13) CARILLO V.

PEOPLE

FACTS: Petitioner filed a petition for review on certiorari on the decision of the Court of Appeals
affirming his conviction by the RTC of the crime of simple negligence resulting in homicide, for the death
of his 13-year-old patient Catherine Acosta after an appendectomy procedure conducted on the patient.

ISSUE: Whether or not Dr. Carillo is guilty of the crime of simple negligence resulting in homicide.

HELD: YES.

Simple negligence, penalized under what is now Article 365 of the Revised Penal Code, is defined as "a
mere lack of prevision in a situation where either the threatened harm is not immediate or the danger not
openly visible." Put in a slightly different way, the gravamen of the offense of simple negligence is the
failure to exercise the diligence necessitated or called for the situation which was not immediately life-
destructive but which culminated, in the present case, in the death of a human being three (3) days later.
In the case at bar, we consider that the chain of circumstances above noted, namely: (1) the failure of
petitioner and Dr. Madrid to appreciate the serious post-surgery condition of their patient and to monitor
her condition and provide close patient care to her; (2) the summons of petitioner by Dr. Madrid and the
cardiologist after the patient's heart attack on the very evening that the surgery was completed; (3) the low
level of care and diligence exhibited by petitioner in failing to correct Dr. Madrid's prescription of Nubain
for post-operative pain; (4) the extraordinary failure or refusal of petitioner and Dr. Madrid to inform the
parents of Catherine Acosta of her true condition after surgery, in disregard of the requirements of the
Code of Medical Ethics; and (5) the failure of petitioner and Dr. Madrid to prove that they had in fact
exercised the necessary and appropriate degree of care and diligence to prevent the sudden decline in the
condition of Catherine Acosta and her death three (3) days later, leads the Court to the conclusion, with
moral certainty, that petitioner and Dr. Madrid were guilty of simple negligence resulting in homicide.

14) BATIQUIN V. CA

FACTS: Mrs. Villegas submitted to Dr. Batiquin for prenatal care as the latter's private patient sometime
before September 21, 1988. In the morning of September 21, 1988 Dr. Batiquin, along with other
physicians and nurses, performed a caesarean operation on Mrs. Villegas and successfully delivered the
latter’s baby. After leaving the hospital, Mrs. Villegas began to suffer abdominal pains and complained of
being feverish. She also gradually lost her appetite, so she consulted Dr. Batiquin at the latter's polyclinic
who prescribed for her certain medicines. However, the pains still kept recurring. She then consulted Dr.
Ma. Salud Kho. After examining her, Dr Kho suggested that Mrs. Villegas submit to another surgery.
When Dr. Kho opened the abdomen of Mrs. Villegas she found whitish-yellow discharge inside, an
ovarian cyst on each of the left and right ovaries which gave out pus, dirt and pus behind the uterus, and a
piece of rubber material on the right side of the uterus, embedded on the ovarian cyst. The piece of
rubber appeared to be a part of a rubber glove. This was the cause of all of the infection of the ovaries and
consequently of all the discomfort suffered by Mrs. Villegas. The piece of rubber allegedly found was not
presented in court, and Dr. Kho testified that she sent it to a pathologist in Cebu City for examination.
Aside from Dr. Kho's testimony, the evidence which mentioned the piece of rubber are a Medical
Certificate, a Progress Record, an Anesthesia Record, a Nurse's Record, and a Physician's Discharge
Summary. The trial court, however, regarded these documentary evidence as mere hearsay, "there being
no showing that the person or persons who prepared them are deceased or unable to testify on the facts
therein stated- There was also doubts as to the whereabouts of the piece of rubber, as 2 versions arose
from Dr. Kho’s testimony: 1) that it was sent to the Pathologist in Cebu as testified to in Court by Dr. Kho
and (2) that Dr. Kho threw it away as told by her to Defendant. The failure of the Plaintiffs to reconcile
these two different versions served only to weaken their claim against Defendant Batiquin. The trial court
ruled in favor of the defendants. The CA reversed the decision.

ISSUE: Whether or not Batiquin is liable.

HELD: YES.

The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of negligence which
recognizes that prima facie negligence may be established without direct proof and furnishes a substitute
for specific proof of negligence. The doctrine is not a rule of substantive law, but merely a mode of proof
or a mere procedural convenience. The rule, when applicable to the facts and circumstances of a particular
case, is not intended to and does not dispense with the requirement of proof of culpable negligence on the
party charged. It merely determines and regulates what shall be prima facie evidence thereof and
facilitates the burden of plaintiff of proving a breach of the duty of due care. The doctrine can be invoked
when and only when, under the circumstances involved, direct evidence is absent and not readily
available. In the instant case, all the requisites for recourse to the doctrine are present. First, the entire
proceedings of the cesarean section were under the exclusive control of Dr. Batiquin. In this light, the
private respondents were bereft of direct evidence as to the actual culprit or the exact cause of the foreign
object finding its way into private respondent Villegas' body, which, needless to say, does not occur unless
through the intervention of negligence. Second, since aside from the cesarean section, private respondent
Villegas underwent no other operation which could have caused the offending piece of rubber to appear in
her uterus, it stands to reason that such could only have been a by-product of the cesarean section
performed by Dr. Batiquin. The petitioners, in this regard, failed to overcome the presumption of
negligence arising from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable for
negligently leaving behind a piece of rubber in private respondent Villegas' abdomen and for all the
adverse effects thereof.

15) RUEDA V. OFFICE OF THE PROSECUTOR

FACTS: Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent surgical operation
at the UST hospital for the removal of a stone blocking his ureter. He was attended by Dr. Domingo
Antonio, Jr. who was the surgeon, while Dr. Erlinda Balatbat-Reyes was the anaesthesiologist. Six hours
after the surgery, however, Florencio died of complications of "unknown cause," according to officials of
the UST Hospital. Not satisfied with the findings of the hospital, petitioner requested the National Bureau
of Investigation (NBI) to conduct an autopsy on her husband's body. Consequently, the NBI ruled that
Florencio's death was due to lack of care by the attending physician in administering anaesthesia.
Pursuant to its findings, the NBI recommended that Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes
be charged for Homicide through Reckless Imprudence before the Office of the City Prosecutor. During
the preliminary investigation, what transpired was a confounding series of events which we shall try to
disentangle. The case was initially assigned to Prosecutor Antonio M. Israel, who had to inhibit himself
because he was related to the counsel of one of the doctors. As a result, the case was re-raffled to
Prosecutor Norberto G. Leono who was, however, disqualified on motion of the petitioner since he
disregarded prevailing laws and jurisprudence regarding preliminary investigation. The case was then
referred to Prosecutor Ramon O. Carisma, who issued a resolution recommending that only Dr. Reyes be
held criminally liable and that the complaint against Dr. Antonio be dismissed. The case took another
perplexing turn when Assistant City Prosecutor Josefina Santos Sioson, in the "interest of justice and
peace of mind of the parties," recommended that the case be re-raffled on the ground that Prosecutor
Carisma was partial to the petitioner. Thus, the case was transferred to Prosecutor Leoncia R. Dimagiba,
where a volte face occurred again with the endorsement that the complaint against Dr. Reyes be dismissed
and instead, a corresponding information be filed against Dr. Antonio. Petitioner filed a motion for
reconsideration, questioning the findings of Prosecutor Dimagiba. Pending the resolution of petitioner's
motion for reconsideration regarding Prosecutor Dimagiba's resolution, the investigative "pingpong"
continued when the case was again assigned to another prosecutor, Eudoxia T. Gualberto, who
recommended that Dr. Reyes be included in the criminal information of Homicide through Reckless
Imprudence. While the recommendation of Prosecutor Gualberto was pending, the case was transferred to
Senior State Prosecutor Gregorio A. Arizala, who resolved to exonerate Dr. Reyes from any wrongdoing,
a resolution which was approved by both City Prosecutor Porfirio G. Macaraeg and City Prosecutor Jesus
F. Guerrero. Aggrieved, petitioner filed graft charges specifically for violation of Section 3(e) of Republic
Act No. 3019 3against Prosecutors Guerrero, Macaraeg, and Arizala for manifest partiality in favor of Dr.
Reyes before the Office of the Ombudsman. However, on July 11, 1994, the Ombudsman issued the
assailed resolution dismissing the complaint for lack of evidence. In fine, petitioner assails the exercise of
the discretionary power of the Ombudsman to review the recommendations of the government
prosecutors and to approve and disapprove the same. Petitioner faults the Ombudsman for, allegedly in
grave abuse of discretion, refusing to find that there exists probable cause to hold public respondent City
Prosecutors liable for violation of Section 3(e) of R.A. No. 3019.

ISSUE: Whether or not expert testimony is necessary to prove the negligent act of the respondent.

HELD: YES.

In accepting a case, a doctor in effect represents that, having the needed training and skill possessed by
physicians and surgeons practicing in the same field, he will employ such training, care and skill in the
treatment of his patients. He therefore has a duty to use at least the same level of care that any other
reasonably competent doctor would use to treat a condition under the same circumstances. It is in this
aspect of medical malpractice that expert testimony is essential to establish not only the standard of care
of the profession but also that the physician's conduct in the treatment and care falls below such standard.
Further, inasmuch as the causes of the injuries involved in malpractice actions are determinable only in
the light of scientific knowledge, it has been recognized that expert testimony is usually necessary to
support the conclusion as to causation. Immediately apparent from a review of the records of this case is
the absence of any expert testimony on the matter of the standard of care employed by other physicians of
good standing in the conduct of similar operations. The prosecution's expert witnesses in the persons of
Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of Investigation (NBI) only
testified as to the possible cause of death but did not venture to illuminate the court on the matter of the
standard of care that petitioner should have exercised. The better and more logical remedy under the
circumstances would have been to appeal the resolution of the City Prosecutors dismissing the criminal
complaint to the Secretary of Justice under the Department of Justice's Order No. 223, otherwise known
as the "1993 Revised Rules on Appeals From Resolutions In Preliminary Investigations/
Reinvestigations," as amended by Department Order No. 359, Section 1 of which provides: Sec. 1. What
May Be Appealed. — Only resolutions of the Chief State Prosecutor/Regional State Prosecutor/Provincial
or City Prosecutor dismissing a criminal complaint may be the subject of an appeal to the Secretary of
Justice except as otherwise provided in Section 4 hereof. What action may the Secretary of Justice take on
the appeal? Section 9 of Order No. 223 states: "The Secretary of Justice may reverse, affirm or modify the
appealed resolution." On the other hand, "He may motu proprio or on motion of the appellee, dismiss
outright the appeal on specified grounds.” In exercising his discretion under the circumstances, the
Ombudsman acted within his power and authority in dismissing the complaint against the Prosecutors and
this Court will not interfere with the same. Petition is dismissed.

16) CRUZ V. CA

FACTS: Petitioner Dr. Ninevetch Cruz was accused of reckless impudence resulting in homicide arising
from am alleged medical malpractice for the death of a certain Lydia Umali due to negligence and
carelessness of the former which resulted to loss of blood or Disseminated Intravascular Coagulation
(DIC) as the antecedent cause, causing shock, the immediate cause of the death of the patient. Private
complainant and witness claimed that there was evident unpreparedness and for lack of skill on the post
of the Petitioner for having untidy and unequipped clinic and failure to perform necessary tests before the
operation.

ISSUE: Whether or not there was medical malpractice, which resulted imprudence resulting in homicide.

HELD: NO.

The Court ruled that based on the testimonies of the experts, since it has no recourse but to rely on them,
such allegations could not be attributed to the negligence of fault of the Petitioner. There was no
indication that such negligence of the Petitioner as the surgeon had resulted to possible causes of
hemorrhage or hemorrhagic shock which caused the death of the deceased and that DIC, while not being
precluded as cause of hemorrhage, cannot be prevented from happening to anyone.

17) RAMOS V. CA

FACTS: Erlinda Ramos, a 47-year-old robust woman, underwent a surgical procedure to remove stone
from her gall bladder (cholecystectomy). During the procedure, Dr. Hosaka, a surgeon, arrived 3 hours
late for the operation, while Dra. Gutierrez, the anesthesiologist “botched” the administration of the
anesthesia causing Erlinda to go into a coma and suffer brain damage. The botched operation was
witnessed by Herminda Cruz, sister in law of Erlinda and Dean of College of Nursing of Capitol Medical
Center. The family of Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist for
damages.
ISSUE: Whether or not the private respondents were negligent and thereby caused the comatose
condition of Ramos.

HELD: YES.

The private respondents were all negligent and are solidarily liable for the damages. The Doctrine of 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 plaintiff’s
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.
However, without undergoing surgery, she went out of the operating room already decerebrate and totally
incapacitated. Obviously, brain damage, which Erlinda sustained, is an injury which does not normally
occur in the process of a gall bladder operation

18) REYES V. SISTERS OF MERCY HOSPITAL

FACTS: Five days before his death, Jorge had been suffering from a recurring fever with chills. The
doctors confirmed through the Widal test that Jorge has typhoid fever. After he failed to get relief from
some home medication he was taking, which consisted of analgesic, antipyretic, and antibiotics, he
decided to see the doctor.

ISSUE: Whether or not the court erred that the doctrine of res ipsa loquitur is not applicable.

HELD: NO.

In this case, while it is true that the patient died just a few hours after professional medical assistance was
rendered, there is really nothing unusual or extraordinary about his death. Prior to his admission, the
patient already had recurring fevers and chills for five days unrelieved by the analgesic, antipyretic, and
antibiotics given him by his wife. This shows that he had been suffering from a serious illness and
professional medical help came too late for him.

19) RUEZ V. JURADO

FACTS: Ruez Sr. arrived by himself at the courts clinic complaining of dizziness and his blood pressure
and pulse rate were 200/100 mmhg and 112 beats a minute. Dr. Jurado instructed the nurse to administer
one tablet of capoten 25mg and informed Ruez, Sr. that he will be taken to the hospital. Ruez Sr. stood up
and walked out saying Doktora, hanap lang ako ng kasama and Ruez, Sr began experiencing nausea,
abnormal palpitation and uneasiness and had to be bought back to the hospital. Ruez, Sr had a C.T. Scan
which revealed a blood cloth and unfortunately, Ruez Sr. never recovered from his ailment and passed
away due to medical complications.

ISSUE: Whether or not Dr. Jurado is liable for simple neglect of duty.

HELD: NO.

It has been held that a patient cannot attribute to a physician damages resulting from his own failure to
follow his advice, even if a patient leaves the hospital contrary to instructions, the physician is not liable
for subsequent events. Dr. Jurado was obligated to care for Ruez Sr. when the latter asked for medical
treatment, which she did, but when he left on his own accord Dr. Jurado was not expected, much less
duty-bound, to seek out her patient and continue being his doctor.

20) NOGALES V. CAPITOL MEDICAL CENTER

FACTS: Corazon’s cause of death was hemorrhage postpartum as Dr. Estrada applied low forceps to
extract her baby causing her cervical tissue to be allegedly torn. Throughout Corazon’s pregnancy she was
under the exclusive prenatal care of Dr. Estrada. Dr. Estrada who is an independent contractor physician,
was allowed by Capitol Medical Center to use its facilities when Corazon was about to give birth.

ISSUE: Whether Capitol Medical Center is vicariously liable for the negligence of Dr. Estrada.

HELD: YES.

In general, a hospital is not liable for the negligence of an independent contractor-physician except when
physician is the ostensible agent of the hospital under the doctrine of apparent authority. For hospital to be
liable under the doctrine of apparent authority, the plaintiff must show that hospital or its agent acted in a
manner that will lead reasonable person to conclude that individual who was alleged negligent was an
employee or agent of the hospital; where the acts of agent create appearance of authority, the plaintiff
must also prove that the hospital had knowledge of and acquiesced in them; and the plaintiff acted in
reliance upon the conduct of the hospital or its agent, consistent with ordinary care and prudence. In the
instant case Capitol Medical Center impliedly held out Dr. Estrada as a member of its medical staff
through its acts, CMC clothed Dr. Estrada with apparent authority thereby leading the Spouses Nogales to
believe that Dr. Estrada was an employee or agent of CMC.

21) PSI V. AGANA

FACTS: Natividad Agana was rushed to Medical City due to complaint of difficulty in bowel movement
and bloody anal discharge from cancer of the sigmoid. Dr. Ampil and Dr. Fuentes performed two different
surgeries on Natividad. She complained of anal pains after the surgery which Dr. Ampil told her that it
was a natural consequence of the surgery.
ISSUES #1: Whether or not Dr. Ampil is liable for negligence and malpractice.

ISSUES #2: Whether or not Dr. Fuentes is liable for any act of negligence or malpractice.

ISSUES #2: Whether or not PSI is solidarily liable for Dr. Ampil’s negligence.

HELD #1: YES.

Dr. Ampil is liable for negligence and malpractice. Under the Captain of the Ship rule, the operating
surgeon is the person who is in complete charge of the surgery room and all personnel are under his
orders in connection to the operation. Clearly, Dr. Ampil was the lead surgeon when he called, examined,
and allowed Dr. Fuentes to leave after performing hysterectomy, which means Dr. Ampil is the Captain of
the Ship.

HELD #2: NO.

Dr. Fuentes is not liable for the act of negligence or malpractice. After he performed the surgery to
Natividad, he reported and showed his work to Dr. Ampil. The latter examined and found everything to be
in order and Dr. Fuentes was allowed to leave, thereafter. Dr. Ampil took over to complete the operation
and directed the incision to be closed regardless to the lack of count of gauzes after notification by the
nurse. 


HELD #3: YES.

Hospital owner, PSI, is solidarily liable for the acts committed by Dr. Ampil. Under the doctrine of
corporate negligence, the hospital likewise incurs liability for the acts of its health professionals. In PSI’s
failure to investigate from a matter reported in the nota bene of the count nurse, such failure established
PSI’s part in the dark conspiracy of silence and concealment about the gauzes.

22) CANTRE VS. GO

FACTS: Nora Go gave birth to a child and then two hours later, she suffered profuse bleeding inside her
womb due to some placenta parts which were not completely expelled after delivery. Dr. Milagros Cantre,
an Ob-Gyne specialist and Nora’s attending physician, performed medical procedures to stop the bleeding
and to restore Nora’s BP. While Dr. Cantre was massaging Nora’s uterus for it to contract and stop
bleeding, she ordered a droplight to warm Nora and her baby. Nora’s husband noticed a fresh gaping
wound in the inner portion of her left arm near the armpit. John David, Nora’s husband, brought the latter
to the NBI for a physical examination. The medico-legal said that the injury appeared to be a burn and
that a droplight, when placed near the skin for about 10 minutes could cause such burn. He dismissed the
likelihood that the wound was caused by a blod pressure cuff since the scar was not around the arm, but
just on one side of the arm.

ISSUE: Whether or not petitioner is liable for the injury suffered by Nora.
HELD: YES.

The Hippocratic Oath mandates physicians to give primordial consideration to the well-being of their
patients. If a doctor failed to live up to his precept, he is accountable for his acts. This is not withstanding,
courts face a unique restraint in adjudicating medical negligence cases because physicians are not
guardians of care and they never set out to intentionally cause injury to their patients. However, intent is
immaterial in negligence cases because where negligence exist and is proven, it automatically gives the
injured a right to reparation for the damage caused. In cases involving medical negligence, the doctrine of
res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the part
of the person who controls the instrument causing the injury, provided that the following requisites
concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or defendant;
3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.
Under the captain of the ship doctrine, the surgeon in charge of the operation is liable for the
negligence of his assistants during the time when those are under the surgeon’s control.

23) ILAO-ORETA V. SPOUSES RONQUILLO

FACTS: Respondent spouses had not been blessed with a child despite several years of marriage so they
consulted the petitioner-doctor, Dr. Ilao-Orata, an obstetrician-gynecologist-consultant at the St. Luke’s
Medical Center. Upon the petitioner-doctor’s advice, Eva Marie agreed to undergo laparoscopic procedure
which would determine the real cause of her infertility. The procedure was scheduled on April 5, 1999 at
2:00 PM however the petitioner-doctor did not arrive at the scheduled time for the procedure without any
prior notice or cancellation. According to the petitioner-doctor, she was at her honeymoon in Hawaii and
was originally scheduled to go back on time to perform the procedure however the forgot to consider the
time difference between the Philippines and Hawaii and therefore arrived at 10:00 PM of April 5, 1999,
well after the supposed scheduled procedure. As a result thereof, spouses Ronquillo filed a complaint
against Dr. Ilao-Oreta for breach of professional and service contract and for damages. The Regional Trial
Court of Batangas ruled in favor of spouses Ronquillo and ordered the doctor to pay P 9, 939 for actual
damages. On appeal, the Court of Appeals found the doctor guilty of gross negligence and modified the
trial court’s decision by increasing the actual damages and including moral damages, exemplary damages
and attorney’s fees. Because of this, Dr. Ilao-Oreta filed a Petition for Review.

ISSUE: Whether petitioner-doctor is guilty of gross negligence.

HELD: NO.

The Petition for Review is granted and the decision appealed from is modified by reducing the actual
damages to respondents-spouses Noel and Eva Marie Ronquillo to ₱2,288.70, to bear interest at a rate of
6% per annum from the time of the filing of the complaint on May 18, 1999 and, upon finality of this
judgment, at the rate of 12% per annum until satisfaction and the award of moral and exemplary damages
and attorney’s fees is deleted. In the present case, the Court held that Dr. Ilao-Oreta is not guilty of gross
negligence. This is evidenced by the records showing that before leaving for Hawaii, Dr. Ilao-Oreta left
an admitting order with her secretary for one of the spouses to pick up, apprised Eva Marie of the
necessary preparations for the procedure, and instructed the hospital staff to perform pre-operative
treatments. These acts of the doctor reflect an earnest intention to perform the procedure on the day and
time scheduled. The records also show that on realizing that she missed the scheduled procedure, Dr. Ilao-
Oreta, upon arrival in Manila, immediately sought to rectify the same. The Supreme Court held that since
the negligence of the doctor is not gross, spouses are not entitled to recover exemplary damages.
Additionally, the spouses also cannot recover exemplary damages in the absence of showing that the
doctor acted in wanton, fraudulent, reckless, oppressive or malevolent manner. Lastly, Dr. Ilao-Oreta’s
prayer for the reduction of actual damages is well-taken. Article 2201 of the Civil Code provides: “In
contracts and quasi-contracts, the damages for which the obligor who acted in good faith is liable shall be
those which are the natural and probable consequences of the breach of the obligation, and which the
parties have foreseen or could have reasonably foreseen at the time the obligation was constituted.”

24) FLORES V. PINEDA

FACTS: Teresita Pineda consulted her townmate Dr. Fredelicto Flores regarding her medical condition,
and was advised to continue medications as he suspected that Teresita might be suffering from diabetes.
When her conditions persisted, she went to UDMC where she was admitted and wherein a D & C
operation was performed upon her by Dra. Felicisima Flores (wife of Dr. Flores) despite the laboratory
results released prior to the operation which indicated of diabetes. Two days after the D & C operation
was performed upon her, it was found out that she has diabetes melitus type II; hence, insulin was
administered to her but it arrived late, as she died.

ISSUE: Whether or not Sps. Flores are liable for medical negligence.

HELD: YES.

From the expert testimony presented, it was proved that the decision to proceed with the D & C operation
(a form of physical stress) notwithstanding Teresita's hyperglycemia and without adequately preparing her
for the procedure, was contrary to the standards observed by the medical profession. Deviation from this
standard amounted to a breach of duty which resulted in the patient's death; hence, liability must attach to
the petitioner spouses.

25) LASAM V. RAMOLETE

FACTS: On July 28, 1994, respondent, three months pregnant Editha Ramolete was brought to the Lorma
Medical Center (LMC) in San Fernando, La Union due to vaginal bleeding. Upon advise of the petitioner,
Dr. Fe Cayao-Lasam, she was admitted to the LMC on the same day. Necessary tests were conducted and
due to persistent and profuse vaginal bleeding, petitioner advised Editha to undergo a Dilatation and
Curettage Procedure (D&C) or raspa. 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, which resulted to her having no more chance to bear a
child. Editha and her husband Claro Ramolete filed a Complaint for Gross Negligence and Malpractice
against petitioner before the Professional Regulations Commission (PRC).

ISSUE #1: Whether or not Lasam is liable for medical malpractice.

ISSUE #2: Whether the CA is the proper venue to appeal the decisions of the PRC.

HELD #1: NO.

There are four elements involved in medical negligence cases: duty, breach, injury, and proximate cause.
It is undisputed that Editha did not return for follow-up evaluation; in defiance of the petitioners advise.
This is as foud out as the proximate cause of the injury she sustained.

HELD #2: YES.

Batas Pambansa Blg. 129, Section 29, conferred on the Court of Appeals “exclusive appellate
jurisdiction over all final judgments, decisions, resolutions, orders or awards of Regional Trial
Courts and quasi-judicial agencies, instrumentalities, boards or commissions except those
falling under the exclusive appellate jurisdiction of the Supreme Court.”

26) LUCAS V. TUAÑO

FACTS: Peter Lucas first consulted Dr. Tuaño on soreness and redness of his right eye. Dr. Tuaño, after
consucting examinations, diagnosed Lucas with conjunctivitis then prescribed Spersacet-C6 eye drops.
Lucas’condition seemed to have worsened. Upon examination, Dr. Tuaño told Peter that the "sore eyes" in
the latter’s right eye had already cleared up and he could discontinue the Spersacet-C. However, the same
eye developed Epidemic Kerato Conjunctivitis (EKC), a viral infection. To address the new problem with
Peter’s right eye, Dr. Tuaño prescribed to the former a steroid-based eye drop called Maxitrol. Lucas’
condition did not improve despite his compliance with all prescriptions and instructions by Dr. Tuaño.
There were incidents where Lucas suffered from swelling of his right eye, headaches, nausea, and
blindness of the same eye. Fatima, Lucas’ wife, read literature on the prolonged use of Maxitrol and found
therein that one of its adverse effects may result in glaucoma. Lucas consulted Dr. Aquino, who,
according to Petitioners, essentially told Peter that the latter’s condition would require lifetime medication
and follow-ups. Petitioners filed a civil complaint for damages against Dr. Tuaño. Petitioners’ position, in
sum, is that Peter’s glaucoma is the direct result of Dr. Tuaño’s negligence in his improper administration
of the drug Maxitrol; "thus, [the latter] should be liable for all the damages suffered and to be suffered by
petitioners."

ISSUE: Whether or not Dr. Tuaño is liable for any medical negligence or malpractice.

HELD: NO.

The claim for damages is dismissed for insufficiency of evidence. The present controversy is a classic
illustration of a medical negligence case against a physician based on the latter’s professional negligence.
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. There is breach of duty of care, skill and diligence, or the improper performance of
such duty, by the attending physician when the patient is injured in body or in health [and this] constitutes
the actionable malpractice. Proof of such breach must likewise rest upon the testimony of an expert
witness that the treatment accorded to the patient failed to meet the standard level of care, skill and
diligence which physicians in the same general neighborhood and in the same general line of practice
ordinarily possess and exercise in like cases. The critical and clinching factor in a medical negligence
case is proof of the causal connection between the negligence which the evidence established and the
plaintiff’s injuries. The plaintiff must plead and prove not only that he has been injured and defendant has
been at fault, but also that the defendant’s fault caused the injury. A verdict in a malpractice action cannot
be based on speculation or conjecture. Causation must be proven within a reasonable medical probability
based upon competent expert testimony. The causation between the physician’s negligence and the
patient’s injury may only be established by the presentation of proof that Peter’s glaucoma would not
have occurred but for Dr. Tuaño’s supposed negligent conduct. Petitioners failed in this regard. In civil
cases, the party having the burden of proof must establish his case by a preponderance of evidence.
Herein, the burden of proof was clearly upon petitioners, as plaintiffs in the lower court, to establish their
case by a preponderance of evidence showing a reasonable connection between Dr. Tuaño’s alleged
breach of duty and the damage sustained by Peter’s right eye. This, they did not do.

27) LI V. SOLIMAN

FACTS: Angelica Soliman is the daughter of Reynaldo and Lina Soliman who is sick with a disease
called Osteosarcoma. Angelica underwent leg amputation to remove the mass located in her lower
extremity then she was referred to Dr. Rubi Li for chemotherapy to eliminate any remaining cancer cells.
Before Dr. Li administers the chemotherapy, she informed the spouses Soliman that it has side effects
such as vomiting, hair loss, and weakness. After the administration of chemotherapy, Angelica became
hysterical, vomited blood, her body turned black and later on died. Spouses Soliman now filled a
complaint for damages against Dr. Rubi Li alleging that Dr. Li is guilty of medical negligence since Dr. Li
did not inform them of the possible side effects of the chemotherapy.
ISSUE: Whether or not Dr. Li can he held liable for the failure to fully disclose the side effects to the
parents of the child.

HELD: NO.

Dr. Li cannot be held liable. The doctrine of informed consent provides that a physician has a duty to
disclose what a reasonable prudent physician in the medical community in the exercise of reasonable care
would disclose to his patient. In this case, records show that there was adequate disclosure of material
risks inherent in the chemotherapy procedure performed with the consent of Angelica’s parents. The
severities of the side effects will not be the same for all patients thus even with laboratory tests,
physicians cannot precisely determine the side effects that the patient will show. Informed consent law
generally require only a reasonable explanation of potential harms, so specific disclosure’s such as
statistical data, may not be legally necessary.

28) ATIENZA V. BOARD OF MEDICINE

FACTS: Editha Sioson filed a complaint before the Board of Medicine (BOM) for Gross Negligence and/
or Incompetence against the doctors of Rizal Medical Center including Atienza for allegedly removing
Sioson’s fully functional right kidney, instead of the left non-functional and non-visualizing kidney. The
BOM heard the complaint to which Sioson filed fher formal offer of documentary evidence to prove that
her kidneys were both in their proper anatomical locations at the time she was operated. Atienza filed his
comment/objections to Sioson’s formal offer of evidence alleging that said evidence are inadmissible
because the same are mere photocopies. The BOM admitted the formal offer of documentary evidence by
Sioson.

ISSUE: Whether or not the doctors who conducted the kidney operation are liable for gross negligence
despite the evidence presented were mere photocopies.

HELD: YES.

To begin with, it is a well settled rule that the rules of evidence are not strictly applied in proceedings
before administrative bodies such as the Board of Medicine. It is the safest policy to be liberal, not
rejecting them on doubtful or technical grounds, but admitting them unless plainly irrelevant, immaterial
or incompetent, for the reason that their rejection places them beyond the consideration of the court, if
they are thereafter found relevant or competent; on the other hand, their admission, if they turn out later to
be irrelevant or incompetent, can easily be remedied by completely discarding them or ignoring them.
29) DR. JARCIA AND BASTAN V. PEOPLE

FACTS: Dr. Jarcia and Dr. Bastan were accused of neglect of professional duty that caused serious
physical injuries to the victim. The doctors examined the victim who was hit by a taxi cab and advised
him that there was no fracture and that there was no need to examine the upper leg. Eleven (11) days later,
a right mid-tibial fracture and a linear hairline fracture in the shaft of the bone was revealed. The court
affirmed the lower court's decision of finding the doctors guilty of simple imprudence resulting in serious
physical injuries. The early treatment of the leg of the victim would have lessen his suffering if not
entirely relieve him from the fracture. As junior residents who only practice general surgery and without
specialization with the case consulted before them, they should have referred the matter to a specialist.
This omission constitutes simple imprudence on their part.

ISSUE: Whether or not the doctors are guilty of simple imprudence resulting in serious physical injuries.

HELD: YES.

The court affirmed the lower court's decision of finding the doctors guilty of simple imprudence resulting
in serious physical injuries. The early treatment of the leg of the victim would have lessen his suffering if
not entirely relieve him from the fracture. As junior residents who only practice general surgery and
without specialization with the case consulted before them, they should have referred the matter to a
specialist. This omission constitutes simple imprudence on their part.

30) CERENO V. CA

FACTS: Raymond Olavere sustained stab wounds and was rushed to the Bicol Regional Medical Center
for operation performed by Dr. Cereno and Dr. Zafe. Raymond eventually died and his family sued the
surgeons for damages due to gross negligence in not immediately conducting the surgery and blood
transfusion.

ISSUE: Whether or not Drs. Cereno and Zafe are guilty of gross negligence.

HELD: YES.

The the surgeons were not negligent in the performance of their duties because it was evident that
petitioners exerted earnest efforts to save the life of Raymond. In medical negligence cases, the
complainant has the burden of establishing breach of duty on the part of the doctors or surgeons, which
Raymond’s family failed to do by not presenting any expert witness. It must be proven that such breach of
duty has a causal connection to the resulting death of the patient. A verdict in malpractice action cannot be
based on speculation or conjecture.
31) DR. LUMANTAS V. CALAPIZ

FACTS: Hilario Calapiz, Jr. and Herlita Calapiz’ son, Hanz Calapiz, underwent an emergency
appendectomy and a circumcision with Dr. Encarnacion C. Lumantas. Several days later Hanz’ penis
experienced painful complications which necessitated a visit with a urologist, Dr. Henry Go during which
he was diagnosed with a broken urethra and had to be operated 3 times. Dr. Encarnacion C. Lumantas was
charged with reckless imprudence resulting to serious physical injuries. The RTC acquitted Lumantas
which both the CA and the SC upheld.

ISSUE: Whether the CA erred in affirming Luntantas’ civil liability despite his acquittal of the criminal
charge.

HELD: NO.

There are two kinds of acquittal. One based on the finding that the accused did not author the charge
imputed against him; and the second, this instance, the criminal liability is discharged but the civil
liability may be proved based on mere preponderance of evidence.

32) CABUGAO V. PEOPLE

FACTS: On June 14, 2000, at around 4 o'clock in the afternoon, ten (10)-year old Rodolfo F. Palma, Jr.
(JR) complained of abdominal pain to his mother, Rosario Palma. At 5 o’clock that same afternoon,
Palma's mother and father, Atty. Rodolfo Palma Sr., brought JR to the clinic of accused Dr. Cabugao. Dr.
Cabugao, a general practitioner, specializing in family medicine gave medicines for the pain and told
Palma's parents to call him up if his stomach pains continue. Due to persistent abdominal pains, at 4:30 in
the early morning of June 15, 2000, they returned to Dr. Cabugao, who advised them to bring JR to the
Nazareth General Hospital in Dagupan City, for confinement. JR was admitted at the said hospital at 5:30
in the morning. Blood samples were taken from JR for laboratory testing. Dr. Cabugao did a rectal
examination noting the following: "rectal: good sphincter, negative tenderness, negative mass." The initial
impression was Acute Appendicitis, and hence, he referred the case to his co-accused, Dr. Ynzon, a
surgeon. In the later part of the morning of June 15, 2000, Dr. Ynzon went to the hospital and read the
CBC and ultrasound results. The administration of massive antibiotics and pain reliever to JR were
ordered. Thereafter, JR was placed on observation for twenty-four (24) hours. In the morning of June 16,
2000, JR complained again of abdominal pain and his parents noticed a swelling in his scrotum. In the
afternoon of the same day, JR vomited out greenish stuff three (3) times and had watery bowels also three
(3) times. The nurses on-duty relayed JR's condition to Dr. Ynzon who merely gave orders via telephone.
Accused continued medications to alleviate JR's abdominal spasms and diarrhea. By midnight, JR again
vomited twice, had loose bowel movements and was unable to sleep. The following morning, June
17,2000, JR's condition worsened, he had a running fever of 38°C. JR's fever remained uncontrolled and
he became unconscious, he was given Aeknil and Valium. JR's condition continued to deteriorate that by 2
o'clock in the afternoon, JR's temperature soared to 42°C, had convulsions and finally died. No post-
mortem examination was conducted on JR. On February 1, 2001, an Information was filed against
accused for reckless imprudence resulting to homicide. Both the trial court and the Court of Appeals
found Drs. Ynzon and Cabugao guilty of reckless imprudence resulting to homicide for the death of JR.
Hence, the appeal to the Supreme Court under Rule 45 of the Rules of Court.

ISSUE: Whether or not Drs. Ynzon and Cabugao are guilty of reckless imprudence resulting to homicide.

HELD: YES (DR. YNZON) AND NO (DR. CABUGAO)

As to Dr. Ynzon, he is guilty. Reckless imprudence consists of voluntarily doing or failing to do, without
malice, an act from which material damage results by reason of an inexcusable lack of precaution on the
part of the person performing or failing to perform such act. 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. As correctly observed by the appellate court, Dr. Ynzon revealed want of reasonable skill and
care in attending to the needs of JR by neglecting to monitor effectively the developments and changes on
JR's condition during the observation period, and to act upon the situation after the 24-hour period when
his abdominal pain persisted, and his condition worsened. Lamentable, Dr. Ynzon appeared to have
visited JR briefly only during regular rounds in the mornings. He was not there during the crucial times
on June 16, 2000 when JR's condition started to deteriorate until JR's death. As the attending surgeon, he
should be primarily responsible in monitoring the condition of JR, as he is in the best position considering
his skills and experience to know if the patient's condition had deteriorated. While the resident-doctors-on
duty could likewise monitor the patient’s condition, he is the one directly responsible for the patient as the
attending surgeon. Indeed, it is reckless and gross negligence of duty to relegate his personal
responsibility to observe the condition of the patient. Again, acute appendicitis was the working
diagnosis, and with the emergence of graver symptoms after the 24-hour observation, Dr. Ynzon ruled out
surgery for no apparent reason. We, likewise, note that the records are devoid of showing of any
reasonable cause which would lead Dr. Ynzon to overrule appendectomy despite the initial diagnosis of
appendicitis. Neither was there any showing that he was entertaining another diagnosis, nor he took
appropriate steps towards another diagnosis. To be sure, 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. 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. Sadly, Dr. Ynzon did not display that degree of care and precaution demanded by the
circumstances.
As to Dr. Cabugao, he is not guilty. Immediately apparent from a review of the records of this case is the
fact that Dr. Cabugao is not a surgeon, but a general practitioner specializing in family medicine; thus,
even if he wanted to, he cannot do an operation, much less an appendectomy on JR. It is precisely for this
reason why he referred JR to Dr. Ynzon after he suspected appendicitis. Neither do we find evidence that
Dr. Cabugao has been negligent or lacked the necessary precaution in his performance of his duty as a
family doctor. On the contrary, a perusal ofthe medical records would show that during the 24-hour
monitoring on JR, it was Dr. Cabugao who frequently made orders on the administration of antibiotics
and pain relievers. There were also repetitive instructions from Dr. Cabugao to refer JR to Dr. Ynzon as it
appeared that he is suspecting appendicitis. The referral of JR to Dr. Ynzon, a surgeon, is actually an
exercise of precaution as he knew that appendicitis is not within his scope of expertise. This clearly
showed that he employed the best of his knowledge and skill in attending to JR's condition, even after the
referral of JR to Dr. Ynzon. To be sure, the calculated assessment of Dr. Cabugao to refer JR to a surgeon
who has sufficient training and experience to handle JR’s case belies the finding that he displayed
inexcusable lack of precaution in handling his patient. Moreover, while both appeared to be the attending
physicians of JR during his hospital confinement, it cannot be said that the finding of guilt on Dr. Ynzon
necessitates the same finding on the co-accused Dr. Cabugao. Conspiracy is inconsistent with the idea of a
felony committed by means of culpa.

33) CASUMPANG V. CORTEJO

FACTS: Cortejo brought her 11-year old son, Edmer Cortejo (Edmer), to the Emergency Room of the
San Juan de Dios Hospital (SJDH) because of fever.Dr. Livelo diagnosed Edmer with
"bronchopneumonia."7 Edmer's blood was also taken for testing, typing, and for purposes of
administering antibiotics. Afterwards, Dr. Livelo gave Edmer an antibiotic medication to lessen his fever
and to loosen his phlegm. Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune Care card
and was referred to an accredited Fortune Care coordinator, who was then out of town. She was thereafter
assigned to Dr. Noel Casumpang (Dr. Casumpang), a pediatrician also accredited with Fortune CareDr.
Casumpang for the first time examined Edmer in his room. Using only a stethoscope, he confirmed the
initial diagnosis of "Bronchopneumonia." Mrs. Cortejo recalled entertaining doubts on the doctor's
diagnosis. She immediately advised Dr. Casumpang that Edmer had a high fever, and had no colds or
cough10 but Dr. Casumpang merely told her that her son's "bloodpressure is just being active," Dr.
Casumpang next visited and examined Edmer at 9:00 in the morning the following day.13 Still suspicious
about his son's illness, Mrs. Cortejo again called Dr. Casumpang's attention and stated that Edmer had a
fever, throat irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted Dr. Casumpang about
the traces of blood in Edmer's sputum. Despite these pieces of information, however, Dr. Casumpang
simply nodded, inquired if Edmer has an asthma, and reassured Mrs. Cortejo that Edmer's illness is
bronchopneumonia. Edmer died His Death Certificate indicated the cause of death as "Hypovolemic
Shock/hemorrhagic shock;" "Dengue Hemorrhagic Fever Stage IV."

ISSUE: Whether or not the petitioning doctors had committed "inexcusable lack of precaution" in
diagnosing and in treating the patient.
HELD: YES.

In failing to perform an extensive medical examination to determine the extent of patients's injuries,
doctor remiss of their duties as members of the medical profession. In the present case, evidence on
record established that in confirming the diagnosis of bronchopneumonia, Dr. Casumpang selectively
appreciated some and not all of the symptoms presented, and failed to promptly conduct the appropriate
tests to confirm his findings. In sum, Dr. Casumpang failed to timely detect dengue fever, which failure,
especially when reasonable prudence would have shown that indications of dengue were evident and/or
foreseeable, constitutes negligence.

34) CRUZ V. AGAS

FACTS: Doctor Jaime Cruz engaged the services of St. Luke for a medical check up, he underwent
various medical check up. He gave the colonoscopy result to the anaesthesiologist for the information and
then he was sedated and the endoscopic examination was carried out, he regained consciousness and felt
something went wrong during the procedure. He felt dizzy, difficulty in breathing and pain to his
abdomen. Thereafter he consulted Dr. Del Rosario and advised him to undergo an emergency surgical
operation, which he did, he found out that there is a portion of the left side of his colon was cut which
caused internal bleeding and he was under tremendous pain in the incision area, that Dr. Agas, the one
who performed the colonoscopy procedure claimed by Cruz. Doctor Agas, in his defense, asserted that the
operation conducted to Cruz was successful and that he followed all precautionary measures and exercise
competence and diligence. Cruz filed an action against Agas but the same was dismissed by the DOJ and
the CA because the alleged negligence was not adequately established by Cruz.

ISSUE: Whether or not the CA was correct in affirming the decision of the DOJ that there is no probable
cause exists for the filing of an information against the respondent Agas.

HELD: YES.

The CA was correct in affirming the decision of the Department of Justice. Here, under the doctrine of
separation of powers, courts have no right to directly decide on matters over which full discretionary
authority has been delegated to the Executive Branch of the Government, or to substitute their own
judgement for that of the Executive Branch, represented by the DOJ in this case.

35) DELA TORRE V. DR. IMBUIDO

FACTS: Carmen dela torre, wife of Pedrito, was admitted at the Divine Spirit General Hospital where
she gave birth through caesarian section operation. After such operation, she suffered abdominal pain and
her stomach grew bigger. A second operation was performed but her condition worsened which resulted to
her death. Pedrito claimed that respondents failed to exercise the degree of diligence required of them and
were negligentor practicing surgery on Carmen in the most unskilled, ignorant and cruel manner.

ISSUE: Whether or not respondents are liable for medical negligence.

HELD: NO.

In medical negligence cases, a patient must prove that a health care provider, in most cases a physician
either failed to do something a reasonably prudent health care provide would have done, or thAt he or she
did something a prudent provider would have not done; and that failure or action caused injury to the
patient and that essential elements, such as: duty, breach, injury and proximate causation, must be proven
to establish the physician-patient relationship. in the case, petitioner failed to established the breach in the
duty of the respondents.

36) ROSIT V. DDH

FACTS: Rosit was involved in a car accident. His x-ray in DDH showed that he had fractures in his jaw.
When he was later on operated by Dr. Gestuvo, a specialist, the latter knew that Rosit neeeded the
smallest screw but he only cut the screw on hand without informing Rosit because he supposed that Rosit
cannot afford the smallest screw available in Manila. Following the operation, Rosit could not open and
close his mouth properly. It was shown on his x-ray that the screws touched his molars. He was referred
to a dentist, Dr. Pangan, which operated him later on and replaced the screw with the smallest screw.
Rosit can now talk and eat properly. Thus, Rosit is filing an action against Dr. Gestuvo for the
reimbursement of his expenses for the replacement of the plate and the screw. RTC ruled in favor of Rosit
and ordered Dr. Gestuvo to pay the former. However, the complaint against DDH was dismissed due to
lack of merit. In so ruling, the trial court applied the res ipsa loquitur principle holding that “the need for
expert medical testimony may be dispensed with because the injury itself provides the proof of
negligence.” CA reversed the lower court's ruling. Unlike the RTC, the CA ruled that the res ipsa loquitur
principle is not applicable and that the testimony of an expert witness is necessary for a finding of
negligence. The appellate court also gave credence to Dr. Pangan’s letter stating the opinion that Dr.
Gestuvo did not commit gross negligence in his emergency management of Rosit’s fractured mandible.

ISSUE: Whether the appellate court correctly absolved Dr. Gestuvo from liability.

HELD: NO.

A medical negligence case is a type of claim to redress a wrong committed by a medical professional, that
has caused bodily harm to or the death of a patient. There are four elements involved in a medical
negligence case, namely: duty, breach, injury, and proximate causation. When the doctrine of res ipsa
loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed with because the
injury itself provides the proof of negligence. The reason is that the general rule on the necessity of expert
testimony applies only to such matters clearly within the domain of medical science, and not to matters
that are within the common knowledge of mankind which may be testified to by anyone familiar with the
facts.

37) SOLIDUM V. PEOPLE

FACTS: Gerald Albert Gercayo (Gerald) was born on June 2, 19922 with an imperforate anus. Gerald,
then three years old, was admitted at the Ospital ng Maynila for a pull-through operation. The
anesthesiologists petitioner (Dr. Solidum).6 During the operation, Gerald experienced bradycardia,7 and
went into a coma and regained consciousness only after a month.10 He could no longer see, hear or move.
The mother filed a complaint for reckless imprudence resulting in serious physical injuries against the
attending physicians. RTC rendered its judgment finding Dr. Solidum. CA affirmed the conviction of Dr.
Solidum.

ISSUE: Whether or not the doctrine of res ipsa loquitur was applicable.

HELD: NO.

Res ipsa loquitur is literally translated as "the thing or the transaction speaks for itself." The doctrine res
ipsa loquitur means that "where the thing which causes injury is shown to be under the management of
the defendant, and the accident is such as in the ordinary course of things does not happen if those who
have the management use proper care, it affords reasonable evidence, in the absence of an explanation by
the defendant, that the accident arose from want of care.” Medical malpractice cases do not escape the
application of this doctrine. Thus, res ipsa loquitur has been applied when the circumstances attendant
upon the harm are themselves of such a character as to justify an inference of negligence as the cause of
that harm. The application of res ipsa loquitur in medical negligence cases presents a question of law
since it is a judicial function to determine whether a certain set of circumstances does, as a matter of law,
permit a given inference. Although generally, expert medical testimony is relied upon in malpractice suits
to prove that a physician has done a negligent act or that he has deviated from the standard medical
procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical
testimony is dispensed with because the injury itself provides the proof of negligence. The reason is that
the general rule on the necessity of expert testimony applies only to such matters clearly within the
domain of medical science, and not to matters that are within the common knowledge of mankind which
may be testified to by anyone familiar with the facts. In order to allow resort to the doctrine, therefore,
the following essential requisites must first be satisfied, to wit: (1) the accident was of a kind that does not
ordinarily occur unless someone is negligent; (2) the instrumentality or agency that caused the injury was
under the exclusive control of the person charged; and (3) the injury suffered must not have been due to
any voluntary action or contribution of the person injured. The Court considers the application here of the
doctrine of res ipsa loquitur inappropriate. Although it should be conceded without difficulty that the
second and third elements were present, considering that the anesthetic agent and the instruments were
exclusively within the control of Dr. Solidum, and that the patient, being then unconscious during the
operation, could not have been guilty of contributory negligence, the first element was undeniably
wanting. Luz delivered Gerald to the care, custody and control of his physicians for a pull-through
operation. Except for the imperforate anus, Gerald was then of sound body and mind at the time of his
submission to the physicians. Yet, he experienced bradycardia during the operation, causing loss of his
senses and rendering him immobile. Hypoxia, or the insufficiency of oxygen supply to the brain that
caused the slowing of the heart rate, scientifically termed as bradycardia, would not ordinarily occur in
the process of a pull-through operation, or during the administration of anesthesia to the patient, but such
fact alone did not prove that the negligence of any of his attending physicians, including the
anesthesiologists, had caused the injury. In fact, the anesthesiologists attending to him had sensed in the
course of the operation that the lack of oxygen could have been triggered by the vago-vagal reflex,
prompting them to administer atropine to the patient.

38) CHAN V. CHAN

FACTS: Josielene Lara Chan (Josielene) filed before the Regional Trial Court (RTC) of Makati City,
Branch 144 a petition for the declaration of nullity of her marriage to respondent Johnny Chan (Johnny),
the dissolution of their conjugal partnership of gains, and the award of custody of their children to her.
Josielene claimed that Johnny failed to care for and support his family and that a psychiatrist diagnosed
him as mentally deficient due to incessant drinking and excessive use of prohibited drugs. Indeed, she had
convinced him to undergo hospital confinement for detoxification and rehabilitation. Johnny resisted the
action, claiming that it was Josielene who failed in her wifely duties. To save their marriage, he agreed to
marriage counseling but when he and Josielene got to the hospital, two men forcibly held him by both
arms while another gave him an injection. The marriage relations got worse when the police temporarily
detained Josielene for an unrelated crime and released her only after the case against her ended. By then,
their marriage relationship could no longer be repaired.

ISSUE: Whether or not the CA erred in ruling that the trial court correctly denied the issuance of a
subpoena duces tecum covering Johnny’s hospital records on the ground that these are covered by the
privileged character of the physician-patient communication.

HELD: YES.

Josielene requested the issuance of a subpoena duces tecum covering the hospital records of Johnny’s
confinement, which records she wanted to present in court as evidence in support of her action to have
their marriage declared a nullity. Respondent Johnny resisted her request for subpoena, however, invoking
the privileged character of those records. He cites Section 24(c), Rule 130 of the Rules of Evidence which
reads:SEC. 24. Disqualification by reason of privileged communication.— The following persons cannot
testify as to matters learned in confidence in the following cases!c) A person authorized to practice
medicine, surgery or obstetrics cannot in a civil case, without the consent of the patient, be examined as to
any advice or treatment given by him or any information which he may have acquired in attending such
patient in a professional capacity, which information was necessary to enable him to act in that capacity,
and which would blacken the reputation of the patient.The physician-patient privileged communication
rule essentially means that a physician who gets information while professionally attending a patient
cannot in a civil case be examined without the patient’s consent as to any facts which would blacken the
latter’s reputation. This rule is intended to encourage the patient to open up to the physician, relate to him
the history of his ailment, and give him access to his body, enabling the physician to make a correct
diagnosis of that ailment and provide the appropriate cure. Any fear that a physician could be compelled
in the future to come to court and narrate all that had transpired between him and the patient might
prompt the latter to clam up, thus putting his own health at great risk.

39) KROHN V. CA

FACTS: A confidential psychiatric evaluation report is being presented in evidence before the trial court
in a petition for annulment of marriage grounded on psychological incapacity. The witness testifying on
the report is the husband who initiated the annulment proceedings, not the physician who prepared the
report. The subject of the evaluation report, invoking the rule on privileged communication between
physician and patient, seeks to enjoin her husband from disclosing the contents of the report. After failing
to convince the trial court and the appellate court, she is now before us on a petition for review
on certiorari.

ISSUE: Whether or not physician-patient privileged communication be successfully invoked in this case.

HELD: NO.

The physician-patient privileged communication cannot be successfully invoked in this case. Lim v. Court
of Appeals (214 SCRA 273 [1992]) clearly lays down the requisites in order that the physician-patient
privileged communication may be successfully invoked: (a) the privilege is claimed in a civil cases; (b)
the person against whom the privilege is claimed is one duly authorized to practice medicine, surgery or
obstetrics; (c) such person acquired the information while he was attending to the patient in his
professional capacity; (d) the information was necessary to enable him to act in that capacity; and, (e) the
information was confidential and, if disclosed, would blacken the reputation (formerly character) of the
patient.” In the instant case, the person against whom the privilege is claimed is not one duly authorized
to practice medicine, surgery obstetrics. He is simply the patient’s husband who wishes to testify on a
document executed by medical practitioners. Plainly and clearly, this does not fall within the claimed
prohibition. Neither can his testimony be considered a circumvention of the prohibition because his
testimony cannot have the force and effect of the testimony of the physician who examined the patient
and executed the report.
40) LIM V. CA

FACTS: Juan filed a petition for annulment of his marriage with Nelly on the ground that the latter has
been allegedly suffering from a mental illness called schizophrenia "before, during and after the marriage
and until the present." During trial, Juan's counsel announced that he would present as his next witness
Dr. Lydia Acampado, a Doctor of Medicine who specializes in Psychiatry. Said counsel forthwith orally
applied for the issuance of a subpoena ad testificandum. Nelly's counsel opposed the motion on the
ground that the testimony sought to be elicited from the witness is privileged since the latter had
examined the Nelly in a professional capacity and had diagnosed her to be suffering from schizophrenia.
Juan's counsel contended, however, that Dr. Acampado would be presented as an expert witness and
would not testify on any information acquired while attending to Nelly in a professional capacity. The
trial court denied the motion and allowed the witness to testify. Dr. Acampado thus took the witness stand,
was qualified as an expert witness and was asked hypothetical questions related to her field of expertise.
She neither revealed the illness she examined and treated Nelly for nor disclosed the results of her
examination and the medicines she had prescribed.

ISSUE #1: Whether or not the information given by the physician in her testimony in open court was a
privileged communication.

ISSUE #2: Whether or not there was a waiver of the privilege.

HELD #1: NO.

The physician may be considered to be acting in his professional capacity when he attends to the patient
for curative, preventive, or palliative treatment. Thus, only disclosures which would have been made to
the physician to enable him "safely and efficaciously to treat his patient" are covered by the privilege. It is
to be emphasized that "it is the tenor only of the communication that is privileged. The mere fact of
making a communication, as well as the date of a consultation and the number of consultations, are
therefore not privileged from disclosure, so long as the subject communicated is not stated." One who
claims this privilege must prove the presence of these aforementioned requisites. Dr. Acampado was
presented and qualified as an expert witness. She did not disclose anything obtained in the course of her
examination, interview and treatment of the petitioner; moreover, the facts and conditions alleged in the
hypothetical problem did not refer to and had no bearing on whatever information or findings the doctor
obtained while attending to the patient. There is, as well, no showing that Dr. Acampado’s answers to the
questions propounded to her relating to the hypothetical problem were influenced by the information
obtained from the petitioner. Otherwise stated, her expert opinion excluded whatever information or
knowledge she had about the petitioner which was acquired by reason of the physician-patient
relationship existing between them. As an expert witness, her testimony before the trial court cannot then
be excluded.

HELD #2: YES.

While it may be true that counsel for the petitioner opposed the oral request for the issuance of a
subpoena ad testificandum to Dr. Acampado and filed a formal motion for the quashal of the said
subpoena a day before the witness was to testify, the petitioner makes no claim in any of her pleadings
that her counsel had objected to any question asked of the witness on the ground that it elicited an answer
that would violate the privilege, despite the trial court’s advise that said counsel may interpose his
objection to the testimony "once it becomes apparent that the testimony, sought to be elicited is covered
by the privileged communication rule." The particular portions of the stenographic notes of the testimony
of Dr. Acampado quoted in the petitioner’s Petition and Memorandum, and in the private respondent’s
Memorandum, do not at all show that any objections were interposed. Even granting ex gratia that the
testimony of Dr. Acampado could be covered by the privilege, the failure to seasonably object thereto
amounted to a waiver thereof.