DECS v SAN DIEGO, G.R.

89572 21 December 1989

TOPIC: Basis of Medical Practice
FACTS:
1.Respondent San Diego is a graduate of University of the East with a
degree in BS Zoology. He then took the National Medical Admission Test
(NMAT) 3 times and flunked it as many times. When he applied to take
it the 4th time.
2.Petitioner DECS contends that under MECS Order No. 12: a student
shall be allowed only 3 chances to take the NMAT. After 3 consecutive
failures, a student shall no longer be allowed to take it the fourth time.
3.San Diego insists he can, on constitutional grounds. He challenged the
constitutionality of the MECS Order as being violative of due process
and equal protection. He was adjudged in the lower court to have been
deprived of his right to pursue a medical education through an exercise
of police power.
ISSUE: Whether or not the MECS Order was a valid exercise of police power
RULING/HELD: Yes. It was a valid exercise of police power.
1. The Supreme Court reversed the decision of the respondent judge.
Police power is validly exercised if (a) the interests of the public
generally, as distinguished from those of a particular class, require the
interference of the State, and (b) the means employed are reasonably
necessary to the attainment of the object sought to be accomplished and
not unduly oppressive upon individuals. The proper exercise of the
police power requires the concurrence of a lawful subject and a lawful
method. Clearly, the 3-flunk rule employed by the MECS Order is not
irrelevant to the purpose of the law nor is it arbitrary or oppressive
because it is intended to insulate the medical schools and ultimately the
medical profession from the intrusion of those not qualified to be
doctors. While every person is entitled to aspire to be a doctor, he does
not have a constitutional right to be a doctor. The medical profession
directly affects the very lives of the people. For this reason, it
requires more vigilant regulation. Further, the ruling in Tablarin v
Gutierrez was applied which upheld the constitutionality of the NMAT as
a measure intended to limit the admission to medical schools only to
those who have initially proved their competence and preparation for a
medical education. The court believes that the government is entitled to
prescribe the NMAT as a means of achieving its stated objective of
"upgrading the selection of applicants into medical schools" and of
"improving the quality of medical education in the country."  The right to
quality education invoked by the private respondent is not absolute and
there would be unequal protection if some applicants who have passed
the tests are admitted and others who have also qualified are denied
entrance. In other words, what the equal protection requires is equality
among equals.

2. PETITION GRANTED.

Prepared by Monica T. Buenaventura

January 2020
ROGELIO E. RAMOS, et. al. v CA, G.R. 124354, 29 December 1999
TOPIC: Medical Professional Liability/Doctrines applied in MedMal cases
FACTS:
Plaintiff Erlinda Ramos was advised to undergo a gall bladder operation to
be headed by Dr. Hosaka. Rogelio, husband of Erlinda, asked Dr. Hosaka to
look for a good anesthesiologist. On the day of the operation, her sister-in-
law accompanied her. Dr. Hosaka arrived 3 hours later than the scheduled
operation. When Dr. Gutierrez intubated the patient, Dr. Hosaka noticed
there was something “wrong”. Thereafter, they noticed a bluish
discoloration of the nailbeds of the left hand of the Erlinda. Despite the
efforts of the doctors, Erlinda was brought to the ICU. She stayed at the ICU
for a month. This prompted petitioners to file a civil case for damages
against Dr. Hosaka, Dr. Gutierrez, and the hospital, for the alleged
negligence in the management and care of Erlinda Ramos.

ISSUE: Whether or not (1) it was the negligence of the respondents which
caused the comatose condition of Erlinda and (2) the doctrine of res ipsa
loquitor may be applied

RULING/HELD: (1) Yes. The negligence of the respondents was the proximate
cause of Erlinda’s condition. (2) Yes. Res ipsa loquitor is applied in this case.

Dr. Gutierrez is negligent in the care of Erlinda in the anesthesia phase. She
failed to properly intubate the patient. Her defense that it was difficult to
administer the intubation on the patient because of her obesity is not tenable.
She met Erlinda for the first time on the day of the operation. The operation
done was not an emergency case. Hence, the doctor had all the opportunity to
conduct a pre-operative evaluation of the patient. This could have helped
prevented the difficulties as she would have had knowledge of the
physiological characteristics of her patient before the actual administration.
Res ipsa loquitur is a Latin phrase which literally means "the thing or the
transaction speaks for itself." The doctrine is applied in conjunction with the
doctrine of common knowledge. Before resort to its application, the following
requisites must be satisfactorily shown:

(a)The accident is of a kind which ordinarily does not occur in the absence of
someone's negligence, (b) It is caused by an instrumentality within the
exclusive control of the defendant or defendants; and (c) The possibility of
contributing conduct which would make the plaintiff responsible is
eliminated. 

In the above requisites, the fundamental element is the "control of

instrumentality" which caused the damage.  Such element of control must be

Prepared by Monica T. Buenaventura

January 2020
shown to be within the dominion of the defendant. All the defendants were
held liable.
PROF. SERVICES, INC. v NATIVIDAD and ENRIQUE AGANA, G.R. 126297
TOPIC: Medical Professional Liability/Doctrines applied in MedMal cases
FACTS:
Respondent Natividad was advised to undergo an anterior resection
surgery for having been diagnosed with cancer of the sigmoid. Dr. Miguel Ampil
performed the surgery. He seeked the assistance of Dr. Fuentes. After the latter
had completed the operation, Dr. Ampil took over to finalize the operation. In the
corresponding Record of Operations, the attending nurses entered the remarks:
"sponge count lacking 2” but Dr. Ampil still ordered the closure of the incision.
After a couple of days, Natividad complained of excruciating pain in her anal
region. The pains intensified, prompting Natividad to seek treatment at another
hospital. The doctors there detected a foul-smelling gauze measuring 1.5 inches in
width which badly infected her vaginal vault. Natividad and her husband filed a
complaint for damages against Prof. Serivces, Inc. , Dr. Ampil, and Dr. Fuentes.
They alleged their negligence for leaving two pieces of gauze inside Natividad’s
body and malpractice for concealing their acts of negligence.

ISSUE: Whether or not (1) Dr. Fuentes is guilty of negligence or medical

malpractice, invoking the doctrine of res ipsa loquitur, that the pieces of gauze are
prima facie proofs that the operating surgeons have been negligent and (2) Dr.
Ampil is liable for negligence and malpractice

RULING/HELD:
1. No, the requisites for the applicability of the doctrine of res ipsa loquitur
are: (1) the occurrence of an injury; (2) the thing which caused the injury was
under the control and management of the defendant; (3) the occurrence was
such that in the ordinary course of things, would not have happened if those
who had control or management used proper care; and (4) the absence of
explanation by the defendant. The most instrumental is the "control and
management of the thing which caused the injury." We find such element to be
wanting. Hence, the doctrine of res ipsa loquitur will not lie. A "diligent search"
was conducted, but the misplaced gauzes were not found. Still, Dr. Ampil
directed that the incision be closed. During this entire period, Dr. Fuentes was
no longer in the operating room and had, in fact, left the hospital. Under the
"Captain of the Ship" rule, the operating surgeon is the person in complete
charge of the surgery room and all personnel connected with the operation. Dr.
Ampil was the lead surgeon. In other words, he was the "Captain of the Ship."

2. Yes, Dr. Ampil is liable. He did not inform Natividad about the missing 2
pieces of gauze. Worse, he even misled her that the pain she was experiencing
was the ordinary consequence of her operation. Had he been more candid,
Natividad could have taken the immediate and appropriate medical remedy to
remove the gauzes from her body. To our mind, what was initially an act of

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January 2020
 negligence by Dr. Ampil has ripened into a deliberate wrongful act of deceiving
his patient. This is a clear case of medical malpractice or more appropriately,
medical negligence.
PROF. CHI MING TSOI v CA, G.R. 119190, 16 January 16, 1997
TOPIC: Medicolegal Aspects of sex and marriage
FACTS:
Plaintiff and private defendant are married. However, no sexual
intercourse took place after their marriage. Because of this, they submitted
themselves for medical examinations where she was found healthy, normal and
still a virgin. The plaintiff claims, that the defendant is impotent, a closet
homosexual who married her only for the citizenship. The plaintiff is not willing to
reconcile with her husband. The defendant claims that should the marriage be
annulled, it is his wife’s fault. He claims no defect on his part, as he was found not
to be impotent, and any differences between the two of them can still be
reconciled. He admitted that they have not had intercourse since their marriage
until their separation because his wife avoided him. The trial court declared the
marriage void. On appeal, the Court of Appeals affirmed the trial court’s decision.
Hence, the instant petition.

ISSUE: Whether or not the petitioner is psychologically incapacitated

RULING/HELD: Yes. The senseless and protracted refusal to consummate the

marriage is equivalent to psychological incapacity.

The appellant’s abnormal reluctance or unwillingness to consummate his

marriage is strongly indicative of a serious personality disorder which to the mind
of the Court clearly demonstrates an ‘utter insensitivity or inability to give
meaning and significance to the marriage’ within the meaning of Article 36 of the
Family Code. Evidently, one of the essential marital obligations under the Family
Code is "To procreate children based on the universal principle that procreation
of children through sexual cooperation is the basic end of marriage." Constant
non- fulfillment of this obligation will finally destroy the integrity or wholeness of
the marriage. In the case at bar, the senseless and protracted refusal of one of the
parties to fulfill the above marital obligation is equivalent to psychological
incapacity.The purpose of the Family Code is “to procreate children based on the
universal principle that procreation of children through sexual cooperation is the
basic end of marriage.” In the case at bar, the senseless and protracted refusal of
one of the parties to fulfil the above marital obligation is equivalent to
psychological incapacity.

The petition is DENIED.

Prepared by Monica T. Buenaventura

January 2020
Prepared by Monica T. Buenaventura
January 2020