Professional Documents
Culture Documents
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* FIRST DIVISION.
468
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469
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aggravated the anxiety that the latter must have been feeling at the
time, such that it could be safely said that her anxiety adversely
affected the administration of anesthesia on her.—It is equally
important to point out that Dr. Hosaka was remiss in his duty of
attending to petitioner Erlinda promptly, for he arrived more
than three (3) hours late for the scheduled operation. The
cholecystectomy was set for June 17, 1985 at 9:00 a.m., but he
arrived at DLSMC only at around 12:10 p.m. In reckless
disregard for his patient’s
470
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471
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RESOLUTION
KAPUNAN, J.:
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474
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II
III
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2 Rollo, p. 217.
3 Id., at 226.
475
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4 Id., at 252-253.
476
II
III
IV
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5 Id., at 469.
6 Id., at 440.
7 Id., at 454-455.
477
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8 Resolution, dated March 19, 2001, pp. 1-2; Rollo, pp. 543-544.
9 TSN, March 19, 2001, p. 51.
478
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10 Id., at 182-184.
11 Memorandum of Amicus Curiae Dr. Iluminada M. Camagay, Rollo, p.
620.
479
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480
CHIEF JUSTICE:
Mr. Counsel, you started your argument saying that
this involves a comatose patient?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
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481
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
17
Thank you.
DR. CAMAGAY:
All right, let us qualify an allergic reaction. In medical
terminology an allergic reaction is something which is
not usual response and it is further qualified by the
release of a hormone called histamine and histamine
has an effect on all the organs of the body generally
release because the substance that entered the body
reacts with the particular cell, the mass cell, and the
mass cell secretes this histamine. In a way it is some
form of response to take away that which is not mine,
which is not part of the body. So, histamine has
multiple effects on the body. So, one of the effects as
you will see you will have redness, if you have an
allergy you will have tearing of the eyes, you will have
swelling, very crucial swelling sometimes of the
larynges which is your voice box main airway, that
swelling may be enough to obstruct the entry of air to
the trachea and
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482
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483
DR. ESTRELLA
Q. You mentioned that there were two (2) attempts in the
intubation period?
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484
DR. GUTIERREZ
Yes.
Q There were two attempts. In the first attempt was the
tube inserted or was the laryngoscope only inserted,
which was inserted?
A All the laryngoscope.
Q All the laryngoscope. But if I remember right
somewhere in the re-direct, a certain lawyer, you were
asked that you did a first attempt and the question was
—did you withdraw the tube? And you said—you never
withdrew the tube, is that right?
A Yes.
Q Yes. And so if you never withdrew the tube then there
was no, there was no insertion of the tube during that
first attempt. Now, the other thing that we have to
settle here is—when cyanosis occurred, is it recorded in
the anesthesia record when the cyanosis, in your
recording when did the cyanosis occur?
A (sic)
Q Is it a standard practice of anesthesia that whatever
you do during that period or from the time of induction
to the time that you probably get the patient out of the
operating room that every single action that you do is so
recorded in your anesthesia record?
A I was not able to record everything I did not have time
anymore because I did that after the, when the patient
was about to leave the operating room. When there was
second cyanosis already that was the (interrupted)
Q When was the first cyanosis?
A The first cyanosis when I was (interrupted)
Q What time, more or less?
A I think it was 12:15 or 12:16.
Q Well, if the record will show you started induction at
12:15?
A Yes, Your Honor.
Q And the first medication you gave was what?
A The first medication, no, first the patient was
oxygenated for around one to two minutes.
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485
Q 12:18?
A Yes, and then after giving the oxygen we start the
menorcure which is a relaxant. After that relaxant
(interrupted)
Q After that relaxant, how long do you wait before you do
any manipulation?
A Usually you wait for two minutes or three minutes.
Q So, if our estimate of the time is accurate we are now
more or less 12:19, is that right?
A Maybe.
Q 12:19. And at that time, what would have been done to
this patient?
A After that time you examine the, if there is relaxation of
the jaw which you push it downwards and when I saw
that the patient was relax because that monorcure is a
relaxant, you cann ot intubate the patient or insert the
laryngoscope if it is not keeping him relax. So, my first
attempt when I put the laryngoscope on I saw the
trachea was deeply interiorly. So, what I did ask
“mahirap ata ito ah.” So, I removed the laryngoscope
and oxygenated again the patient.
Q So, more or less you attempted to do an intubation after
the first attempt as you claimed that it was only the
laryngoscope that was inserted.
A Yes.
Q And in the second attempt you inserted the
laryngoscope and now possible intubation?
A Yes.
Q And at that point, you made a remark, what remark did
you make?
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A I said “mahirap ata ito” when the first attempt I did not
see the trachea right away. That was when I
(interrupted)
Q That was the first attempt?
A Yes.
Q What about the second attempt?
A On the second attempt I was able to intubate right
away within two to three seconds.
Q At what point, for purposes of discussion without
accepting it, at what point did you make the comment
“na mahirap ata to intubate, mali ata ang pinasukan”.
A I did not say “mali ata ang pinasukan” I never said
that.
486
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487
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488
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489
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For his part, Dr. Hosaka mainly contends that the Court
erred in finding him negligent30 as a surgeon by applying the
Captain-of-the-Ship doctrine. Dr. Hosaka argues that the
trend in United States jurisprudence has been to reject
said doctrine in light of the developments in medical
practice. He points out that anesthesiology and surgery are
two distinct and specialized fields in medicine and as a
surgeon, he is not deemed to have control over the acts of
Dr. Gutierrez. As anesthesiologist, Dr. Gutierrez is a
specialist in her field and has acquired skills and
knowledge in the course of her training
31
which Dr. Hosaka,
as a surgeon, does not possess. He states further that
current American jurisprudence on the matter recognizes
that the trend towards specialization in medicine has
created situations where surgeons do not always have the 32
right to control all personnel 33
within the operating room,
especially a fellow specialist.
Dr. Hosaka
34
cites the case of Thomas v. Raleigh General
Hospital, which involved a suit filed by a patient who lost
his voice due to the wrongful insertion of the endotracheal
tube preparatory to the administration of anesthesia in
connection with the laparotomy to be conducted on him.
The patient sued both the anesthesiologist
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29 Id., at 971.
30 The Captain-of-the-Ship Doctrine was discussed in McConnell v.
Williams (65 A 2d 243 [1949]), where the Supreme Court of Pennsylvania
stated that under this doctrine, a surgeon is likened to a captain of the
ship, in that it is his duty to control everything going on in the operating
room.
31 Motion for Reconsideration of Dr. Hosaka, Rollo, p. 231.
32 Id., at 229.
33 Id., at 231, citing Thomas vs. Raleigh General Hospital, 358 SE 2d
222 (1987).
34 Supra.
490
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35 Id., at 225.
36 TSN, March 19, 2001, pp. 11-12.
37 Id., at 7.
491
watertight compartments
38
because their duties intersect
with each other.
While the professional services of Dr. Hosaka and Dr.
Gutierrez were secured primarily for their performance of
acts within their
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492
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493
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494
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Who gave the order for Dra. Calderon to help in the intubation of the
patient?
RET. JUSTICE HOFILEÑA:
I understand. Your Honor that she did it voluntarily, she just
happened to pass by.
JUSTICE REYNATO S. PUNO:
And Dr. Hosaka did not object?
RET. JUSTICE HOFILEÑA:
No, Your Honor, because his position is that this is outside of his
expertise, Dr. Calderon is also an anesthesiologist so, he just left
them alone.
JUSTICE REYNATO S. PUNO:
How long have Dr. Hosaka and Dr. Gutierrez worked together as a
team?
RET. JUSTICE HOFILEÑA:
They started their association way back in 1977, Your Honor, at the
time of this incident about eight years, Your Honor.
JUSTICE REYNATO S. PUNO:
Would you know how the relationship of Dr. Hosaka and Dr.
Gutierrez is defined by any kind of agreement, oral or written, or is it
defined by the standard practice of the profession?
RET. JUSTICE HOFILEÑA:
I would say it would be in accordance of the standard practice of the
profession, Your Honor. There is no particular agreement between
them.
JUSTICE REYNATO S. PUNO:
What do you say is the standard practice, how would the practice
vary from case to case?
RET. JUSTICE HOFILEÑA:
I believe. Your Honor, that the, in the first place if the patient would
have his own anesthesiologist, would prefer his own anesthesiologist,
he can retain the services of another anesthesi
495
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ologist but of his own but if he does not know of anybody and he asks
the surgeon to provide one, then this surgeon can recommend. But I
would like to emphasize, Your Honor, that the relationship is between
the patient and the anesthesiologist. It is not that the
anesthesiologist is the employee of the surgeon.
JUSTICE REYNATO S. PUNO:
But is there an agreement, expressed or implied, between the two (2),
to the effect that, you know the anesthesiologist could say to the
surgeon that you have no business interfering with my work as
anesthesiologist. Is that how the relationship is def ined?
RET. JUSTICE HOFILEÑA:
Once the start the (interrupted)
JUSTICE REYNATO S. PUNO:
Right from the very beginning?
RET. JUSTICE HOFILEÑA:
I believe Your Honor that on the matter of retaining the services of
the anesthesiologist in the sense that the surgeon reposes confidence
on the ability of the anesthesiologist, he hires him if he is authorized,
he hires him on behalf of the patient if he is authorized to do that but
once they are already performing their own task, then there should be
no interference.
JUSTICE REYNATO S. PUNO:
But the work of the two cannot be separated in watertight
compartments, do you agree?
RET. JUSTICE HOFILEÑA:
I agree, Your Honor (TSN, March 19, 2001, pp. 14-23).
39 Id., at 19.
496
DR. CAMAGAY:
x x x Pre-operative medication has three main
functions: One is to alleviate anxiety. Second is to dry
up the secretions and Third is to relieve pain. Now, it
is very important to alleviate anxiety because anxiety
is associated with the outpouring of certain substances
formed in the body called adrenalin. When a patient is
anxious there is an outpouring of adrenalin which
would have adverse effect on the patient. One of it is
high blood pressure, the other is that he opens himself
to dist urbances in the heart rhythm, which would
have adverse implications. So, we would like to
alleviate patient’s anxiety
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497
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CHIEF JUSTICE:
Two other points. The first, Doctor, you were talking
about anxiety, would you consider a patient’s stay on
the operating table for three hours sufficient enough to
aggravate or magnify his or her anxiety?
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:
In other words, I understand that in this particular
case that was the case, three hours waiting and the
patient was already on the operating table
(interrupted)
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:
Would you therefore conclude that the surgeon
contributed to the aggravation of the anxiety of the
patient?
DR. CAMAGAY:
That this operation did not take place as scheduled is
already a source of anxiety and most operating tables
are very narrow and that patients are usually at risk
of falling on the floor so there are restraints that are
placed on them and they are never, never left alone in
the operating room by themselves specially if they are
already pre-medicated because they may not be aware
of some of their movement that they make which
would contribute to their injury.
CHIEF JUSTICE:
In other words due diligence would require a surgeon
to come on time?
DR. CAMAGAY:
I think it is not even due diligence it is courtesy.
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498
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CHIEF JUSTICE:
Courtesy.
DR. CAMAGAY:
And care.
CHIEF JUSTICE:
Duty as a matter of fact?
DR. CAMAGAY:
43
Yes, Your Honor.
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43 Id., at 205-206.
44 Batiquin vs. Court of Appeals, 258 SCRA 334, 346 (1996); Carillo vs.
People, 229 SCRA 386, 396 (1994).
45 Article 2180 states:
The obligation imposed by Article 2176 is demandable not only for one’s own acts
or omissions, but also for those of persons for whom one is responsible.
The father and, in case of his death or incapacity, the mother, are responsible
for the damages caused by the minor children who live in their company.
Guardians are liable for damages caused by the minors or incapacitated persons
who are under their authority and live in their company.
The owners and managers of an establishment or enterprise are likewise
responsible for damages caused by their employees in the service of the branches
in which the latter are employed or on the occasion of their functions.
Employers shall be liable for the damages caused by their employees and
household helpers acting within the scope of their as-
499
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signed tasks, even though the former are not engaged in any business
or industry.
46 Decision, p. 40; Rollo, p. 209.
47 Traders Royal Bank vs. National Labor Relations Commission, 321
SCRA 467 (1999).
48 Motion for Reconsideration of DLSMC, p. 10; Rollo, p. 477.
49 Ibid.
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500
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50 Id., at 478.
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51 Id., at 480.
52 TSN, March 9, 2001, pp. 113-116.
501
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502
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503
SO ORDERED.
Judgment modified.
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——o0o——
504
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