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Legmed Draft
Legmed Draft
Issue:
Whether or not respondent is liable for medical GR No. 191225 October 13, 2014
negligence due to the death of Allen. Zarsona Medical Clinic (ZMC) v Philippine Health
Insurance Corporation
Held:
No. The trial court erred in applying the doctrine of res FACTS:
ipsa liquitor to pin liability on respondent for Allen’s Philhealth filed a claim against ZMC for violation of
death. Res ipsa liquitor is a rebuttable presumption or Section 149 of the Revised Implementing Rules and
influence that the defendant was negligent. The Regulations of Republic Act No. 7875 the National Health
presumption only arises upon proof that the Insurance Act of 1995 particularly Section 149 thereof
instrumentality causing injury was in the defendant’s which penalizes any health care provider that increases
exclusive control, and that the accident was one which the period of actual confinement of any patient with
ordinarily does not happen in the absence of negligence. revocation of accreditation. The case is based on the fact
It is a rule of evidence whereby negligence of the alleged that ZMC made a claim to Philhealth for the confinement
wrong does may be inferred from the mere fact that the of Lorna M. Alestre (Alestre) from 6-12 August 2003.
accident happened, provided that the character of the However, in the latter’s salaysay it was stated that her
accident and circumstances attending it lead reasonably actual confinement was only from 10-11 August 2003.
to the belief that in the absence of negligence it would The defense of ZMC was that Midwife/Clerk Jennifer R.
not have occurred and that the thing which caused injury Acuram commited an honest mistake in writing 6-12
is shown to have been under the management and August 2003 when it should onle be 10-12 August 2003.
control of the alleged wrong doer. Furthermore, ZMC provided an affidavit of explanation
by Alestre wherein she admitted that despite being
Res ipsa liquitor is not a rigid or ordinary doctrine to be confined in the hospital, she was able to log in in the
perfunctorily used but a rule to be cautiously applied school (where she was working) on August 12, 2003.
defending upon the circumstances of each case. In ISSUE: WON ZMC extended the period of confinement
malpractice case, the doctrine is generally restricted to punishable under Section 149 of the Revised
situations where a layman is able to say, as a matter of Implementing Rules and Regulations of RA 7875.
common knowledge and observation, that the LAW: Section 149. Extending Period of Confinement. —
consequence of professional care were not as such as This is committed by any health care provider who, for
would ordinarily have followed if due care had been the purpose of claiming payment from the NHIP, files a
exercised. claim with extended period of confinement
Moreover, we note that in the instant case, the a. Increasing the actual confinement of any patient;
instrument which caused the injury or damage was not b. Continuously charting entries in the Doctor's
even within respondent’s exclusive control and Order, Nurse's Notes and Observation despite
management as Dr. Jabagat was exclusively in control actual discharge or absence of the patients;
and management of the anesthesia and endotracheal c. Using such other machinations that would result
tube. The doctrine of res ipsa liquitor allows the mere in the unnecessary extension of confinement.
existence of an injury to justify a presumption of
The foregoing offenses shall be penalized by revocation ZMC moved for reconsideration but it was denied for lack
of accreditation. In addition, a recommendation shall be of merit on 7 December 2009. In his Dissent, Court of
submitted to the DOH for cancellation of its license, or Appeals Associate Justice Ruben Ayson believed that
accreditation, or clearance to operate, as appropriate. ZMC should be given the opportunity to rectify any
defect or infirmity in the petition pursuant to the
CASE HISTORY: preference on liberal construction of the Rules of Court
Philhealth Arbiter On 12 December 2007, ZMC was found over strict construction.cralawlawlibrary
liable for the charge of “Extending Period of RULING OF THE SUPREME COURT: The Philhealth Arbiter
Confinement” in violation of Section 149 of the Revised and the Board did not give weight to the Affidavit of
Rules and Regulations of Republic Act No. 7875 and was Explanation submitted by the patient herself recanting
meted the penalty of suspension from participating in her previous statement and categorically stating that she
the NHIP for a period of three (3) months and a fine of was discharged only on 12 August 2003.
P10,000.00.
It is an oft-repeated rule that findings of administrative
While Health Insurance Arbiter Michael Troy Polintan agencies are generally accorded not only respect but also
considered the admission date of 6 August 2003 finality when the decision and order are not tainted with
reflected in Alestre’s clinical record as a mere clerical unfairness or arbitrariness that would amount to abuse
error, he refused to believe Alestre’s claim that she was of discretion or lack of jurisdiction. The findings of facts
discharged only on 12 August 2003 but on that day, she must be respected, so long as they are supported by
was travelling back and forth from hospital to the school substantial evidence even if not overwhelming or
where she teaches. The Philhealth Arbiter gave more preponderant.20cralawlawlibrary
evidentiary weight to the signature of Alestre in the
school’s attendance logbook which established the fact After an exhaustive review of the records, we find that
that she reported for work on 12 August 2003. this case warrants a departure from said rule.
Philhealth Board of Directors ZMC appealed but on 24
July 2008, the Philhealth Board of Directors (the Board) We are inclined to give more credence to Alestre’s
issued Philhealth Board Resolution No. 1151, Series of Affidavit, which is essentially a recantation of her
2008 dismissing the appeal and affirming the 12 previous Salaysay, for the following reasons: First,
December 2007 Decision of the Philhealth Arbiter. Alestre has fully explained to our satisfaction why she
initially misdeclared her dates of confinement in ZMC. In
The Board ruled that the contents of the Affidavit of her desire to report and be compensated for one day of
Explanation dated 3 May 2005 executed by Alestre is work, Alestre hied back and forth between school and
“too good to be true” because “in the first place, she has the hospital. It is difficult to believe that she would risk
stated in detail all her acts from 7:17 a.m. to 8:15 [a.m.], her reputation as a public school teacher, as well as
9:30 [a.m.], 9:50 [a.m.], 12:00 [noon]; 12:55 p.m., 1:30 prosecution for violation of civil service rules, to be an
p.m., 1:50 p.m., 2:15 p.m. and 2:30 p.m. The recollection abettor of ZMC. Second, Alestre truly cannot be in two
of all these times after 22 months is not only fantastic but places at the same time. But her narration clearly
likewise incredible.” Moreover, the Board also noted accounts for her whereabouts on 12 August 2003. She
that Alestre could not possibly be in ZMC and in the travelled at least 3 times to and from the hospital and
school at the same time on 12 August 2003 while her son school. She admitted that the school was a mere ten-
was still confined at the hospital. minute drive away from the hospital so she can easily
traverse between the two locations. Third, ZMC had in
Court of Appeals: fact admitted to its error in indicating the dates of
On 28 January 2009, the Court of Appeals dismissed the Alestre’s confinement so there is no reason for ZMC to
petition for failure on the part of ZMC to attach a valid further conceal the actual days of Alestre’s confinement.
SPA. The appellate court found the SPA defective on the Fourth, the Salaysay is not notarized. While recantation
ground that it does not explicitly authorize Dr. Bragat to is frowned upon and hardly given much weight in the
sign and execute the required verification and determination of a case, the affidavit is still a notarized
certification of non-forum shopping in this case. The document which carries in its favor the presumption of
appellate court noted that the powers granted to Dr. regularity with respect to its due execution, and that
Bragat pertain only to her administrative functions as there must be clear, convincing and more than merely
Medical Director of ZMC. preponderant evidence to contradict the same.
Based on the foregoing, the ZMC is not guilty of
extending the period of confinement. Issue:
Whether or not the hospital is liable for damages
The form of restraint must be total; movement must be 571 SCRA 585 – Labor Law – Labr Relations – Labor
restrained in all directions. If restraint is partial, e.g., in a Standards – Strike – Managerial Employees – Control –
particular direction with freedom to proceed in another, Illegal Dismissal
the restraint on the person's liberty is not total.
Facts:
However, the hospital may legally detain a patient Ronaldo Lanzanas and Merceditha Lanzanas are doctors
against his will: employed by Calamba Medical Center, Inc. They are
a. when he is a detained or convicted prisoner, or given a retainer’s fee by the hospital as well as shares
b. when the patient is suffering from a very from fees obtained from patients.
contagious disease where his release will be
prejudicial to public health, or when the patient One time, Ronaldo was overheard by Dr. Trinidad talking
is mentally ill such that his release will endanger to another doctor about how low the admission rate to
public safety, the hospital is. That conversation was reported to Dr.
c. or in other exigent cases as may be provided by Desipeda who was then the Medical Director of the
law. hospital.
Moreover, under the common law doctrines on tort, it Eventually Ronaldo was suspended. Ronaldo filed a case
does not constitute a trespass to the person to for Illegal Suspension in March 1998. In the same month,
momentarily prevent him from leaving the premises or the rank and file employees organized a strike against the
any part thereof because he refuses to comply with some hospital for unfair labor practices. Desipeda eventually
reasonable condition subject to which he entered them. fired Ronaldo for his alleged participation in the strike,
In all cases, the condition of this kind of restraint must be which is not allowed under the Labor Code for he is a
reasonable in the light of the circumstances. managerial employee. Desipeda also fired Merceditha on
the ground that she is the wife of Ronaldo who naturally
At any rate, as stated above, the patient is free to leave sympathizes with him.
the premises, even in the ostensible violation of these
conditions, after being momentarily interrupted by the The Labor Arbiter ruled that there was no Illegal
hospital staff for purposes of informing him of those Suspension for there was no employer-employee
reasonable conditions, such as the assessment of relationship because the hospital has no control over
whether the patient is fit to leave, insane, or suffering Ronaldo as he is a doctor who even gets shares from the
from a contagious disease, etc., or simply for purposes of hospitals earnings.
making a demand to settle the bill.
The National Labor Relations Commission as well as the
If the patient chooses to abscond or leave without the Court of Appeals reversed the LA.
consent of the hospital in violation of any of the
conditions deemed to be reasonable under the ISSUE:
circumstances, the hospital may nonetheless register its Whether or not there is an employer-employee
protest and may choose to pursue the legal remedies relationship?
available under law, provided that the hospital may not
physically detain the patient, unless the case falls under HELD:
the exceptions abovestated. Yes. Under the control test, an employment relationship
exists between a physician and a hospital if the hospital
controls both the means and the details of the process
by which the physician is to accomplish his task. There is
control in this case because of the fact that Desipeda
schedules the hours of work for Ronaldo and his wife.