G.R. No. 124354 RAMOS (1999) v.

CA 321 SCRA 584

RAMOS v. CA

G.R. No. 124354

December 29, 1999

321 SCRA 584

FACTS: Plaintiff Erlinda Ramos was experiencing occasional pains allegedly caused by stones in her gall bladder. She
was told to undergo an operation and after some tests and exams, she was indicated fit for surgery.

Dr. Orlino Hozaka, defendant, decided that Erlinda should undergo a “cholecystectomy” operation. Rogelio, husband
of Erlinda, asked Dr. Hosaka to look for a good anesthesiologist.

Around 7:30 AM of June 17, 1985, Herminda (sister-in-law of Erlinda) accompanied Erlinda to the operating room
and saw Dr. Gutierrez, the other defendant, who was to administer anesthesia. Dr. Hosaka only arrived around
12:15 PM, three hours late. Nonetheless, the operation continued and Herminda then saw Dr. Gutierrez intubating
the patient and heard her saying “and hirap ma-intubate nito, mali yata ang pagkakapasok”. Thereafter, bluish
discoloration of the nailbeds appeared on the patient. Hence, Dr. Hosaka issued an order for someone to call Dr.
Calderon, another anesthesiologist. The patient was placed in a trendelenburg position for decrease of blood supply
in her brain. At 3:00 PM, the patient was taken to the ICU.

Four months after, the patient was released from the hospital. However, the patient has been in a comatose
condition.

Hence, the petition filed a civil case for damages against herein private respondents alleging negligence in the
management and care of Erlinda Ramos.

Petitioners contended that the faulty management of her airway casused the lack of oxygen in the patient’s brain.
On the respondent’s part, they contended that the brain damage was Erlinda's allergic reaction to the anesthetic
agent.

ISSUES: (1) Will the doctrine of res ipsa loquitur apply in this case? and (2) Did the negligence of the respondents
cause the unfortunate comatose condition of petitioner Erlinda Ramos?

RULING: (1) Yes. The Court finds the doctrine of res ipsa loquitur appropriate in the case at bar.

The doctrine of res ipsa loquitur is where the thing which caused the injury complained of is shown to be under the
management of the defendant or his servants and the accident is such as in ordinary course of things does not
happen if those who have its management or control use proper care, it affords reasonable evidence, in the absence
of explanation by the defendant, that the accident arose from or was caused by the defendant's want of care.

In cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper
proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common
knowledge can determine the proper standard of care.

Erlinda submitted herself soundly and fit for surgery. However, during the administration of anesthesia and prior to
the performance of cholecystectomy she suffered irreparable damage to her brain. Thus, 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.

Considering that a sound and unaffected member of the body (the brain) is injured or destroyed while the patient is
unconscious and under the immediate and exclusive control of the physicians, we hold that a practical
administration of justice dictates the application of res ipsa loquitur.

(2a) With regard to Dra. Gutierrez, the court find her negligent during the anesthesia phase. As borne by the records,
respondent Dra. Gutierrez failed to properly intubate the patient which she admitted.

During intubation, such distention indicates that air has entered the gastrointestinal tract through the esophagus
instead of the lungs through the trachea. Entry into the esophagus would certainly cause some delay in oxygen
delivery into the lungs as the tube which carries oxygen is in the wrong place.

Even granting that the tube was successfully inserted during the second attempt, it was obviously too late.

An experienced anesthesiologist, adequately alerted by a thorough pre-operative evaluation, would have had little
difficulty going around the short neck and protruding teeth.

Hence, she was negligent.

(2b) For Dr. Orlino Hosaka, as the head of the surgical team and as the so-called captain of the ship, it is the
surgeons responsibility to see to it that those under him perform their task in the proper manner

Respondent Dr. Hosakas negligence can be found in his failure to exercise the proper authority (as the captain of the
operative team) in not determining if his anesthesiologist observed proper anesthesia protocols. In fact, no evidence
on record exists to show that respondent Dr. Hosaka verified if respondent Dra. Gutierrez properly intubated the
patient. Furthermore, it does not escape the court that respondent Dr. Hosaka had scheduled another procedure in
a different hospital at the same time as Erlinda's operation, and was in fact over three hours late for the latter's
operation. Because of this, he had little or no time to confer with his anesthesiologist regarding the anesthesia
delivery. This indicates that he was remiss in his professional duties towards his patient.

Thus, he shares equal responsibility for the events which resulted in Erlindas condition.

(2c) As for the hospital (employer) itself, the Court ruled that for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and
visiting physicians.

In the instant case, respondent hospital, apart from a general denial of its responsibility over respondent physicians,
failed to adduce evidence showing that it exercised the diligence of a good father of a family in the hiring and
supervision of the latter. It failed to adduce evidence with regard to the degree of supervision which it exercised
over its physicians. In neglecting to offer such proof, or proof of a similar nature, respondent hospital thereby failed
to discharge its burden under the last paragraph of Article 2180.

Having failed to do this, respondent hospital is consequently solidarily responsible with its physicians for Erlindas
condition.

Posted by King Monteclaro-Montereal at 00:10

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Labels: Captain of the Ship, Cupla Aquiliana, Medical Malpractice, Medical Negligence, Negligence, Oblicon,Res Ipsa
Loquitur