Cariaga v.
LTB WHO WON: Cariaga subsistence allowance of P10 daily during his period of recovery, having spent in this
DOCTRINE:
- The income of the plaintiff which he could have earned if he should he finish his
course and pass the board exams must be deemed to be within the natural and probable
consequences of the breach –along with medical, hospital and other expenses– because
they could have reasonably been foreseen by the parties at the time the plaintiff boarded
the bus owned and operated by the common carrier.
- Moral damages may only be awarded upon showing of any of the instances
enumerated under Art. 2219 of the New Civil Code or upon showing of bad faith or fraud
under Art. 2220 of the same Code.
- Attorney’s fees may only be recovered upon showing of any of the instances
enumerated under Art. 2208 of the New Civil Code.
FACTS:
- At about 1PM on June 18, 1952, a passenger bus of the Laguna Tayabas Bus Co. (LTB)
driven by Alfredo Moncada, left for Lilio, Laguna, with Edgardo Cariaga, a fourth-year
medical student of the University of Santo Tomas, as one of its passengers.
- As the bus reached that part of the poblacion of Bay, Laguna, where the national
highway crossed a railroad track, it bumped against the engine of a train then passing by
with such terrific force that the first six wheels of the train were derailed, the engine and the
front part of the body of the bus was wrecked, the driver of the bus died instantly, while
many of its passengers, Edgardo among them, were severely injured.
- Edgardo was first confined at the San Pablo City Hospital (June 18) and then brought
next to the De los Santos Clinic (June 20), Quezon City. He again left such clinic to be
transferred to the University of Santo Tomas Hospital (Oct 14-Nov 15) where he stayed for a
relatively longer period. On this last date he was taken back to the De los Santos Clinic (Jan
15). He was unconscious during the first 35 days after the accident. Dr. Gustilo removed the
fractured bones which lacerated the right frontal lobe of his brain and at the UST Hospital,
Dr. Gustilo performed another operation to cover a big hole on the right frontal part of the
head with a tantalum plate.
- LTB paid the sum of P16,964.45 for all the hospital, medical and miscellaneous
expenses incurred from June 18, 1952 - April, 1953. From January 15, 1953 - April 1953,
Edgardo stayed in a private house in Quezon, City, the LTB having agreed to give him a
connection the total sum of P775.30 in addition to the amount already referred to.
- Edgardo filed a civil suit against LTB and the Manila Railroad Co. the total sum of
P312,000 as actual, compensatory, moral and exemplary damages, and for his parents, the
sum of P18,000 in the same concepts.
- LTB disclaimed liability claiming that the accident was due to the negligence of its co-
defendant Manila Railroad Co., for not providing a crossing bar at the point where the
national highway crossed the railway track, and for the reason filed the corresponding cross-
claim against the latter company to recover the total sum of P18,194.75 representing the
expenses paid to Edgardo.
- Manila Railroad Co, in turn, denied liability upon the complaint and cross-claim
alleging that it was reckless negligence of the bus driver that caused the accident.
- The lower court held that it was the negligence of the bus driver that caused the
accident and, as a result, rendered judgment sentencing the LTB to pay Edgardo Cariaga the
sum of P10,490 as compensatory damages, with interest at the legal rate from the filing of
the complaint, and dismissing the cross-claim against the Manila Railroad Company. From
this decision the Cariagas and the LTB appealed.
- Cariagas claim that the TC erred in awarding only P10,490 as compensatory damages
to Edgardo; in not awarding them actual and moral damages, and in not sentencing LTB to
pay attorney’s fees.
- LTB's contends that the TC should have held that the collision was due to the fault of
both the locomotive driver and the bus driver and erred, as a consequence, in not holding
the Manila Railroad Company liable upon the cross-claim filed against it. LTB also avers that
the driver of the train locomotive, like the bus driver, violated the law, first, in sounding the
whistle only when the collision was about to take place instead of at a distance at least 300
meters from the crossing, and second, in not ringing the locomotive bell at all.
ISSUE/S:
1. W/N Manila Railroad Company should also be held liable in the collision? NO
2. W/N the award of compensatory damages to Eduardo is inadequate considering the
nature and the after effects of the physical injuries suffered by him? YES
3. W/N Edgardo Cariaga is entitled to moral damages and attorney’s fees? NO
RULING: 3. Plaintiffs' claim for moral damages cannot be granted. Article 2219 of the Civil Code
enumerates the instances when moral damages may be covered and the case under
1. The Supreme Court quoted the lower court’s finding regarding LTB’s contention on Manila
consideration does not fall under any one of them. The present action cannot come under
Railroad Company’s alleged liability to wit: “While the train was approximately 300 meters
paragraph 2 of said article because it is not one of quasi-delict because of the pre-existing
from the crossing, the engineer sounded two long and two short whistles and upon reaching
contractual relation between the Laguna Tayabas Bus Company and Edgardo Cariaga.
a point about 100 meters from the highway, he sounded a long whistle which lasted up to
Neither could defendant Laguna Tayabas Bus Company be held liable to pay moral damages
the time the train was about to cross it. The bus proceeded on its way without slackening its
to Edgardo Cariaga under Article 2220 of the Civil Code on account of breach of its contract
speed and it bumped against the train engine, causing the first six wheels of the latter to be
of carriage because said defendant did not act fraudulently or in bad faith in connection
derailed…”
therewith. Defendant Laguna Tayabas Bus Company had exercised due diligence in the
Moreover, LTB’s charge against Manila Railroad Company of its contributory negligence due selection and supervision of its employees like the drivers of its buses in connection with the
to an alleged violation of section 91 of Art. 1459 of MRR’s chapter by its failure to ring the discharge of their duties and so it must be considered an obligor in good faith.
bell was not satisfactorily proven. Consequently, the burden of proof on the part of LTB was
The plaintiff Edgardo Cariaga is also not entitled to recover for attorney's fees, because this
not discharged.
case does not fall under any of the instances enumerated in Article 2208 of the Civil Code.
2. According to Edgardo’s neurosurgeon Dr. Romeo Gustilo, it appears that, as a result of the Defendant has not committed in connection with this case any "criminal offense resulting in
injuries suffered by him, his right forehead was fractured necessitating the removal of physical injuries". The present complaint is not based either on a "quasi-delict causing
practically all of the right frontal lobe of his brain. From the testimony of Dr. Jose A. physical injuries” nor “any criminal offense resulting in physical injuries” –
Fernandez, a psychiatrist, it may be gathered that, because of the physical injuries suffered
LTB’s driver herein being the one who committed the offense is already dead from the
by Edgardo, his mentality has been so reduced that he can no longer finish his studies as a
collision.
medical student; that he has become completely misfit for any kind of work; that he can
hardly walk around without someone helping him, and has to use a brace on his left leg and To reiterate, the sum of P2,000 awarded as moral damages by the trial court has to be
feet. Thus, as a result of the physical injuries suffered by Edgardo Cariaga, he is now in a eliminated, for under the law it is not a compensation awardable in a case like the one at
helpless condition, virtually an invalid, both physically and mentally. bar. The claim made by said spouses for actual and compensatory damages is likewise
without merits since the present action is based upon a breach of contract of carriage to
The SC is of the opinion that the income which Edgardo Cariaga could have earned if he
which said spouses were not a party, and neither can they premise their claim upon the
should finish the medical course and pass the corresponding board examinations must be
negligence or quasi-delict of the LTB simply because they were not themselves injured as a
deemed to be within the natural and probable consequences of the breach –along with
result of the collision between the LTB bus and train owned by the Manila Railroad Company.
medical, hospital and other expenses totaling P17,719.75– because they could have
reasonably been foreseen by the parties at the time he boarded the bus owned and
operated by the LTB. At that time he was already a fourth-year student in medicine in a
reputable university.

As regards the income that he could possibly earn as a medical practitioner, it appears that,
according to Dr. Amado Doria, a witness for the LTB, the amount of P300 could easily be
expected as the minimum monthly income of Edgardo had he finished his studies.

Upon consideration of all the facts mentioned heretofore this Court is of the opinion, and so
holds, that the compensatory damages awarded to Edgardo Cariaga should be increased to
P25,000. Reyes vs. Sisters of Mercy Hospital G.R No. 130547 (October 3, 2000)
Facts:
Jorge Reyes has been suffering from recurring fever with chills for around days.
Home medication afforded him no relief so he went to Mercy Community Clinic. He was then
attended by Dr. Marlyn Rico. Since typhoid fever was common at that time, the Widal test
was performed and he was found positive for typhoid.
Thereafter, Dr. Marlyn Rico indorse Jorge Reyes to Dr. Marvie Blanes. Suspecting that Jorge
had typhoid fever, Dr. Marvie Blanes ordered that Jorge be tested for compatibility with
chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente. As there was no
adverse reaction, Dr. Blanes administered 500 mg of the antibiotic. Another dose was given 3
hours later.
Subsequently, Jorge Reyes developed high fever and experienced vomiting and convulsions.
He then turned blue due to deficiency in oxygen – cyanosis – and died. The cause of death
was stated to be “ventricular arrhythmia secondary to hyperpyrexia and typhoid fever.”
The heirs of Reyes filed with the RTC a complaint for damages against Sisters of Mercy, Sister
Rose Palacio, Dr. Blanes, Dr. Rico and Mercy Community Clinic contending that the death of
Jorge was due to the wrongful administration of chloromycetin. (NOTE: Petitioner’s action is
for medical malpractice.)
RTC ruled in favor of the respondents. The CA affirmed in toto the RTC decision. Hence, this
appeal.
Petitioners contend that:
Dr. Marlyn Rico hastily and erroneously relied upon the Widal test, diagnosed Jorge’s illness
as typhoid fever, and immediately prescribed the administration of the antibiotic
chloromycetin
Dr. Marvie Blanes erred in ordering the administration of the second dose of 500 milligrams
of chloromycetin barely 3 hours after the first was given.
Testimony presented: That of Dr. Apolinar Vacalares, (Chief Pathologist of the Northern
Mindanao Training Hospital) who performed an autopsy on the body – Dr. Vacalares testified
that Reyes did not die of typhoid fever but of shock undetermined, which could be due to
allergic reaction or chloromycetin overdose.
Issue: WON there was medical malpractice. NO
Held:
Dr. Apolinar Vacalares is not a specialist of typhoid fever and he is thus not qualified to prove
that Dr. Marlyn Rico erred in her diagnosis.
While petitioners presented Dr. Apolinar Vacalares as an expert witness, we do not find him
to be so as he is not a specialist on infectious diseases like typhoid fever. Furthermore,
although he may have had extensive experience in performing autopsies, he admitted that
he had yet to do one on the body of a typhoid victim at the time he conducted the
postmortem on Jorge Reyes. It is also plain from his testimony that he has treated only about
three cases of typhoid fever.
The two doctors presented by respondents clearly were experts on the subject
They vouched for the correctness of Dr. Marlyn Rico’s diagnosis. Dr. Peter Gotiong, a
diplomate whose specialization is infectious diseases and microbiology and an associate
professor at the Southwestern University College of Medicine and the Gullas College of
Medicine, testified that he has already treated over a thousand cases of typhoid fever.
According to him, when a case of typhoid fever is suspected, the Widal test is normally used,
and if the 1:320 results of the Widal test on Jorge Reyes had been presented to him along
with the patient’s history, his impression would also be that the patient was suffering from
typhoid fever. As to the treatment of the disease, he stated that chloromycetin was the drug
of choice. He also explained that despite the measures taken by respondent doctors and the
intravenous administration of two doses of chloromycetin, complications of the disease
could not be discounted.
Respondents also presented the testimony of Dr. Ibarra T. Panopio who is a member of the
Philippine and American Board of Pathology, an examiner of the Philippine Board of
Pathology, and chief pathologist at the MetroCebu Community Hospital, Perpetual Succor
Hospital, and the Andres Soriano Jr. Memorial Medical Center.
He stated that, as a clinical pathologist, he recognized that the Widal test is used for typhoid
patients, although he did not encourage its use because a single test would only give a
presumption necessitating that the test be repeated, becoming more conclusive at the
second and third weeks of the disease.
He corroborated Dr. Gotiong’s testimony that the danger with typhoid fever is really the
possible complications which could develop like perforation, hemorrhage, as well as liver
and cerebral complications.
Dr. Rico was not negligent in administering the 2 doses of 500 g of chloromycetin
The chloromycetin was likewise a proper prescription is best established by medical
authority. Even if the deceased suffered from an anaphylactic shock, this, of itself, would not
yet establish the negligence of the appellee-physicians for all that the law requires of them is
that they perform the standard tests and perform standard procedures. The law cannot
require them to predict every possible reaction to all drugs administered.
The practice of medicine requires the highest degree of diligence
The practice of medicine is a profession engaged in only by qualified individuals. It is a right
earned through years of education, training, and by first obtaining a license from the state
through professional board examinations. Such license may, at any time and for cause, be
revoked by the government. In addition to state regulation, the conduct of doctors is also
strictly governed by the Hippocratic Oath, an ancient code of discipline and ethical rules
which doctors have imposed upon themselves in recognition and acceptance of their great
responsibility to society. Given these safeguards, there is no need to expressly require of
doctors the observance of “extraordinary” diligence.
As it is now, the practice of medicine is already conditioned upon the highest degree of
diligence. And, as we have already noted, the standard contemplated for doctors is simply
the reasonable average merit among ordinarily good physicians. That is reasonable diligence
for doctors or, as the Court of Appeals called it, the reasonable “skill and competence . . .
that a physician in the same or similar locality . . . should apply.”
There are thus four elements involved in medical negligence cases, namely: duty, breach,
injury, and proximate causation
Petitioner’s action is for medical malpractice. This 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.
In order to successfully pursue such a claim, a patient must prove that the physician or
surgeon either failed to do something which a reasonably prudent physician or surgeon
would have done, or that he or she did something that a reasonably prudent physician or
surgeon would not have done, and that the failure or action caused injury to the patient.
The doctrine of Res Ipsa Loquitor is not applicable in this case.
Was there a physician-patient relationship between the respondent doctors and Jorge
Reyes? Yes.
Respondents were thus duty-bound to use at least the same level of care that any
reasonably competent doctor would use to treat a condition under the same circumstances.
It is breach of this duty which constitutes actionable malpractice.
As to this aspect of medical malpractice, the determination of the reasonable level of care
and the breach thereof, expert testimony is essential. 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.
The doctrine of res ipsa loquitor is not applicable in the case at bar
Though expert testimony is usually needed to prove malpractice, where common knowledge
and experience teach that the injury would not have occurred if due care had been
exercised, the doctrine of res ipsa loquitur can be invoked to establish negligence.
Hence, 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. Where common knowledge and experience teach that a resulting injury
would not have occurred to the patient if due care had been exercised, an inference of
negligence may be drawn giving rise to an application of the doctrine of res ipsa loquitur
without medical evidence, which is ordinarily required to show not only what occurred but
how and why it occurred.
When the doctrine is appropriate, all that the patient must do is prove a nexus between the
particular act or omission complained of and the injury sustained while under the custody
and management of the defendant without need to produce expert medical testimony to
establish the standard of care.
There is nothing unusual about the death of Jorge Reyes (absence of 1st requisite that the
accident was of a kind which does not ordinarily occur unless someone is negligent)
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.

It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit
against a physician or a surgeon which involves the merits of a diagnosis or of a scientific
treatment. The physician or surgeon is not required at his peril to explain why any particular
diagnosis was not correct, or why any particular scientific treatment did not produce the
desired result.

RES IPSA LOQUITOR

Under the doctrine of res ipsa loquitur, “[w]here the thing that caused the injury complained
of is shown to be under the management of the defendant or his servants; and the accident,
in the ordinary course of things, would not happen if those who had management or control
used proper care, it affords reasonable evidence – in the absence of a sufficient, reasonable
and logical explanation by defendant – that the accident arose from or was caused by the
defendant’s want of care.”[40] Res ipsa loquitur is “merely evidentiary, a mode of proof, or a
1. The accident is of a kind which ordinarily does not occur in the absence of someone’s
mere procedural convenience, since it furnishes a substitute for, and relieves a plaintiff of,
negligence;
the burden of producing a specific proof of negligence.”[41] It “recognizes that parties may
establish prima facie negligence without direct proof, thus, it allows the principle to
substitute for specific proof of negligence. It permits the plaintiff to present along with
proof of the accident, enough of the attending circumstances to invoke the doctrine, create 2. It is caused by an instrumentality within the exclusive control of the defendant or
an inference or presumption of negligence and thereby place on the defendant the burden defendants; and
of proving that there was no negligence on his part.”[42] The doctrine is based partly on
“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 while 3. the possibility of contributing conduct would make the plaintiff responsible is eliminated.
the plaintiff has no such knowledge, and is therefore compelled to allege negligence in
general terms.”[43]
The concept of res ipsa loquitur has been explained in this wise:

The requisites of the doctrine of res ipsa loquitur as established by jurisprudence are as
follows:
1) the accident is of a kind which does not ordinarily occur unless someone is negligent;
2) the cause of the injury was under the exclusive control of the person in charge and
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 defendant’s part, under the doctrine ofres 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.

3) the injury suffered must not have been due to any voluntary action or contribution on
the part of the person injured.[44]

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 defendant’s want of care.
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:
One of the theoretical bases for the doctrine is its necessity, i.e., that necessary evidence is
absent or not available.

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 defendant’s negligence is beyond plaintiff’s power.
Accordingly, some courts 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.