Republic of the Philippines
SUPREME COURT
Manila
SECOND DIVISION
G.R. No. 171636               April 7, 2009
NORMAN A. GAID, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES, Respondent.
DECISION
TINGA, J.:
Before the Court is a petition for review on certiorari 1 assailing the 12 July
2005 Decision2 of the Court of Appeals and its subsequent
Resolution3 denying petitioner’s motion for reconsideration.
Petitioner Norman A. Gaid was charged with the crime of reckless
imprudence resulting in homicide in an information which reads as follow:
That on or about 12:00 high noon of October 25, 2001, infront of the
Laguindingan National High School, Poblacion, Laguindingan, Misamis
Oriental, Philippines and within the jurisdiction of this Honorable Court, the
said accused mentioned above while driving a passenger’s jeepney color
white bearing plate no. KVG-771 owned by barangay captain Levy Etom has
no precautionary measure to preempt the accident, did then and there
willfully, unlawfully and feloniously ran [sic] over Michael Dayata resulting
of [sic] his untimely death as pronounced by the attending physician of
Northern Mindanao Medical Center Hospital, Cagayan de Oro City.
CONTRARY TO LAW.4
Petitioner entered a not guilty plea. Thereafter, trial ensued.
The antecedent facts are undisputed.
At around 12:00 noon on 25 October 2001, petitioner was driving his
passenger jeepney along a two-lane road where the Laguindingan National
High School is located toward the direction of Moog in Misamis Oriental.
His jeepney was filled to seating capacity. 5 At the time several students were
coming out of the school premises. 6 Meanwhile, a fourteen year-old student,
Michael Dayata (Dayata), was seen by eyewitness Artman Bongolto
(Bongolto) sitting near a store on the left side of the road. From where he
was at the left side of the road, Dayata raised his left hand to flag down
petitioner’s jeepney7 which was traveling on the right lane of the
road.8 However, neither did petitioner nor the conductor, Dennis Mellalos
(Mellalos), saw anybody flagging down the jeepney to ride at that point. 9
The next thing Bongalto saw, Dayata’s feet was pinned to the rear wheel of
the jeepney, after which, he laid flat on the ground behind the
jeepney.10 Another prosecution witness, Usaffe Actub (Actub), who was also
situated on the left side of the street but directly in front of the school gate,
heard "a strong impact coming from the jeep sounding as if the driver forced
to accelerate in order to hurdle an obstacle." 11 Dayata was then seen lying on
the ground12 and caught in between the rear tires. 13 Petitioner felt that the left
rear tire of the jeepney had bounced and the vehicle tilted to the right side. 14
Mellalos heard a shout that a boy was run over, prompting him to jump off
the jeepney to help the victim. Petitioner stopped and saw Mellalos carrying
the body of the victim.15 Mellalos loaded the victim on a motorcycle and
brought him to the hospital. Dayata was first brought to the Laguindingan
Health Center, but it was closed. Mellalos then proceeded to the El Salvador
Hospital. Upon advice of its doctors, however, Dayata was brought to the
Northern Mindanao Medical Center where he was pronounced dead on
arrival.16
Dr. Tammy Uy issued an autopsy report stating cranio-cerebral injuries as
the cause of death.17 She testified that the head injuries of Dayata could have
been caused by having run over by the jeepney.18
The Municipal Circuit Trial Court (MCTC) of Laguindingan 19 found
petitioner guilty beyond reasonable doubt of the crime charged. The lower
court held petitioner negligent in his driving considering that the victim was
dragged to a distance of 5.70 meters from the point of impact. He was also
scored for "not stopping his vehicle after noticing that the jeepney’s left rear
tire jolted causing the vehicle to tilt towards the right." 20 On appeal, the
Regional Trial Court (RTC)21 affirmed in toto the decision of the MCTC.
The Court of Appeals affirmed the trial court’s judgment with modification
in that it found petitioner guilty only of simple negligence resulting in
homicide.1avvphi1.zw+
The Court of Appeals exonerated petitioner from the charge of reckless
imprudence resulting to homicide on the ground that he was not driving
recklessly at the time of the accident. However, the appellate court still found
him to be negligent when he failed "to promptly stop his vehicle to check
what caused the sudden jotting of its rear tire."22
In its 6 February 2006 Resolution, the Court of Appeals denied petitioner’s
motion for reconsideration.23
Hence, the instant petition.
Petitioner submits that the Court of Appeals erred in finding that "there is
(sic) absolutely lack of precaution on the part of the petitioner when he
continued even after he had noticed that the left rear tire and the jeep tilted to
its right side."24 Petitioner stressed that he, in fact, stopped his jeep when its
left rear tire bounced and upon hearing that somebody had been ran over.
Moreover, petitioner asserts that the Court of Appeals committed a grave
abuse of discretion in convicting him of the offense of simple negligence
resulting in homicide. Assuming arguendo that he failed to promptly stop his
vehicle, petitioner maintains that no prudent man placed in the same situation
could have foreseen the vehicular accident or could have stopped his vehicle
in time when its left rear tire bounced due to the following reasons: (1) the
victim was only a trespasser; (2) petitioner’s attention was focused on the
road and the students outside the school’s gate; and (3) the jeepney was fully
loaded with passengers and cargoes and it was impossible for the petitioner
to promptly stop his vehicle.25
The Office of the Solicitor-General (OSG) maintained that petitioner was
negligent when he continued to run towards the direction of Moog,
Laguindingan, dragging the victim a few meters from the point of impact,
despite hearing that a child had been run over.26
The presence or absence of negligence on the part of petitioner is determined
by the operative events leading to the death of Dayata which actually
comprised of two phases or stages. The first stage began when Dayata
flagged down the jeepney while positioned on the left side of the road and
ended when he was run over by the jeepney. The second stage covered the
span between the moment immediately after the victim was run over and the
point when petitioner put the jeepney to a halt.
During the first stage, petitioner was not shown to be negligent.
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.27
In Manzanares v. People,28 this Court convicted petitioner of the crime of
reckless imprudence resulting in multiple homicide and serious physical
injuries when he was found driving the Isuzu truck very fast before it
smashed into a jeepney.29 Likewise, in Pangonorom v. People, 30 a public
utility driver, who was driving very fast, failed to slow down and hit a
swerving car. He was found negligent by this Court.
In the instant case, petitioner was driving slowly at the time of the accident,
as testified to by two eyewitnesses. Prosecution witness Actub affirmed this
fact on cross-examination, thus:
ATTY. MACUA:
(to the witness)
Q Mr. Witness, when the passenger jeepney passed by the gate of the
Laguindingan National High School, is it running slowly, am I
correct?
A Yes, he was running slowly.31
The slow pace of the jeepney was seconded by Mellalos:
Q You testified that you heard somebody outside from the vehicle
shouting that a boy was ran over, am I correct?
A Yes, Sir.
Q Now, before you heard that shouting, did you observe any motion
from the vehicle?
 A The jeep was moving slowly and I noticed that there was
something that [sic] the jeep a little bit bounced up as if a hump
that’s the time I heard a shout from outside.32
Petitioner stated that he was driving at no more than 15 kilometers per hour. 33
It appears from the evidence Dayata came from the left side of the street.
Petitioner, who was driving the jeepney on the right lane, did not see the
victim flag him down. He also failed to see him go near the jeepney at the
left side. Understandably, petitioner was focused on the road ahead. In
Dayata’s haste to board the jeep which was then running, his feet somehow
got pinned to the left rear tire, as narrated by Bongolto. Actub only saw
Dayata after he heard a strong impact coming from the jeep.
With the foregoing facts, petitioner can not be held liable during the first
stage. Specifically, he cannot be held liable for reckless imprudence resulting
in homicide, as found by the trial court. The proximate cause of the accident
and the death of the victim was definitely his own negligence in trying to
catch up with the moving jeepney to get a ride.
In the instant case, petitioner had exercised extreme precaution as he drove
slowly upon reaching the vicinity of the school. He cannot be faulted for not
having seen the victim who came from behind on the left side.
However, the Court of Appeals found petitioner guilty of simple negligence
resulting in homicide for failing to stop driving at the time when he noticed
the bouncing of his vehicle. Verily, the appellate court was referring to the
second stage of the incident.
Negligence has been defined as the failure to observe for the protection of the
interests of another person that degree of care, precaution, and vigilance
which the circumstances justly demand, whereby such other person suffers
injury.34
The elements of simple negligence: are (1) that there is lack of precaution on
the part of the offender; and (2) that the damage impending to be caused is
not immediate or the danger is not clearly manifest. 35
The standard test in determining whether a person is negligent in doing an act
whereby injury or damage results to the person or property of another is this:
could a prudent man, in the position of the person to whom negligence is
attributed, foresee harm to the person injured as a reasonable consequence of
the course actually pursued? If so, the law imposes a duty on the actor to
refrain from that course or to take precautions to guard against its
mischievous results, and the failure to do so constitutes negligence.
Reasonable foresight of harm, followed by the ignoring of the admonition
born of this provision, is always necessary before negligence can be held to
exist.36
In Philippine National Construction Corporation v. Court of Appeals, 37 the
petitioner was the franchisee that operates and maintains the toll facilities in
the North and South Luzon Toll Expressways. It failed to exercise the
requisite diligence in maintaining the NLEX safe for motorists. The lighted
cans and lane dividers on the highway were removed even as flattened
sugarcanes lay scattered on the ground. The highway was still wet from the
juice and sap of the flattened sugarcanes. The petitioner should have foreseen
that the wet condition of the highway would endanger motorists passing by at
night or in the wee hours of the morning. 38 Consequently, it was held liable
for damages.
In an American case, Hernandez v. Lukas, 39 a motorist traveling within the
speed limit and did all was possible to avoid striking a child who was then
six years old only. The place of the incident was a neighborhood where
children were playing in the parkways on prior occasions. The court ruled
that it must be still proven that the driver did not exercise due care. The
evidence showed that the driver was proceeding in lawful manner within the
speed limit when the child ran into the street and was struck by the driver’s
vehicle. Clearly, this was an emergency situation thrust upon the driver too
suddenly to avoid.
In this case, the courts below zeroed in on the fact that petitioner did not stop
the jeepney when he felt the bouncing of his vehicle, a circumstance which
the appellate court equates with negligence. Petitioner contends that he did
not immediately stop because he did not see anybody go near his vehicle at
the time of the incident.40
Assuming arguendo that petitioner had been negligent, it must be shown that
his negligence was the proximate cause of the accident. Proximate cause is
defined as that which, in the natural and continuous sequence, unbroken by
any efficient, intervening cause, produces the injury, and without which the
result would not have
occurred.41 In order to establish a motorist's liability for the negligent
operation of a vehicle, it must be shown that there was a direct causal
connection between such negligence and the injuries or damages complained
of. Thus, negligence that is not a substantial contributing factor in the
causation of the accident is not the proximate cause of an injury. 42
The head injuries sustained by Dayata at the point of impact proved to be the
immediate cause of his death, as indicated in the post-mortem findings. 43 His
skull was crushed as a result of the accident. Had petitioner immediately
stopped the jeepney, it would still not have saved the life of the victim as the
injuries he suffered were fatal.
The evidence on record do not show that the jeepney dragged the victim after
he was hit and run over by the jeepney. Quite the contrary, the evidence
discloses that the victim was not dragged at all. In fact, it is the other way
around. Bongolto narrated that after the impact, he saw Dayata left behind
the jeepney.44 Actub saw Dayata in a prone position and bleeding within
seconds after impact.45 Right after the impact, Mellalos immediately jumped
out of the jeepney and saw the victim lying on the ground. 46 The distance of
5.70 meters is the length of space between the spot where the victim fell to
the ground and the spot where the jeepney stopped as observed by the trial
judge during the ocular inspection at the scene of the accident. 47
Moreover, mere suspicions and speculations that the victim could have lived
had petitioner stopped can never be the basis of a conviction in a criminal
case.48 The Court must be satisfied that the guilt of the accused had been
proven beyond reasonable doubt.49 Conviction must rest on nothing less than
a moral certainty of the guilt of the accused. The overriding consideration is
not whether the court doubts the innocence of the accused but whether it
entertains doubt as to his guilt.50
Clearly then, the prosecution was not able to establish that the proximate
cause of the victim’s death was petitioner’s alleged negligence, if at all, even
during the second stage of the incident.
If at all again, petitioner’s failure to render assistance to the victim would
constitute abandonment of one’s victim punishable under Article 275 of the
Revised Penal Code. However, the omission is not covered by the
information. Thus, to hold petitioner criminally liable under the provision
would be tantamount to a denial of due process.
Therefore, petitioner must be acquitted at least on reasonable doubt. The
award of damages must also be deleted pursuant to Article 2179 of the Civil
Code which states that when the plaintiff’s own negligence was the
immediate and proximate cause of his injury, he cannot recover damages.
WHEREFORE, the petition is GRANTED. The decision of the Court of
Appeals dated 12 July 2005 is REVERSED and SET ASIDE. Petitioner
Norman A. Gaid is ACQUITTED of the crime of Simple Negligence
Resulting in Homicide as found by the Court of Appeals and of the charge of
Reckless Imprudence Resulting in Homicide in Criminal Case No. 1937 of
the MCTC of Laguindingan, Misamis Oriental.
SO ORDERED.
G.R. No. 143363               February 6, 2002
ST. MARY'S ACADEMY, petitioner,
vs.
WILLIAM CARPITANOS and LUCIA S. CARPITANOS, GUADA
DANIEL, JAMES DANIEL II, JAMES DANIEL, SR., and VIVENCIO
VILLANUEVA, respondents.
DECISION
PARDO, J.:
The Case
The case is an appeal via certiorari from the decision1 of the Court of
Appeals as well as the resolution denying reconsideration, holding petitioner
liable for damages arising from an accident that resulted in the death of a
student who had joined a campaign to visit the public schools in Dipolog
City to solicit enrollment.
The Facts
The facts, as found by the Court of Appeals, are as follows:
"Claiming damages for the death of their only son, Sherwin Carpitanos,
spouses William Carpitanos and Lucia Carpitanos filed on June 9, 1995 a
case against James Daniel II and his parents, James Daniel Sr. and Guada
Daniel, the vehicle owner, Vivencio Villanueva and St. Mary’s Academy
before the Regional Trial Court of Dipolog City.
"On 20 February 1997, Branch 6 of the Regional Trial Court of Dipolog City
rendered its decision the dispositive portion of which reads as follows:
"‘WHEREFORE, PREMISES CONSIDERED, judgment is hereby rendered
in the following manner:
1. Defendant St. Mary’s Academy of Dipolog City, is hereby ordered to pay
plaintiffs William Carpitanos and Luisa Carpitanos, the following sums of
money:
a. FIFTY THOUSAND PESOS (P50,000.00) indemnity for the loss of life of
Sherwin S. Carpitanos;
b. FORTY THOUSAND PESOS (P40,000.00) actual damages incurred by
plaintiffs for burial and related expenses;
c. TEN THOUSAND PESOS (P10,000.00) for attorney’s fees;
d. FIVE HUNDRED THOUSAND PESOS (P500,000.00) for moral
damages; and to pay costs.
2. Their liability being only subsidiary, defendants James Daniel, Sr. and
Guada Daniel are hereby ordered to pay herein plaintiffs the amount of
damages above-stated in the event of insolvency of principal obligor St.
Mary’s Academy of Dipolog City;
3. Defendant James Daniel II, being a minor at the time of the commission of
the tort and who was under special parental authority of defendant St. Mary’s
Academy, is ABSOLVED from paying the above-stated damages, same
being adjudged against defendants St. Mary’s Academy, and subsidiarily,
against his parents;
4. Defendant Vivencio Villanueva is hereby ABSOLVED of any liability.
His counterclaim not being in order as earlier discussed in this decision, is
hereby DISMISSED.
IT IS SO ORDERED."’ (Decision, pp. 32-33; Records, pp. 205-206)."
"From the records it appears that from 13 to 20 February 1995, defendant-
appellant St. Mary’s Academy of Dipolog City conducted an enrollment
drive for the school year 1995-1996. A facet of the enrollment campaign was
the visitation of schools from where prospective enrollees were studying. As
a student of St. Mary’s Academy, Sherwin Carpitanos was part of the
campaigning group. Accordingly, on the fateful day, Sherwin, along with
other high school students were riding in a Mitsubishi jeep owned by
defendant Vivencio Villanueva on their way to Larayan Elementary School,
Larayan, Dapitan City. The jeep was driven by James Daniel II then 15 years
old and a student of the same school. Allegedly, the latter drove the jeep in a
reckless manner and as a result the jeep turned turtle.
"Sherwin Carpitanos died as a result of the injuries he sustained from the
accident."2
In due time, petitioner St. Mary’s academy appealed the decision to the Court
of Appeals.3
On February 29, 2000, the Court of Appeals promulgated a decision reducing
the actual damages to P25,000.00 but otherwise affirming the decision a quo,
in toto.4
On February 29, 2000, petitioner St. Mary’s Academy filed a motion for
reconsideration of the decision. However, on May 22, 2000, the Court of
Appeals denied the motion.5
Hence, this appeal.6
The Issues
1) Whether the Court of Appeals erred in holding the petitioner liable
for damages for the death of Sherwin Carpitanos.
2) Whether the Court of Appeals erred in affirming the award of
moral damages against the petitioner.
The Court’s Ruling
We reverse the decision of the Court of Appeals.
The Court of Appeals held petitioner St. Mary’s Academy liable for the death
of Sherwin Carpitanos under Articles 2187 and 2198 of the Family Code,
pointing out that petitioner was negligent in allowing a minor to drive and in
not having a teacher accompany the minor students in the jeep.
Under Article 218 of the Family Code, the following shall have special
parental authority over a minor child while under their supervision,
instruction or custody: (1) the school, its administrators and teachers; or (2)
the individual, entity or institution engaged in child care. This special
parental authority and responsibility applies to all authorized activities,
whether inside or outside the premises of the school, entity or institution.
Thus, such authority and responsibility applies to field trips, excursions and
other affairs of the pupils and students outside the school premises whenever
authorized by the school or its teachers.9
Under Article 219 of the Family Code, if the person under custody is a
minor, those exercising special parental authority are principally and
solidarily liable for damages caused by the acts or omissions of the
unemancipated minor while under their supervision, instruction, or custody. 10
However, for petitioner to be liable, there must be a finding that the act or
omission considered as negligent was the proximate cause of the injury
caused because the negligence must have a causal connection to the
accident.11
"In order that there may be a recovery for an injury, however, it must be
shown that the ‘injury for which recovery is sought must be the legitimate
consequence of the wrong done; the connection between the negligence and
the injury must be a direct and natural sequence of events, unbroken by
intervening efficient causes.’ In other words, the negligence must be the
proximate cause of the injury. For, ‘negligence, no matter in what it consists,
cannot create a right of action unless it is the proximate cause of the injury
complained of.’ And ‘the proximate cause of an injury is that cause, which,
in natural and continuous sequence, unbroken by any efficient intervening
cause, produces the injury, and without which the result would not have
occurred.’"12
In this case, the respondents failed to show that the negligence of petitioner
was the proximate cause of the death of the victim.
Respondents Daniel spouses and Villanueva admitted that the immediate
cause of the accident was not the negligence of petitioner or the reckless
driving of James Daniel II, but the detachment of the steering wheel guide of
the jeep.
In their comment to the petition, respondents Daniel spouses and Villanueva
admitted the documentary exhibits establishing that the cause of the accident
was the detachment of the steering wheel guide of the jeep. Hence, the cause
of the accident was not the recklessness of James Daniel II but the
mechanical defect in the jeep of Vivencio Villanueva. Respondents,
including the spouses Carpitanos, parents of the deceased Sherwin
Carpitanos, did not dispute the report and testimony of the traffic investigator
who stated that the cause of the accident was the detachment of the steering
wheel guide that caused the jeep to turn turtle.
Significantly, respondents did not present any evidence to show that the
proximate cause of the accident was the negligence of the school authorities,
or the reckless driving of James Daniel II. Hence, the respondents’ reliance
on Article 219 of the Family Code that "those given the authority and
responsibility under the preceding Article shall be principally and solidarily
liable for damages caused by acts or omissions of the unemancipated minor"
was unfounded.
Further, there was no evidence that petitioner school allowed the minor
James Daniel II to drive the jeep of respondent Vivencio Villanueva. It was
Ched Villanueva, grandson of respondent Vivencio Villanueva, who had
possession and control of the jeep. He was driving the vehicle and he allowed
James Daniel II, a minor, to drive the jeep at the time of the accident.
Hence, liability for the accident, whether caused by the negligence of the
minor driver or mechanical detachment of the steering wheel guide of the
jeep, must be pinned on the minor’s parents primarily. The negligence of
petitioner St. Mary’s Academy was only a remote cause of the accident.
Between the remote cause and the injury, there intervened the negligence of
the minor’s parents or the detachment of the steering wheel guide of the jeep.
"The proximate cause of an injury is that cause, which, in natural and
continuous sequence, unbroken by any efficient intervening cause, produces
the injury, and without which the result would not have occurred." 13
Considering that the negligence of the minor driver or the detachment of the
steering wheel guide of the jeep owned by respondent Villanueva was an
event over which petitioner St. Mary’s Academy had no control, and which
was the proximate cause of the accident, petitioner may not be held liable for
the death resulting from such accident.
Consequently, we find that petitioner likewise cannot be held liable for moral
damages in the amount of P500,000.00 awarded by the trial court and
affirmed by the Court of Appeals.
Though incapable of pecuniary computation, moral damages may be
recovered if they are the proximate result of the defendant’s wrongful act or
omission.14 In this case, the proximate cause of the accident was not
attributable to petitioner.
For the reason that petitioner was not directly liable for the accident, the
decision of the Court of Appeals ordering petitioner to pay death indemnity
to respondent Carpitanos must be deleted. Moreover, the grant of attorney’s
fees as part of damages is the exception rather than the rule. 15 The power of
the court to award attorney’s fees under Article 2208 of the Civil Code
demands factual, legal and equitable justification. 16 Thus, the grant of
attorney’s fees against the petitioner is likewise deleted.
Incidentally, there was no question that the registered owner of the vehicle
was respondent Villanueva. He never denied and in fact admitted this
fact.1âwphi1 We have held that the registered owner of any vehicle, even if
not used for public service, would primarily be responsible to the public or to
third persons for injuries caused the latter while the vehicle was being driven
on the highways or streets."17 Hence, with the overwhelming evidence
presented by petitioner and the respondent Daniel spouses that the accident
occurred because of the detachment of the steering wheel guide of the jeep, it
is not the school, but the registered owner of the vehicle who shall be held
responsible for damages for the death of Sherwin Carpitanos.
The Fallo
WHEREFORE, the Court REVERSES and SETS ASIDE the decision of
the Court of Appeals18 and that of the trial court. 19 The Court remands the
case to the trial court for determination of the liability of defendants,
excluding petitioner St. Mary’s Academy, Dipolog City.
No costs.
SO ORDERED.
G.R. No. 163879               July 30, 2014
DR. ANTONIO P. CABUGAO, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES and SPOUSES RODOLFO M.
PALMA and ROSARIO F. PALMA, Respondents.
x-----------------------x
G.R. No. 165805
DR. CLENIO YNZON, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES and SPOUSES RODOLFO M.
PALMA AND ROSARIO F. PALMA, Respondents.
DECISION
PERALTA, J.:
Before this Court are appeals via Rule 45 from the Decision 1 dated June 4,
2004 of the Court of Appeals in CA-G.R. CR No. 27293, affirming the
Decision2 dated February 28,2003 of the Regional Trial Court (RTC),
convicting appellant Dr. Antonio P. Cabugao (Dr. Cabugao) and Dr. Clenio
Ynzon (Dr. Ynzon) of the crime of Reckless Imprudence Resulting to
Homicide.
The Information3 alleged –
That on or about June 17, 2000in the City of Dagupan, Philippines, and
within the jurisdiction of this Honorable Court, the abovenamed accused,
DR. ANTONIO P.CABUGAO and DR. CLENIO YNZON, being then the
attending physicians of one RODOLFO PALMA, JR., a minor 10 years old,
confederating and acting jointly with one another, did, then and there,
willfully, unlawfully and feloniously fail through negligence, carelessness
and imprudence to perform immediate operation upon their patient,
RODOLFO PALMA, JR. of acute appendicitis, when they, the said
physicians, should have been done so considering that examinations
conducted upon their patient Rodolfo Palma, Jr. seriously manifest todo so,
causing by such negligence, carelessness, and imprudence the victim,
RODOLFO PALMA JR., to die due to:
"CARDIORESPIRATORY ARREST, METABOLIC
ENCEPHALOPATHY, SEPTICEMIA (ACUTE APPENDICITIS),
CEREBRAL ANEURYSM RUPTURED (?)"
As per Certificate of Death issued by accused Dr. Antonio P. Cabugao, to the
damage and prejudice of the legal heirs of said deceased RODOLFO
PALMA, JR. and other consequential damages relative thereto.
CONTRARY to Article 365, 1st par. of the Revised Penal Code.
Dagupan City, Philippines, January 29, 2001.
Arising from the same events, the Court resolved to consolidate these
cases.4 The facts, as culled from the records, are as follows:
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 sameafternoon, 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 familymedicine 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 returnedto 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. 5
Blood samples were taken from JR for laboratory testing. The complete
blood count conveyed the following result: wbc – 27.80 x 10 9/L;
lymphocytes – 0.10 and neutrophils – 0.90. Diagnostic ultrasound was
likewise conducted on the patient's lower abdomen by radiologist, Dr. Ricky
V. Querubin, with the following findings:
Normal liver, bile ducts, gallbladder, pancreas, spleen, kidneys and urinary
bladder.
There is no free peritoneal fluid.
There is localized tenderness in the paraumbilical region, more so in the
supra and right paraumbilical areas.
There is a vague elongated hypoechoic focus in the right periumbilical region
roughly about 47 x 18 mm surrounded by undistended gas-filled bowels.
This is suggestive of an inflammatory process wherein appendiceal or
periappendiceal pathology cannot be excluded. Clinical correlation is
essential."6
Dr. Cabugao did a rectal examination noting the following: "rectal: good
sphincter, negative tenderness, negative mass." The initial impression was
Acute Appendicitis,7 and hence, he referred the case to his co-accused, Dr.
Ynzon, a surgeon.8 In the later part of the morning of June 15, 2000, Dr.
Ynzon went to the hospital and readthe CBC and ultrasound results. The
administration of massive antibiotics and pain reliever to JRwere 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 noticeda swelling in his scrotum. In the afternoon of the same
day, JR vomitted 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 gaveorders via telephone.9 Accused continued medications to
alleviate JR's abdominal spasms and diarrhea. By midnight, JR again
vomitted 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 (1 ampule) and Valium (1 ampule). 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.
The Death Certificate10 dated June 19, 2000 prepared by Dr. Cabugao
indicated the following causes of death:
Immediate cause: CARDIORESPIRATORY ARREST
Antecedent cause: METABOLIC ENCEPHALOPATHY
Underlying cause: SEPTICEMIA (ACUTE APPENDICITIS)
Other significant conditionscontributing to death:
CEREBRAL ANEURYSM RUPTURED (?)
No post-mortem examination was conducted on JR. On February 1, 2001, an
Information was filed against accused for reckless imprudence resulting to
homicide. At their arraignment, both accused, duly assisted by counsel,
pleaded not guilty to the charge.
On February 28, 2003, in convicting both the accused, the trial court found
the following circumstances as sufficient basis to conclude that accused were
indeed negligent in the performance of their duties:
It is unquestionable that JR was under the medical care of the accused from
the time of his admission for confinement at the Nazareth General Hospital
until his death. Upon his admission, the initial working diagnosis was to
consider acute appendicitis. To assist the accused in the consideration of
acute appendicitis, Dr. Cabugao requested for a complete blood count (CBC)
and a diagnostic ultrasound on JR. The findings of the CBC and ultrasound
showed that an inflammatory process or infection was going on inside the
body of JR. Said inflammatory process was happening in the periumbilical
region where the appendix could be located. The initial diagnosis of acute
appendicitis appears to be a distinct possibility. x x x.
Dr. Ynzon ordered medications to treat the symptoms being manifested by
JR. Thereafter, he ordered that JR be observed for 24 hours. However, the
accused, as the attending physicians, did not personally monitor JR in order
to check on subtle changes that may occur. Rather, they left the monitoring
and actual observation to resident physicians who are just on residency
training and in doing so, they substituted their own expertise, skill and
competence with those of physicians who are merely new doctors still on
training. Not having personally observed JR during this 24-hour critical
period of observation, the accused relinquished their duty and thereby were
unable to give the proper and correct evaluation as to the real condition of
JR. In situations where massive infection is going on as shown by the
aggressive medication of antibiotics, the condition of the patient is serious
which necessitated personal, not delegated, attention of attending physicians,
namely JR and the accused in this case.
xxxx
Throughout the course of the hospitalization and treatment of JR, the accused
failed to address the acute appendicitis which was the initial diagnosis. They
did not take steps to find out if indeed acute appendicitis was what was
causing the massive infection that was ongoing inside the body of JR even
when the inflammatory process was located at the paraumbilical region
where the appendix can be located. x x x
There may have been other diseases but the records do not show that the
accused took steps to find outwhat disease exactly was plaguing JR. It was
their duty to find out the disease causing the health problem of JR, but they
did not perform any process of elimination. Appendicitis, according to expert
testimonies, could be eliminated only by surgery but no surgery was done by
the accused. But the accused could not have found out the real disease of JR
because they were treating merely and exclusively the symptoms by means
of the different medications to arrest the manifested symptoms. In fact, by
treating the symptoms alone, the accused were recklessly and wantonly
ignoring the same as signs of the graver health problem of JR. This gross
negligence on the part of the accused allowed the infection to spread inside
the body of JR unabated. The infection obviously spread so fastand was so
massive that within a period of only two and a half (2 ½) days from the day
of admission to the hospital on June 15, 2000, JR who was otherwise healthy
died [of] Septicemia (Acute Appendicitis) on June 17, 2000. 11
On June 4, 2004, in affirming the accused' conviction, the Court of Appeals
gave similar observations, to wit:
The foregoing expert testimony clearly revealed such want of reasonable
skill and care on the part of JR's attending physicians, appellants Dr.
Cabugao and Dr. Ynzon in neglecting to monitor effectively and sufficiently
the developments/changes during the observation period and act upon the
situation after said 24-hour period when his abdominal pain subsisted, his
condition even worsened with the appearance of more serious symptoms of
nausea, vomiting and diarrhea. Considering the brief visit only made on
regular rounds, the records clearly show such gross negligence in failing to
take appropriate steps to determine the real cause of JR's abdominal pain so
that the crucial decision to perform surgery (appendectomy) had even been
ruled out precisely because of the inexcusable neglect to undertake
suchefficient diagnosis by process of elimination, as correctly pointed out by
the trial court. As has been succinctly emphasized by Dr. Mateo, acute
appendicitis was the working diagnosis, and with the emergence of
symptoms after the 24-hour observation (high fever, vomiting, diarrhea) still,
appellants ruled out surgery, not even considering exploratory laparoscopy.
Dr. Mateo also expressed the opinion that the decision to operate could have
been made after the result of the ultrasound test, considering that acute
appendicitis was the initial diagnosis by Dr. Cabugao after he had conducted
a rectal examination.
Medical records buttress the trial court's finding that in treating JR,
appellants have demonstrated indifference and neglect of the patient's
condition as a serious case. Indeed, appendicitis remains a clinical
emergencyand a surgical disease, as correctly underscored by Dr. Mateo, a
practicing surgeon who has already performed over a thousand
appendectomy. In fact, appendectomy is the only rational therapy for acute
appendicitis; it avoids clinical deterioration and may avoid chronic or
recurrent appendicitis. Although difficult, prompt recognition and immediate
treatment of the disease prevent complications. Under the factual
circumstances, the inaction, neglect and indifference of appellants who, after
the day of admission and after being apprised of the ongoing infection from
the CBC and initial diagnosis as acute appendicitis from rectal examination
and ultrasound testand only briefly visited JR once during regular rounds and
gave medication orders by telephone – constitutes gross negligenceleading to
the continued deterioration of the patient, his infection having spread in
sofast a pace that he died within just two and a half (2 ½) days’ stay inthe
hospital. Authorities state that if the clinical picture is unclear a short period
of 4 to 6 hours of watchful waiting and a CT scan may improve diagnostic
accuracy and help to hasten diagnosis.Even assuming that JR's case had an
atypical presentation in view of the location of his appendix, laboratory tests
could have helped to confirm diagnosis, as Dr. Mateo opined thatthe
possibility of JR having a retrocecal appendicitis should have been a strong
consideration. Lamentably, however, as found by the trial court, appellants
had not taken steps towards correct diagnosis and demonstrated laxity even
when JR was already running a high fever in the morning of June 17, 2000
and continued vomiting with diarrhea, his abdominal pain becoming more
intense. This is the reason why private complainants were not even apprised
of the progress of appellants' diagnosis – appellants have nothing to report
because they did nothing towards the end and merely gave medications to
address the symptoms.12
Thus, these appeals brought beforethis Court raising the following
arguments:
I CARE APPLIED BY PETITIONER DR. CABUGAO;
WHETHER THE CAUSE OF ACCUSATION AS CONTAINED IN THE
INFORMATION IS "FAILURE TO PERFORM IMMEDIATE
OPERATION UPON THE PATIENT ROFOLFO PALMA JR. OF ACUTE
APPENDICITIS;
II
WHETHER THE SUBJECT INFORMATION APPEARS TO HAVE
ACCUSED BOTH ACCUSED DOCTORS OF CONSPIRACY AND THE
APPEALED DECISION SEEMS TO HAVE TREATED BOTH ACCUSED
DOCTORS TO BE IN CONSPIRACY;
III
WHETHER PETITIONER DR. CABUGAO IS A GENERAL
PRACTITIONER (NOT A SURGEON) AND HAVE EXCLUDED
SURGERY FROM THE LIMITS OFHIS PRACTICE, AND IT WAS NOT
AND NEVER HIS DUTY TO OPERATE THE PATIENT RODOLFO
PALMA JR., THAT WAS WHY HE REFERRED SUBJECT PATIENT TO
A SURGEON, DR. CLENIO YNZON;
IV
WHETHER THE DEFENSE NEVER STATED THAT THERE IS
GUARANTEE THAT DOING SURGERY WOULD HAVE SAVED THE
PATIENT;
V
WHETHER THE WITNESSES FOR THE PROSECUTION INCLUDING
PROSECUTION'S EXPERT WITNESSES EVER DECLARED/TESTIFIED
THAT PETITIONER DR. CABUGAO HAD THE DUTY TO PERFORM
IMMEDIATE OPERATION ON RODOLFO PALMA, JR., AND THEY
FAILED TO STATE/SHOW THAT THE PROXIMATE CAUSE OF
DEATH OF JR WAS ACUTE APPENDICITIS;
VI
WHETHER THE EXPERT WITNESSES PRESENTED BY THE
PROSECUTION EVER QUESTIONED THE MANAGEMENT AND
VII
WHETHER THE EXPERT WITNESSES PRESENTED BY THE
DEFENSE ARE UNANIMOUS IN APPROVING THE METHOD OF
TREATMENT APPLIED BY BOTH ACCUSED DOCTORS ON SUBJECT
PATIENT, AND THEY DECLARED/AFFIRMED THAT THEY WOULD
FIRST PLACE SUBJECT THE PATIENT UNDER OBSERVATION, AND
WOULD NOT PERFORM IMMEDIATE OPERATION;
VIII
WHETHER THE CONVICTION OF PETITIONER DR. YNZON WAS
ESTABLISHED WITH THE REQUIRED QUANTUM OF PROOF
BEYOND REASONABLE DOUBT THAT THE PATIENT WAS
SPECIFICALLY SUFFERING FROM AND DIED OF ACUTE
APPENDICITIS; and
IX
WHETHER THE FAILURE TO CONDUCT THE SPECIFIC SURGICAL
OPERATION KNOWN AS APPENDECTOMY CONSTITUTED
CRIMINAL NEGLIGENCE.
In a nutshell, the petition brought before this Court raises the issue of
whether or not petitioners' conviction of the crime of reckless imprudence
resulting in homicide, arising from analleged medical malpractice, is
supported by the evidence on record.
Worth noting is that the assigned errors are actually factual in nature, which
as a general rule, findings of factof the trial court and the Court of Appeals
are binding and conclusiveupon this Court, and we will not normally disturb
such factual findings unless the findings of the court are palpably
unsupported by the evidence on record or unless the judgment itself is based
on misapprehension of facts. Inthe instant case, we find the need to make
certain exception.
AS TO DR. YNZON'S LIABILITY:
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 precautionon the part of the person performing or failing
to perform such act.13 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 bewithout 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. 14
With respect to Dr. Ynzon, all the requisites of the offense have been clearly
established by the evidence on record. The court a quoand the appellate court
were one in concluding that Dr. Ynzon failed to observe the required
standard of care expected from doctors.
In the instant case, it was sufficiently established that to prevent certain
death, it was necessary to perform surgery on JR immediately. Even the
prosecution’s own expert witness, Dr. Antonio Mateo, 15 testified during
cross-examination that he would perform surgery on JR:
ATTY. CASTRO:
Q. Given these data soft non-tender abdomen, ambulatory, watery diarrhea,
Exhibit C which is the ultrasound result, with that laboratory would you
operate the patient?
A Yes, I would do surgery.
Q And you should have done surgery with this particular case?"
A Yes, sir.16
xxxx
COURT:
Q You stated a while ago doctor thatyou are going to [do] surgery to the
patient, why doctor, if you are notgoing to do surgery, what will happen?
A If this would be appendicitis, the usual progress would be that it would be
ruptured and generalized peritonitis and eventually septicemia, sir.
Q What do you mean by that doctor?
A That means that infection would spread throughout the body, sir.
Q If unchecked doctor, what will happen?
A It will result to death.17
xxxx
Q And what would have you doneif you entertain other considerations from
the time the patient was admitted?
A From the time the patient was admitted until the report of the sonologist, I
would have made a decision by then.
Q And when to decide the surgery would it be a particular exact time, would
it be the same for all surgeons?
A If you are asking acute appendicitis, it would be about 24 hours because
acute appendicitis is a 24-hour disease, sir.
Q. And would it be correct to say that it depends on the changes on the
condition of the patient?
A. Yes, sir.
Q. So, are you saying more than 24 hours when there are changes?
A. If there are changes in the patient pointing towards appendicitis then you
have to decide right there and then, sir.
Q. So if there are changes in the patient pointing to appendicitis?
A. It depends now on what you are trying to wait for in the observation
period, sir.
Q. So precisely if the change is a condition which bring you in doubt that
there is something else other than appendicitis, would you extend over a
period of 24 hours?
A. It depends on the emergent development, sir.
Q. That is the point, if you are the attending physician and there is a change
not pointing to appendicitis, would you extend over a period of 24 hours?
A. In 24 hours you have to decide, sir.
xxxx
Q. And that is based on the assessment of the attending physician?
A. Yes, sir.18
Dr. Mateo further testified on cross-examination:
ATTY. CASTRO:
Q: So you will know yourself, as far as the record is concerned, because if
you will agree with me, you did not even touch the patient?
A. Yes, I based my opinion on what is put on record, sir. The records show
that after the observation period, the abdominal pain is still there plus there
are already other signs and symptoms which are not seen or noted.
Q. But insofar as you yourself not having touched the abdomen of the
patient, would you give a comment on that?
A. Yes, based on the record, after 24 hours of observation, the pain
apparently was still there and there was more vomiting and there was
diarrhea. In my personal opinion, I think the condition of the patient was
deteriorating.
Q. Even though you have not touched the patient?
A. I based on what was on the record, sir.19
From the foregoing, it is clear that if JR’s condition remained unchecked it
would ultimately result in his death, as what actually happened in the present
case. Another expert witness for the defense, Dr. Vivencio Villaflor, Jr.
testified on direct examination that he would perform a personal and
thorough physical examination of the patient as frequent as every 4 to 6
hours, to wit:
ATTY. CASTRO:
Q. As an expert doctor, if you were faced with a history of abdominal pain
with nausea, vomiting, fever, anurecia (sic), elevated white blood cell count,
physical examination of a positive psoas sign, observation of the sonologist
of abdominal tenderness and the ultrasound findings of the probability of
appendiceal (sic) pathology, what will you do if you have faced these
problems, Doctor?
A. I will examine the patient thoroughly and it will depend on my physical
examination and that isprobably every 4 to 6 hours, sir.20
On cross-examination, Dr. Villaflor affirmed:
Cross Exam. By Atty. Marteja:
Q. x x x However, there are corrections and admissions made at that time,
your Honor, do I understand thatT/C does not mean ruled out but rather to
consider the matter?
A. Yes, now that I have seen the records of the patient, it says here,
impression and T/C means to consider the appendicitis.
Q. Isn't it that it is worth then to say that the initial working diagnosis on
Rodolfo Palma, Jr., otherwise known as JR, to whom I shall now refer to as
JR, the primary consideration then is acute appendicitis, is that correct to say
Doctor?
A. I think so, that is the impression.
Q. x x x Now if it is to be considered as the primary consideration in the
initial working diagnosis, isn't it a fact that it has tobe ruled out in order to
consider it as not the disease of JR?
A. Yes. Sir.
Q. Isn't it a fact thatto rule out acute appendicitis as not the disease of JR,
surgery or operation must be done, isn't it Doctor?
A. You have to correlate all the findings.
Q. Is it yes or no, Doctor?
A. Yes.
Q. So, you are saying then that in order to rule out acute appendicitis there
must be an operation, that is right Doctor?
A. No, sir. If your diagnosis is toreally determine if it is an acute
appendicitis, you have to operate.21
xxxx
Q. Now Doctor, considering the infection, considering that there was a
[symptom] that causes pain, considering that JR likewise was feverish and
that he was vomiting, does that not show a disease of acute appendicitis
Doctor?
A. Its possible.
Q. So that if that is possible, are we getting the impression then Doctor what
you have earlier mentioned that the only way to rule out the suspect which is
acute appendicitis is by surgery, you have said that earlier Doctor, I just want
any confirmation of it?
A. Yes, sir.22
Verily, whether a physician or surgeon has exercised the requisite degree of
skill and care in the treatment of his patient is, in the generality of cases, a
matter of expert opinion. The deference of courts to the expert opinions of
qualified physicians stems from its realization that the latter possess unusual
technical skills which laymen in most instances are incapable of intelligently
evaluating.23 From the testimonies of the expert witnesses presented, it was
irrefutably proven that Dr. Ynzon failed to practice that degree of skill and
care required in the treatment of his patient.
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 developmentsand 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 JRbriefly 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-onduty
could likewise monitor the patient’scondition, 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 tooverrule appendectomy despite the initial diagnosis of
appendicitis. Neitherwas there any showing that he was entertaining another
diagnosis nor he took appropriate steps towards another diagnosis.
Among the elements constitutive of reckless imprudence, what perhaps is
most central to a finding of guilt is the conclusive determination that the
accused has exhibited, by his voluntary act without malice, an inexcusable
lack of precaution. It is that which supplies the criminal intent so
indispensable as tobring an act of mere negligence and imprudence under the
operation of the penal law. This is because a conscious indifference to the
consequences of the conduct is all that is required from the standpoint of the
frame of mind of the accused. 24 Quasioffenses penalize the mental attitudeor
condition behind the act, the dangerous recklessness, the lack of care or
foresight, the "imprudencia punible," unlike willful offenses which punish
the intentional criminal act. 25 This is precisely where this Court found Dr.
Ynzon to be guilty of - his seemingly indifference to the deteriorating
condition of JR that he as a consequence, failed to exercise lack of precaution
which eventually led to JR's death.
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.26 Sadly, Dr. Ynzon did not display that degree of
care and precaution demanded by the circumstances.
AS TO DR. CABUGAO'S LIABILITY:
Every criminal conviction requires of the prosecution to prove two things —
the fact of the crime, i.e., the presence of all the elements of the crime for
which the accused stands charged, and the fact that the accused is the
perpetrator of the crime. Based on the above disquisitions, however, the
prosecution failed to prove these two things. The Court is not convinced with
moral certainty that Dr. Cabugao isguilty of reckless imprudence as the
elements thereof were not proven by the prosecution beyond a reasonable
doubt.
Both the trial court and the appellate court bewail the failure to perform
appendectomy on JR, or the failure to determine the source of infection
which caused the deterioration of JR's condition. However, a review of the
records fail to show that Dr. Cabugao is in any position to perform the
required appendectomy.
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;27 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. Dr. Mateo, the prosecution’s
expert witness, emphasized the role of the surgeon during direct examination,
to wit:
ATTY. MARTEJA:
Q. You had mentioned that under this circumstances and condition, you have
mentioned that surgery is the solution, would you have allowed then a 24
hour observation?
A. If there is a lingering doubt, inshort period of observation of 18-24 hours
can be allowed provided that there would be close monitoring of the patient,
sir.
Q. Would you please tell us who would be doing the monitoring doctor?
A. The best person should be the first examiner, the best surgeon, sir.
Q. So that would you say that it is incumbent on the surgeon attending to the
case to have been the one to observe within the period of observation?
A. Yes, because he will be in the best position to observe the sudden changes
in the condition of the patient, sir.
Q. And how often would in your experience doctor, how often would the
surgeon re-assist (sic) the condition of the patient during the period of
observation?
A. Most foreign authors would recommend every four (4) hours, some
centers will recommend hourly or every two hours but here in the
Philippines, would recommend for 4 to 6 hours, sir.28
Dr. Cabugao’s supervision does not cease upon his endorsement of his
patient to the surgeon. Here, Dr. Cabugao has shown to have exerted all
efforts to monitor his patient and under these circumstances he did not have
any cause to doubt Dr. Ynzon’s competence and diligence. Expert
testimonies have been offered to prove the circumstances surrounding the
case of JR and the need to perform an operation. Defense witness, Dr.
Villaflor, on cross examination testified, to wit:
Q. Isn't it a fact that torule out acute appendicitis as notthe disease of JR,
surgery or operation mustbe done, isn't it Doctor?
A. You have to [correlate] all the findings.
Q. Is it yes or no, Doctor?
A. Yes.
Q. So, you are saying then that in order to rule out acute appendicitis there
must be an operation, that is right Doctor?
A. No, sir. If your diagnosis is to really determine if it is an acute
appendicitis, you have to operate.29
xxxx
Q. Now Doctor, considering the infection, considering that there was a
[symptom] that causes pain, considering that JR likewise was feverish and
that he was vomitting, does that not show a disease of acute appendicitis
Doctor?
A. It’s possible.
Q. So that if that is possible, are we getting the impression then Doctor what
you have earlier mentioned that the only way to rule out the suspect which is
acute appendicitis is by surgery, you have said that earlier Doctor, I just want
any confirmation of it?
A. Yes, sir.30
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 was 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 JRto 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.31
We likewise note that Dr. Cabugao was out of town when JR's condition
began to deteriorate. Even so, before he left, he made endorsement and
notified the resident-doctor and nurses-on-duty that he will be on leave.
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.32 Thus, the accused-doctors to be found guilty of reckless imprudence
resulting in homicide, it must be shown that both accused-doctors
demonstratedan act executed without malice or criminal intent – but with
lack of foresight, carelessness, or negligence. Noteworthy, the evidence on
record clearly points to the reckless imprudence of Dr. Ynzon; however, the
same cannot be said in Dr. Cabugao's case.
AS TO CIVIL LIABILITY
While this case is pending appeal, counsel for petitioner Dr. Ynzon informed
the Court that the latter died on December 23, 2011 due to "multiorgan
failure" as evidenced by a copy of death certificate. 33 Thus, the effect of
death, pending appeal of his conviction of petitioner Dr. Ynzon with regard
to his criminal and pecuniary liabilities should be in accordance to People v.
Bayotas,34 wherein the Court laid down the rules in case the accused dies
prior to final judgment:
1. Death of the accused pending appeal of his conviction
extinguishes his criminal liability as well as the civil liability based
solely thereon. As opined by Justice Regalado, in this regard, "the
death of the accused prior to final judgment terminates his criminal
liability and only the civil liability directly arising from and based
solely on the offense committed, i.e.,civil liability ex delictoin senso
strictiore."
2. Corollarily, the claim for civil liability survives notwithstanding
the death of accused, if the same may also be predicated on a source
of obligation other than delict. Article 1157 of the Civil Code
enumerates these other sources of obligation fromwhich the civil
liability may arise as a result of the same act or omission:
a) Law
b) Contracts
c) Quasi-contracts
d) x x x x x x x x x
e) Quasi-delicts
3. Where the civil liability survives, as explained in Number 2 above,
an action for recovery therefor may be pursued but only by way of
filing a separate civil action and subject to Section 1, Rule 111 of the
1985 Rules on Criminal Procedure as amended. This separate civil
action may be enforced either againstthe executor/administrator or
the estate of the accused, depending on the source of obligation upon
which the same is based as explained above.
4. Finally, the private offended party need not fear a forfeiture of his
right to file this separate civil action by prescription, in cases where
during the prosecution of the criminal action and prior to its
extinction, the private-offended party instituted together therewith
the civil action. In such case, the statute of limitationson the civil
liability is deemed interrupted during the pendency of the criminal
case, conformably with provisions of Article 1155 of the Civil Code,
that should thereby avoid any apprehension on a possible privation
of right by prescription.35
In view of the foregoing, it is clear that the death of the accused Dr. Ynzon
pending appeal of his conviction extinguishes his criminal liability. However,
the recovery of civil liability subsists as the same is not based on delictbut by
contract and the reckless imprudence he was guilty of under Article 365 of
the Revised Penal Code.1âwphi1 For this reason, a separate civil action may
be enforced either against the executor/administrator or the estate of the
accused, depending on the source of obligation upon which the same is
based,36 and in accordance with Section 4, Rule 111 of the Rules on Criminal
Procedure, we quote:
Sec. 4. Effect of death on civil actions. – The death of the accused after
arraignment and during the pendency of the criminal action shall extinguish
the civil liability arising from the delict. However, the independent civil
action instituted under section 3 of this Rule or which thereafter is instituted
to enforce liability arising from other sources of obligation may be continued
against the estate or legal representative of the accused after proper
substitution or against said estate, as the case may be. The heirs of the
accused may besubstituted for the deceased without requiring the
appointment of an executor or administrator and the court may appoint a
guardian ad litem for the minor heirs.
The court shall forthwith order said legal representative or representatives to
appear and be substituted within a period of thirty (30) days from notice.
A final judgment entered in favor of the offended party shall be enforced in
the manner especially provided in these rules for prosecuting claims against
the estate of the deceased.
If the accused dies before arraignment, the case shall be dismissed without
prejudice to any civil action the offended party may file against the estate of
the deceased. (Emphases ours)
In sum, upon the extinction of the criminal liability and the offended party
desires to recover damages from the same act or omission complained of, the
party may file a separate civil action based on the other sources of obligation
in accordance with Section 4, Rule 111. 37 If the same act or omission
complained of arises from quasi-delict,as in this case, a separate civil action
must be filed against the executor or administrator of the estate of the
accused, pursuant to Section 1, Rule 87 of the Rules of Court: 38
Section 1. Actions which may and which may not be brought against
executor or administrator. — No action upon a claim for the recovery of
money or debtor interest thereon shall be commenced against the executor or
administrator; but to recover real or personal property, or an interest therein,
from the estate, or to enforce a lien thereon, and actions to recover damages
for an injury to person or property, real or personal, may be commenced
against him. (Emphases ours)
heirs of JR must choose which of the available causes of action for damages
they will bring.
WHEREFORE, premises considered, petitioner DR. ANTONIO P.
CABUGAO is hereby ACQUITTEDof the crime of reckless imprudence
resulting to homicide.
Due to the death of accused Dr. Clenio Ynzon prior to the disposition of this
case, his criminal liability is extinguished; however, his civil liability
subsists. A separate civil action may be filed either against the
executor/administrator, or the estateof Dr. Ynzon, depending on the source of
obligation upon which the same are based.
SO ORDERED.

Conversely, if the offended party desires to recover damages from the same
act or omission complained of arising from contract, the filing of a separate
civil action must be filed against the estate, pursuant to Section 5, Rule 86 of
the Rules of Court, to wit:

Section 5. Claims which must be filed under the notice. If not filed, barred;
exceptions. — All claims for money against the decent, arising from
contract, express or implied, whether the same be due, not due, or contingent,
all claims for funeral expenses and expense for the last sickness of the
decedent, and judgment for money against the decent, must be filed within
the time limited in the notice; otherwise they are barred forever, except that
they may be set forth as counterclaims in any action that the executor or
administrator may bring against the claimants. Where an executor or
administrator commencesan action, or prosecutes an action already
commenced by the deceased in his lifetime, the debtor may set forth by
answer the claims he has against the decedent, instead of presenting them
independently to the court as herein provided, and mutual claims may be set
off against each other in such action; and if final judgment is rendered in
favor of the defendant, the amount so determined shall be considered the true
balance against the estate, as though the claim had been presented directly
beforethe court in the administration proceedings. Claims not yet due, or
contingent, may be approved at their present value.

As a final note, we reiterate thatthe policy against double recovery requires

that only one action be maintained for the same act or omission whether the
action is brought against the executor or administrator, or the estate. 39 The