speaks for itself, or in one jurisdiction, that the thing or instrumentality speaks for
itself, the facts or circumstances accompanying an injury may be such as to raise a presumption, or at least permit an inference of
negligence on the part of the defendant, or some other person who is charged with negligence.
x x x where it is shown that the thing or instrumentality which caused the injury complained of was under the control or
management of the defendant, and that the occurrence resulting in the injury was such as in the ordinary course of things would
not happen if those who had its control or management used proper care, there is sufficient evidence, or, as sometimes stated,
reasonable evidence, in the absence of explanation by the defendant, that the injury arose from or was caused by the defendants
want of care.21

One of the theoretical based for the doctrine is its necessity, i.e., that necessary evidence is absent or not available.22
The res ipsa loquitur doctrine is based in part upon the theory that the defendant in charge of the instrumentality which causes the
injury either knows the cause of the accident or has the best opportunity of ascertaining it and that the plaintiff has no such
knowledge, and therefore is compelled to allege negligence in general terms and to rely upon the proof of the happening of the
accident in order to establish negligence. The inference which the doctrine permits is grounded upon the fact that the chief
evidence of the true cause, whether culpable or innocent, is practically accessible to the defendant but inaccessible to the injured
person.

It has been said that the doctrine of res ipsa loquitur furnishes a bridge by which a plaintiff, without knowledge of the cause,
reaches over to defendant who knows or should know the cause, for any explanation of care exercised by the defendant in respect
of the matter of which the plaintiff complains. The res ipsa loquitur doctrine, another court has said, is a rule of necessity, in that it
proceeds on the theory that under the peculiar circumstances in which the doctrine is applicable, it is within the power of the
defendant to show that there was no negligence on his part, and direct proof of defendants negligence is beyond plaintiffs power.
Accordingly, some court add to the three prerequisites for the application of the res ipsa loquitur doctrine the further requirement
that for the res ipsa loquitur doctrine to apply, it must appear that the injured party had no knowledge or means of knowledge as to
the cause of the accident, or that the party to be charged with negligence has superior knowledge or opportunity for explanation of
the accident.

Petitioner apparently misapprehends the procedural effect of the doctrine. As stated earlier, the defendants negligence is
presumed or inferred25 when the plaintiff establishes the requisites for the application of res ipsa loquitur. Once the plaintiff makes
out a prima facie case of all the elements, the burden then shifts to defendant to explain.26 The presumption or inference may be
rebutted or overcome by other evidence and, under appropriate circumstances disputable presumption, such as that of due care or
innocence, may outweigh the inference.27 It is not for the defendant to explain or prove its defense to prevent the presumption or
inference from arising. Evidence by the defendant of say, due care, comes into play only after the circumstances for the application
of the doctrine has been established.1wphi1.nt

Petitioner is correct. Fabros sworn statement is hearsay and inadmissible. Affidavits are inadmissible as evidence under the hearsay
rule, unless the affiant is placed on the witness stand to testify thereon.28 The inadmissibility of this sort of evidence is based not
only on the lack of opportunity on the part of the adverse party to cross-examine the affiant, but also on the commonly known fact
that, generally, an affidavit is not prepared by the affiant himself but by another who uses his own language in writing the affiants
statements which may either be omitted or misunderstood by the one writing them.29 Petitioner, therefore, cannot use said
statement as proof of its due care any more than private respondent can use it to prove the cause of her husbands death.
Regrettably, petitioner does not cite any other evidence to rebut the inference or presumption of negligence arising from the
application of res ipsa loquitur, or to establish any defense relating to the incident.

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

FACTS: dr. Ninevetchcruz was aanaesthesiologist and surgeon in in perpetual C Help Clinic and General Hospital. LYDIA Umali,
deceased respondent, was her patient who was accompanied by respondent daughter umali. She was examined by dr. Cruz and
found a " myoma" in her uterus and was thereafter scheduled for hysterectomy operation. Rowena and her mother slept in the
clinic and noticed the untidiness if the clinic. Rowena tried to pursuade her mother to postponed the operation. When Lydia asked
Dr. Cruz, the latter ingormed that she had must be operated. Thereafter, the operation proceeded while the relatives of Lydia where
waiting, Dr. Ercilla instructed them to buy a blood for Lydia. After lapse of hours, they were informed that the operation was
finished. But again instructed to buy a blood, unfortunately there were no blood A in the blood bank of the clinic. Rowena noticed
that her mother was attached to an oxygen tank, gasping for breath. Apparently the oxygen run out of supply and Rowena had to go
to another hospital to gerkxgen.
Lydia was given fresh supply of oxygen but later she went into shock had unstable vondition which necessitated her to transfer to
San Pablo District Hospital. Such was without prior consent of rowena nor of other relatives. Thereafter, she was reoperated but Dr.
Angeles, Head of Obstetrics and Gynecology Department informed them that there was nothing he can do as Lydia ws already in
shock as her blood pressure was 0/0. MTCC found dr. Cruzand Dr. Ercilla guilty of negligence. The RTC reiterated the
abovementioned findings of the MTCC and upheld the latter's declaration of "incompetency, negligence and lack of foresight and
skill of appellant (herein petitioner) in handling the subject patient before and after the operation."[24] And likewise affirming the
petitioner's conviction, the Court of Appeals echoed similar observations.hence, this case.
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 PART II

ISSUE: Whether or not a physician has committed an "inexcusable lack of precaution" in the treatment of his patient is to be
determined according to the standard of care observed by other members of the profession in good standing[ under similar
circumstances bearing in mind the advanced state of the profession at the time of treatment or the present state of medical
science.]

RULING NO. In the recent case of Leonila Garcia-Rueda 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 surgeons practicing in the same
field, he will employ such training, care and skill in the treatment of his patients. He therefore has a duty to use at least the same
level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. It is in this
aspect of medical malpractice that expert testimony is essential to establish not only the standard of care of the profession but also
that the physician's conduct in the treatment and care falls below such standard.[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 necessary to support the conclusion as to causation.[29] Immediate
For whether a physician or surgeon has exercised the requisite degree of skill and care in the treatment of his patient is, in the
generality of cases, a matter of expert opinion.[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 falling below the standard of care employed by other physicians in good standing when performing the same
operation

In litigations involving medical negligence, the plaintiff has the burden of establishing appellant's negligence and for a reasonable
conclusion of negligence, there must be proof of breach of duty on the part of the surgeon as well as a casual connection of such
breach and the resulting death of his patient.[33] In Chan Lugay v. St Luke's Hospital, Inc.,[34] where the attending physician was
absolved of liability for the death of the complainant's wife and newborn baby, this court held that: "In order that there may be a
recovery for an injury, however, it must be shown that the 'injury for which recovery is sought must be the legitimate consequence
of the wrong done; the connection between the negligence and the injury must be a direct and natural sequence of events,
unbroken by intervening efficient causes.' In other words, the negligence must be the proximate cause of the injury. For,
'negligence, no matter in what it consists, cannot create a right of action unless it is the proximate cause of the injury complained
of.' And 'the proximate cause of an injury is that cause, which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have occurred.''

Cayao-Lasam vs. Sps. Ramolete

FACTS: On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was brought to the Lorma Medical Center
(LMC) in San Fernando, La Union due to vaginal bleeding. Upon advice of petitioner relayed via telephone, Editha was admitted to
the LMC on the same day. A pelvic sonogram was then conducted on Editha revealing the fetus weak cardiac pulsation. The
following day, Edithas repeat pelvic sonogram showed that aside from the fetus weak cardiac pulsation, no fetal movement was
also appreciated. Due to persistent and profuse vaginal bleeding, petitioner advised Editha to undergo a Dilatation and Curettage
Procedure (D&C) or "raspa." The procedure was performed by the petitioner and Editha was discharged the next day. On September
16, 1994, Editha was once again brought at the LMC, as she was suffering from vomiting and severe abdominal pains. She was found
to have a massive intra-abdominal hemorrhage and a ruptured uterus. Thus, Editha had to undergo a procedure for hysterectomy
and as a result, she has no more chance to bear a child. Respondents: first, petitioners failure to check up, visit or administer
medication on Editha during her first day of confinement at the LMC; second, petitioner recommended that a D&C procedure be
performed on Editha without conducting any internal examination prior to the procedure; third, petitioner immediately suggested a
D&C procedure instead of closely monitoring the state of pregnancy of Editha.

Petitioner: it was Edithas gross negligence and/or omission in insisting to be discharged against doctors advice and her unjustified
failure to return for check-up as directed by petitioner that contributed to her life-threatening condition on; that Edithas
hysterectomy was brought about by her very abnormal pregnancy known as placenta increta, which was an extremely rare and very
unusual case of abdominal placental implantation; that whether or not a D&C procedure was done by her or any other doctor, there
would be no difference at all because at any stage of gestation before term, the uterus would rupture just the same.

RULING: Medical malpractice is a particular form of negligence which consists in the failure of a physician or surgeon to apply to his
practice of medicine that degree of care and skill which is ordinarily employed by the profession generally, under similar conditions,
and in like surrounding circumstances. There are four elements involved in medical negligence cases: duty, breach, injury and
proximate causation. In the present case, respondents did not present any expert testimony to support their claim that petitioner
failed to do something which a reasonably prudent physician or surgeon would have done. Petitioner, on the other hand, presented
the testimony of Dr. Augusto M. Manalo, who was clearly an expert on the subject. He testified that the rupture occurred minutes
prior to the hysterectomy or right upon admission on September 15, 1994 which is about 1 months after the patient was
discharged, after the D&C was conducted. It is evident that the D&C procedure was not the proximate cause of the rupture of
Edithas uterus. The defenses in an action for damages, provided for under Article 2179 of the Civil Code are:

Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause of his injury he cannot recover damages.
But if his negligence was only contributory, the immediate and proximate cause of the injury being the defendants lack of due care,
the plaintiff may recover damages, but the courts shall mitigate the damages to be awarded. Proximate cause has been defined as
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 PART II

that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which
the result would not have occurred. An injury or damage is proximately caused by an act or a failure to act, whenever it appears
from the evidence in the case that the act or omission played a substantial part in bringing about or actually causing the injury or
damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. The
Court notes the findings of the Board of Medicine: When complainant was discharged on July 31,1994, herein respondent advised
her to return on August 4, 1994 or four (4) days after the D&C. This advise was clear in complainants Discharge Sheet. However,
complainant failed to do so. This being the case, the chain of continuity as required in order that the doctrine of proximate cause
can be validly invoked was interrupted. Had she returned, the respondent could have examined her thoroughly. Contributory
negligence is the act or omission amounting to want of ordinary care on the part of the person injured, which, concurring with the
defendants negligence, is the proximate cause of the injury. Difficulty seems to be apprehended in deciding which acts of the
injured party shall be considered immediate causes of the accident. Where the immediate cause of an accident resulting in an injury
is the plaintiffs own act, which contributed to the principal occurrence as one of its determining factors, he cannot recover
damages for the injury.

PETER PAUL PATRICK LUCAS, FATIMA GLADYS LUCAS, ABBEYGAIL LUCAS AND GILLIAN LUCAS, Petitioners, v. DR. PROSPERO MA.
C. TUAO, Respondent.
Lucas v. Tuao, G.R. No. 178763, April 21, 2009

Facts: The petitioners, Peter Lucas and his family, is suing respondent,Dr. Prospero Ma. C.Tuao, for damages due to medical
malpractice on the grounds thatTuao was negligent intreating Lucas conjunctivitis or sore eyes which led to glaucoma which in
turn made himirritable and unable to support his family. Lucas consultedTuao when he had severe painin his right eye to which the
respondent performed an ocular routine examination where hediagnosed Lucas to be suffering conjunctivitis or sore eyes which
developed EpidemicKerato Conjunctivitis (EKC), a viral infection to whichTuaoprescribed a steroid-basedeye drop called Maxitrol
which Lucas was using before. Lucas couldnt get a hold ofMaxitrol soTuaosuggested Blephamide instead which was also steroid-
based and Lucaslater used Maxitrol when it became available. Later on, Fatima Lucas, the wife, found outfrom the accompanying
literature of the medicine that prolonged use of steroid-basedmedication can result to glaucoma. Lucass right eye pain reduced for
a while but later onreturned and it became severe thatTuao referred him to another ophthalmologist, Dr.Manuel B. Agulto, for a
second opinion to which Dr. ManielAgulto wrote a letter toTuaostating the Lucas sustained significant glaucoma damage.The
Regional Trial Court denied the petitioners claim for damages due toinsufficient evidence provingTuaos medical malpractice in
treating Lucas because theyfailed to present a medical expert that could support their claim that whatTuaodid wasindeed medical
malpractice. Petitioners appealed to the Court of Appeals to which the courtaffirmed the Regional Trial Courts decision. Hence, the
petitioners appealed to the SupremeCourt.

Issue:Whether respondent Dr. Prospero Ma. C. Tuao is guilty of medicalmalpractice.

Ruling:

The Supreme Court ruled that respondent,Dr. Prospero Ma. C. Tuao, is not guiltyof medical malpractice.
The Supreme Court emphasizes that in order for medical malpractice to be proven, amedical expert should be a witness to attest to
the accuseds medical malpractice.Petitioners complaint for damages is merely based on a statement in the literature ofMaxitrol
identifying the risks of its use and Dr. Agultos comment.
In this type of suit, the patient or his heirs, in order to prevail, is required to prove by preponderance of evidence that the physician
failed to exercise that degree of skill, care, and learning possessed by other persons in the same profession; and that as a proximate
result of such failure, the patient or his heirs suffered damages. Just as with the elements of duty and breach of the same, in order
to establish the proximate cause [of the injury] by a preponderance of the evidence in a medical malpractice action,
the patient must similarly use expert testimony, because the question of whether the alleged professional negligence caused the
patients injury is generally one for specialized expert knowledge beyond the knowledge of the average layperson; using the
specialized knowledge and training of his field, theexperts role is to present to the court a realistic assessment of the likelihood that
the physicians alleged negligence caused the patients injury.The medical expert setsa standard and when there is failure to present
one, the courts have no standard by which togauge the basic issue of breach thereof by the physician or surgeon.

The deference of courts to the expert opinion of qualified physicians or surgeons stems from the formers realization that the latter
possess unusual technical skills which laymen in most instances are incapable of intelligently evaluating; hence, the indispensability
of expert testimonies.

The qualifications of a physician are taken into account and there is

inevitable presumption that he takes the necessary precaution and employs the best of his knowledgeand skill in attending to his
clients, unless the contrary is sufficiently established. Therefore,a medical expert as a witness in essential in medical malpractice
cases to give light to theerrors of the accused. Also, it serves as a reminder for people in the medical field to becautious and take the
necessary precautions when attending to their clients to avoid medicalmalpractice.

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 PART II

G.R. No. 124354. December 29, 1999

ROGELIO E. RAMOS and ERLINDA RAMOS
vs.
COURT OF APPEALS
KAPUNAN, J.:

FACTS: Erlinda Ramos, 47-year old robust woman underwent on an operation to the stone at her gall bladder removed after being
tested that she was fit for "cholecystectomy operation performed by Dr. OrlinoHozaka. Dr. Hosaka charged a fee of P16,000.00,
which was to include the anesthesiologist's fee and which was to be paid after the operation. He assured Rogelio E. Ramos,
husband that he will get a good anesthesiologist who was Dra. Perfecta Gutierrez. Erlinda's hand was held by Herminda Cruz, her
sister -in-law who was the Dean of the College of Nursing at the Capitol Medical Center together with her husband went down with
her to the operating room.

Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M.Herminda noticing what Dra. Perfecta Gutierrez was doing, saw the
nailbed of Erlinda becoming bluish and Dr. Hosaka called for another anesthesiologist Dr. Calderon.
She went out of the operating room to tell Rogelio that something is wrong.
When she went back she saw Erlinda in a trendelenburg position and at 3 p.m. she was taken to the Intensive Care Unit (ICU) where
she stayed for a month due to bronchospasm incurring P93,542.25 and she was since then comatosed.

She suffered brain damage as a result of the absence of oxygen in her brain for four to five minutes.

She was also diagnosed to be suffering from "diffuse cerebral parenchymal damage"
Monthly expenses ranged from P8,000 to P10,000. Spouses Ramos and their minors filed against Dr. Hosaka and Dra. Perfecta
Gutierrez.

The trial court favored the Ramos' awarding P8,000 as actual monthly expenses totalling to P632,000 as of April 15, 1992, P100,000
atty. fees, P800,000 moral damages,P200,000 exemplary damages and cost of suit. The appellate court reversed ordering the
Ramos' to pay their unpaid bills of P93,542.25 plus interest.

ISSUE: Whether respondents were negligent and liable.

RULING: YES. Private respondents were all negligent and are solidarily liable for the damages.
Res ipsa loquitur a procedural or evidentiary rule which means the thing or the transaction speaks for itself. It is a maxim for the
rule that the fact of the occurrence of an injury, taken with the surrounding circumstances, may permit an inference or raise a
presumption of negligence, or make out a plaintiffs prima facie case, and present a question of fact for defendant to meet with an
explanation, where ordinarily in a medical malpractice case, the complaining party must present expert testimony to prove that the
attending physician was negligent.

This doctrine finds application in this case. On the day of the operation, Erlinda Ramos already surrendered her person to the
private respondents who had complete and exclusive control over her. Apart from the gallstone problem, she was neurologically
sound and fit. Then, after the procedure, she was comatose and brain damagedres ipsa loquiturthe thing speaks for itself!

Negligence Private respondents were not able to disprove the presumption of negligence on their part in the care of Erlinda and
their negligence was the proximate cause of her condition. One need not be an anesthesiologist in order to tell whether or not the
intubation was a success. [resipsa loquitur applies here]. The Supreme Court also found that the anesthesiologist only saw Erlinda
for the first time on the day of the operation which indicates unfamiliarity with the patient and which is an act of negligence and
irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper authority as the captain of the ship in
determining if the anesthesiologist observed the proper protocols. Also, because he was late, he did not have time to confer with
the anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good father of the family in hiring and supervision
of its doctors (Art. 2180). The hospital was negligent since they are the one in control of the hiring and firing of their consultants.
While these consultants are not employees, hospitals still exert significant controls on the selection and termination of doctors who
work there which is one of the hallmarks of an employer-employee reationship. Thus, the hospital was allocated a share in the
liability.

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